Teaching the Evaluation of Female Pelvic Pain: A Hands-On Simulation to Reinforce Exam Skills and Introduce Transvaginal Ultrasound

Abstract

Introduction: Reproductive-age female patients commonly seek evaluation for pelvic pain in a variety of health care settings. Thus, teaching medical students how to effectively evaluate female pelvic pain is a necessary part of medical education. There are limited opportunities, however, to reinforce the needed skills for this common but sensitive presentation that can be anxiety-producing for preclinical students. Methods: The case involved a 23-year-old female presenting with lower abdominal/pelvic pain. Students performed the necessary history, physical examination, cervical sampling, and transvaginal ultrasound evaluation to make the diagnosis of pelvic inflammatory disease (PID) complicated by a tubo-ovarian abscess. The 30-minute simulated patient encounter was followed by a 30-40 minute faculty-led debrief. Results: This simulation case has been sustained in the curriculum since 2011 for 65 students per year. Through use of a faculty critical action checklist, debrief discussion, examination performance, and student evaluation feedback, this simulation has demonstrated effectiveness. Of students, 93 of 193 students (48%) who participated in the simulation case from 2018-2020 completed a survey in which they rated the degree of agreement with statements about the simulation based on a 5-point Likert Scale (1 = strongly disagree, 5 = strongly agree). All questions had a mean response of 4.5-4.8 in 2018-2020, demonstrating the consistent agreement by students of the clarity, fidelity, and knowledge-enhancing value of the simulation. Discussion: This simulation provided a useful opportunity and a safe environment for preclinical medical students to acquire knowledge and skills necessary to evaluate a female patient with pelvic pain and PID.

Trans-vaginal ultrasound simulation: An exploratory qualitative research study focused on the end-users perception of learning

“…Another study of 15 doctors, showed improved confidence, more systematic approach and documentation [16] but also limited perceptions to questionnaire analysis. A similar study reported questionnaire responses from 28 participants following a four hour TVUS simulation course, showing that participants believed that simulation training applied to clinical practice and that their performance would improve after simulation training [15]; a final study of medical students showed enhanced clarity and knowledge following TVUS simulation training [17].…”

“…Previous work has further focused on the effect of trainee preconceived bias of simulation education and shown that it can limit the benefits of simulation [17]. If trainees see simulation as only a re-creation of life events, then their learning may be stunted; in comparison those that saw beyond a method for practicing basic skill can grasp the additional educational opportunities that simulation afforded.…”

“…Of the publications to date that studied trainee's perspectives of TVUS simulation training, most are quantitative studies using questionnaires or self-assessed confidence scores [10,[13][14][15][16][17] with one mixed methods study [12]. In contrast, qualitative research allows use of open-ended questions that aim to explore what is important to the trainee themselves.…”

Technology Complements Physical Examination and Facilitates Skills Development among Health Sciences Clerkship Students: <em>An Integrative Literature Review</em>

“…The study by Goldsworthy et al [ 41 ] found that virtual auscultation using authentic real patient sounds (rather than synthetically derived sounds used by past interventions), had improved performance in nursing students’ competence in detecting cardiac murmurs. Pearson et al [ 49 ] explored the implementation of simulation to provide a comprehensive basis for the learning of female pelvic examination that combined touch-based examination and transvaginal ultrasound. These high-fidelity simulations were shown to assist students to develop these physical examination skills that combined touch and ultrasound, and these skills were transferable to clinical encounters [ 49 ].…”

“…Pearson et al [ 49 ] explored the implementation of simulation to provide a comprehensive basis for the learning of female pelvic examination that combined touch-based examination and transvaginal ultrasound. These high-fidelity simulations were shown to assist students to develop these physical examination skills that combined touch and ultrasound, and these skills were transferable to clinical encounters [ 49 ].…”