Simulation-based Training for Pelvic and Breast Physical Examination: Effect on the Anxiety and Self-confidence of Medical Students

Orsi, Talles Dias; Valadares, Ana Lucia Ribeiro; Orsi, Paula Miranda Esteves; Orsi, Isabella Miranda Esteves; Moura, Alexandre Sampaio

doi:10.1055/s-0040-1718433

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev. Bras. Ginecol. Obstet. 42 (11) • Nov 2020 • https://doi.org/10.1055/s-0040-1718433 copy

Simulation-based Training for Pelvic and Breast Physical Examination: Effect on the Anxiety and Self-confidence of Medical Students

Treinamento baseado em simulação para exame físico pélvico e de mamas: Efeito na ansiedade e autoconfiança dos estudantes de medicina

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate factors associated with anxiety and the effect of simulation-based training (SBT) on student anxiety, self-confidence and learning satisfaction in relation to pelvic and breast examination.

Methods:

A longitudinal study was conducted with 4^th year medical students at the Universidade José do Rosário Vellano. A 12-item, self-report questionnaire on student anxiety at performing gynecological examinations was applied before and after SBT, with answers being given on a Likert-type scale. After training, the self-confidence levels and satisfaction of the students related to the learning process were also evaluated.

Results:

Eighty students with a mean age of 24.1 ± 4.2 years were included in the study. Of these, 62.5% were women. Pre-SBT evaluation showed that students were more anxious at performing a pelvic examination than a breast examination (2.4 ± 1.0 versus 1.7 ± 0.8, respectively; p < 0.001). The primary reason for anxiety regarding both pelvic and breast examination was fear of hurting the patient. SBT significantly reduced student anxiety (2.0 ± 0.8 versus 1.5 ± 0.5, respectively; p < 0.001). The satisfaction and self-confidence of the students were found to be high (6.8 ± 0.3 and 6.0 ± 0.9, respectively), with no difference between genders.

Conclusion:

The use of SBT in teaching students to perform pelvic and breast examinations resulted in reduced anxiety and increased self-confidence in a group of medical students of both genders, with high levels of satisfaction in relation to the training.

Keywords:
vaginal examination; medical students; simulation-based training; anxiety; satisfaction

	Frequency
Sociodemographic and behavioral characteristics	n^* * Although the overall database consisted of 80 students, the number of students does not always add up to 80 for all the variables analyzed due to missing data in some cases.	%
Type of secondary education
Public	9	11.4
Private	69	87.3
Public and Private	1	1.3
Does the student perform any paid work?
Yes	1	1.2
No	79	98.8
Monthly family income
≤ R$ 5,000.00	6	7.7
Between R$ 5,001.00 and R$ 12,000.00	27	34.6
> R$ 12,000.00	45	57.7
Is currently participating in or has participated in an extension program or academic league in gynecology?
Yes	5	6.2
No	75	93.8
Is currently participating or has participated in a practical work experience in gynecology?
Yes	7	8.8
No	73	91.2
Has already initiated his/her sexual life?
Yes	77	96.3
No	3	3.8
At what age did you first have sexual intercourse?(For the students who have already initiated their sexual life)
13–15 years	19	26.4
16–18 years	39	54.1
> 18 years	14	19.5
Sexual orientation
Heterosexual	76	97.4
Homosexual	2	2.6
Have you ever been submitted to a digital rectal examination?
Yes	5	6.2
No	75	93.8
Have you ever been submitted to a gynecological examination? (Only for female students)
Yes	48	96.0
No	2	4.0

Anxiety Scores		Descriptive Measures
Phase	n	Minimum	Maximum	Mean	SD	p-value ^* * Student's t-test for paired samples. The number of students differs from the total sample of 80 students due to missing data for some of the variables.
Pelvic examination
Baseline	80	1.00	5.17	2.40	1.00
Post-SBT	80	1.00	3.33	1.64	0.68	< 0.001
Baseline - Post-SBT				0.76	0.82
Breast examination
Baseline	72	1.00	4.67	1.70	0.79
Post-SBT	72	1.00	3.00	1.33	0.46	< 0.001
Baseline - Post-SBT				0.37	0.64
Pelvic and breast examination
Baseline	72	1.00	4.92	2.04	0.80
Post-SBT	72	1.00	3.00	1.46	0.51	p < 0.001
Baseline - Post-SBT				0.58	0.64

Scores	r	p-value ^* * Student's t-test for paired samples.
Anxiety regarding pelvic examination: baseline versus post-SBT	0.53	< 0.001
Anxiety regarding breast examination: baseline versus post-SBT	0.60	< 0.001
Anxiety regarding pelvic and breast examination: baseline versus post-SBT	0.61	< 0.001

Scores	Satisfaction (p-value)^* * Pearson correlation analysis. Correlation analysis between anxiety regarding pelvic examination and anxiety regarding breast examination (r = 0.64; p < 0.001).	Self-Confidence (p-value)^* * Pearson correlation analysis. Correlation analysis between anxiety regarding pelvic examination and anxiety regarding breast examination (r = 0.64; p < 0.001).
Anxiety regarding pelvic examination	−0.03 (0.799)	−0.10 (0.409)
Anxiety regarding breast examination	−0.04 (0.763)	−0.02 (0.867)
Anxiety regarding pelvic and breast examination	−0.04 (0.771)	−0.07 (0.561)

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