The influence of social and cultural factors on infertility and new reproductive technologies

Two hundred and eight second-year students were matched with respect to gender, age, academic standing, minority status, and prior pelvic examination experience. After didactic instruction, individuals from each matched pair were randomly assigned to alternate training modalities—a plastic pelvic model (Gynny) and surrogate patients (Gynecology Teaching Associates, GTAs)—for pelvic examination instruction. A sample of 52 study- and 54 control-group students were then evaluated while they examined women with normal or deviant (hysterectomy/ pregnancy) pelvic anatomy. Communication and manual skills were evaluated on the basis of specially designed instruments in which the components of a ‘good’ pelvic examination were identified and described. Immediately after the objective evaluation, each student was interviewed to determine his/her subjective feelings about the training experience. The subjective data obtained in this way indicated that students evaluated the GTA modality significantly more favorably than the Gynny experience and strongly preferred the former to the latter. They preferred the GTA experience because they felt 1) knowledge gained from examining a human being (as opposed to a plastic model) was directly transferable to other patients and 2) it helped defuse sexual embarrassment involved in conducting one's first pelvic examination. Examining a trained surrogate (as opposed to either a plastic model or a clinic patient) also assured immediate identification and correction of errors through instant and direct feedback in an optimal learning environment, which resulted in increased competence and self-confidence. These data provide a likely explanation for previously published objective results indicating superior performance on the part of GTA-trained students.