- Email: [email protected]
Oocyte donors as gynecologic teaching associates
Graduate Education Oocyte donors as gynecologic teaching associates Richard S. Legro, MD, Carol L. Gnatuk, MD, Allen R. Kunselman, MA, Joanna Cain, MD Objective: To fulfill the need for gynecologic teaching associates for an expanded pelvic examination module for thirdyear medical students, we sought women who were able to provide feedback to medical students. Oocyte donors were hypothesized as a useful potential pool of gynecologic teaching associates. Methods: Gynecologic teaching associates were recruited from a pool of women who were involved in our oocyte donor program. Students were evaluated on a scale of 1 (best) to 5 (worst) on their performance on the pelvic examination by themselves (n 5 91), by the gynecologic teaching associate (n 5 10), and by the supervising faculty (n 5 6). Students were shown their evaluations, and these were reviewed at the end of the session to provide students with immediate feedback. Results: Students consistently ranked their skills lower than either the gynecologic teaching associate or supervising faculty member for all four categories evaluated (communication skills, technical skills, professional demeanor, and overall performance) (P < .001). Students gave their communications skills the highest mean rankings, whereas gynecologic teaching associates gave them the lowest. The highest correlation and agreement between pairs of evaluators were between the gynecologic teaching associate and the supervising faculty member. Gynecologic teaching associates and faculty members also were more likely to praise the students’ performance in written comments (x2 58.2, P < .001), whereas no student found anything praiseworthy in his or her performance. Conclusion: Oocyte donors represent a useful pool of potential gynecologic teaching associates. They provide important feedback to students. Their evaluation of the profiFrom the Departments of Obstetrics and Gynecology and Health Evaluation Sciences, Pennsylvania State University College of Medicine, M.S. Hershey Medical Center, Hershey, Pennsylvania. Presented in part at the 1998 Council on Resident Education in Obstetrics and Gynecology and Association of Professors of Gynecology and Obstetrics Annual Meeting at Lake Buena Vista, Florida, March 4 –7, 1998.
VOL. 93, NO. 1, JANUARY 1999
ciency of the student correlates well with that of the supervising faculty member. (Obstet Gynecol 1999;93:147–50. © 1999 by The American College of Obstetricians and Gynecologists.)
Recruiting women to serve as gynecologic teaching associates has traditionally been a difficult task.1 The concern about exploitation raised by the role of the gynecologic teaching associate inhibits women from serving in this capacity. Our pelvic examination teaching module changed from a small session staffed by a small number of experienced gynecologic teaching associates held during each of the third-year clerkship rotations throughout the year to an intensive series of small workshops held over the course of a week. This change was precipitated by the desire to introduce all incoming third-year medical students to the pelvic examination before the start of their clinical clerkships, so that these skills could be used and developed in all clerkships. This change also required the recruitment of a new and larger pool of gynecologic teaching associates to teach the entire incoming third-year class. We sought women who would serve as useful gynecologic teaching associates and who would provide students with feedback on their performance. Kretschmar2 has noted how important an educational role the gynecologic teaching associate plays in instructing students. Oocyte donors have been shown to be a highly educated, altruistic group of women.3 More intensive psychosocial screening has proven that they are outgoing, enthusiastic, and relatively free from psychopathology.4 Oocyte donors appeared, from these published characteristics and from our practical experience with them, to be an ideal group to recruit as gynecologic teaching associates. The aim of this study was to establish if this population formed a suitable and useful population to serve as gynecologic teaching associates.
Materials and Methods Women, who had either served as oocyte donors or volunteered to serve as oocyte donors, were contacted by telephone or by word of mouth from our pool of oocyte donors to serve as gynecologic teaching associates. The gynecologic teaching associates were recruited without difficulty from a pool of roughly 50 oocyte donors. Records were not kept on the number who declined to participate. Nine gynecologic teaching associates were recruited in this fashion, and one volunteered when she became aware of the recruitment process. None of the women had served as gynecologic teaching associates, and none of the former gynecologic
0029-7844/99/$20.00 PII S0029-7844(98)00348-2
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teaching associates participated in this new format. Mean (6 standard deviation) age of the oocyte donors was 32 6 3.0 years. Gynecologic teaching associates were oriented to the pelvic examination and their role before the session by one author (RSL). All the gynecologic teaching associates were deemed on evaluation adequate to participate. Gynecologic teaching associates were instructed to inform the student of any discomfort or inadequacy they noted in the examination, as well as to confirm that the patient was palpating the appropriate pelvic organ. These abilities allow the gynecologic teaching associate to comment on the technical proficiency of the student performing the examination. The students were oriented in a total of 11 sessions that stretched over 1 week. Each session contained a small group of ten to 12 students and began with a discussion of technique, examination of the equipment used in a pelvic examination, and an instructional video demonstrating pelvic examination, again performed by one author (CLG). They were then further divided into groups of three to four for the actual examination. The supervising faculty member first performed a pelvic examination on the gynecologic teaching associate, which the small groups of three to four students witnessed. Then the student performed the examination on the gynecologic teaching associate with only the faculty member present. Evaluation forms were then filled out after the examination by the student, the supervising faculty member, and the gynecologic teaching associate without discussion or review of the forms between evaluators. Written results were shared immediately with the student. Each gynecologic teaching associate participated in a maximum of five examinations per session, including the initial examination by the supervising faculty member. Students were evaluated on a scale from 1 (best) to 5 (worst) by themselves (n 5 91), by the supervising faculty members (n 5 6), and by the gynecologic teaching associates (n 5 10) for the following categories: overall performance, communication skills, technical skills, and professional demeanor. Of 117 eligible students in the entering third-year class, 111 appeared as scheduled. From these, 93 evaluations were completed by gynecologic teaching associates, 93 from supervising faculty members, and 91 from students. Data were analyzed using SAS statistical software package (SAS Institute, Inc., Cary, NC). Kruskal-Wallis testing was used to compare rankings between the groups. Spearman rank correlation was used for evaluating correlation, and a weighted kappa for agreement between pairs of evaluators: faculty members– gynecologic teaching associates, gynecologic teaching associates– students, faculty members–students. A value of 0 indi-
148 Legro et al
Oocyte Donors as GTAs
Figure 1. Mean 1 standard deviation for four categories of student performance on the pelvic examination training session as ranked on a scale of 1 (best) to 5 (worst) according to examiner, student, gynecologic teaching associate (GTA), and supervising faculty member (MD). * P , .001 compared with GTA and MD.
cates no agreement or correlation, and a value of 1 indicates perfect agreement or correlation. Written comments for improvement of the student’s performance were summarized to six categories: improve confidence, improve overall skills through practice, improve communication, improve professional demeanor or appearance, praise for the performance, or no written
Obstetrics & Gynecology
Table 1. Weighted Kappa Statistics* and Spearman Rank Correlation Coefficients (Rho Values)† Between Pairs of Evaluators
Communication Technical Professional Overall
Gynecologic teaching associate–faculty member
Gynecologic teaching associate– student
Faculty member– student
0.52 (0.48) 0.34 (0.35) 0.27 (0.28) 0.39 (0.39)
0.33 (0.36) 0.14 (0.22) 0.18 (0.19) 0.19 (0.32)
0.27 (0.36) 0.17 (0.32) 0.13 (0.17) 0.20 (0.37)
* Kappa statistic is a measure of agreement. Spearman rank correction coefficient (rho value) is a measure of linear correlation. A value of 0 indicates no agreement or correlation; a value of 1 indicates perfect agreement or correlation. †
comments. x2 Analysis was performed on the frequency of categories of written comments.
Results One oocyte donor did not appear as scheduled, whereas six students did not appear for their session. Attendance as scheduled was therefore 97% (32 of 33) for the gynecologic teaching associates and 95% (111 of 117) for the students. The mean results of the survey according to evaluator are found in Figure 1. Students consistently ranked their skills lower than either the gynecologic teaching associate or supervising faculty member for all four categories evaluated (communication skills, technical skills, professional demeanor, and overall performance (P , .001). Of the four categories evaluated, students gave themselves the highest mean ranks for communications, for which gynecologic teaching associates gave them the lowest mean ranks. The students gave themselves the lowest mean ranks for technical skills. Agreement and linear correlation between pairs of evaluators are found in Table 1. The gynecologic teaching associate–supervising faculty member pair
Table 2. Frequency of Written Comment Summary Items by Group
Written comment summary None Lack of confidence Lack of practice Lack of communication Inadequate professional demeanor Overall praise* Data are presented as % (n). * x2 58.2, P , .001.
VOL. 93, NO. 1, JANUARY 1999
Gynecologic Faculty teaching member associate Student (n 5 93) (n 5 93) (n 5 91) 13 (12) 32 (29) 31 (28) 21 (19) 3 (3) 0 (0)
18 (17) 18 (17) 10 (9) 18 (17) 3 (3) 32 (30)
5 (5) 9 (8) 4 (4) 32 (30) 0 (0) 49 (46)
showed the highest degree of agreement and correlation compared with the other pairs. Overall, 83% of the students received written feedback from the gynecologic teaching associate, 87% received written feedback from the supervising faculty member, and 95% provided written feedback on their own performance on the pelvic examination (Table 2). The most common critique by the students of themselves was lack of confidence (32%), followed by the need for more practice (31%). No student praised their performance. The most common comment by the supervising faculty member was overall praise for their performance (49%). For the gynecologic teaching associate, the most common comment also was praise (32%). The most common critique of professional demeanor (n 5 2 students and n 5 2 gynecologic teaching associates) related to the length of the student’s fingernails. Combining the pelvic examination training sessions of third-year medical students into a week-long period also resulted in a significant reduction of gynecologic teaching associate fees: $4725 in the prior year compared with $2775 in the new system.
Discussion We report here that oocyte donors are a useful teaching resource as gynecologic teaching associates for thirdyear medical students. They are punctual, willing participants in the teaching process and provide both positive and negative feedback to medical students. Their evaluations tend to be very close to those of the supervising faculty members. The institution of this revised gynecologic teaching associate program also resulted in a reduction in the amount of fees paid to gynecologic teaching associates. This cost savings was the result of increased efficiency of scheduling due to the availability of a larger pool of gynecologic teaching associates, and not due to any quality of oocyte donors. Nonetheless, reducing costs may be necessary for preserving programs using gynecologic teaching associates in the present economic climate.5 Students tend to be more critical of themselves than either the faculty member or gynecologic teaching associate and tend to focus on technical deficits. This may reflect their lack of experience with patient interaction, physical examination, and specifically the intimate nature of the pelvic examination. It has been acknowledged that much anxiety surrounds the first pelvic examination of a patient.6 Most commonly in our experience, both gynecologic teaching associates and faculty members found something to praise in the student’s performance or had no written suggestions for improvement, implying an adequate performance. Although consistent with a prior survey that noted that
Legro et al
Oocyte Donors as GTAs
149
only 30% of gynecologic teaching associates found student problems in the encounter,7 there are other more critical surveys of medical students by gynecologic teaching associates focusing largely on communication inadequacies (29%) of students.8 The increased prevalence of critical comments in our written evaluations is most likely due to the specific instructions of our question to suggest “improvements” in the student’s performance. Communications skills of the students were the lowest-ranked skill by the gynecologic teaching associates. Medical students in Australia tended to see their technical skills of the pelvic examination as their weakest, whereas they are relatively confident in their sensitivity and communications skills.9 A similar trend is noted here, suggesting that the student deficit that should be addressed most is communicating to the patient during the pelvic examination. A recent study suggested that the use of laywomen to supervise the pelvic examination training modules of medical students improves interpersonal skills.10 It is not possible from the design of our study to ascertain the motives of the women who volunteered to serve as gynecologic teaching associates nor do we have data from the prior pool of gynecologic teaching associates from which to make a comparison between the two groups of gynecologic teaching associates. However, the high rate of the oocyte donors’ compliance as well as the fact that all have volunteered to serve again in the future as gynecologic teaching associates, supports the published experience and our personal experience, that these women have a deep desire not only to help others, but also to participate in the education of doctors. This willingness to contribute suggests that oocyte donors are very useful as gynecologic teaching associates and also may serve as an ideal pool of women to be trained as programmed patients.
2. Kretschmar RM. Evolution of the gynecology teaching associate: An education specialist. Am J Obstet Gynecol 1978;131:367–73. 3. Sauer MV, Ary BR, Paulson RJ. The demographic characterization of women participating in oocyte donation: A review of 300 consecutively performed cycles. Int J Obstet Gynaecol 1994;45:147– 51. 4. Lessor R, Cervantes N, O’Connor N, Balmaceda J, Asch RH. An analysis of social and psychological characteristics of women volunteering to be oocyte donors. Fertil Steril 1993;59:65–71. 5. Beckmann CR, Lipscomb GH, Williford L, Bryant E, Ling FW. Gynecological teaching associates in the 1990’s. Med Educ 1992; 26:105–9. 6. Buchwald J. The first pelvic examination: Helping students cope with their emotional reactions. J Med Educ 1979;54:735– 8. 7. Plauche WC, Baugniet-Nebrija W. Students’ and physicians’ evaluations of gynecologic teaching associate program. J Med Educ 1985;60:870 –5. 8. Hillard PJ, Fang WL. Medical students’ gynecologic examination skills. Evaluation by gynecologic teaching associates. J Reprod Med 1986;31:491– 6. 9. Abraham S. Vaginal and speculum examination in medical curricula. Aust N Z J Obstet Gynaecol 1995;35:56 – 60. 10. Kleinman DE, Hage, ML, Hool AJ, Kowlowitz V. Pelvic examination instruction and experience: A comparison of laywomantrained and physician-trained students. Acad Med 1996;71:1239 – 43.
Address reprint requests to:
Richard S. Legro, MD PO Box 850 Department of Obstetrics and Gynecology M.S. Hershey Medical Center Hershey, PA 17033 E-mail: [email protected]
Received March 23, 1998. Received in revised form June 15, 1998. Accepted June 26, 1998.
References 1. Kapaslis T. Public privates: Performing gynecology from both ends of the speculum. Durham North Carolina: Duke University Press, 1997.
150 Legro et al
Oocyte Donors as GTAs
Copyright © 1999 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
Obstetrics & Gynecology
VOL. 93, NO. 1, JANUARY 1999
ciency of the student correlates well with that of the supervising faculty member. (Obstet Gynecol 1999;93:147–50. © 1999 by The American College of Obstetricians and Gynecologists.)
Recruiting women to serve as gynecologic teaching associates has traditionally been a difficult task.1 The concern about exploitation raised by the role of the gynecologic teaching associate inhibits women from serving in this capacity. Our pelvic examination teaching module changed from a small session staffed by a small number of experienced gynecologic teaching associates held during each of the third-year clerkship rotations throughout the year to an intensive series of small workshops held over the course of a week. This change was precipitated by the desire to introduce all incoming third-year medical students to the pelvic examination before the start of their clinical clerkships, so that these skills could be used and developed in all clerkships. This change also required the recruitment of a new and larger pool of gynecologic teaching associates to teach the entire incoming third-year class. We sought women who would serve as useful gynecologic teaching associates and who would provide students with feedback on their performance. Kretschmar2 has noted how important an educational role the gynecologic teaching associate plays in instructing students. Oocyte donors have been shown to be a highly educated, altruistic group of women.3 More intensive psychosocial screening has proven that they are outgoing, enthusiastic, and relatively free from psychopathology.4 Oocyte donors appeared, from these published characteristics and from our practical experience with them, to be an ideal group to recruit as gynecologic teaching associates. The aim of this study was to establish if this population formed a suitable and useful population to serve as gynecologic teaching associates.
Materials and Methods Women, who had either served as oocyte donors or volunteered to serve as oocyte donors, were contacted by telephone or by word of mouth from our pool of oocyte donors to serve as gynecologic teaching associates. The gynecologic teaching associates were recruited without difficulty from a pool of roughly 50 oocyte donors. Records were not kept on the number who declined to participate. Nine gynecologic teaching associates were recruited in this fashion, and one volunteered when she became aware of the recruitment process. None of the women had served as gynecologic teaching associates, and none of the former gynecologic
0029-7844/99/$20.00 PII S0029-7844(98)00348-2
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teaching associates participated in this new format. Mean (6 standard deviation) age of the oocyte donors was 32 6 3.0 years. Gynecologic teaching associates were oriented to the pelvic examination and their role before the session by one author (RSL). All the gynecologic teaching associates were deemed on evaluation adequate to participate. Gynecologic teaching associates were instructed to inform the student of any discomfort or inadequacy they noted in the examination, as well as to confirm that the patient was palpating the appropriate pelvic organ. These abilities allow the gynecologic teaching associate to comment on the technical proficiency of the student performing the examination. The students were oriented in a total of 11 sessions that stretched over 1 week. Each session contained a small group of ten to 12 students and began with a discussion of technique, examination of the equipment used in a pelvic examination, and an instructional video demonstrating pelvic examination, again performed by one author (CLG). They were then further divided into groups of three to four for the actual examination. The supervising faculty member first performed a pelvic examination on the gynecologic teaching associate, which the small groups of three to four students witnessed. Then the student performed the examination on the gynecologic teaching associate with only the faculty member present. Evaluation forms were then filled out after the examination by the student, the supervising faculty member, and the gynecologic teaching associate without discussion or review of the forms between evaluators. Written results were shared immediately with the student. Each gynecologic teaching associate participated in a maximum of five examinations per session, including the initial examination by the supervising faculty member. Students were evaluated on a scale from 1 (best) to 5 (worst) by themselves (n 5 91), by the supervising faculty members (n 5 6), and by the gynecologic teaching associates (n 5 10) for the following categories: overall performance, communication skills, technical skills, and professional demeanor. Of 117 eligible students in the entering third-year class, 111 appeared as scheduled. From these, 93 evaluations were completed by gynecologic teaching associates, 93 from supervising faculty members, and 91 from students. Data were analyzed using SAS statistical software package (SAS Institute, Inc., Cary, NC). Kruskal-Wallis testing was used to compare rankings between the groups. Spearman rank correlation was used for evaluating correlation, and a weighted kappa for agreement between pairs of evaluators: faculty members– gynecologic teaching associates, gynecologic teaching associates– students, faculty members–students. A value of 0 indi-
148 Legro et al
Oocyte Donors as GTAs
Figure 1. Mean 1 standard deviation for four categories of student performance on the pelvic examination training session as ranked on a scale of 1 (best) to 5 (worst) according to examiner, student, gynecologic teaching associate (GTA), and supervising faculty member (MD). * P , .001 compared with GTA and MD.
cates no agreement or correlation, and a value of 1 indicates perfect agreement or correlation. Written comments for improvement of the student’s performance were summarized to six categories: improve confidence, improve overall skills through practice, improve communication, improve professional demeanor or appearance, praise for the performance, or no written
Obstetrics & Gynecology
Table 1. Weighted Kappa Statistics* and Spearman Rank Correlation Coefficients (Rho Values)† Between Pairs of Evaluators
Communication Technical Professional Overall
Gynecologic teaching associate–faculty member
Gynecologic teaching associate– student
Faculty member– student
0.52 (0.48) 0.34 (0.35) 0.27 (0.28) 0.39 (0.39)
0.33 (0.36) 0.14 (0.22) 0.18 (0.19) 0.19 (0.32)
0.27 (0.36) 0.17 (0.32) 0.13 (0.17) 0.20 (0.37)
* Kappa statistic is a measure of agreement. Spearman rank correction coefficient (rho value) is a measure of linear correlation. A value of 0 indicates no agreement or correlation; a value of 1 indicates perfect agreement or correlation. †
comments. x2 Analysis was performed on the frequency of categories of written comments.
Results One oocyte donor did not appear as scheduled, whereas six students did not appear for their session. Attendance as scheduled was therefore 97% (32 of 33) for the gynecologic teaching associates and 95% (111 of 117) for the students. The mean results of the survey according to evaluator are found in Figure 1. Students consistently ranked their skills lower than either the gynecologic teaching associate or supervising faculty member for all four categories evaluated (communication skills, technical skills, professional demeanor, and overall performance (P , .001). Of the four categories evaluated, students gave themselves the highest mean ranks for communications, for which gynecologic teaching associates gave them the lowest mean ranks. The students gave themselves the lowest mean ranks for technical skills. Agreement and linear correlation between pairs of evaluators are found in Table 1. The gynecologic teaching associate–supervising faculty member pair
Table 2. Frequency of Written Comment Summary Items by Group
Written comment summary None Lack of confidence Lack of practice Lack of communication Inadequate professional demeanor Overall praise* Data are presented as % (n). * x2 58.2, P , .001.
VOL. 93, NO. 1, JANUARY 1999
Gynecologic Faculty teaching member associate Student (n 5 93) (n 5 93) (n 5 91) 13 (12) 32 (29) 31 (28) 21 (19) 3 (3) 0 (0)
18 (17) 18 (17) 10 (9) 18 (17) 3 (3) 32 (30)
5 (5) 9 (8) 4 (4) 32 (30) 0 (0) 49 (46)
showed the highest degree of agreement and correlation compared with the other pairs. Overall, 83% of the students received written feedback from the gynecologic teaching associate, 87% received written feedback from the supervising faculty member, and 95% provided written feedback on their own performance on the pelvic examination (Table 2). The most common critique by the students of themselves was lack of confidence (32%), followed by the need for more practice (31%). No student praised their performance. The most common comment by the supervising faculty member was overall praise for their performance (49%). For the gynecologic teaching associate, the most common comment also was praise (32%). The most common critique of professional demeanor (n 5 2 students and n 5 2 gynecologic teaching associates) related to the length of the student’s fingernails. Combining the pelvic examination training sessions of third-year medical students into a week-long period also resulted in a significant reduction of gynecologic teaching associate fees: $4725 in the prior year compared with $2775 in the new system.
Discussion We report here that oocyte donors are a useful teaching resource as gynecologic teaching associates for thirdyear medical students. They are punctual, willing participants in the teaching process and provide both positive and negative feedback to medical students. Their evaluations tend to be very close to those of the supervising faculty members. The institution of this revised gynecologic teaching associate program also resulted in a reduction in the amount of fees paid to gynecologic teaching associates. This cost savings was the result of increased efficiency of scheduling due to the availability of a larger pool of gynecologic teaching associates, and not due to any quality of oocyte donors. Nonetheless, reducing costs may be necessary for preserving programs using gynecologic teaching associates in the present economic climate.5 Students tend to be more critical of themselves than either the faculty member or gynecologic teaching associate and tend to focus on technical deficits. This may reflect their lack of experience with patient interaction, physical examination, and specifically the intimate nature of the pelvic examination. It has been acknowledged that much anxiety surrounds the first pelvic examination of a patient.6 Most commonly in our experience, both gynecologic teaching associates and faculty members found something to praise in the student’s performance or had no written suggestions for improvement, implying an adequate performance. Although consistent with a prior survey that noted that
Legro et al
Oocyte Donors as GTAs
149
only 30% of gynecologic teaching associates found student problems in the encounter,7 there are other more critical surveys of medical students by gynecologic teaching associates focusing largely on communication inadequacies (29%) of students.8 The increased prevalence of critical comments in our written evaluations is most likely due to the specific instructions of our question to suggest “improvements” in the student’s performance. Communications skills of the students were the lowest-ranked skill by the gynecologic teaching associates. Medical students in Australia tended to see their technical skills of the pelvic examination as their weakest, whereas they are relatively confident in their sensitivity and communications skills.9 A similar trend is noted here, suggesting that the student deficit that should be addressed most is communicating to the patient during the pelvic examination. A recent study suggested that the use of laywomen to supervise the pelvic examination training modules of medical students improves interpersonal skills.10 It is not possible from the design of our study to ascertain the motives of the women who volunteered to serve as gynecologic teaching associates nor do we have data from the prior pool of gynecologic teaching associates from which to make a comparison between the two groups of gynecologic teaching associates. However, the high rate of the oocyte donors’ compliance as well as the fact that all have volunteered to serve again in the future as gynecologic teaching associates, supports the published experience and our personal experience, that these women have a deep desire not only to help others, but also to participate in the education of doctors. This willingness to contribute suggests that oocyte donors are very useful as gynecologic teaching associates and also may serve as an ideal pool of women to be trained as programmed patients.
2. Kretschmar RM. Evolution of the gynecology teaching associate: An education specialist. Am J Obstet Gynecol 1978;131:367–73. 3. Sauer MV, Ary BR, Paulson RJ. The demographic characterization of women participating in oocyte donation: A review of 300 consecutively performed cycles. Int J Obstet Gynaecol 1994;45:147– 51. 4. Lessor R, Cervantes N, O’Connor N, Balmaceda J, Asch RH. An analysis of social and psychological characteristics of women volunteering to be oocyte donors. Fertil Steril 1993;59:65–71. 5. Beckmann CR, Lipscomb GH, Williford L, Bryant E, Ling FW. Gynecological teaching associates in the 1990’s. Med Educ 1992; 26:105–9. 6. Buchwald J. The first pelvic examination: Helping students cope with their emotional reactions. J Med Educ 1979;54:735– 8. 7. Plauche WC, Baugniet-Nebrija W. Students’ and physicians’ evaluations of gynecologic teaching associate program. J Med Educ 1985;60:870 –5. 8. Hillard PJ, Fang WL. Medical students’ gynecologic examination skills. Evaluation by gynecologic teaching associates. J Reprod Med 1986;31:491– 6. 9. Abraham S. Vaginal and speculum examination in medical curricula. Aust N Z J Obstet Gynaecol 1995;35:56 – 60. 10. Kleinman DE, Hage, ML, Hool AJ, Kowlowitz V. Pelvic examination instruction and experience: A comparison of laywomantrained and physician-trained students. Acad Med 1996;71:1239 – 43.
Address reprint requests to:
Richard S. Legro, MD PO Box 850 Department of Obstetrics and Gynecology M.S. Hershey Medical Center Hershey, PA 17033 E-mail: [email protected]
Received March 23, 1998. Received in revised form June 15, 1998. Accepted June 26, 1998.
References 1. Kapaslis T. Public privates: Performing gynecology from both ends of the speculum. Durham North Carolina: Duke University Press, 1997.
150 Legro et al
Oocyte Donors as GTAs
Copyright © 1999 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
Obstetrics & Gynecology