Learning intimate examinations with simulated patients: the evaluation of medical students' performance.

Background: For fifth-year's undergraduates of the medical school, a project with simulated patients (Intimate Examination Associates, IEA) was implemented in 2002 at the University of Antwerp. In this project, students from the new curriculum (NC) learned uro-genital, rectal, gynaecological and breast examination in healthy, trained volunteers and received feedback focused on personal attitude, technical and communication skills. Former curriculum (FC) students however trained these skills only during internship in the sixth year after a single training on manikins.
Aims: This study assessed the effect of learning intimate examinations with IEA's by comparing students from FC and NC on four different outcome parameters.
Methods: Three groups were compared: FC after internships without IEA training, NC after internships with IEA training and fifth year NC immediately after the IEA training. Four assessment instruments: an OSCE using checklists and global rating scales to assess the technical skills, a score list on students attitudes and performance filled in by the IEA's, a student questionnaire on self-assessed competence and a questionnaire on the frequency of performing intimate skills during internships.
Results: Both NC groups scored globally better in the OSCE (significance for male examination). Sub-scores for 'completeness' and 'systematic' approach was significantly higher in both NC groups for male and female examinations. NC students reported better self-assessed competence and performance concerning gynaecological and urological clinical and communication skills during internship. The best results were obtained after IEA training and internship was done for the four outcomes. IEA's are influenced by the 'experienced' students after internship: FC and NC after internship both scored better than the fifth year NC who only received the IEA training so far.
Conclusion: Learning intimate examinations with IEA's has a positive effect on the performance of medical students. This beneficial effect is on its turn reinforced during internships.