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PP21 Genital exam education and instruction: lowering anxiety and raising competence
  1. Isle Polonko,
  2. Richard Claflin
  1. Clinical Practice Resources for Training and Education, Hardwick, USA


Introduction Gynecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology has been utilized for decades in effective breast, pelvic and urogenital examination clinical skills instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with genital examination. While data has shown it is the most effective way to learn these procedures, outside of the United States and Canada, there are few GTA and MUTA programs in existence at medical learning institutions.

Methods The GTA/MUTA acts as both instructor and live simulated patient, using their own bodies as primary teaching tools to guide learners through examination techniques while providing them with real-time, instant feedback. This provides a unique opportunity for skills acquisition: learners receive step-by-step ‘hands on’ instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centered form of instruction also addresses the complicated emotional reaction patients may have to these exams. Therefore, GTA/MUTA instruction also includes: patient education and communication skills, relaxation and transition techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of genital examination and the embarrassment often accompanying the exam, does not become an obstacle to acquiring safe, effective clinical technique.

Results Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including: higher overall scores; superior communication skills; better ability to identify pathology having been introduced to healthy well patient anatomy; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’; ability to conduct safe, effective genital examination techniques on patients after exposure to a GTA/MUTA instructor.

Discussion and conclusion Despite definitive results over decades of research in both qualitative and quantitative studies, GTA/MUTA instruction is not routinely used in the UK or the rest of Europe and almost not at all in other areas of the world including Asia, South America and Africa. Brief exploration of cultural and historical stop gaps to inclusion of this method will be discussed following explanation of the method, its effectiveness and use in the US and Canada as well as brief review of the data.


  1. Kleinman DE, et al. Pelvic examination instruction and experience: a comparison of lay-woman trained and physician trained students. Academic Medicine 1996;Nov 71 (11):1239–43.

  2. Smith PP, et al. The effectiveness of gynaecological teaching associates in teaching pelvic examination: a systematic review and meta-analysis. Medical EducationDec 2015;49(12):1197–206.

  3. Shain RN, et al. Evaluation of the gynecology teaching associate vs. pelvic model approach to teaching pelvic examination. Journal of Medical Education 1982;5:645–647.

  4. Gleisner, Jenny, and Karin Siwe. Differences in teaching female and male intimate examinations: a qualitative study. Medical Education 2020(4);54:348–355. doi:10.1111/medu.14126.

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