ANALYSIS OF THE ABILITY OF MEDICAL STUDENTS IN THE EVALUATION OF PELVIC ORGAN PROLAPSE
M. FRANCA, C. K. NOGUEIRA, M. J. GIRAO, M. G. SARTORI;
Gynecology, Escola Paulista de Med., São paulo, Brazil.
Introduction: Despite the advancement of technology and the modifications incorporated by medical practice in recent decades, the physical examination remains of great importance for medical practice and its learning is imperative during medical training. Furthermore, the ability to perform correctly the physical examination in gynecology is one of the requirements of graduates of medical school. POP-Q (pelvic organ prolapse quantification) is one of the tools to improve the medical student assistance to women with pelvic organ prolapse.
Objective: to evaluate the ability to analyze pelvic organ prolapse of the fifth year undergraduate students, after training in Gynecology Sector, and to infer the inter-examiner agreement (students and preceptor) on POP-Q ICS classification .
Methods: A prospective, randomized observational study that evaluated urogynecology learning by fifth year students of medicine using a questionnaire based on the Likert scale before and after Gynecology Sector stage. We also compared the pelvic organ prolapse staging with POP-Q between students and the preceptor after internship in gynecology. The stage given by the preceptor, who was a doctor with a specialization in gynecology, was considered as the gold standard in prolapse staging.
Results: A total of 85 students and 5 preceptors were included. 94% of the students reported feeling totally uncomfortable or uncomfortable assessing patients with genital dystopia prior to the internship in gynecology, and 42% remained totally uncomfortable or uncomfortable after the stage. Approximately 46% of the students reported being important or very important to have training prior to the care of patients with dystopia, 58% reported being very important or important theoretical classes prior to the practical training and 76% of the students reported to be relatively important, important or very important training in anatomical models before to exam patients. Regarding the inter-examiner agreement, it was verified when the preceptor considered the patient as stage 0, 44.4% of the students gave the same stage. However, in stage 1, only 18.2% of the students gave the same stage and when evaluating prolapse in stage 2, 60% of the students were correct. It is also observed that the students tended to underestimate the stage of the patients in their evaluation (table 1).Table 1. Concordance between the stage of prolapse by preceptors and students
Conclusions: We can conclude that the students are able to perform evaluation using POP-Q prolapse system, however, it is necessary to improve their accuracy. Students generally leave satisfied with the gynecological care after the internship. The comfort to attend patients with genital prolapse after the gynecology stage presented a relative improvement, however, only a small portion of the students were fully comfortable in this care. The structure and cases discussed were not identified as deficient, however, the number of women with dystopia effectively attended seems to influence the comfort of students to attend patients. Finally, the evaluation demonstrates that students report having deficiency in knowledge and evaluation of genital prolapse. This could be improved by prior training, particularly in simulators. Thus, teachers and preceptors should seek teaching methods that improve the learning of future physicians to better evaluate this condition so frequent and disabling that is genital prolapse
References: Drutz HP; IUGA Education Committee. IUGA guidelines for training in female pelvic medicine and reconstructive pelvic surgery (FPM-RPS). Updated guidelines 2010. Int Urogynecol J. 2010 Dec;21(12):1445-53.Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JOL, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175:10-7.
Students POP-Q staging
% correct evaluation