Historically, pelvic floor/women’s health physiotherapists have been taught to perform intimate pelvic examinations using peers. Other health professionals, such as medicine and nursing, utilise mannequins or teaching associates to learn gynaecological examinations. A key component of a physiotherapy intimate pelvic examination (IPE) is the assessment of pelvic floor muscle function. Mannequins are not utilised to teach physiotherapists as mannequins are unable to simulate pelvic floor muscle contraction. Teaching associates have not been used in physiotherapy predominantly due to the cost and the lack of trained personnel.
The aim of this study was to explore graduate physiotherapists’ experiences of learning to perform IPE using peers within a postgraduate university course. The objective of this project was to provide qualitative information about the experience and acceptability of physiotherapy postgraduate students to learning intimate pelvic examinations through peer examination. This information will be used to inform the teaching methods of peer examination for future students in pelvic floor physiotherapy. The study addressed the following key questions:
What is the graduate student’s experience and acceptability of:
a) learning intimate pelvic examinations on their peers, and
b) being the patient for their peers to learn intimate pelvic examinations?

This is a descriptive study exploring the experience and acceptability of graduate physiotherapy students to learning intimate pelvic examinations through peer examination. Inclusion criteria for participation were postgraduate students at two universities within the 2017 and 2018 cohorts, who were adults over 18 years of age. They were invited to participate in an on-line anonymous survey (Survey Monkey). The anticipated number of participants was 50 students. Participants were invited to complete two on-line questionnaires; Questionnaire A prior to learning intimate pelvic examinations and Questionnaire B approximately 10 days after learning this intimate examination. The survey data was analysed using descriptive statistics. A general inductive approach was taken to analyse the free text responses. Two of the responsible researchers repeatedly studied the transcripts and discussed possible meanings and emerging themes which were developed and categorised.

Fifty adult female postgraduate physiotherapists were recruited and all gave written informed consent. The mean (SD) years from graduation was 8.6 (5.7) years. Sixty-two percent had had previous training in IPE, 87% of these physiotherapists through short courses of continuing education, in which 93.6% had learned this examination on peers. Of those with previous training, 21% reported their technical ability to perform an IPE, and 25% their ability to interpret the findings from an IPE, as good to very good before learning within the postgraduate university courses. After IPE training within the postgraduate courses, this had increased to 87% and 78% respectively. As detailed in Tables 1 and 2, there were positive changes for both technical skills learning and emotional responses after the IPE training. 
Two main themes emerged from 48 free text transcripts prior to the training regarding their experience and the acceptability of learning on peers, when being the examiner. In the major theme (26/48 responses), ‘educational value’, students expressed positive feelings toward their potential for personal learning, helping their peers to learn, and gaining an understanding of the patient’s experience of pelvic examinations. The second theme (22/48 responses) was ‘emotional response’. Students expressed strong emotions such as anxiety and nervousness, and the milder emotions of apprehension and daunting, in anticipation of the training.  The same two themes emerged from the 39 responses anticipating being the patient for IPE training. Again the major theme of ‘educational value’ emerged (22/39 responses), with positive responses expressed regarding the opportunity for skills training, feedback on performance and gaining an understanding of the patient’s experience. In the ‘emotional response’ theme (17/39 responses), there were two relatively equal categories of anxiety and nervousness, and fear about their body image of intimate body parts.
In response to ‘provide suggestions for change’ about this form of learning (21/35 responses), 13/21 participants responded that no change was required. No themes emerged from the eight other responses. Three participants commented on the expertise and understanding of tutors in modelling the IPE, which allayed their anxiety; two participants wanted to use teaching associates, and one participant found the learning took an emotional toll on her.

The results of this study provide a valuable insight into the experiences and acceptability of learning to undertake intimate peer examinations. All student participants in the two university cohorts were given written information regarding the process and experience of learning IPE on their peers, prior to, and on entering the postgraduate courses. Despite this, there was a high level of anxiety within the cohorts prior to their IPE learning. The emotional responses were balanced with the cognitive understanding of the educational benefits of undertaking peer examinations, and for some students, a combination of the two themes. Educators ameliorated the emotional responses by their sensitive approach to this learning and by feedback. This resulted in a positive shift in survey responses to both improved skills and reduced emotional response.

The results of this study provide a better understanding of the student perspective of the teaching and learning of intimate examinations and can be used to inform the educational approach in physiotherapy programs that teach IPE. Educators must balance both emotional and educational needs of their students and be aware that peer learning may not be acceptable to some students.