Genital and rectal examinations are challenging examinations for medical students to learn, in part due to the difficulty in gaining practice opportunities. A randomised control trial was carried out to directly compare the efficacy of teaching the male intimate examinations to third year medical students using Clinical Teaching Associates (CTAs) compared with the current standard teaching already offered at our medical school. CTAs are members of the lay-public professionally trained to teach intimate examinations.

A single-blinded parallel-group RCT was conducted, recruiting 96 students. Ethical Committee approval has been obtained. Block randomisation separated these students into two equal groups. The control group were only given access to the current standard teaching (lecture and model) whilst the intervention group were offered a bespoke teaching session and students were allowed to examine the CTAs. Three outcomes were measured: student competence as assessed by the clinician using a bespoke Objective Structured Clinical Examination (OSCE); student competence as assessed by the CTA acting as the patient in the OSCE; and student confidence before and after the teaching session, measured on a 1-9 Likert scale. Comparison of student competence between the control and intervention groups, assessed by both the clinician and the teaching associate, was made using parametric Analysis of Variance (ANOVA). Student confidence before and after the teaching was compared using a paired t-test.

Assessed by an experienced clinician, the group receiving the additional teaching scored significantly higher than the control group in the OSCE in 55% (n = 11) of domains. This included, but was not limited to, competence in performing hernial orifice (F = 16.269, p = <0.001), testicular (F = 11.165, p = 0.002), penile (F = 17.114, p = <0.001) and digital rectal (F = 5.211, p = 0.026) examinations. No significant difference was found in the remaining domains. Assessment of the OSCE by the CTA, acting as the patient, showed a significant superiority of the intervention group in all domains (n = 9). This included whether the student explained the examinations thoroughly (F = 58.206, p < 0.001), whether the patient felt safe (F = 15.260, p < 0.001) and whether the patient would see the student again (F = 32.873, p < 0.001). Finally, student confidence significantly improved following the teaching session in all domains (n = 9). This included confidence in performing the testicular examinations t(5.97, 0.236) < 0.001, (p < 0.001) and  the digital rectal examination t(5.42, 0.351) < 0.001, (p < 0.001) respectively.

The use of CTAs for teaching of the male intimate examination results in significantly greater student competence and confidence compared to standard lecture-based teaching.

Medical schools should consider implementing the use of Clinical Teaching Associates into the medical curriculum to facilitate intimate male genital examination.

Continence 7S1 (2023) 101011
DOI: 10.1016/j.cont.2023.101011