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Cost-effective analysis of teaching pelvic examination skills using Gynaecology Teaching Associates (GTAs) compared with manikin models (The CEAT Study)
  1. Aisha Janjua1,
  2. Tracy Roberts2,
  3. Nicola Okeahialam3,
  4. T Justin Clark4
  1. 1 Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham, UK
  2. 2 Department of Health Economics Unit, School of Health and Population Science, The Public Health Building, University of Birmingham, Birmingham, UK
  3. 3 Obstetrics and Gynaecology, London, UK
  4. 4 Obstetrics and Gynaecology, Birmingham Women’s Hospital, Birmingham, UK
  1. Correspondence to Dr Aisha Janjua; aishajanjua{at}


Objective To determine the cost-effectiveness of Gynaecology Teaching Associate (GTA) teaching versus conventional pelvic model (manikin) teaching of pelvic examination skills for final year medical students within a UK undergraduate obstetrics and gynaecology (O&G) curriculum.

Methods An economic evaluation was carried out alongside a randomised controlled trial involving 492 final year medical students. 240 students received manikin teaching, and 241 GTA-led teaching. 418 (85%) students completed their assessment. Proficiency in gynaecological pelvic examination on GTAs was estimated by a senior clinical examiner, blinded to the method of teaching, using a standardised assessment tool. University of Birmingham Medical School thresholds were applied to determine proficiency levels; competence (pass) 50%, merit 60% and distinction 70%. Costs incurred in the delivery of both the educational pathways (control and intervention) were combined. All costs are reported in 2013–2014 prices and earlier costs adjusted using inflation indices.

Outcome measures Cost per student competent in pelvic examination at completion of a 5-week clinical O&G placement.

Results GTA teaching was more effective compared with conventional teaching with 12 more students considered competent at pass level and 28 more students competent at merit and distinction levels, respectively. However, the average cost of GTA teaching was £45.06 per student compared with £7.40 per student for conventional teaching, with an increased cost of £37.66 per student. The incremental cost-effectiveness ratio demonstrated that it cost an additional £640.20 per competent student and £274.37 per student competent at merit level and £274.37 at distinction level compared with conventional manikin-based teaching.

Conclusions GTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements is shown to cost more and be more effective. GTA teaching is likely to be considered cost-effective in the context of other tests, and over the lifespan of a competent doctor’s career.

Trial registration number NCT01944592.

  • undergraduate medical education
  • medical student
  • pelvic examination
  • gynaecology teaching associates (gtas)
  • cost effectiveness
  • competence

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  • Contributors All authors meet the criteria for authorship, in detail: JC, TR and AJ designed the study; AJ conducted the study; collected and analysed the data. NO assisted with sensitivity analysis and bootstrapping. AJ wrote and revised the manuscript. TR supervised the study and assisted in analyses and review of the manuscript.

  • Funding Funding received from the University of Birmingham for payment of GTA teaching sessions to continue the trial.

  • Competing interests GTAs are currently employed by BWH where TJC is Director of Academy.

  • Patient consent Not required.

  • Ethics approval University of Birmingham and Birmingham Women’s Hospital ethical approval granted.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data for the randomised controlled trial, including demographics of the students, questionnaire information and student assessment scores, is available to authors: AJ and TJC. Detailed sensitivity analysis using Microsoft Excel is available to authors: AJ, TJC and TR.

  • Presented at RCOG Annual Academic Meeting 2017(2 –3 March 2017)