Simulation training for breast and pelvic physical examination: a systematic review and meta-analysis

BJOG. 2013 Sep;120(10):1171-82. doi: 10.1111/1471-0528.12289. Epub 2013 Jun 11.


Background: Breast and pelvic examinations are challenging intimate examinations. Technology-based simulation may help to overcome these challenges.

Objective: To synthesise the evidence regarding the effectiveness of technology-based simulation training for breast and pelvic examination.

Search strategy: Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles; the date of the last search was January 2012.

Selection criteria: Original research studies evaluating technology-enhanced simulation of breast and pelvic examination to teach learners, compared with no intervention or with other educational activities.

Data collection and analysis: The reviewers evaluated study eligibility and abstracted data on methodological quality, learners, instructional design, and outcomes, and used random-effects models to pool weighted effect sizes.

Main results: In total, 11 272 articles were identified for screening, and 22 studies were eligible, enrolling 2036 trainees. In eight studies comparing simulation for breast examination training with no intervention, simulation was associated with a significant improvement in skill, with a pooled effect size of 0.86 (95% CI 0.52-1.19; P < 0.001). Four studies comparing simulation training for pelvic examination with no intervention had a large and significant benefit, with a pooled effect size of 1.18 (95% CI 0.40-1.96; P = 0.003). Among breast examination simulation studies, dynamic models providing feedback were associated with improved outcomes. In pelvic examination simulation studies, the addition of a standardised patient to the simulation model and the use of an electronic model with enhanced feedback improved outcomes.

Author's conclusions: In comparison with no intervention, breast and pelvic examination simulation training is associated with moderate to large effects for skills outcomes. Enhanced feedback appears to improve learning.

Keywords: Breast examination; pelvic examination; simulation training.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Clinical Competence
  • Computer Simulation
  • Education, Medical / methods*
  • Educational Technology*
  • Female
  • Gynecology / education*
  • Humans
  • Manikins
  • Obstetrics / education*
  • Patient Simulation
  • Physical Examination*