For the past six weeks, the International GTA MUTA Association, IGMA, has been hosting panel discussions for professionals in the field of GTA MUTA education. The goal of these meetings has been to explore the needs of those working in the field, both current and long term, and initiate dialogue, especially in light of the current crisis. The topic of discussion and scrutiny over these past three meetings has been around the possibility of conducting virtual GTA sessions in order to respond to the needs of medical schools as they try to meet requirements for their learners in this area. Standardized patient sessions have been moved to virtual platforms in all areas including physical examination. Many GTA MUTA program directors have also been asked about the possibility of conducting GTA MUTA labs in virtual settings. The resounding response from those working in the field is that this is not possible given the parameters of invasive examination techniques, and indeed, would ultimately not be beneficial.
The concerns centered around several key issues. GTA MUTA programming has always had at the forefront, the goal of reducing student anxiety during examinations that are extremely anxiety provoking. Additionally, the reality is that it is not possible without extensive 3-D modeling and computer programming, which does not exist for urogenital examination currently, to instruct on key elements such as palpation pressure and location of internal organs. While basic clinical examination palpation technique could be taught virtually, it would be impossible to assess the success of its application virtually, ie; did the learner maintain contact with the patient’s skin or move only a finger to a finger and a half’s distance between palpations, without the techniques being conducted on a live simulated patient. Therefore, it was deemed by the professionals in the field that for novice, first time learners, this would simply not be possible.
However, West Virginia University (WVU), under the direction of medical director, Dorian Williams, MD and program director, Lee Ann Miller, EdD, with the assistance of Kristie McVicker, Lead GTA Trainer, did have a virtual program scheduled for learners at their institution. Dr. Miller did agree that virtual GTA MUTA labs would not work for first time learners, however, WVU had requested that virtual sessions be conducted for third year students about to enter into Ob-GYN rotation as a review. The parameters for these virtual sessions were such that learners would have previously needed to have attended the face to face GTA sessions that had been conducted for the student population in second year. Each of the students would have had the specialized training that only a face to face session with a simulated patient instructor would be able to provide. They would have learned appropriate pressure, correct examination techniques and procedures and location of internal organs. The review sessions then, would include a review of all patient education and communication protocols as well as a review of the order of examination techniques and a verbal “walk-through” of a patient encounter from introduction to conclusion. There were five medical students scheduled to enter third year Ob/Gyn rotation. The five students would be divided into one group of two and one group of three and would virtually meet with a GTA. Dr. Miller informed the IGMA panel of the project at the April 17th meeting and was to report on programmatic outcome at the following IGMA meeting.
The May 1 IGMA meeting was approximately one week after the pilot program was conducted at West Virginia University. Dr. Miller reported that evaluations were filled out by the learners after attending their sessions with the GTA and that the evaluations showed a very positive response to the virtual sessions by the learners. Both GTAs and students utilized images of female genitalia as students talked through a gynecologic session. The students were able to practice verbal communication skills and provide patient education information to the GTA during the virtual session and were given feedback on these skills. It was reported that as a review, it seemed to work very well and that the University was looking to continue these virtual GTA review sessions as long as face to face sessions continued to be shelved during the pandemic.
Others on the call expressed concern that program administrators at other major institutions might decide to switch from face to face sessions to these virtual sessions permanently which would be contradictory to the goals and objectives of GTA and MUTA programming. There is simply no virtual replacement for sessions where the person on the table is both the instructor and the patient. This unique situation provides learners with an incomparable experience where they receive immediate feedback and step by step instruction in a quality controlled environment where critical elements of physical contact, palpation and examination of internal organs are disseminated to novice learners. Indeed the original intent of this kind of programming when Robert Kretzschmar, MD developed the first pilot program in the late 1960s to address the poor education medical students were receiving in gynecologic clinical examination skills, was to markedly improve student learning via step by step instruction and immediate feedback by a new version of standardized patient who was both the patient AND instructor. The benefits of GTA and MUTA programming has been well documented over the course of these decades and concerns that should virtual GTA MUTA sessions become accepted as an alternative, the methodology would in fact be regressing.
Dr. Miller responded to these concerns by explaining that administrators at West Virginia University fully supported the GTA program as it exists and this was developed in response to needs of the university to provide some manner of review of these techniques for their students. Other attendees expressed interest in additional information as their universities were also requesting information on virtual review sessions. All the GTA MUTA professionals in attendance on the call agreed however, that for novice learners experiencing GTA or MUTA sessions for the first time, virtual learning is not possible.
Kudos to Dr. Williams and Dr. Miller for sharing their unique program with IGMA members. It is a question that has come up with fair frequency recently as institutions deal with closures caused by the current pandemic. The response by West Virginia University was timely and generated interesting and important dialogue on the subject. If you would like to be a part of these discussions and to be a part of the only professional organization formed exclusively to meet the needs of professionals in the field of GTA MUTA programming, send an email to admin@GTAMUTA.org. You will receive a response from a member of the IGMA Board of Directors with the login information for our next call. The future of GTA MUTA programming is impacted by the work we do in the field. Be a part of the future of this work and make your voice heard.