Learning the breast examination with Physical Exam Teaching Associates: development and evaluation of the teaching setup. An action research approach

Figures & data

Figure 1. The action research cycle.

Table 1. Final training course for PETAs.

Workshop	Content
A	1. Introduction of the teaching session for students Aims of the teaching session and learning goals for the various workshops Get to know each other Setup of a teaching session with students 2. Anatomy Breast and regional lymph node anatomy Medical terminology 3. The clinical breast examination Outline of the CBE and the examination of the regional lymph nodes Practicing the CBE on manikins
B	4. Providing feedback as a PETA 5. History taking 6. The clinical breast examination Repetition of the procedure: techniques of inspection and palpation Practicing the CBE and the regional lymph nodes examination on each other Giving feedback 7. Examination of each PETA by specialized nurse
C	8. Role play in pairs Practicing history taking and the CBE in the role of PETA Repeating the techniques of the CBE Practicing giving feedback
D	9. Simulated sessions with medical students Coaching a student throughout history taking and the CBE Practice debriefing with students 10. Debrief simulation session 11. Handling complex situations with students

This overview shows the final training course for PETAs, after adaptations were made based on evaluation of the first action research cycle. A training manual was available prior to the training workshops, so that the PETAs could familiarize themselves with the course content.

Initially, section 4 was part of workshop A; section 2 and 3 took place in workshop B.

Table 2. The PETA-based teaching session for students.

At home: Preparatory assignment prior to the on-campus teaching session

60 minutes

On campus: Present: 12 students, 6 PETAs, 1 clinical skills teacher Plenary session: outline of the CBE, explanation of the setup with PETAs Small groups are formed with 2–3 students per PETA. Each small group goes to a separate learning space. Introduction Students perform history taking together Each student performs the CBE on the PETA, under guidance of the PETA, with immediate feedback from the PETA Debrief session together Teacher available in the background for questions

15 minutes 75 minutes

This overview shows the final PETA-based teaching session. Based on evaluation of the first action research cycle, the session was adapted to a flipped classroom approach using a preparatory assignment.

Table 3. Final teaching setup questionnaire: answers to closed-ended questions.

	Mean (N, SD)
Visual analogue scale (1–10)
Please score the training	9.1 (N 117, SD .8)
Likert scale statements (1–5)
I felt tense before starting the training	2.7 (N 118, SD 1.1)
I felt tense after finishing the training	1.4 (N 118, SD .8)
After completing the training, I felt confident that I could perform the CBE on a female without any symptoms	4.4 (N 118, SD .5)
The medical subject matter was sufficiently covered during the training session (including the preparatory assignment*)	4.2 (N 118, SD .7)
The PETA created a safe environment, in which I felt at ease	4.8 (N 118, SD .5)
The PETA provided proper structure during the training	4.6 (N 117, SD .7)
The PETA was able to properly convey the content of the physical examination	4.6 (N 117, SD .6)
The PETA provided constructive feedback on my performance	4.7 (N 118, SD .5)
Yes/no questions
In your opinion, does using a PETA add value compared to practicing on a fellow student?
Yes	99 percent (N 117)
No	1 percent (N 1)

*Section in italic: this was added in the second cycle.

Table 4. Final teaching setup questionnaire: the open-ended questions.

(1) Follow-up question to: ‘In your opinion, does using a PETA add value compared to practicing on a fellow student?’ (Yes/No) - Yes: what value does the PETA add? - No: Why does the PETA not add any value?

(2) Do you have suggestions for improving this training session with a PETA?

Figure 2. Flow chart showing the sequence of actions taken for the development of the PETA-based teaching session.