Dr Neelani Nackeeran MBBS; DSRH; PG cert HE; FHA

Clinical Teaching Fellow & Speciality Doctor in SRH- Epsom & St. Helier University Hospitals NHS Trust, UK

Honorary Lecturer- St George’s University London, UK

Associate Director for FSRH Training programme, Sutton, UK


This small observational study demonstrates that teaching correct techniques through simulation before clinical practice will enhance long term memory and instil good clinical practice in the future.

45 medical students and 24 junior doctors who came for induction before clinical attachment were compared to see the outcome.  


Medical students are taught pelvic examination skills during early years in medical school.

When they come for Obstetrics & Gynaecology placement during Pre- Final year some errors in practice have been noted:

  • Performing bimanual examination prior to speculum examination
  • Not separating labia minora before insertion of speculum
  • Rotating the speculum while withdrawing
  • Confused smear and swab taking techniques


The junior doctors who started Obstetrics & Gynaecology rotation either on Foundation Year or General practice Speciality Training level also performed with similar errors in clinical practice.


According to National Training Laboratory learning triangle, 75% of learning is retained during practice by performing and 90% is retained by teaching others. “Simulation and Learning” has proved to enhance learning with better results in retention of memory. Therefore, we decided to teach pelvic examination skills through simulation and see the outcome of their learning and future practice.


A pre-simulation questionnaire was given to both the groups. The correct techniques were taught by gynaecologists, and simulation practiced on models with peer support and doctor’s supervision. Post simulation confirmed that majority of medical students adopted the correct techniques quicker than junior doctors. They all maintained their skills on patients during attachment. The students’ knowledge was tested before completion of final year and found majority of them adopted the correct techniques they learnt a year ago.


This observational study concludes that the junior doctors who were already practicing appeared to find it more challenging to adopt the correct techniques when re-taught, whereas the medical students learnt quicker and retained for future practice.