Objective: To explore the use of self-efficacy theory in examining the impact of an educational encounter with genito-urinary teaching associates (GUTAs) incorporating actual behavior performance (enactive mastery) upon confidence (self-efficacy expectation) and comfort levels of nurse practitioner students for doing female breast, female pelvic, and male genital/prostate examinations. Self-efficacy theory posits that a potent source of efficacy information such as actual behavior performance (enactive mastery) will improve confidence in ability to perform the three specified behaviors.
Design: Pre-test post-test.
Population, Sample, Setting, Years: Subjects were 107 nurse practitioner students in enrolled in a graduate level physical assessment course as the first clinical core course for various clinical specialties. This educational encounter took place during a fall semester in a comprehensive clinical education and evaluation laboratory incorporating standardized patients and GUTAs in an academic health sciences center. GUTAs are lay people highly trained as to serve as live patient models who also teach breast, pelvic, and genital/prostate examinations.
Intervention and Outcome Variables: The intervention consisted of an educational encounter which included actual performance of the three focus examinations with two GUTAs (female and male): 1) a female GUTA for the breast and pelvic examinations; and 2) a male GUTA for the genital/prostate examination. Concepts studied as outcome variables were confidence (self-efficacy expectation) and comfort levels in learning (pre) and performing (post) breast, pelvic, and genital/prostate examinations.
Methods: Confidence in ability to perform the breast, pelvic, and genital/prostate examinations was rated immediately before and after the educational encounter on an 11-point confidence scale (0=not at all and 10=very). Level of comfort with learning to perform the three examinations was also rated by the students immediately before the educational encounter, indicating whether they strongly agreed, agreed, disagreed, or strongly disagreed with three statements “I feel comfortable learning to perform a breast exam, pelvic exam, or genital/prostate exam." Immediately after the three examinations, confidence in ability to perform the breast, pelvic, and genital/prostate examinations was again self-rated on a scale of 0 to 10. The students also rated level of comfort in performing the three exams immediately after the educational encounter indicating whether they strongly agreed, agreed, disagreed, or strongly disagreed with three statements “I feel comfortable performing a breast exam/pelvic exam, or genital/prostate exam.”
Findings: Confidence levels for all three examinations increased significantly following the educational encounter (p< .001). Pre-test confidence in performing the examinations was highest for breast (M=7.19; SD=2.01), followed by pelvic (M=4.81;SD=2.36) and genital/prostate (M=4.45;SD=2.30). Post-test confidence increased significantly for all three exams, including breast (M=8.8;SD=1.10), pelvic (M=7.87;SD=1.42), and genital/prostate (M=8.12;SD=1.40). Comfort levels in learning/performing examinations these three examinations also increased significantly following the educational encounter (p<.001). In the pre-test, the majority of students either strongly agreed or agreed with feeling comfortable in learning to perform breast (n=105; 98.1%), pelvic (n=98; 91.6%) and genital/prostate (n=94; 87.9%) examinations. While 40 (37.4%) students reported having performed a breast exam prior to the educational encounter, only 12 (11.2%) a female pelvic exam, and 4 (3.7%) a genital/prostate exam. The majority of students (n=74; 69.2%) felt they had been adequately prepared through reading and lectures to perform a male exam as well as a female exam (n=76; 71%). Following completion of the GUTA experience, all participants (100%) either strongly agreed or agreed with feeling comfortable with performing a breast examination on a patient. Nearly all students (99.1%) either strongly agreed or agreed with feeling comfortable with performing a female pelvic examination and a male genito-urinary examination (99.1%).
Conclusions: This study demonstrated the effectiveness of the GUTA educational encounter in increasing the confidence and comfort of nurse practitioner students learning to perform breast, pelvic, and genital/prostate examinations. These findings are consistent with the tenets of self-efficacy theory.
Implications: These results offer evidence of the utility of self-efficacy theory as a framework for studying complex educational encounters with nurse practitioner students. The educational encounter is designed to facilitate the transition of clinical examination skills to clinical work with actual patients. These results demonstrate that having the opportunity to actually perform the examinations (enactive mastery) in a controlled laboratory environment also increases nurse practitioner student confidence and comfort in performing the examinations which contributes to better patient care.
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