Literature Review

Peer Physical Examination (PPE)

A review of literature reveals limited contemporary study into the use of PPE generally, with even less investigation into its use in the examination of intimate regions (breasts; genitalia). Further, Koehler and McMenamin (2014) identify a clear need for a consistent regulatory framework for the use and implementation of PPE, building upon recognition by Rees et al. (2005) that informed consent cannot sufficiently safeguard students against pressures such as academic expectations to agree to PPE.

Students’ primary concerns relating to conducting PPE generally were social impacts of student relationships, describing their experiences with intimate examinations as feeling “invaded”, “vulnerable”,” uncomfortable”, and “embarrassed”, emblematic of a lack in dignity in intimate assessment education, with 21.7% of students refusing to participate in the examination of breasts, and 18.6% for groin region- though without the exposure of genitals

Most seriously, ethical frameworks must be placed to mitigate the consequence of discovering a health condition in the participant, or to prevent the lack of a trauma-informed teaching perspective acting as a trigger to students with prior sexual abuse or assault (Elisseou, Adams and Adler, 2022).

Simulation-Based Learning

Relating to the artificial re-creation of a real event to instill an experiential educational experience, simulations provide an interactive space for ‘safe’ development and practice of clinical skills- protecting both patients and students (Lateef, 2010).

Journal articles illustrate the use of simulation as increasingly adopted within a new revolution of integrated medical learning . Crucially, simulation is identified offering varied, repeatable, and controlled experiences for medical learning that would otherwise be inaccessible or available through using exclusively traditional training methods such as clinical observations, easing ethical complications. Therefore, simulations offer the ability to build students’ confidence prior to clinical skills applications, allowing effective delivery of care through the ability to focus on a patient’s wellbeing in clinical scenarios.

In physiotherapy specifically, studies have shown positive self-efficacy and satisfaction with simulation-based learning. Simulation is a commonly used technique in physiotherapeutic education, though limitations from the high financial cost of high-fidelity simulation devices provide a significant barrier to institutions’ ability to offer this training.

Closely associated with technology, specifically computerised controls to enhance realism of experience, modern simulators are beginning to integrate the relatively new technology of Augmented Reality (AR). This offers key learning advantages in further immersive and customisable learning scenarios, as well as remote learning- a key benefit in a post-COVID globalised world, by utilising technology to enhance a real-world based experience through artificial haptic, auditory, or visual stimuli.

Within the NHS, acquisition of simulators and training materials is achieved through a bidding process. Rapidly evolving clinical practice and growing evidence of efficacy of simulation-based training has contributed to increased training materials expenditure, especially following the global pandemic.