Objective: 
For more than twenty years, our institution has provided Male Uro-genital Teaching Associates (MUTA) and Gynecological Teaching Associates (GTA) to expose our second-year medical students to technically and emotionally challenging physical examination techniques.  To make the MUTA/GTA exercise a more comprehensive learning experience, each session was restructured from a 30 minute patient encounter into a 3-step learning exercise.  We present our 3-Step program as a model for other institutions.

Methods: 
All sessions are conducted in the Standardized Patient Center. Students are grouped so that half starts with the GTA session while the other half begins with the MUTA session.  Each session involves three steps:  Step 1: Audio-Visual: Students begin with a video of the examination technique.   Step 2: Examination/Demonstration:  For the male genital & rectal exam: a urologist reviews anatomy and examination techniques while students handle prostate models to explore examination findings.  For the pelvic and breast exam: an OB/Gyn staff member allows students to practice using speculums on simulated pelvic models then demonstrates the pelvic examination on a GTA.  Students then work in pairs with the MUTA or GTA to practice the PE skills.  Step 3: Debriefing: students return to their orientation area for question/answer sessions and additional time with the simulation models.  The groups switch orientation rooms and the process is repeated.

Results: 
Each session lasts two hours, utilizes 5 MUTA and 5 GTA and accommodates 20 students.  Written and verbal feedback from the students has been consistently positive.  Prior to using the 3-step process, students felt the experience was overwhelming and felt rushed into interactions with the MUTA/GTAs.

Conclusion: 
In an effort to maximize each student’s learning potential, our experience supports the on-going use of on-site orientations and debriefings for students in the GTA/MUTA sessions. Student comfort with the exercise has been enhanced, allowing them to concentrate on the acquisition of skills in this unique learning experience