ADDIE-guided pelvic examination teaching intervention: a quasi-experimental three-cohort study in an undergraduate clerkship

Objectives To evaluate whether an Analysis, Design, Development, Implementation, and Evaluation (ADDIE)-guided, iteratively refined pelvic examination curriculum improves directly observed procedural performance in clerkship students. Methods A single-center quasi-experimental study was conducted with three cohorts (total n=86) to compare training approaches. Cohort 1 received a conventional simulation package (n=20); cohort 2 received an enhanced package supplemented with micro-courses and flashcards (n=20); and cohort 3 received a comprehensive package that additionally incorporated scenario simulation (n=46). The primary outcome was assessed using a 12-item formative checklist, scored from 0 to 100. Between-cohort differences were evaluated using the Kruskal–Wallis test, and the effect size was reported as epsilon-squared ( ε 2 ). To account for potential confounding, an ordinary least squares (OLS) regression model was fitted, with adjustment for gender, age, and baseline self-rated skill; heteroskedasticity-consistent (HC3) robust standard errors (SEs) were used, and two-sided Wald tests were applied for inference. Results Significant differences in total scores were found across cohorts ( H =49.76, p<0.001; ε 2 =0.575), with scores observed to increase progressively from cohort 1 (59.05 ± 14.78) to cohort 2 (92.80 ± 6.35) and cohort 3 (96.76 ± 3.37). After adjustment for covariates, both enhanced training approaches were found to be associated with substantially higher scores relative to conventional training (cohort 2 vs. cohort 1: β =35.03, 95 % confidence interval [ CI ]: 27.54–42.51, p<0.001; cohort 3 vs. cohort 1: β =38.92, 95 % CI : 31.75–46.08, p<0.001). Female gender was independently associated with higher scores ( β =5.47, 95 % CI : 1.98–8.95; p=0.002). Progressive improvement in self-rated skill was also observed across cohorts, with mean increases of 2.35, 2.80, and 3.17 points recorded, respectively. Conclusions ADDIE-guided iterative optimization was associated with large gains in observed pelvic examination performance. The largest increment followed integration of micro-courses and flashcards.