Is paediatric resident knowledge and comfort with pubertal exams adequate? Performance of a needs assessment and development of a learning module
CPS ePoster Library. Ens A. Jun 25, 2015; 99210; 148
Andrea Ens
Andrea Ens
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Background: It is important that paediatric residents (our future paediatricians) know how to perform pubertal examinations. Without appropriate training, there is a risk that exams are done inaccurately, patients experience unnecessary discomfort and physicians avoid needed exams.

Objectives: To conduct a learning needs assessment (LNA) of paediatric residents to determine their knowledge of and comfort in performing a Tanner Staging pubertal examination and to develop a learning module (LM), informed by the LNA, to address deficits identified in the LNA.

Method: The LNA questionnaire was developed to assess residents’ previous education, experience, confidence, and knowledge related to Tanner Staging. The questionnaire underwent content and face validity testing. The LNA was administered to residents in four Canadian paediatric training programs that varied in geography and size to sample residents across Canada. The results of the LNA were analyzed using quantitative and qualitative methods to identify themes regarding knowledge and comfort.

Results: Sixty-four PGY-1 to PGY-4 residents responded. Half (51.6%) reported discomfort introducing the puberty exam to patients, and 50% reported lack of confidence in their ability to perform a puberty exam. Over half (56.3%) reported having avoided a warranted puberty exam. Of concern, avoidance rates were not statistically different between junior (PGY-1 and PGY-2) and senior (PGY-3 and PGY-4) residents (p=0.69). Over a third (39.1%) did not correctly identify the numeric scale used for Tanner Staging, and 15.6% erroneously identified Tanner Stage 0 as a component of the system. Based on provided pictures, 57.6% assigned the incorrect Tanner Stage for breast development and 67.2% assigned the incorrect Tanner Stage for pubic hair. There were no differences in performance on the knowledge based questions between senior and junior residents, or between residents who had completed an endocrine rotation (54.7%) and those who had not. Quantitative and qualitative analyses identified barriers and enabling factors for exam performance. Together all results were used to develop a case-based, web-based LM that addressed education gaps.

Conclusion: This study demonstrated the importance of re-evaluating paediatric residents’ experiences with Tanner Staging. Residents report being uncomfortable with Tanner Staging and avoiding the puberty exam, and they have significant knowledge gaps. To address these issues, we have developed a case-based, web-based LM to help residents learn to perform accurate and compassionate pubertal exams. An important next step will be to examine the utility and effectiveness of the LM.
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