Pediatric Resident Training in Prepubertal Vulvar Conditions

Abstract

Study ObjectiveTo assess pediatric resident training in diagnosing and managing prepubertal gynecologic conditions. DesignVoluntary 32-question survey e-mailed to participants. SettingE-mail contact through the American Academy of Pediatrics listserv. ParticipantsSeven thousand seventy-five US pediatrics and combined internal medicine-pediatric residents. InterventionsDescriptive analysis including χ2 tests was performed on survey results. Main Outcome MeasuresResidents' training experiences and comfort, confidence, and knowledge in evaluating pediatric gynecologic concerns. ResultsIn the 866 of 7075 (12%) completed surveys, a greater proportion of residents reported they were “very” or “extremely” comfortable talking to parents about general pediatric topics compared with gynecologic topics (88.5% vs 30.4%; P < .001). Similarly, they reported being “very” or “extremely” confident diagnosing general pediatric conditions compared with prepubertal gynecologic conditions (87.6% vs 32.8%; P < .001). These differences were also observed according to residency year (comfort: first year, 10.2% vs third/fourth year, 39.9%; P < .001; confidence: first year, 22.5% vs third/fourth year, 37.6%; P < .001). Residents learned about vulvovaginal concerns from attendings in clinic (79.8%), residency-specific didactics (34.7%), and conferences, meetings, and workshops (24.1%). Confidence examining, diagnosing, and treating vulvovaginitis was associated with participation in any learning activity and exposure to more than 5 patients with this concern. Additional education or training in prepubertal vulvovaginal conditions was requested by 97% of residents. ConclusionOur findings suggest that pediatric residents are lacking in comfort, confidence, and knowledge of prepubertal vulvovaginal conditions, especially compared with general pediatric topics. Although this improves during training, it remains low, and more education is indicated and desired by residents.