Pediatric Resident Training in Prepubertal Vulvar Conditions

Study objective: To assess pediatric resident training in diagnosing and managing prepubertal gynecologic conditions.

Design: Voluntary 32-question survey e-mailed to participants.

Setting: E-mail contact through the American Academy of Pediatrics listserv.

Participants: Seven thousand seventy-five US pediatrics and combined internal medicine-pediatric residents.

Interventions: Descriptive analysis including χ² tests was performed on survey results.

Main outcome measures: Residents' training experiences and comfort, confidence, and knowledge in evaluating pediatric gynecologic concerns.

Results: In 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.

Conclusion: Our 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.