Pediatric and Adolescent Gynecology: the Use of a Pediatric Simulator to Improve Residency Perceptions of Training in the Pediatric Exam

Background: The CREOG Educational Objectives and the ACGME Residency Program Requirements include sections dedicated to adolescent and pediatric gynecology. However, at our institution, resident experience and competence with the gynecologic exam in the pediatric population (ages 1 month to 12 years old) is limited. The primary objective of this investigation was to provide a simulation of the pediatric gynecologic examination, and perform a self assessment of resident ability and comfort with these exams before and after the simulation. A secondary objective was to measure residents’ opinions regarding simulator training, and its potential inclusion into their curriculum. Methods: Participants included residents in an academic inner city university program. Two self assessment surveys (pre and post simulation) were developed and validated. Surveys included demographic information and a 5-point scale rating residents’ attitudes and comfort with the pediatric and adolescent gynecologic exam. The pre-survey also assessed attitudes regarding opportunities for improvements. Residents then performed the pediatric exam on a simulation apparatus. Following the simulation, residents were provided with a lecture detailing the proper technique for the pediatric exam. After several weeks, simulation was repeated, and a post-simulation survey was used to re-assess their comfort and ability with the exam. Results: 26 residents from all four year groups were enrolled in the study. The typical resident was Caucasian, female, and between 29e33 years old. Prior to simulation, 3 of 26 residents reported being comfortable with the pediatric exam. Comfort levels with specific ages were inversely proportional to the age of the patient. 80.7% of residents had less than 2 hours experience with children in the 1 month to 5 years old, while 65.4% had examined more than 10 patients in the 12 to 18 year age range. Residents were uncomfortable with addressing physical and sexual abuse in this population (Mean 2.6). 80.8% of residents indicated that their residency training in pediatric gynecology was insufficient, and all indicated that simulation training could be beneficial. Following the simulations and lectures, preliminary data has revealed an improvement in resident comfort with the pediatric exam (Mean 4.17). Comfort levels with specific ages improved, with 83.3% comfortable with ages 1 month to 5 years old. Residents were overall more comfortable with ages 5 years or older. Comfort dealing with physical and sexual abuse issues following the simulation training also improved. All residents who completed both surveys reported simulation training should be integrated into their curriculum. Conclusions: Despite requirements for competency in adolescent and pediatric gynecology, residents in this program indicate they have not had enough experience with training in pediatric gynecology, especially in younger children, and expressed interest in obtaining skills regarding this exam. Simulation training appears to be an effective tool for improving confidence and skills in the pediatric exam, and resident attitudes reflect a desire to have it incorporated into their training.