741 - Neonatal Circumcision Curriculum: Longitudinal Outcomes in Interns

Publication Number: 3717.741

Casey Freymiller, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michael R.. Lasarev, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Most newborn males receive a circumcision prior to hospital discharge in America. Rates of adverse outcomes can be mitigated with proper training, but education and access to it is variable. Procedural skill education continues to evolve with increasing use of simulation and competency-based metrics.

Objective: Study 1st-year resident circumcision comfort and knowledge over the first year.

Design/Methods: Over two academic years, all 1st-year pediatric residents in our program were invited to participate in this study during didactic learning. Each was given a standard lecture on the history, cultural significance, benefits, risks, complications, and procedural knowledge followed by a simulation on a model. A pre-test collected baseline self-reported comfort and knowledge using 5-point Likert scales (+2 for strongly agree to -2 for strongly disagree) and objective knowledge using a 10-point quiz. Comfort and knowledge scores were followed using post-test surveys sent one day after lecture and on day two of their rotation in the newborn nursery (12-327 days; median 124 days). Linear mixed-effect models were used to examine how responses changed over time.

Results: A total of 34 residents were available to participate in data collection with 28 (82%) completing the pre-test, lecture, simulation, and post-test. Comfort to counsel families was neutral at baseline (-0.21; p=0.29) but increased by 1.59 points after lecture (p < 0.01). This comfort was maintained when in the newborn nursery (+0.82; p=0.05). Self-reported knowledge of the steps was below neutral at baseline (−0.96; p < 0.01) but increased by 2.51 points (p < 0.01) after lecture. In the nursery, this feeling was improved compared to the pre-test (+1.53) but had significantly dropped compared to after lecture (-0.98; p=0.02). Self-reported comfort to perform a circumcision was below average prior to lecture (-1.54; p< 0.01) and increased by 2.56 points (p < 0.01) afterwards. In the nursery, this comfort was still positive compared to the pre-test (+1.47; p< 0.01) but had significantly dropped compared to after lecture (-1.09; p< 0.01). Objective knowledge scores after lecture rose on average by 21.8% and this improved knowledge was maintained in the nursery (+14.7%).

Conclusion(s): When given education on neonatal circumcision, pediatric residents showed improved comfort and knowledge of the procedure. When followed throughout their first year, these effects waned, especially in their perceived knowledge and comfort to perform the procedure. Continuing education is essential for residents as they finish their training and move into clinical practice.

Table 1: Self reported comfort and knowledge and quiz scores.
Resident mean level of self-reported agreement prior to lecture, after lecture, and during rotation in newborn nursery reported on 5-point Likert scales. Objective knowledge assessed using 10-point quiz (percent correct).

Table 2: Change over time.
Change in mean level of self-reported agreement and objective knowledge after each time-point.