Assistant Professor University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, United States
Background: Neonatal circumcision is a common procedure performed worldwide. Nationally, most newborn males are circumcised before hospital discharge, but there remains great variability in technique, access, and educational opportunities for trainees. Objective: We developed and implemented a standard circumcision curriculum for first-year residents at our institution. Design/Methods: Faculty general pediatricians and newborn hospitalists used Kern’s six-step approach and the theory of automaticity to create a curriculum that detailed the history, cultural context, benefits, contraindications, complications, and procedural steps of circumcision. All first-year pediatric and family medicine residents in our program were offered this curriculum during didactic lectures at the start of their training. Following the lecture, each individual resident completed a clamp circumcision using a model with guidance by an attending physician. Residents completed two additional simulations with guidance while on rotation in the newborn nursery during their first year (12-327 days after lecture). Data on interest, knowledge, and comfort using 5-point Likert scales was collected before and after the lecture and during nursery rotation. Feedback on the curriculum was collected via surveys and interviews with residents after simulations. Results: A total of 68 first-year residents attended lectures and completed initial surveys. Family medicine residents comprised 59% (n=40) of the sample with the remaining 41% (n=28) being pediatric residents. 78% were interested in learning the procedure while 71% agreed that knowledge was important to their career. Post-test surveys were completed by 65% (n=44) of residents. Average consent comfort, procedure comfort, and knowledge ratings rose by 1.6, 2.3, and 2.6 points respectively within two weeks of lecture. Pediatric ratings decreased on average by 0.7, 1.1, and 1.1 points respectively by the start of nursery rotation. Residents highlighted the benefits of hands-on practice with real instruments. Additional additions included additional simulations, explicit consent simulation, and the use of videos for increased understanding. Lecture content that was free of bias was important to some residents.
Conclusion(s): Residents are interested and uniquely poised to benefit from early circumcision content during their first year when the nursery rotation occurs. Multi-modal, unbiased content via lecture and simulation was desired and effective, but explicit practice with consent was highlighted. The addition of refresher content is necessary to maintain resident knowledge and comfort longitudinally.
