725 - Bridging Confidence and Competence in Prepubertal Female Genital Examinations: A Needs Assessment of Emergency Medicine Clinicians

Publication Number: 3701.725

Yasmin H. Soliman, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Amy P. Goldberg, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Stephanie M. Ruest, Hasbro Children's Hospital at Rhode Island Hospital, Foxboro, MA, United States

Background: Emergency medicine (EM) clinicians may perform genitourinary (GU) exams for prepubertal females, particularly in suspected abuse cases. Knowledge of anatomy and exam techniques is essential to recognize normal and abnormal findings; however, no EM-specific training requirement exists. Studies have not assessed GU exam confidence and knowledge among EM faculty, trainees, pediatric EM (PEM) faculty, and advanced practice providers (APPs). Establishing baseline competency is critical to inform educational interventions.

Objective: To assess EM clinicians’ knowledge and confidence in performing prepubertal female GU exams.

Design/Methods: This IRB-approved anonymous survey, adapted from previously published surveys, was distributed to PEM faculty and fellows (PEMF), EM faculty, EM residents, and APPs who work at Rhode Island Hospital and affiliated pediatric and general emergency departments. The survey assessed demographics, prior education, self-reported confidence (Likert scale), and image-based knowledge using de-identified images. Descriptive analyses summarized confidence and knowledge across clinician groups.

Results: Of 225 invited participants, 64 (28.4%) responded: 13 EM faculty, 24 EM trainees, 21 PEMF, and 6 APPs. 46.2% of EM Faculty and 62.5% of EM trainees reported formal education on female pediatric GU exams versus 95.2% of PEM respondents. 2.7% of EM faculty or trainees completed a child abuse rotation versus 69.2% of PEM respondents. Confidence differed markedly by specialty (Table 1); >80% of PEMF reported high confidence in exam preparation compared to < 25% of EM clinicians. Similarly, >50% of PEMF reported high confidence in identifying normal variants and injuries, compared to < 10% of EM faculty or trainees. Knowledge also varied by group (Tables 2-3). >70% of respondents in each group correctly identified the urethral meatus, but recognition of the labia minora was ≤50% across all groups. Hymen identification showed the largest gap between EM and PEM clinicians. < 25% of respondents in any group correctly identified the finding most concerning for child abuse in a clinical vignette.

Conclusion(s): EM clinicians demonstrated notably lower confidence and variable knowledge in performing and interpreting prepubertal GU exams compared to PEM counterparts. Despite similar performance in identifying normal variants, deficits persist in recognizing both normal and abnormal anatomy and findings of abuse. These results highlight the need for an educational curriculum to improve competency and confidence among all ED providers caring for pediatric patients with GU complaints.

Proportion of Respondents reporting high or very high confidence with the prepubertal GU exam
Table1_GU.pdf

Proportion of respondents correctly identifying normal anatomy
Table2_GU.pdf*Respondents who correctly assessed the image as a normal GU exam

Proportion of respondents correctly identifying normal variants and GU abnormalities
Table3_GU.pdf