Pediatric Gynecology E-learning Module for Resident Knowledge and Clinical Skills

Research background: removing barriers to training obstetrics and gynecology residents

Obstetricians and gynecologists are expected to be trained in pediatric and adolescent gynecology and demonstrate knowledge and clinical skills in the evaluation and management of prepubertal vaginal bleeding.

A young girl presenting with prepubertal vaginal bleeding will often be referred to an obstetrician or gynecologist. There are several barriers to meeting pediatric resident training requirements, leaving obstetrics and gynecology residents ill-equipped to provide pediatric gynecologic care. These barriers include time constraints on residency work hours, limited exposure to pediatric and adolescent gynecology experts, and lack of standardized curricula across resident training programs.

Experts in the Division of Pediatric and Adolescent Gynecology at Children’s Hospital Colorado and other authors designed and validated a pediatrics and adolescent gynecology self-study e-learning module for obstetrics and gynecology residents to see if it would improve their short-term knowledge and procedural skills.

Research methods: trial of e-learning for knowledge and clinical skills in pediatric and adolescent gynecology

Study authors conducted a randomized controlled trial of their e-learning module to assess the association of an e-learning module with resident knowledge and clinical skills. The study was conducted from July 2018 to June 2019 and included 115 obstetrics and gynecology residents.

• Participants were enrolled from four institutions, each with:
  • at least one faculty member with focused practice designation in pediatric and adolescent gynecology, recognized by the American Board of Obstetrics and Gynecology
  • opportunity for clinical exposure to pediatric and adolescent gynecology cases
• Divided into two randomized groups:
  • Non-intervention: completed objective structured clinical examination and knowledge survey
  • Intervention: completed online e-learning module, followed by the same objective structured clinical examination and survey

E-learning Module

The e-learning module was created by created by six pediatric and adolescent gynecology experts. The module was validated through expert feedback, focus groups and a prospective satisfaction survey. The case topic in the module was a 4-year-old girl presenting with vaginal bleeding.

The 20-minute long, self-study module included:

• narration
• animation
• video demonstrations
• brief quizzes

Objective structured clinical examination

A prepared script with the scenario was read by the faculty supervisor and each encounter was videotaped. Participants were asked to:

• interview patient and mother
• examine patient
• perform any indicated procedures with a simulated pelvic model

Questions were addressed to the supervisor as though participants were speaking to the patient and mother. They were provided with a model for performing an examination and all necessary examination and procedural equipment.

Knowledge survey

After the residents completed the objective structural exam, they received a link to a five-question knowledge survey and were instructed to complete it immediately.

Research results: differences between intervention group and non-intervention group

Of the eligible residents,

• 97 (83%) completed the trial
• 90.7% were female
• 36% had prior didactics on prepubertal bleeding
• 33% had prior exposure to prepubertal exam

The intervention group scored higher in all knowledge domains except in the treatment of vulvovaginitis. They significantly outperformed the non-intervention group in multiple clinical exam domains, most notably in appropriately avoiding a speculum exam on a pediatric patient in the office setting.

Research discussion: resident knowledge and clinical skill improvement

The module resulted in significant gains in resident knowledge and skill. When researchers analyzed participants’ exposure to prior educational materials, there were few differences between the two groups, demonstrating that exposure to the module was the main driver of improvement.

Researchers believe the e-learning module was successful for two reasons:

1. Overcame barriers to resident education in pediatric and adolescent gynecology, including time constraints and limited exposure to pediatric patients during training by creating access to expert pediatric gynecology knowledge and skill performance
2. Applied proven principles of multimodal design theory, which uses audio and video feedback with written language to allow for meaningful learning and long-term knowledge retention

Study authors believe applying this learning technique in other programs could help address deficiencies in pediatric and adolescent gynecology education and training.