Precepting genital exams: challenges in implementing a complex educational intervention in the continuity clinic

Area of Science:

• Medical Education
• Pediatric Gynecology
• Resident Training

Background:

• Female genital exams are frequently omitted in routine physicals, hindering familiarity with normal findings.
• This omission represents a missed opportunity for early detection of urogenital abnormalities in girls.
• Continuity clinics provide a setting to develop and evaluate teaching interventions for this issue.

Purpose of the Study:

• To assess the impact of precepted female genital exams on resident confidence and comfort.
• To evaluate changes in resident knowledge and documentation of female genital anatomy.
• To determine the effectiveness of a teaching intervention in a continuity clinic setting.

Main Methods:

• A controlled trial involving 10 continuity clinics with residents in 5 clinics receiving an intervention.
• Intervention group reviewed genital anatomy, exam positions, and documentation, completing 6 precepted exams over 6 months.
• Pre- and post-intervention tests assessed knowledge, confidence, and comfort; documentation was also reviewed.

Main Results:

• Post-intervention, 97% of the intervention group reported high confidence in recognizing normal exams (vs. 73% control, P=.01).
• Comfort performing exams was high for 94% of the intervention group (vs. 64% control, P=.01).
• No significant differences were found in knowledge scores or documentation between groups.

Conclusions:

• Precepted female genital exams effectively enhance resident confidence and comfort.
• The intervention did not improve knowledge or documentation of genital anatomy.
• Findings support the development of future educational interventions to address these gaps.