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Are physicians performing neonatal circumcisions well-trained?
Jorge Demaria1, Alym Abdulla, Julia Pemberton
1Division of Urology, Department of Surgery, McMaster Children's Hospital, Hamilton, ON; ; Department of Surgery, McMaster University, Hamilon, ON.
Summary
Most physicians performing neonatal circumcisions lack formal training, leading to complications. A new teaching module aims to improve surgical outcomes and physician confidence in managing neonatal circumcision procedures.
Area of Science:
- Pediatric Surgery
- Medical Education
- Neonatal Care
Background:
- Neonatal circumcision is common despite guidelines from the Canadian Pediatric Association and American Academy of Pediatrics.
- There is a need to assess the training, practices, and outcomes of physicians performing neonatal circumcisions.
- Identifying knowledge gaps is crucial for developing targeted educational interventions.
Purpose of the Study:
- To evaluate the training and practices of physicians performing neonatal circumcisions.
- To identify areas for improvement in neonatal circumcision procedures.
- To develop and assess a teaching module to enhance outcomes and reduce complications.
Main Methods:
- A cross-sectional survey of 87 physicians performing neonatal circumcisions in Southwestern Ontario, Canada.
- Development of a surgical technique training video (Gomco clamp, Plastibell).
- A workshop on contraindications, anesthesia, and complication management, followed by a 6-month follow-up to assess practice impact.
Main Results:
- A 62% response rate (54 physicians), with 85% being family doctors/pediatricians and 15% surgeons/urologists.
- No respondents reported formal training; many non-surgeons learned from colleagues.
- Significant differences in comfort managing complications (bleeding, urinary retention, wound dehiscence, meatal stenosis) between surgeons and non-surgeons were observed.
Conclusions:
- Physicians performing neonatal circumcisions often lack formal, structured training, contributing to complications.
- Many practitioners are unaware of contraindications and unprepared to manage post-surgical issues.
- A formal training course was developed to address identified deficiencies and improve neonatal circumcision outcomes.
