(66) Implementing a Pediatric Gynecology Curriculum in a Rural Healthcare System

Background: Our targeted needs assessment determined the need for and interest in a pediatric gynecology curriculum for physicians in a rural healthcare system. A curriculum focused on performing a pediatric pelvic exam was created to improve the confidence to do so across subspecialties caring for pediatric patients.

Methods: Our curriculum included a case-based didactic followed by simulation with a pelvic model created with assistance from our 3D printing lab. To date, our residents in Obstetrics and Gynecology (Ob/Gyn) and Emergency Medicine (EM) have voluntarily participated. A four-question, 3-point Likert scale pre-curriculum survey determined baseline confidence in performing a pediatric gynecologic exam. A one-hour pediatric gynecology-focused, case-based didactic was then presented, followed by a case scenario and simulation where participants demonstrated the ability to perform a pediatric gynecologic pelvic exam on our model. Participants were assessed on their ability to properly position the patient, identify relevant anatomy, and list indications for a gynecologic exam. A six-question post-curriculum survey was administered to assess improvement in confidence in the ability to perform the exam and the efficacy of the curriculum.

Results: Sixteen EM and 9 Ob/Gyn resident physicians completed the curriculum. Pre-curriculum, 6.2% of EM and 11.1% of Ob/Gyn residents were very confident in knowing when to perform a pediatric pelvic exam. Only 12.5% of EM and 11.1% of Ob/Gyn residents were very confident in the ability to properly identify vulvar anatomy, and 0.0% of EM and 11.1% of Ob/Gyn residents were very confident in the ability to perform an indicated exam. During the simulation, 100.0% of EM and Ob/Gyn residents demonstrated proper patient positioning, identified relevant anatomy, and listed indications to perform an exam. Post-curriculum, 93.8% of EM and 88.9% of Ob/Gyn residents were very confident in knowing when to perform an exam; 75.0% of EM and 77.8% of Ob/Gyn residents were very confident in their ability to do so. Of EM and Ob/Gyn residents, 93.8% and 88.9%, respectively, felt this curriculum improved their confidence in performing a pediatric pelvic exam.

Conclusions: This curriculum successfully improved confidence in performing an indicated pediatric gynecologic exam in both EM and Ob/Gyn resident physicians. Ongoing implementation of our novel curriculum is planned for Pediatric, Medicine Pediatric, and Family Medicine resident physicians in our rural healthcare system.