Prepubescent Female Genital Examination Images: Evidence Informed Learning Opportunities

J Pediatr Adolesc Gynecol. 2020 Nov 12;S1083-3188(20)30359-4. doi: 10.1016/j.jpag.2020.11.006. Online ahead of print.


Objectives: To determine diagnoses and image features that are associated with difficult prepubescent female genital image interpretations.

Design: and Setting. This was a mixed methods study conducted at a tertiary care pediatric centre using images from a previously developed education platform.

Participants: These included 107 medical students, residents, fellows and attendings who interpreted 158 cases to derive case difficulty estimates.

Interventions: This was a planned secondary analysis of participant performance data obtained from a prospective multi-center cross-sectional study. An expert panel also performed a descriptive review of images with the highest frequency of diagnostic error.

Main outcome measures: We derived the proportion of participants that interpreted an image correctly and features that were common in images with the most frequent diagnostic error.

Results: We obtained 16,906 image interpretations. The mean proportion correct scores for each diagnosis were as follows: normal/normal variants 0.84 (95% CI 0.82, 0.87); infectious/dermatology pathology 0.59 (95% CI 0.45, 0.73); anatomic pathology 0.61 (95% CI 0.41, 0.81); and, traumatic pathology 0.64 (95% CI 0.49, 0.79). The mean proportion correct scores varied by diagnosis, p < 0.001. The descriptive review demonstrated that poor image quality, infant genitalia, normal variant anatomy, external material (cream) in genital area, and nonspecific erythema were common features in images with lower accuracy scores.

Conclusions: A quantitative and qualitative examination of prepubescent female genital examination image interpretations provided insight into diagnostic challenges for this complex examination. These data can be used to inform the design of teaching interventions to improve skill in this area.

Keywords: Gynecology; assessment; children; genital examination; medical education; medical image interpretation; paediatric; prepubescent.