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Cognitive Gains but Not Expertise

Ann S. Botash, MD; Anne E. Galloway, RN; Trish Booth, MA; Robert Ploutz-Snyder, PhD; Jamie Hoffman-Rosenfeld, MD; Linda Cahill, MD

Arch Pediatr Adolesc Med. 2005;159:561-566.

Objective  Describe the effect of an educational intervention on medical provider knowledge and competency regarding child sexual abuse.

Design  Using a before and after trial design with an educational intervention, the study assesses knowledge changes in specific content areas and describes a postintervention competency assessment.

Setting/Participants  Voluntary participation of practicing medical providers and pediatric residents.

Intervention  Completion of a self-study, case-based, published learning curriculum on child sexual abuse, including a workbook and videotaped genital examinations.

Main Outcome Measures  Pre- and postintervention multiple choice and short answer (30 questions) test results as well as a written response to a clinical case scenario.

Results  Sixty-four participants completed pre- and post-tests. The average posttest score (26.9/30, SD = 4.13) was significantly higher (P<.001) than the average pretest score (20.4/30, SD = 1.65). More than half (59.4%) of providers did not correctly interpret the exam findings, 28.1% did not correctly reassure the child and family, and 39.1% did not indicate an appropriate understanding of the legal implications.

Conclusions  Motivated medical providers demonstrated significant knowledge gains regarding the evaluation of child sexual abuse following participation in the educational program. This new knowledge was not enough to provide competency in the interpretation of genital findings or in offering legal advocacy to the families. Competence in these areas may in fact represent the domain of experts, not primary care providers, and further studies are needed to determine how much experience is necessary to provide competency in these areas.

Author Affiliations: State University of New York, Upstate Medical University, Syracuse (Drs Botash and Ploutz-Snyder, Mss Galloway and Booth); Child Protection Center, Children’s Hospital at Montefiore, Bronx, NY (Drs Rosenfeld and Cahill).