Endocrine Abstracts

Introduction: Neonatal ambiguous genitalia can herald sensitive, time-critical, and life-threatening diagnoses and thus paediatric doctors must be competent in their management. However, ambiguous genitalia are rare, limiting clinical exposure. We assessed paediatric doctors’ knowledge of and confidence in managing this condition.

Methods: A questionnaire was circulated to paediatric doctors at six paediatric teaching hospitals. It established doctors’ clinical experience of ambiguous genitalia and used a Likert scale to assess their confidence in its management (1=I am very unconfident, 5=I am very confident). A clinical vignette followed by multiple choice questions (MCQ) assessed knowledge of diagnostic tests and differential diagnoses. A response was deemed correct if a right answer was selected or if a wrong answer was not selected. An educational module was designed and the questionnaire re-administered.

Results: Response rate was 100% (n=42; 26.2% male; 71.4% (n=30) junior trainees, 14.3% (n=6) senior, 14.3% (n=6) consultants). 61.9% (n=26) worked in tertiary centres. 42.9% (n=18) had never seen ambiguous genitalia. Junior trainees had seen fewer cases (M=0.9, SD 1.4) than senior (M=2.4, SD=2.2), (t(14.7)=−2.2, P=0.04). 33.3% (n=14) had helped manage a case. 21.4% (n=9) had been the first to review an infant with ambiguous genitalia, and 11.9% (n=5) the first to inform parents of the finding. On 1 5 Likert scoring, doctors were not confident in the overall management of ambiguous genitalia (M=2.5), in discussing findings with parents (M=2.9), or in examining ambiguous genitalia (M=2.9). Seniority, number of cases seen, and tertiary experience did not significantly influence confidence levels. MCQ responses were correct a mean of 64.0% of the time, and improved to 83.4% when re-tested after the educational session (P<0.01). Seniority, number of cases seen, and tertiary experience did not significantly influence performance. Reported confidence levels did not improve after the educational session.

Discussion: Paediatric doctors, regardless of seniority, have insufficient knowledge and confidence to manage neonatal ambiguous genitalia. This reflects limited clinical exposure. As we cannot rely on experiential learning, paediatric doctors must receive targeted educational sessions on the management of ambiguous genitalia to improve their knowledge of this rare condition.