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Pubertal assessment: a national survey of attitudes, knowledge and practices of the US pediatric trainees

  • Aditi Khokhar EMAIL logo , Yagnaram Ravichandran , Dimitre G. Stefanov und Sheila Perez-Colon EMAIL logo
Veröffentlicht/Copyright: 6. Juli 2017
International Journal of Adolescent Medicine and Health
Aus der Zeitschrift International Journal of Adolescent Medicine and Health Band 30 Heft 6

Abstract

Background and objective

Sex maturity rating (SMR), defines different levels of sexual maturity, based on the development of secondary sexual characteristics. Periodic assessment of pubertal maturation by physicians is crucial for timely identification of puberty-related disorders. With this pilot study, we aimed to assess the attitudes, knowledge and practices of pubertal assessment by current US pediatric trainees.

Methods

An anonymous online survey questionnaire was sent to categorical pediatric residents at different levels of training and pediatric chief residents across the US.

Results

We received responses from 2496 pediatric residents from all over the US. We found that 96% of trainees understand the importance of assessing SMR, 62% feel confident in assessing it and 55% feel comfortable assessing the need for an endocrinology referral. Only 33% of trainees performed external genital exams during all regular clinic visits while 26.9% never performed them during sick visits and 6% never assessed SMR during any of the patient visits. Higher levels of training and having completed an endocrinology rotation were associated with improvement in comfort level, practice and knowledge of trainees regarding pubertal assessment.

Conclusion

This study revealed that the current clinical practices of performing external genital exams and SMR among pediatric residents need improvement. Stronger reinforcement from continuity clinic preceptors and/or online and clinic based resources for SMR assessment for trainees may improve adherence to the recommended guidelines.

Keywords: attitude; knowledge; pediatric residents; practices; puberty

  1. Funding Source: No external funding was received for this article.

  2. Financial Disclosure: The authors have indicated that they have no financial relationships to disclose relevant to this article.

  3. Conflict of Interest: The authors have indicated that they have no potential conflicts of interest to disclose.

A APPENDIX

Study Questionnaire – Pubertal Assessment

Demographics:

  1. PGY level:

  1. PGY 1

  2. PGY 2

  3. PGY 3

  4. PGY 4

  1. Gender:

  1. Male

  2. Female

  1. Did you graduate from a medical school within the United States of America?

  1. Yes

  2. No

  1. Have you done a Pediatric endocrinology rotation so far in your residency?

  1. Yes

  2. No

Attitude:

  1. Do you feel it is important to assess/assign Tanner staging in pediatric patients?

  1. Yes

  2. No

  1. Do you feel confident in assessing/assigning Tanner staging in your patients?

  1. Yes

  2. No

  1. Do you feel comfortable assessing the need for referral to an endocrinologist based on abnormal findings in the Tanner Stages?

  1. Yes

  2. No

  1. For male residents- how comfortable do you feel performing a breast and external genitalia exam on adolescent female patients?

  1. Comfortable

  2. Not comfortable

  3. N/A

  1. For female residents-how comfortable do you feel performing external genitalia exam on adolescent male patients?

  1. Comfortable

  2. Not comfortable

  3. N/A

Practice:

  1. How often do you perform external genitalia exam on pediatric patients during regular visits in your clinic?

  1. Always

  2. Most of the times

  3. Sometimes

  4. Never

  1. How often do you perform external genitalia exam on pediatric patients during sick visits in your clinic?

  1. Always

  2. Most of the times

  3. Sometimes

  4. Never

  1. How often do you assess/assign Tanner staging on your pediatric patients during each patient encounter?

  1. Always

  2. Most of the times

  3. Sometimes

  4. Never

  1. How many times in past 1 year have you referred a patient from your clinic to Pediatric endocrinology due to puberty-related issues (precocious or delayed)?

  1. None

  2. 1–3 times

  3. >3 times

Knowledge:

  1. What is the first objective physical sign of puberty in males?

  1. Growth Spurt

  2. Pubic Hair growth

  3. Testicular enlargement

  4. Penile lengthening

  1. What is the first objective physical sign of puberty in females?

  1. Growth Spurt

  2. Pubic Hair growth

  3. Breast development

  4. Menarche

  1. What Tanner stage is associated with the onset of puberty?

  1. Tanner 1

  2. Tanner 2

  3. Tanner 3

  4. Tanner 4

  5. Tanner 5

Clinical Cases (Each clinical vignette has 2 questions)

In a 6-year-old boy on physical exam you find dark, curled, coarse pubic hair spread over the mons pubis and extending to the medial thighs.

  1. What is his pubic hair Tanner stage?

  1. Tanner 1

  2. Tanner 2

  3. Tanner 3

  4. Tanner 4

  5. Tanner 5

  1. Are you concerned about his pubertal development?

  1. Yes

  2. No

In a 6-months old Full Term female you find bilateral breast buds on physical exam

  1. What is her breast Tanner stage?

  1. Tanner 1

  2. Tanner 2

  3. Tanner 3

  4. Tanner 4

  5. Tanner 5

  1. Are you concerned about her breast development?

  1. Yes

  2. No

In a 6 year old female on physical examination you notice bilateral breast buds with enlargement of breast and areola but no separation of areola from breast.

  1. What is patient’s Tanner stage?

  1. Tanner 1

  2. Tanner 2

  3. Tanner 3

  4. Tanner 4

  5. Tanner 5

  1. Are you concerned about her pubertal development?

  1. Yes

  2. No

[1] Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45(239):13–23.10.1136/adc.45.239.13Suche in Google Scholar PubMed PubMed Central

[2] Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291–303.10.1136/adc.44.235.291Suche in Google Scholar PubMed PubMed Central

[3] Tanner JM. Growth at adolescence, 2nd ed UK: Oxford: Blackwell Scientific Publications; 1962.Suche in Google Scholar

[4] Kaprio J, Rimpela A, Winter T, Viken RJ, Rimpela M, Rose RJ. Common genetic influences on BMI and age at menarche. Hum Biol. 1995;67(5):739–53.Suche in Google Scholar PubMed

[5] van Wieringen JC. Secular growth changes. US: Springer; 1978. p. 445–73.10.1007/978-1-4684-2622-9_16Suche in Google Scholar

[6] Bridges NA, Christopher JA, Hindmarsh PC, Brook CG. Sexual precocity: sex incidence and aetiology. Arch Dis Child. 1994;70(2):116–8.10.1136/adc.70.2.116Suche in Google Scholar PubMed PubMed Central

[7] Klein KO. Precocious puberty: who has it? Who should be treated?. J Clin Endocrinol Metab. 1999;84(2):411–4.10.1210/jcem.84.2.5533Suche in Google Scholar PubMed

[8] Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12(4):394–9.10.1097/00008480-200008000-00020Suche in Google Scholar PubMed

[9] Fuqua JS. Treatment and outcomes of precocious puberty: an update. J Clin Endocrinol Metab. 2013;98(6):2198–207.10.1210/jc.2013-1024Suche in Google Scholar PubMed

[10] Kaplowitz P, Bloch C. Section on endocrinology AAoP. Evaluation and referral of children with signs of early puberty. Pediatrics. 2016;137(1):e20153732.10.1542/peds.2015-3732Suche in Google Scholar PubMed

[11] Mogensen SS, Aksglaede L, Mouritsen A, Sorensen K, Main KM, Gideon P, et al. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab. 2011;96(5):1393–401.10.1210/jc.2010-2745Suche in Google Scholar PubMed

[12] Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Obstet Gynecol Neonatal Nurs. 2007;36(3):263–74.10.1111/j.1552-6909.2007.00145.xSuche in Google Scholar PubMed

[13] Kaplowitz PB, Oberfield SE. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics. 1999;104(4 Pt 1):936–41.10.1542/peds.104.4.936Suche in Google Scholar PubMed

[14] Ehrhardt AA, Meyer-Bahlburg HF. Psychosocial aspects of precocious puberty. Horm Res. 1994;41(Suppl 2):30–5.10.1159/000183956Suche in Google Scholar PubMed

[15] Herman-Giddens ME, Sandler AD, Friedman NE. Sexual precocity in girls. An association with sexual abuse?. Am J Dis Child. 1988;142(4):431–3.10.1001/archpedi.1988.02150040085025Suche in Google Scholar PubMed

[16] Traggiai C, Stanhope R. Delayed puberty. Best Pract Res Clin Endocrinol Metab. 2002;16(1):139–51.10.1053/beem.2001.0186Suche in Google Scholar PubMed

[17] Lee PA. Normal ages of pubertal events among American males and females. J Adolesc Health Care. 1980;1(1):26–9.10.1016/S0197-0070(80)80005-2Suche in Google Scholar PubMed

[18] Roche AF, Wellens R, Attie KM, Siervogel RM. The timing of sexual maturation in a group of US white youths. J Pediatr Endocrinol Metab. 1995;8(1):11–8.10.1515/JPEM.1995.8.1.11Suche in Google Scholar

[19] Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics. 1997;99(4):505–12.10.1542/peds.99.4.505Suche in Google Scholar PubMed

[20] Biro FM. Normal growth and development. In: Gail B, Slap FM, editors. Adolescent medicine: the requisites in pediatrics. Philadelphia, PA: Elsevier Health Sciences; 2008. p. 3–8.10.1016/B978-032304073-0.10001-9Suche in Google Scholar

[21] Sorensen K, Mouritsen A, Aksglaede L, Hagen CP, Mogensen SS, Juul A. Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr. 2012;77(3):137–45.10.1159/000336325Suche in Google Scholar PubMed

[22] Afsari A, Mirghafourvand M, Valizadeh S, Abbasnezhadeh M, Galshi M, Fatahi S. The effects of educating mothers and girls on the girls’ attitudes toward puberty health: a randomized controlled trial. Int J Adolesc Med Health. 2017;29(2):151–156.10.1515/ijamh-2015-0043Suche in Google Scholar PubMed

[23] Saghi S, Mirghafourvand M, Alizadeh Charandabi SM, Nabighadim A, Seidi S, Rahmani A. Knowledge and attitude about pubertal health and their socio-demographic predictors in Iranian adolescents. Int J Adolesc Med Health. 2016;28(4):397–405.10.1515/ijamh-2015-0016Suche in Google Scholar PubMed

[24] FREIDA Online specialty training search/Pediatrics: FREIDA Online. [Available from: https://freida.ama-assn.org/Freida/user/specStatisticsSearch.do?method = viewDetail&pageNumber = 2&spcCd = 320, 2014.Suche in Google Scholar

[25] Braverman PK, Breech L. Committee on A. American Academy of Pediatrics. Clinical report – gynecologic examination for adolescents in the pediatric office setting. Pediatrics. 2010;126:583–90.10.1542/peds.2010-1564Suche in Google Scholar PubMed

[26] Hagan JF, Shaw JS, Duncan PM. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed Elk Grove Village, IL: The American Academy of Pediatrics; 2008.10.1542/9781581102239Suche in Google Scholar

[27] Balk SJ, Dreyfus NG, Harris P. Examination of genitalia in children: ‘the remaining taboo’. Pediatrics. 1982;70(5):751–3.10.1542/peds.70.5.751Suche in Google Scholar PubMed

[28] Donaruma-Kwoh MM, Tran XG, Giardino AP. Do pediatric chief residents recognize details of prepubertal male genital anatomy. Clin Pediatr (Philadelphia). 2010;49(8):756–9.10.1177/0009922810365726Suche in Google Scholar PubMed

[29] Powell HS, Bridge J, Eskesen S, Estrada F, Laya M. Medical students’ self-reported experiences performing pelvic, breast, and male genital examinations and the influence of student gender and physician supervision. Acad Med. 2006;81(3):286–9.10.1097/00001888-200603000-00022Suche in Google Scholar PubMed

[30] Leder MR, French GM. Precepting genital exams: challenges in implementing a complex educational intervention in the continuity clinic. Ambul Pediatr. 2005;5(2):112–6.10.1367/A04-045R1.1Suche in Google Scholar PubMed

[31] Drolet BC, Christopher DA, Fischer SA. Residents response to duty-hour regulations-a follow-up national survey. N Engl J Med. 2012;366(24):e35.10.1056/NEJMp1202848Suche in Google Scholar PubMed

[32] Drolet BC, Schwede M, Bishop KD, Fischer SA. Compliance and falsification of duty hours: reports from residents and program directors. J Grad Med Educ. 2013;5(3):368–73.10.4300/JGME-D-12-00375.1Suche in Google Scholar PubMed PubMed Central

[33] Jhaveri KD, Sparks MA, Shah HH, Khan S, Chawla A, Desai T, et al. Why not nephrology? A survey of US internal medicine subspecialty fellows. Am J Kidney Dis. 2013;61(4):540–6.10.1053/j.ajkd.2012.10.025Suche in Google Scholar PubMed PubMed Central

[34] Minkovitz CS, Chandra A, Solomon BS, McDonnell KA, Silver GB, Tonniges TF, et al. Community pediatrics: gender differences in perspectives of residents. Ambul Pediatr. 2006;6(6):326–31.10.1016/j.ambp.2006.07.005Suche in Google Scholar PubMed

Received: 2016-10-12
Accepted: 2017-02-12
Published Online: 2017-07-06

©2018 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/ijamh-2016-0122
Schlagwörter für diesen Artikel
attitude; knowledge; pediatric residents; practices; puberty

Artikel in diesem Heft

  1. Pride, shame and health among adolescents – a cross-sectional survey
  2. Illicit substance use among Tunisian college students: prevalence and risk factors
  3. Characteristics of the life habits of obese students at one of Japan's National Colleges of Technology
  4. Social mobilization for safe transition from adolescence: a qualitative research in Iran
  5. Craving for cigarette smoking among male adolescents in Isfahan based on mindfulness and emotional self-regulation
  6. Pathological Internet use, cyberbullying and mobile phone use in adolescence: a school-based study in Greece
  7. Work related musculoskeletal disorders among adolescent girls and young women employees of textile industries in Tamil Nadu, India – a comparative study
  8. Exploring maternal attitudes towards adolescent contraception: implications for use of LARC
  9. The effects of a low-dose physical activity intervention on physical activity and body mass index in severely obese adolescents
  10. Pubertal assessment: a national survey of attitudes, knowledge and practices of the US pediatric trainees
  11. Association between perceived parental style and depressive symptoms among adolescents in Hulu Langat District, Malaysia
  12. Exercise intervention on cardiovascular disease risk factors in a university population in the United Arab Emirates
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