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 center using images from a previously developed education platform.

Participants

Participants comprised 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 who interpreted an image correctly, and features that were common in images with the most frequent diagnostic errors.

Results

We obtained 16,906 image interpretations. The mean proportion correct scores for each diagnosis were as follows: normal/normal variants 0.84 (95% confidence interval [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 < .001). The descriptive review demonstrated that poor image quality, infant genitalia, normal variant anatomy, external material (eg, diaper cream) in the 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.

中文翻译：

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青春期前女性生殖器检查图像：循证学习的机会

目标

确定与困难的青春期前女性生殖器图像解释相关的诊断和图像特征。

设计与设置

这是在三级儿科中心使用以前开发的教育平台上的图像进行的混合方法研究。

参加者

参加者包括107名医学生，住院医师，研究员和随诊人员，他们对158个案例进行了解释，以得出案例难度估算值。

干预措施

这是从一项前瞻性多中心横截面研究中获得的参与者绩效数据的有计划的二级分析。专家小组还对诊断错误发生频率最高的图像进行了描述性检查。

主要观察指标

我们得出正确解释图像的参与者的比例，以及诊断错误最频繁的图像中常见的特征。

结果

我们获得了16,906个图像解释。每种诊断的平均正确分数比例如下：正常/正常变异0.84（95％置信区间[CI] 0.82，0.87）；传染/皮肤病病理学0.59（95％CI 0.45，0.73）; 解剖病理学0.61（95％CI 0.41，0.81）; 以及创伤病理学0.64（95％CI 0.49，0.79）。正确率的平均比例因诊断而异（P  <.001）。描述性审查表明，图像质量差，婴儿生殖器，解剖变异正常，生殖器区域的外部材料（例如尿布膏）和非特异性红斑是准确性评分较低的图像的常见特征。

结论

青春期前女性生殖器检查图像解释的定量和定性检查为这种复杂检查的诊断挑战提供了见识。这些数据可用于指导教学干预措施的设计，以提高该领域的技能。