Continuing medical education in child sexual abuse: Cognitive gains but not expertise

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 posttests. 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.