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 post-intervention 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 work book and videotaped genital examinations. MAIN OUTCOME MEASURES Pre- and post-intervention 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.