Associate Professor, Department of Pediatrics, Virginia Commonwealth University School of Medicine.
Associate Professor, Office of Assessment, Evaluation, and Scholarship, Virginia Commonwealth University School of Medicine.
MedEdPORTAL. 2021 Feb 23;17:11105. doi: 10.15766/mep_2374-8265.11105.
Differences in sex development (DSD) are a heterogenous group of conditions estimated to affect 1 in 4500 infants. A paradigm shift has occurred in societal and cultural acceptance of variant gender outcomes along with increased awareness around diagnostic uncertainty inherent to DSD. Lack of provider knowledge in evaluation of DSD and/or awareness of evolving paradigms relevant to care for patients with DSD can accentuate barriers to access optimal care for this already vulnerable population.
To address this unmet need, we used Kern's six-step framework and piloted a team-based learning (TBL) activity for pediatric residents and medical students (36 learners). This included preactivity reading, an 11-item self-efficacy survey around treatment of patients with DSD at the beginning of the TBL, and a seven-question individual readiness assurance test (RAT). Mixed teams of five to seven learners completed the RAT in small groups followed by large-group discussion. An application exercise followed with two cases focused on initial evaluation of a newborn/child with suspected DSD and an older child with suspected DSD. At the conclusion, learners repeated the self-efficacy measure and answered several evaluation questions.
Individual RAT scores had a mean of 59%, while groups scored with a mean of 82%. Mean self-efficacy scores also increased significantly from 2.4 to 3.4 on a 5-point scale. Of learners, 80% agreed or strongly agreed that the activity was effective for improving DSD skills and knowledge.
TBL is a valuable educational strategy to enhance knowledge and self-efficacy of DSD care for general pediatricians.
性别发育差异（DSD）是一组异质性疾病，据估计，每 4500 名婴儿中就有 1 名受到影响。社会和文化对不同性别结果的接受度发生了转变，同时对 DSD 固有诊断不确定性的认识也有所提高。由于缺乏对 DSD 评估的提供者知识，以及对与 DSD 患者护理相关的不断发展的范式的认识，可能会加剧已经处于弱势地位的人群获得最佳护理的障碍。
为了解决这一未满足的需求，我们使用 Kern 的六步框架并为儿科住院医师和医学生（36 名学习者）试点了团队学习（TBL）活动。这包括在 TBL 开始前的预活动阅读、11 项关于治疗 DSD 患者的自我效能调查，以及 7 项个人准备保证测试（RAT）。五到七名学习者组成的混合小组在小组中完成 RAT，然后进行大组讨论。随后进行应用练习，有两个案例，重点是对疑似 DSD 的新生儿/儿童和年龄较大的疑似 DSD 儿童进行初步评估。在结束时，学习者重复自我效能测量并回答几个评估问题。
个人 RAT 分数的平均值为 59%，而小组的平均分数为 82%。在 5 分制上，平均自我效能分数也显著从 2.4 提高到 3.4。80%的学习者同意或强烈同意该活动对提高 DSD 技能和知识非常有效。
TBL 是一种提高普通儿科医生 DSD 护理知识和自我效能的有价值的教育策略。
