Endocrine Abstracts

Background: General Medical Council (GMC) guidance describes an intimate examination as one that may be embarrassing for the patient, for example, breast or genitalia examination. Documentation of consent and use of a trained impartial observer (chaperone) is recommended for intimate examinations. Pubertal staging is often necessitated for assessment of growth and puberty. We assessed current practice in pubertal staging by paediatricians and paediatric endocrinology nurse specialists (PENS) in the United Kingdom.

Methods: An electronic survey was distributed to paediatricians (consultants and trainees) and PENS across the UK during May and June 2022. The survey enquired about training received, confidence in and typical practice for pubertal staging examinations.

Results: 235 responses were received (117 consultants, 95 trainees and 23 PENS; 74.9% female). Low confidence in pubertal staging was commonly reported by trainees and consultants without an endocrinology interest. Most respondents consider pubertal staging to be an intimate examination for males (94.9%) and females (93.1%). 77.9% were aware of the GMC guidance on intimate examinations, but only 33.6% had read this. 186 respondents perform pubertal staging. Consent to examination is always documented by 38.2% of respondents, usually/occasionally documented by 37.1% and never by 24.7%. More respondents who had read the GMC guidance always documented consent (54.5% vs 29.2%, p<0.001). 62.0% and 54.8% report always using a chaperone for male and female pubertal staging, respectively. Male respondents are more likely than females to always use a chaperone for female pubertal staging (85.4% vs 43.4%, p<0.001), whereas similar proportions of male (58.3%) and female (62.7%) respondents use a chaperone for male pubertal staging. 63.4% and 65.4% would use a parent as chaperone for male and female examinations, respectively. Few document the name of the chaperone used. Ease of finding and availability of chaperones were the most commonly reported barriers to use.

Conclusions: Most clinicians consider pubertal staging an intimate examination, but documentation of consent and use of formal chaperones is not standard practice. The use of a parent as a chaperone was common but is not recommended by the GMC. Local chaperone policies should address these issues to protect patients and clinicians.