title: Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application.
abstract: OBJECTIVE
  The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM).
  
  
  METHODS
  Sixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables.
  
  
  RESULTS
  The highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings.
  
  
  CONCLUSIONS
  These final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.
authors.affiliation: University of Utah School of Medicine, Primary Children's Center for Safe and Healthy Families, 675 E. 500 S, Salt Lake City, UT 84102, USA.
authors.forename: Lori D
authors.initials: LD
authors.lastname: Frasier
authors.forename: Ioana
authors.initials: I
authors.lastname: Thraen
authors.forename: Rich
authors.initials: R
authors.lastname: Kaplan
authors.forename: Patricia
authors.initials: P
authors.lastname: Goede
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D003219:Confidentiality; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D010781:Photography; D016730:Program Development; D012947:Social Work / Q000193:education*; D017216:Telemedicine; D014481:United States; D014584:User-Computer Interface