Knowledge, clinical decision-making, and educational needs in pubertal disorders among pediatricians: a vignette-based cross-sectional survey

Variability in the recognition and management of pubertal disorders in primary care may reflect differences in knowledge, clinical reasoning, and prior training among pediatricians. Understanding these differences is essential for identifying educational gaps and informing continuing medical education strategies. This study aimed to assess pediatricians’ knowledge, vignette-based clinical decision-making, and educational needs regarding the evaluation and referral of pubertal disorders. A cross-sectional survey was conducted among 260 pediatricians. The questionnaire included multiple-choice items assessing theoretical knowledge and vignette-based clinical decision-making, as well as items on referral practices and educational preferences. Knowledge and vignette scores were analyzed as the primary outcome measures, whereas a composite performance score was evaluated as an exploratory outcome. Group comparisons were performed using t-tests and one-way analysis of variance, with post hoc analyses where appropriate. Separate multivariable linear regression analyses were performed for knowledge and vignette scores, and an additional exploratory regression analysis was conducted for the composite score. Substantial variability was observed across knowledge domains, particularly in items related to menarche timing. While overall performance in clinical scenarios was high, accuracy was notably lower in borderline cases, indicating challenges in clinical reasoning. Female sex, higher self-perceived competence, and recent training were independently related to higher vignette-based performance, whereas self-perceived competence was the only independent correlate of knowledge performance. In contrast, ≥ 16 years of professional experience and preference for webinar-based learning were independently related to lower vignette performance. Greater clinical exposure and access to pediatric endocrinology expertise were related to higher vignette performance in univariate analyses. The exploratory composite analysis demonstrated findings broadly consistent with the domain-specific analyses. Among pediatricians participating in this survey, substantial variability was observed in both knowledge and vignette-based clinical reasoning related to pubertal disorders, particularly in borderline presentations requiring nuanced clinical judgment. The differing correlates of knowledge and vignette performance suggest that factual knowledge and clinical reasoning represent related but distinct competencies that may benefit from complementary educational strategies. The findings support targeted educational interventions incorporating case-based learning, interactive teaching methods, and practical decision-support tools. Given the study’s sampling strategy and cross-sectional design, these findings should be interpreted as associations observed within the participating survey sample rather than nationally representative estimates or causal relationships applicable to all pediatricians practicing in Türkiye. Reverse causation and residual confounding cannot be excluded. Not applicable.