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Background: Information sharing in chronic conditions such as disorders of/differences in sex development (DSD) is essential for a comprehensive understanding by parents and patients. We report on a qualitative analysis of communication skills of fellows undergoing training in paediatric endocrinology. Guidelines are created for the assessment of communication between health professionals and individuals with DSD and their parents. Methods: Paediatric endocrinology fellows worldwide were invited to study two interactive online cases (www.espe-elearning.org) and to describe a best practice communication with (i) the parents of a newborn with congenital adrenal hyperplasia and (ii) a young woman with 46,XY gonadal dysgenesis. The replies were analysed regarding completeness, quality, and evidence of empathy. Guidelines for structured assessment of responses were developed by 22 senior paediatric endocrinologists worldwide who assessed 10 selected replies. Consensus of assessors was established and the evaluation guidelines were created. Results: The replies of the fellows showed considerable variation in completeness, quality of wording, and evidence of empathy. Many relevant aspects of competent clinical communication were not mentioned; 15% (case 1) and 17% (case 2) of the replies were considered poor/insufficient. There was also marked variation between 17 senior experts in the application of the guidelines to assess communication skills. The guidelines were then adjusted to a 3-level assessment with empathy as a separate key item to better reflect the qualitative differences in the replies and for simplicity of use by evaluators. Conclusions: E-learning can play an important role in assessing communication skills. A practical tool is provided to assess how information is shared with patients with DSD and their families and should be refined by all stakeholders, notably interdisciplinary health professionals and patient representatives.

Background Using written submission with formative feedback as a teaching method, the European Society for Paediatric Endocrinology (ESPE) developed an interactive elearning portal for predoctoral and postdoctoral education and training: (http://www.espe-elearning.org). The aim of the study was to evaluate the role of e-learning in the assessment of competencies of paediatric endocrinology fellows. Competencies included as medical knowledge communication skills and knowing what information to give to patients and parents with a difference of sex development about diagnosis and management. Materials and Method Sixty-eight fellows and 32 experts from various countries participated in the study. Fellows answered online multiple-choice and open questions relating to two clinical interactive problem solving cases (case 1: a new-born with congenital adrenal hyperplasia; case 2: a 17-year-old girl with gonadal dysgenesis). Experts provided anonymous feedback online, using responses guidance (standard questions for eliciting a uniform consideration of competence). Results Fifty percent of fellows answered 16 out of 20 questions correctly on their first attempt at questions about the clinical case scenarios. However, experts judged that only 50 % of the necessary elements of questions 1 and 2 (case 1) and question 2 (case 2) were given in these correct answers. The personalized formative feedback to the open questions provided by the two to three experts 'marking' each submission was highly valued by participating fellows. The most frequently cited items relating to cultural, religious and regional aspects of differences of sex development (DSD) management were relating fertility and role of the family. These were listed by 12/32 experts. Fellows did not mention them in their first reply to the open questions but acknowledged their importance in their second reply. Conclusion The ESPE e-learning portal, offering direct interaction between fellow and trainer, is highly valued by both parties, as helpful in developing medical competencies and is therefore a feasible tool for distance learning.