No abstract

OBJECTIVE Delivery of reproductive services to adolescents varies by specialty and has been linked to differences in clinical training. Few studies have explored how different specialties’ graduate medical education (GME) programs prepare providers to deliver adolescent reproductive services. We explored the perceptions of resident physicians regarding their training in delivering adolescent reproductive health services. DESIGN Between November 2008 and February 2009, nine focus groups were conducted with graduate medical trainees in three specialties that routinely care for adolescents. The semi-structured discussions were audio-recorded, transcribed and analyzed using an inductive approach to content analysis. SETTING Large, urban academic medical center in Pittsburgh, Pennsylvania PARTICIPANTS 54 resident trainees in pediatrics, family medicine and obstetrics/gynecology INTERVENTIONS None MAIN OUTCOMES Trainees’ perspectives regarding the didactic teaching and clinical training in providing adolescent reproductive services RESULTS Five themes emerged reflecting trainees’ beliefs regarding the best practices GME programs can engage in to ensure that trainees graduate feeling competent and comfortable delivering adolescent reproductive services. Trainees believed programs need to: 1) Provide both didactic lectures as well as diverse inpatient and outpatient clinical experiences; 2) Have faculty preceptors skilled in providing and supervising adolescent reproductive services; 3) Teach skills for engaging adolescents in clinical assessments and decision-making; 4) Train providers to navigate confidentiality issues with adolescents and caregivers; and 5) Provide infrastructure and resources for delivering adolescent reproductive services. CONCLUSIONS The three specialties differed in how well each of the five best practices were reportedly addressed during GME training. Policy recommendations are provided.

Results: A total of 115 (46.1%) participants met criteria for moderateto-severe depressive symptoms. Multivariate analyses revealed that participants who reported depressive symptoms were more likely than those who did not to be African American (versus Hispanic: adjusted odds ratio [AOR] ¼ 2.17; 95% Confidence Interval [CI] ¼ 1.14-4.16; p ¼ .019), and to report limited contact with the father of the baby (AOR ¼ 2.18; 95% CI ¼ 1.16-4.13; p ¼ .016), prior verbal abuse (AOR ¼ 2.23; 95% CI ¼ 1.11-4.47; p ¼ .023), and physical or sexual abuse (AOR ¼ 1.84; 95% CI ¼ 1.04-3.28; p ¼ .038). Depressed adolescents also experienced higher levels of family criticism (AOR ¼ 1.67; 95% CI ¼ 1.07-2.60; p ¼ .025) and lower levels of general support (AOR ¼ 1.81; 95% CI ¼ 1.24-2.64; p ¼ .002). The Hosmer and Lemenshow Goodness of Fit Test ¼ 8.370(8), p ¼ .398, indicating an acceptable fit to the data. Conclusions: The results of the study indicated that pregnant adolescents are confronted with many environmental challenges that affect their mental health and well-being. Interventions that incorporate partners and families to address the multiple needs of this priority population are sorely needed.