Teaching Trainees to Deliver Adolescent Reproductive Health Services

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.

Characteristics Associated with Confidential Consultation for Adolescents in Primary Care

“…Previous studies have found that general pediatricians report having concerns or discomfort about providing confidential consultation and care to adolescents for sensitive health issues. (6, 8, 23, 24) This discomfort with may help explain why general pediatric providers were less likely to endorse the provision of confidential consultation than board certified providers. It is also important to remember, as described in the methods, that visits with adolescent board certified providers differed from visits with general pediatric providers not only in terms of training, but also in terms of staffing and visit time.…”

“…In the current study, board certified adolescent medicine providers saw significantly more adolescents who self-reported health risk factors of substance use and sexual activity. Whereas general pediatric residents receive approximately one month of training in adolescent health rotations,(24) adolescent medicine board certified providers are required to have at least three years of full-time training in adolescent medicine. (25) Although no studies have been published showing that board certified providers are more likely to see high-risk patients, it is reasonable to conclude that high-risk patients are often referred to board certified providers – when available – due to their relative expertise and experience with sensitive adolescent health issues.…”