Abstract

Emans SJ, Bravender T, Knight JR, Frazer
C, Luoni M, Berkowitz C, Armstrong E, Goodman E.

Adolescent medicine training in pediatric residency programs: Are we doing
a good job?

Pediatrics 102(3):588-95. Sept 1998.

Abstract

Objectives: To determine how pediatric residency
programs are responding to the new challenges of teaching adolescent medicine
(AM) to residents by assessing whether manpower is adequate for training,
whether adolescent medicine curricula and skills are adequately covered
by training programs, what types of teaching methodologies are used to
train residents in AM, and the needs for new curricular materials to teach
AM.

Design: A three part 92 item Survey mailed
to all United States pediatric residency training programs

Setting: Pediatric residency programs

Participants: Residency program directors and
directors of adolescent medicine training.

Main outcome measures: Adolescent Medicine divisional structure, clinical
sites of training, presence of a block rotation, and faculty of pediatric
training programs; training materials used and desired in AM; perceived
adequacy of coverage of various AM topics; competency of residents in
performing pelvic examinations in sexually active teens; and manpower
needs.

Results: 155/211 (73.5%) of programs completed
the Program Director and the Adolescent Medicine parts of the Survey.
96% of programs (size range: 5-120 residents) had an AM block rotation
and 90% required the AM block; those without a block rotation were more
likely to be larger programs (p=.026). Only 39% of programs felt that
the number of Adolescent Medicine faculty was adequate for teaching residents.
Almost half of the programs reported lack of time, faculty, and curricula
to teach content in substance abuse. Besides physicians, AM teachers included
nurse practitioners (28%), psychologists (25%), and social workers (19%).
Topics most often cited as adequately covered included STDs (81.9%), confidentiality
(79.4%), puberty (77.0%), contraception (76.1%), and menstrual problems
(73.5%). Topics least often cited as adequately covered included psychological
testing (16.1%), violence in relationships (20.0%), violence and weapon
carrying (29.7%) and sports medicine (29.7%). 58% of respondents thought
that “all” or “nearly all” of their residents were
competent in performing pelvic examinations by the end of training; there
was no difference between perceived competence and the residents’ use
of procedure books. 74% utilized a specific curriculum for teaching Adolescent
Medicine; materials included chapters/articles (85%), lecture outlines
(76.1%), slides (41.9%), videos (35.5%), written case studies (24.5%),
computerized cases (6.5%), and CD-Roms (3.2%). 52% utilized Bright Futures,
48% GAPS, and 14% Guide to Clinical Preventive Services for teaching clinical
preventive services. Programs that utilized Bright Futures were more likely
to feel that preventive services were adequately covered in their programs
than those who did not (78% v 57%; p=0.007). A majority of programs desired
more learner-centered materials.

Conclusions: Although almost all pediatric
programs are now providing AM rotations, there is significant variability
in adequacy of training across multiple topics important for resident
education. Programs desire more learner-centered materials and more faculty
to provide comprehensive resident education in AM.