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Ramírez SI, Partin M, Snyder AH, Ko E, Aruma J, Castaneda MC, Casas RS. A Scoping Review of Obstetrics and Gynecology Curricula in Primary Care Residency Programs. J Gen Intern Med 2024:10.1007/s11606-024-08987-1. [PMID: 39187722 DOI: 10.1007/s11606-024-08987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND While Women's Health (WH) is a priority for primary care, (Family Medicine (FM), Internal Medicine (IM), Pediatrics (Peds), and combined Medicine/Pediatrics (Med/Peds)), residency curricula remain heterogeneous with deficits in graduates' WH expertise and skills. The overall objective of this study was to assess the quality of WH curricula at primary care residency programs in the United States (US), with a focus on topics in obstetrics and gynecology (OBGYN). METHODS PubMed®, ERIC, The Cochrane Library, MedEdPORTAL, and professional organization websites were systematically searched in 2019 and updated in 2021. Included studies described OBGYN educational curricula in US primary care residency programs. Following abstract screening and full-text review, data from eligible studies was abstracted and quality assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 109 studies met the inclusion criteria. Over a quarter of studies were interdepartmental or interdisciplinary. The most common single-department studies were IM (38%) and FM (26%). Twenty (25%) studies addressed comprehensive OBGYN curricula; the most common individual topics were cervical and breast cancer screening (31%) and contraception (16%). Most studies utilized multiple instructional modalities, most commonly didactics (54%), clinical experiences (41%), and/or simulation (21%). Most studies included self-reported outcomes by residents (70%), with few (11%) reporting higher-level assessments (i.e., patient, or clinical outcomes). Most studies were single-group pre- and post-test (42%) with few randomized controlled trials (4%). The mean MERSQI score for studies with sufficient data (90%) was 9.8 (range 3 to 15.5). DISCUSSION OBGYN educational curricula for primary care trainees in the US was varied with gaps in represented residents, content, assessments, and study quality.
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Affiliation(s)
- Sarah I Ramírez
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA.
| | - Michael Partin
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA
| | - Ashley H Snyder
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Elizabeth Ko
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jane Aruma
- Anesthesiology, Northwestern University, Evanston, IL, USA
| | - Marie C Castaneda
- Harrell Health Sciences Library: Research and Learning Commons, Penn State College of Medicine, Hershey, PA, USA
| | - Rachel S Casas
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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2
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Georgakopoulos B, Fei YF. Pediatric and Adolescent Gynecology Experience in Obstetrics and Gynecology Residency Training Across the United States. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00265-1. [PMID: 39103116 DOI: 10.1016/j.jpag.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/07/2024]
Abstract
STUDY OBJECTIVE The purpose of this study is to better understand the pediatric and adolescent gynecology (PAG) experience from the obstetrics and gynecology (OBGYN) resident perspective and its impact on physician comfort with caring for younger patients. METHODS This is a cross-sectional survey study of physicians enrolled in OBGYN residency programs in the United States. For each program, an internet search was also performed to identify the closest PAG providers. Chi-square and Fisher's exact tests were performed to compare categorical variables. This study was IRB approved. RESULTS A total of 74 resident responses from 42 unique OBGYN training programs were included. The majority (62%) of programs offered no PAG clinical experience. Of programs with no PAG clinical experience, 45% had unaffiliated self-identified PAG providers within 30 miles of their institution. Only 26% of residents reported having a dedicated PAG rotation. 68% of residents felt they did not have enough PAG exposure in training. Residents who had a dedicated PAG rotation were more comfortable caring for patients <7 years old (P = .016) and patients 8-14 years old (P = .019) than residents without a rotation. The majority (88%) of residents believe that PAG experience will be useful for their future practice. CONCLUSION Residents with PAG training are more comfortable in caring for patients <14 years than those in programs who lack this training. Residencies without PAG-trained staff physicians could consider partnering with PAG-practicing community physicians with the aim of broadening clinical experience. Improvement in PAG education helps provide graduating obstetrician-gynecologists with the necessary knowledge to provide needed care to younger patients.
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Affiliation(s)
- Bianca Georgakopoulos
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky
| | - Yueyang Frances Fei
- Section of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.
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Lawson AA, Barlow E, Brookhart C, Sophie Gibson ME, Golub S, Imbo-Nloga C, Hernandez A, Justice T, King C, Nos A, Truehart A, French AV. Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 4.0. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00186-4. [PMID: 38432289 DOI: 10.1016/j.jpag.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as both adolescent medicine and PAG fellowship programs. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG trainee education by creating and maintaining this Short Curriculum. The curriculum outlines specific learning objectives central to PAG education and lists high-yield, concise resources for learners. This updated curriculum replaces the previous 2021 publication with a new focus toward accessible online content and updated resources.
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Affiliation(s)
- Ashli A Lawson
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, Missouri; School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Erin Barlow
- Department of Obstetrics & Gynecology, Women and Infants Hospital, Brown University, Providence, Rhode Island
| | - Carolyn Brookhart
- Department of Obstetrics & Gynecology, Kaiser San Francisco, San Francisco, California
| | - M E Sophie Gibson
- Department of Obstetrics & Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Sarah Golub
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Camille Imbo-Nloga
- Department of Pediatric and Adolescent Gynecology, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona
| | - Angela Hernandez
- Department of Obstetrics & Gynecology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Tara Justice
- Department of Obstetrics & Gynecology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Carol King
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | - Andrea Nos
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Amber Truehart
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
| | - Amanda V French
- Department of Obstetrics and Gynecology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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Lawson AA, Ramage K, Gibson MES, King C, Imbo-Nloga CC, French AV. Pediatric and Adolescent Gynecology WebEd: A Brief Report of an Underutilized Online Learning Module. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00181-5. [PMID: 38342296 DOI: 10.1016/j.jpag.2024.01.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
Pediatric and adolescent gynecology (PAG) is a unique subspecialty for which accessible educational resources and clinical exposure have historically been limited; surveys show that trainees in both obstetrics and gynecology and pediatrics agree. In 2014, the North American Society for Pediatric and Adolescent Gynecology (NASPAG) introduced PAG WebEd, an original and interactive online case-based curriculum designed to bridge this learning gap. As of 2023, there are 35 published PAG WebEd clinical cases with key learning points that present, test, and discuss a variety of current PAG topics. The NASPAG Resident Education Committee (REC) compiled and reviewed administrative data from the module platform to investigate trainee utilization and performance. The activity data and assessment scores for 161 registered users are included and reported in this article. This brief report highlights that a relatively small number of medical trainees use PAG WebEd and aims to raise awareness of this resource through publication. There is potential for many more users to benefit from this resource; its efficacy as an examination and clinical practice tool could also be measured. The NASPAG REC hopes to ultimately show, with increased utilization, that PAG WebEd deserves to be a key piece of PAG-focused medical education. For PAG WebEd information and faculty registration, as well as a link that allows faculty to submit new learners, please visit https://www.naspag.org/pagwebed-information.
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Affiliation(s)
- Ashli A Lawson
- Division of Pediatric & Adolescent Gynecology, Children's Mercy Kansas City, Kansas City, Missouri; Department of Obstetrics & Gynecology, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Kristian Ramage
- Department of Obstetrics & Gynecology, University of Missouri-Kansas City, Kansas City, Missouri
| | - M E Sophie Gibson
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Carol King
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Camille C Imbo-Nloga
- Department of Pediatric & Adolescent Gynecology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Amanda V French
- Department of Obstetrics & Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Topcu EG, Khattak H, Boekhorst F, Horala A, Henriques MG, Roos EJ. Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives. J Pediatr Adolesc Gynecol 2023; 36:18-24. [PMID: 35691506 DOI: 10.1016/j.jpag.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe. STUDY DESIGN This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms. RESULTS Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract." CONCLUSION Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.
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Affiliation(s)
| | - Hajra Khattak
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Ferry Boekhorst
- Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands
| | - Agnieszka Horala
- Gynecologic Oncology Department, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
| | | | - Eveline J Roos
- Tergooi MC, Department of Obstetrics and Gynecology, van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
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Tellier PP, Ataman R, Zaccagnini M, Gore G, Rodriguez C. Adolescent medicine training in postgraduate family medicine education: a scoping review. Int J Adolesc Med Health 2023; 35:119-129. [PMID: 36584348 DOI: 10.1515/ijamh-2022-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Adolescents and young adults require age-appropriate healthcare services delivered by clinicians with expertise in adolescent medicine. However, resident family physicians report a low perceived self-efficacy and under-preparedness to deliver adolescent medical care. We conducted a scoping review to map the breadth and depth of the current evidence about adolescent medicine training for family medicine residents. CONTENT We followed Arksey and O'Malley's framework and searched seven electronic databases and key organizations' webpages from inception to September 2020. Informed by the CanMEDS-FM, we analyzed the extracted data concerning basic document characteristics, competencies and medical topics using numerical and qualitative content analysis. SUMMARY We included 41 peer-reviewed articles and six adolescent health competency frameworks (n=47). Most competencies taught in family medicine programs were organized under the roles of family medicine expert (75%), communicator (11.8%), and professional roles (7.9%). Health advocate and leader were rarely included (1.3%), and never scholar. OUTLOOK The omission of multiple competency roles in family medicine resident education on adolescents is insufficient for family physicians to deliver optimal care to adolescents. The combined efforts of family medicine stakeholders to address adolescent medicine competency gaps may positively impact the perceived competence reported by family medicine residents.
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Affiliation(s)
| | - Rebecca Ataman
- The School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Laval, QC, Canada
| | - Marco Zaccagnini
- The School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Laval, QC, Canada
| | - Geneviève Gore
- McGill Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montréal, QC, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, Montréal, QC, Canada.,The Institute of Health Sciences Education, McGill University, Montréal, QC, Canada
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Sun L, Jiang Y, Gao H, He Y, Song P, Shen Q, Zhu L, Zhao Y, Yan S, Zhang X, Yu X, Grover S, Chan SS, Ma J, Yuan C. Patterns of Pediatric and Adolescent Gynecologic Problems in China: A Hospital-Based Retrospective Study of 97,252 Patients. J Pediatr Adolesc Gynecol 2022; 35:444-449. [PMID: 35143978 DOI: 10.1016/j.jpag.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/31/2021] [Accepted: 01/23/2022] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To describe the pattern and population characteristics of pediatric and adolescent gynecologic (PAG) problems in China DESIGN: A clinic-based retrospective study of gynecologic patients (aged 0-18 years) over a period of 13 years SETTING: Department of PAG in the Children's Hospital, Zhejiang University School of Medicine PARTICIPANT: The final analyses included 97,252 patients with gynecologic problems. INTERVENTIONS/METHODS Descriptive analysis was conducted to evaluate the pattern of PAG problems. MAIN OUTCOME MEASURES Spectrum of PAG problems RESULTS AND CONCLUSIONS: The number of first-visit PAG patients increased from 4,582 to 11,876 from 2006 to 2018. Overall, genital inflammation was the most common presentation (57.0%), followed by precocious puberty (18.2%). The disease pattern varied across age groups; the most common problems were genital inflammation for age 0-6 years, genital inflammation and precocious puberty for age 7-9 years, and consultation, genital inflammation, and menstrual disorders for age 10-18 years. Overall, genital inflammation, precocious puberty, consultation, and menstrual disorders were common issues for pediatric and adolescent patients with gynecologic problems in China.
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Affiliation(s)
- Liying Sun
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000
| | - Yiran Jiang
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000; School of Public Health, Zhejiang University School of Medicine, Hangzhou, China, 310000
| | - Huihui Gao
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000
| | - Yusa He
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China, 310000
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China, 310000
| | - Qiuxiang Shen
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000
| | - Li Zhu
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000
| | - Yonggen Zhao
- Department of Information System, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000
| | - Shiyu Yan
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000; School of Public Health, Zhejiang University School of Medicine, Hangzhou, China, 310000
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China, 100142
| | - Xiaojin Yu
- School of Public Health, Dongnan University, Nanjing, China, 210000
| | - Sonia Grover
- Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Australia, 3052
| | - Symphorosa Sc Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China, 999077
| | - Jing Ma
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, United States, 02215.
| | - Changzheng Yuan
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China, 310000; School of Public Health, Zhejiang University School of Medicine, Hangzhou, China, 310000.
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Dumont T, Fleming N, Tsampalieros A, Webster RJ, Black A, Mohammed R, Singh SS. Pediatric and Adolescent Gynecology Practices: A National Survey of Canadian Gynecologists. J Pediatr Adolesc Gynecol 2022; 35:435-443. [PMID: 34958925 DOI: 10.1016/j.jpag.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify 1) the current state of pediatric and adolescent gynecology (PAG) provision of care; 2) barriers to practicing PAG; and 3) the need for increased PAG training in residency and continuing medical education (CME). METHODS Obstetricians and gynecologists (OB/GYNs) across Canada who currently practice gynecology were asked to complete an anonymous, self-administered, Internet-based survey. RESULTS One-hundred and forty-seven OB/GYNs across Canada responded to the survey, and after applying exclusion criteria (retired gynecologists, medical students, postgraduate trainees, gynecologists who do not currently practice gynecology, PAG specialists, or OB/GYNs seeing predominantly pregnant adolescent women), 135 were included. Seventy-six percent of survey respondents stated that they care for pediatric and adolescent patients in their practice. The pathologies and surgeries they are comfortable managing are those that are similar to the adult population, such as intrauterine device insertion in the office/OR, adnexal detorsion, laparoscopy in patients over 12 years of age, examination under anesthesia, and hymenectomy. Respondents who stated wanting to learn more about PAG preferred either online learning modules (85%) or CME workshops at regional meetings (91%). CONCLUSION Canadian OB/GYNs provide PAG care with very little training to support their work. Attention must be given to better training for our residents via available curriculums and teaching modalities, as well as increased access to CME for OB/GYNs.
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Affiliation(s)
- Tania Dumont
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, Ontario, Canada; CHEO, Department of Surgery, Division of Pediatric and Adolescent Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada.
| | - Nathalie Fleming
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, Ontario, Canada; CHEO, Department of Surgery, Division of Pediatric and Adolescent Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada
| | | | | | - Amanda Black
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Roxanna Mohammed
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, Ontario, Canada
| | - Sukhbir S Singh
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Solotke MT, Crabtree J, Cron J, Kallen A, Encandela J, Vash-Margita A. Multifaceted Approach to Evaluation in a Pediatric and Adolescent Gynecology Rotation for Medical Students. J Pediatr Adolesc Gynecol 2022; 35:270-276. [PMID: 34906684 DOI: 10.1016/j.jpag.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/02/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE We evaluated whether and to what extent a novel medical student rotation in pediatric and adolescent gynecology (PAG) increases clinical knowledge and skills and meets student needs and expectations. DESIGN Constructivist prospective pre-post study and post-rotation student survey SETTING: Academic medical center PARTICIPANTS: Pilot study of 9 medical students, which represents the entire population of those who completed the rotation. INTERVENTIONS Four-week clinical rotation in PAG MAIN OUTCOME MEASURES: Changes in clinical knowledge were measured by a pre- and post-intervention multiple-choice assessment, and clinical skills were assessed before and after the intervention using entrustable professional activities (EPAs); these data were analyzed with paired Student's t tests. Student evaluations of the rotation were measured through an anonymous, end-of-rotation, closed- and open-ended survey and were analyzed using descriptive statistics. RESULTS A statistically significant increase in clinical knowledge was observed post-rotation, with a mean pretest score of 67.0% (standard deviation [SD] 1.7%) and a mean posttest score of 75.2% (SD 3.2%, P = 0.02). Statistically significant increases were observed for all EPAs between the first and final day of the rotation. Eight students who completed the post-rotation survey rated the rotation favorably (5 on a scale from 1 to 5). CONCLUSION A multipronged evaluation showed that a new PAG clinical rotation significantly increased medical students' clinical skills and knowledge. This multifaceted evaluation method provides valuable insights to educators on how best to tailor a rotation to individual learners' levels of clinical skills and knowledge. If comparable rotations could be instituted and similarly evaluated in other medical schools, a noticeable knowledge/skill gap among trainees might be addressed.
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Affiliation(s)
- Michael T Solotke
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Janice Crabtree
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Julia Cron
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York
| | - Amanda Kallen
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - John Encandela
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Teaching & Learning Center, Yale School of Medicine, New Haven, Connecticut
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
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10
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Dumont T. The Current State of Pediatric and Adolescent Gynecology Residency Training in Canada: A Needs Assessment From Program Directors. J Pediatr Adolesc Gynecol 2021; 34:787-792.e1. [PMID: 34119662 DOI: 10.1016/j.jpag.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a needs assessment to determine whether a mandatory Pediatric and Adolescent Gynecology (PAG) training experience in each Obstetrics and Gynecology (ObGyn) residency program in Canada is required and feasible. MATERIALS AND METHODS This was a comparative descriptive design in which the 16 ObGyn Residency Program Directors (PD) in Canada were asked to undergo a 20-minute structured phone interview. These interviews were recorded, and explored how PAG and Reproductive Endocrinology (RE) objectives are met in each program, the PD's awareness of PAG opportunities in North America, and the feasibility of a mandatory training experience. This project is Research Ethics Board (REB) approved. RESULTS Of 16 PDs, 12 gave consent and completed the phone interview. There is at least 1 PAG-trained ObGyn per institution, with a wide variety of clinical and academic experiences in PAG for residents between residency programs. There is much overlap among PAG and RE. All PDs interviewed believe that PAG training is important and should be mandatory; however, many feel that they lack the resources to implement a PAG mandatory training experience and that many barriers to such a curriculum exist. CONCLUSION PAG training experiences should be mandatory in all ObGyn training programs, according to participating PDs. PAG providers were identified at all the participating residency programs, and efforts should be made to support these providers in delivering the educational PAG content to ObGyn residents so the residents can become competent in the care of young women and children. PDs should be provided with the available PAG resources and resident elective opportunities.
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Affiliation(s)
- Tania Dumont
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada; Department of Surgery, Division of Gynecology, CHEO, Ottawa, Ontario, Canada; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Hirai CAM, Chern IY, Kumura ND, Hiraoka M. Perceptions Regarding Pediatric and Adolescent Gynecology Training among Obstetrics and Gynecology Residents in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:179-183. [PMID: 34355193 PMCID: PMC8334075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A pediatric and adolescent gynecology curriculum was implemented for obstetrics/gynecology residents at a single institution in Hawai'i. The primary objective of this study was to evaluate the effectiveness of this pediatric and adolescent gynecology (PAG) formal curriculum in improving knowledge. Twelve residents at the University of Hawai'i completed the curriculum during their second year of training. Of these, 6 residents completed an examination assessing knowledge both before and immediately after the curriculum. Five of these residents completed the examination 1-2 years after completing the curriculum. Average pre-rotation examination scores were 57%, which increased significantly immediately after the curriculum to 87% (P=.003) and remained significantly higher after 1-2 years with average scores of 71% (P=.025). A secondary objective was to assess resident comfort and confidence levels in the subject. All residents who completed the curriculum completed surveys assessing comfort in their pediatric and adolescent gynecology training and both perceived confidence and competence in this area. Despite completing the curriculum, 7 of 12 (58%) did not feel comfortable evaluating pediatric gynecology patients, and 5 of 12 (42%) did not feel prepared nor competent to care for pediatric and adolescent patients. A formal pediatric and adolescent gynecology curriculum increased examination performance, which suggests knowledge retention. However, despite curriculum completion, residents still desired more training in the subject area. Residency programs should consider innovative ways to incorporate inpatient and outpatient educational experiences, periodic testing, and feedback longitudinally throughout residency training to improve long-term retention, confidence, and competence in providing gynecologic care in the pediatric and adolescent gynecology population.
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Affiliation(s)
- Cori-Ann M. Hirai
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Ingrid Y. Chern
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Nikki D.S. Kumura
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Mark Hiraoka
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
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Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0. J Pediatr Adolesc Gynecol 2021; 34:291-296. [PMID: 33810968 DOI: 10.1016/j.jpag.2021.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.
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Chemerinski A, Cooney L, Shah D, Butts S, Gibson-Helm M, Dokras A. Knowledge of PCOS in physicians-in-training: identifying gaps and educational opportunities. Gynecol Endocrinol 2020; 36:854-859. [PMID: 32252571 DOI: 10.1080/09513590.2020.1746761] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. A recent study found that many obstetrics and gynecology (ObGyn) practicing physicians are unaware of the Rotterdam criteria recommended for diagnosis. Our objective was to identify gaps in trainee knowledge of PCOS diagnostic criteria and management. An online survey was sent out to US ObGyn physicians-in-training in 2018. The primary outcomes were identification of at least one component of each Rotterdam criteria (Rot-3): (1) oligomenorrhea/amenorrhea, (2) clinical or biochemical hyperandrogenism, and (3) ovarian volume or antral follicle count, and identification of all five components (Rot-5). Secondary outcomes were identification of comorbidities and management of PCOS. Multivariable logistic regression was used controlling for gender, seniority (PGY) status, program type, completion of an REI rotation, and number of PCOS patients seen. 85.4% of 347 trainees completing the survey reported using Rotterdam criteria to diagnose PCOS. However, only 55% identified Rot-3 and less than 10% identified Rot-5. Seniority (PGY4 OR 2.2; 95% CI: 1.2-4.1; p = .01) and completion of REI rotation (OR 1.8 95% CI: 1.2, 1.8; p = .006) were associated with identifying Rot-3. Similar findings were noted with identifying Rot-5. Our study identified significant gaps in knowledge regarding PCOS, suggesting an urgent need for improving strategies for trainee education to increase patient satisfaction and provide comprehensive care.
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Affiliation(s)
- Anat Chemerinski
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Cooney
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Wisconsin, Madison, WI, USA
| | - Divya Shah
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Samantha Butts
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Solotke MT, Crabtree J, Encandela J, Vash-Margita A. Establishing a Pediatric and Adolescent Gynecology Subinternship for Medical Students. J Pediatr Adolesc Gynecol 2020; 33:104-109. [PMID: 31672667 DOI: 10.1016/j.jpag.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 11/26/2022]
Abstract
Within the pediatric and adolescent gynecology (PAG) community, an important issue deserving of our attention is expansion of formalized PAG training opportunities for medical students. In addition to those in obstetrics and gynecology, many physicians practicing family medicine, internal medicine, and surgery provide care to young female patients. However, residency programs provide inconsistent training in addressing specific PAG health care needs and communication skills required for delivery of care to pediatric and adolescent patients; opportunities for supervised clinical experience in these areas at the medical school level therefore have great importance because they might not be offered again during some residencies. At the undergraduate medical education level, training opportunities in PAG are currently limited, with only 3 PAG subinternships in North American medical schools. In contrast, other available subinternships include 113 in maternal fetal medicine and 82 in gynecologic oncology. To address this gap in opportunities for medical students, we developed a PAG subinternship and elective for medical students, which we describe in this report. Our 4-week PAG subinternship and 2-week elective expose students to a variety of ambulatory and surgical opportunities, with formal, informal, and self-guided learning activities. In this article, we explain the process of developing the curriculum, gaining alignment from key stakeholders, obtaining formal approval for the course, and advertising the opportunity to medical students. We also provide resources and guidance for medical educators who wish to establish a PAG subinternship or elective course at their institutions.
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Affiliation(s)
| | - Janice Crabtree
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - John Encandela
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Teaching and Learning Center, Yale School of Medicine, New Haven, Connecticut
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Pediatric and Adolescent Gynecology, Yale School of Medicine, New Haven, Connecticut
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Ritchie JK, Sahu B, Wood PL. Obstetric and gynaecology trainees' knowledge of paediatric and adolescent gynaecology services in the UK: A national qualitative thematic analysis. Eur J Obstet Gynecol Reprod Biol 2019; 235:30-35. [PMID: 30780074 DOI: 10.1016/j.ejogrb.2019.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The British Society of Paediatric and Adolescent Gynaecology (BritSPAG) was created in 2000 with specific aims to include raising the profile of paediatric and adolescent gynaecology (PAG) within the United Kingdom (UK). The Society has since developed a set of clinical standards for all acute hospitals providing gynaecological services to enable successful provision of paediatric and adolescent gynaecology care. AIMS To determine the depth of knowledge that obstetric and gynaecology trainees have with regards to the PAG services provided at their Hospital, reflecting how widely PAG services have had an impact on trainees. METHOD The national survey was distributed to all deaneries in the UK for circulation to all their trainees via e mail during Nov 2017-March 2018. RESULTS 28% of the trainees said there was a PAG clinic at their hospital, 46.9% did not have a clinic and 24.7% were unsure. 41.6% of the respondents were aware of BritSPAG, however only 10.4% were aware of the BritSPAG clinical standards for service planning with regards to PAG clinics. Nearly half were aware of the PAG specialist centre for their region but only 6.5% were aware of the BritSPAG UK map of services. A large majority (93.24%) didn't believe that trainees in O&G received adequate exposure to PAG in their training. CONCLUSION This study represents the largest and first national survey to seek obstetric and gynaecology trainees' thoughts on the provision of PAG training in the UK today. Given that only 28% of trainees answering said that they were aware of a PAG clinic at their hospital, this indicates not only that many hospitals did not have a dedicated PAG clinic but more worryingly five of the trainees were not aware of the existence of a confirmed PAG clinic at their hospital, and therefore are potentially losing out on training opportunities. Disappointingly the results of our survey reveal that trainees in Obstetrics and Gynaecology still have very little experience or exposure to PAG during their training despite there being opportunities to do so.
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Affiliation(s)
- J K Ritchie
- Department of Obstetrics and Gynaecology, Princess Royal Hospital, West Midlands, United Kingdom.
| | - B Sahu
- Department of Obstetrics and Gynaecology, Princess Royal Hospital, West Midlands, United Kingdom
| | - P L Wood
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, United Kingdom
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Hillard PJA. Puberty, Menarche, and the Menstrual Cycle: What Do We Know, and What Do We Teach? J Pediatr Adolesc Gynecol 2018; 31:331-332. [PMID: 29891050 DOI: 10.1016/j.jpag.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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