- Email: [email protected]
Enhancing Residency Education in Pediatric and Adolescent Gynecology: A North American Cross-Specialty Collaboration
168
Poster Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 167e187
Methods: We invited 239 US ObGyn Residency Programs to participate. Programs with PAG-trained faculty were excluded. 14 programs responded and 12 met inclusion criteria. Residents were invited to complete the reading assignments in the Short Curriculum, followed by a 30-item retrospective pre and post questionnaire. The questionnaire queried selfreported knowledge and experience of each resident regarding learning objectives in the Short Curriculum. Primary outcome was self-perceived improvement in PAG knowledge. Secondary outcomes included whether self-reported knowledge correlated with level of training, previous exposure to PAG lectures or clinical exposure to PAG patients. Descriptive statistics were used for continuous variables using means and ranges, with student t-tests for comparison. This study was approved by the Colorado Multi-Institutional Review Board. Results: 227 residents met inclusion criteria; 34 completed the study (15% response). The majority of residents were female (76.5%) and trained at community programs (70.6%). Residents from all training levels (PGY14) participated. When residents were asked about their knowledge of PAG prior to completing the readings, less than 50% reported sufficient knowledge in the areas of pre-pubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, HEEADDSS interview, pelvic pain, and bleeding management in teens with developmental delay. Self-reported knowledge improved in 8 out of 10 learning objectives, with no significant improvement in bleeding disorders or mullerian anomalies (Table 1). There was no association between pre-test knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to clinical cases. Conclusions: Significant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved selfreported knowledge in PAG. Table 1 Improvement in Self-Reported Knowledge after Participation in NASPAG Short Curriculum (n ¼34) Topic
Pre-test Knowledge (%)
Post-test Knowledge (%)
p value
Pre-pubertal vaginal bleeding HEEADDS interview Pre-pubertal vulvovaginitis Delayed puberty AUB in adolescents with developmental delay Precocious puberty Pelvic pain in adolescents Pre-pubertal exam Bleeding disorders in adolescents Mullerian anomalies Total
14 18 29 35 36
68 50 74 68 82
.000 .001 .000 .001 .000
42 50 76 82 94 48
70 79 97 94 97 77
.002 .006 .006 .013 .571 .000
programs in North America and yet PAG learning objectives are an integral part of licensing exams in these programs in Canada and US. Programs without PAG expertise or curriculum may have difficulty fulfilling the training requirements, and therefore risk losing their accreditation. We wished to outline the development of a North American PAG Resident Education Committee and the creation and dissemination of a novel comprehensive curriculum for PAG education. Methods: The North American Society for Pediatric and Adolescent Gynecology (NASPAG) Resident Education Committee was created in 2012. Members include specialists in PAG, Adolescent Medicine and Ob/Gyn with varied educational leadership and expertise including Rotation Directors, Fellowship and Residency Directors in these different specialties. Results: Comprehensive PAG resident education curricula were designed and published: these include the Short and Long Curriculum. In addition, workshops on training and implementation of a PAG curriculum into residency programs were presented at various annual meetings (APGO, SAHM, NASPAG, ASRM). An educational research study to evaluate the Short Curriculum and to validate it as a teaching tool was also completed. In addition, online educational tools were developed. Future direction of the committee includes continued dissemination of the curricula; developing traveling educational teams to residency programs to provide PAG on-site education; and finally, developing a PAG simulation program and eLearning modules. Conclusions: The development of a North American PAG Resident Education Committee has led to the development and dissemination of a comprehensive PAG curriculum based on learning objectives from Ob/Gyn, Adolescent Medicine and Pediatric certification boards. These resources will allow residency programs with limited educational PAG training opportunities the potential to fulfill their PAG objectives for accreditation. 5. Pediatric Residents’ Comfort, Confidence, and Knowledge in Prepubertal Vulvar Conditions Monica Rosen MD, Veronica I. Alaniz MD, MPH, Emily K. Kobernik MPH, CPH, Stephanie Booms MD, Yolanda R. Smith MD, Elisabeth H. Quint MD* University of Michigan, Ann Arbor, MI
Background: Vulvovaginal complaints are common among prepubertal
4. Enhancing Residency Education in Pediatric and Adolescent Gynecology: A North American CrossSpecialty Collaboration Nathalie Fleming 1, Karen J. Browner-Elhanan 2, Yolanda Evans 3, Nicole W. Karjane 4, Paritosh Kaul 5, Meredith Loveless 6, Hina J. Talib 7, Kanani Titchen 7, Carol Wheeler 8, Patricia S. Huguelet*5 1
University of Ottawa, Ottawa, ON Albert Einstein College of Medicine, Bronx, NY University of Washington School of Medicine, Seattle, WA 4 Virginia Commonwealth University School of Medicine, Richmond, VA 5 University of Colorado School of Medicine, Denver, CO 6 Kosair Children’s Hospital, Louisville, KY 7 Albert Einstein College of Medicine, Bronx, NY 8 Medical School of Brown University, Providence, RI 2 3
Background: Pediatric and Adolescent Gynecology (PAG) is a core aspect of training for Ob/Gyn, Pediatrics and Adolescent Medicine training programs. The degree of exposure in PAG is variable across academic
girls, and pediatric providers are often first line in evaluating these concerns. Given the recurrent nature, non-specific etiology, and variety of treatment options, diagnosis and treatment can be challenging. The purpose of this study is to assess comfort, confidence, and knowledge regarding the evaluation, diagnosis, and treatment of prepubertal vulvovaginal conditions among a national sample of pediatric residents. Methods: A 32 question survey was emailed to pediatric and medicinepediatric residents through the American Academy of Pediatrics list serve. The survey was open for one month at the start of the academic year and participation was voluntary. Questions were related to comfort and confidence diagnosing prepubertal vulvar complaints in addition to typical pediatric concerns. To assess knowledge, the survey included two case scenarios on lichen sclerosis and nonspecific vulvovaginitis. Descriptive analysis including Chi-Square tests was performed. Results: A total of 866 of 7,075 (12%) residents completed the survey. Most participants were female (77%) and from an academic program (89%). A greater proportion of residents reported they were “very” or “extremely” comfortable talking to parents about general pediatric topics (vaccines, car seat safety and ear infections), compared to gynecologic topics (vaginal discharge, vulvovaginal hygiene, and the possibility of sexual abuse), (88.5% vs. 30.4%, p<.0001). Similarly, a greater proportion of residents reported they were “very” or “extremely” confident diagnosing general pediatric conditions (strep throat, ear infections and candidal diaper dermatitis), compared to prepubertal gynecologic conditions (lichen sclerosus, bacterial vulvar infections, and nonspecific vulvovaginitis), (87.6% vs. 32.8%, p<.0001). Despite overall low proportions of comfort and confidence regarding gynecologic topics, residents did show significant improvement in these domains during their residency (comfort: 10.2% in HOI -39.9% in HOIII/IV, p<.0001; confidence: 22.5% in HOI -37.6% in HOIII/IV, p<.0001). Responses to case scenarios assessing knowledge showed more residents correctly identified lichen sclerosis compared to nonspecific vulvovaginitis (68.9% vs. 44.6%, p<.0001). Similarly the majority of residents significantly
Poster Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 167e187
Methods: We invited 239 US ObGyn Residency Programs to participate. Programs with PAG-trained faculty were excluded. 14 programs responded and 12 met inclusion criteria. Residents were invited to complete the reading assignments in the Short Curriculum, followed by a 30-item retrospective pre and post questionnaire. The questionnaire queried selfreported knowledge and experience of each resident regarding learning objectives in the Short Curriculum. Primary outcome was self-perceived improvement in PAG knowledge. Secondary outcomes included whether self-reported knowledge correlated with level of training, previous exposure to PAG lectures or clinical exposure to PAG patients. Descriptive statistics were used for continuous variables using means and ranges, with student t-tests for comparison. This study was approved by the Colorado Multi-Institutional Review Board. Results: 227 residents met inclusion criteria; 34 completed the study (15% response). The majority of residents were female (76.5%) and trained at community programs (70.6%). Residents from all training levels (PGY14) participated. When residents were asked about their knowledge of PAG prior to completing the readings, less than 50% reported sufficient knowledge in the areas of pre-pubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, HEEADDSS interview, pelvic pain, and bleeding management in teens with developmental delay. Self-reported knowledge improved in 8 out of 10 learning objectives, with no significant improvement in bleeding disorders or mullerian anomalies (Table 1). There was no association between pre-test knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to clinical cases. Conclusions: Significant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved selfreported knowledge in PAG. Table 1 Improvement in Self-Reported Knowledge after Participation in NASPAG Short Curriculum (n ¼34) Topic
Pre-test Knowledge (%)
Post-test Knowledge (%)
p value
Pre-pubertal vaginal bleeding HEEADDS interview Pre-pubertal vulvovaginitis Delayed puberty AUB in adolescents with developmental delay Precocious puberty Pelvic pain in adolescents Pre-pubertal exam Bleeding disorders in adolescents Mullerian anomalies Total
14 18 29 35 36
68 50 74 68 82
.000 .001 .000 .001 .000
42 50 76 82 94 48
70 79 97 94 97 77
.002 .006 .006 .013 .571 .000
programs in North America and yet PAG learning objectives are an integral part of licensing exams in these programs in Canada and US. Programs without PAG expertise or curriculum may have difficulty fulfilling the training requirements, and therefore risk losing their accreditation. We wished to outline the development of a North American PAG Resident Education Committee and the creation and dissemination of a novel comprehensive curriculum for PAG education. Methods: The North American Society for Pediatric and Adolescent Gynecology (NASPAG) Resident Education Committee was created in 2012. Members include specialists in PAG, Adolescent Medicine and Ob/Gyn with varied educational leadership and expertise including Rotation Directors, Fellowship and Residency Directors in these different specialties. Results: Comprehensive PAG resident education curricula were designed and published: these include the Short and Long Curriculum. In addition, workshops on training and implementation of a PAG curriculum into residency programs were presented at various annual meetings (APGO, SAHM, NASPAG, ASRM). An educational research study to evaluate the Short Curriculum and to validate it as a teaching tool was also completed. In addition, online educational tools were developed. Future direction of the committee includes continued dissemination of the curricula; developing traveling educational teams to residency programs to provide PAG on-site education; and finally, developing a PAG simulation program and eLearning modules. Conclusions: The development of a North American PAG Resident Education Committee has led to the development and dissemination of a comprehensive PAG curriculum based on learning objectives from Ob/Gyn, Adolescent Medicine and Pediatric certification boards. These resources will allow residency programs with limited educational PAG training opportunities the potential to fulfill their PAG objectives for accreditation. 5. Pediatric Residents’ Comfort, Confidence, and Knowledge in Prepubertal Vulvar Conditions Monica Rosen MD, Veronica I. Alaniz MD, MPH, Emily K. Kobernik MPH, CPH, Stephanie Booms MD, Yolanda R. Smith MD, Elisabeth H. Quint MD* University of Michigan, Ann Arbor, MI
Background: Vulvovaginal complaints are common among prepubertal
4. Enhancing Residency Education in Pediatric and Adolescent Gynecology: A North American CrossSpecialty Collaboration Nathalie Fleming 1, Karen J. Browner-Elhanan 2, Yolanda Evans 3, Nicole W. Karjane 4, Paritosh Kaul 5, Meredith Loveless 6, Hina J. Talib 7, Kanani Titchen 7, Carol Wheeler 8, Patricia S. Huguelet*5 1
University of Ottawa, Ottawa, ON Albert Einstein College of Medicine, Bronx, NY University of Washington School of Medicine, Seattle, WA 4 Virginia Commonwealth University School of Medicine, Richmond, VA 5 University of Colorado School of Medicine, Denver, CO 6 Kosair Children’s Hospital, Louisville, KY 7 Albert Einstein College of Medicine, Bronx, NY 8 Medical School of Brown University, Providence, RI 2 3
Background: Pediatric and Adolescent Gynecology (PAG) is a core aspect of training for Ob/Gyn, Pediatrics and Adolescent Medicine training programs. The degree of exposure in PAG is variable across academic
girls, and pediatric providers are often first line in evaluating these concerns. Given the recurrent nature, non-specific etiology, and variety of treatment options, diagnosis and treatment can be challenging. The purpose of this study is to assess comfort, confidence, and knowledge regarding the evaluation, diagnosis, and treatment of prepubertal vulvovaginal conditions among a national sample of pediatric residents. Methods: A 32 question survey was emailed to pediatric and medicinepediatric residents through the American Academy of Pediatrics list serve. The survey was open for one month at the start of the academic year and participation was voluntary. Questions were related to comfort and confidence diagnosing prepubertal vulvar complaints in addition to typical pediatric concerns. To assess knowledge, the survey included two case scenarios on lichen sclerosis and nonspecific vulvovaginitis. Descriptive analysis including Chi-Square tests was performed. Results: A total of 866 of 7,075 (12%) residents completed the survey. Most participants were female (77%) and from an academic program (89%). A greater proportion of residents reported they were “very” or “extremely” comfortable talking to parents about general pediatric topics (vaccines, car seat safety and ear infections), compared to gynecologic topics (vaginal discharge, vulvovaginal hygiene, and the possibility of sexual abuse), (88.5% vs. 30.4%, p<.0001). Similarly, a greater proportion of residents reported they were “very” or “extremely” confident diagnosing general pediatric conditions (strep throat, ear infections and candidal diaper dermatitis), compared to prepubertal gynecologic conditions (lichen sclerosus, bacterial vulvar infections, and nonspecific vulvovaginitis), (87.6% vs. 32.8%, p<.0001). Despite overall low proportions of comfort and confidence regarding gynecologic topics, residents did show significant improvement in these domains during their residency (comfort: 10.2% in HOI -39.9% in HOIII/IV, p<.0001; confidence: 22.5% in HOI -37.6% in HOIII/IV, p<.0001). Responses to case scenarios assessing knowledge showed more residents correctly identified lichen sclerosis compared to nonspecific vulvovaginitis (68.9% vs. 44.6%, p<.0001). Similarly the majority of residents significantly