Paritosh Kaul

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum

The degree of exposure to Pediatric and Adolescent Gynecology (PAG) varies across academic programs in Obstetrics and Gynecology, Pediatrics, and Adolescent Medicine. Nevertheless, these programs are responsible to train residents and provide opportunities within their training programs to fulfill PAG learning objectives. To that end, North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by disseminating the Short Curriculum with specific learning objectives and list of essential resources where key concepts in PAG can be covered.

Effective Feedback Strategies for Teaching in Pediatric and Adolescent Gynecology

The clinical setting of pediatric and adolescent gynecology poses complex tasks for the physician with its numerous procedures and the communication demands of interacting with an adolescent and/or guardian. Needless to say, teaching within this setting is highly demanding. Regardless of the level of learner or the professional role (e.g., nurse, medical student, resident, physician assistant) represented, clinical teaching requires that the instructor provide feedback in ways that benefit the student. Recent research on feedback suggests a more complex understanding of feedback than in the past. This article highlights key research and its implication for effective feedback by presenting a three part framework; know your learner, understand what is to be learned, and plan for improvement.

Long Curriculum in Resident Education.

1 Pediatric and Adolescent Gynecology, Kosair Childrens Hospital, Louisville, Kentucky 2 Pediatric and Adolescent Gynecology, Seattle Childrens Hospital, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington Division of Adolescent Medicine, Childrens Hospital at Memorial University Medical Center, Mercer School of Medicine, Savanah, Georgia Division of Adolescent Medicine, Seattle Childrens Hospital, University of Washington School of Medicine, Seattle, Washington 5 Pediatric and Adolescent Gynecology, Childrens Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 7 Section of Adolescent Medicine, Childrens Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado Division of Adolescent Medicine, Childrens Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island 10 Pediatric and Adolescent Gynecology, Childrens Hospital of Eastern Ontario, Department of Obstetrics and Gynecology, University of Ottawa, Canada

Promoting equity and reducing health disparities among racially/ethnically diverse adolescents: A position paper of the Society for Adolescent Health and Medicine

With this paper, five key domains of advocacy, clinical care and health promotion, education and health services delivery, workforce and professional development, and research are identified. All five require attention in order to reach the overarching goal of health equity for adolescents and young adults. SAHM believes that achieving health equity is related to its organizational mission and vision and is a key factor in driving excellence in adolescent health and medicine. SAHM will continue to expand its capacity, being introspective as an organization as well as make recommendations to others, in an effort to be collaborative and inclusive of professionals, programs, and systems that represent and serve the diverse populations for whom the Society advocates.

Applying the One Minute Preceptor Model to Pediatric and Adolescent Gynecology Education

There are multiple challenges to teaching in the clinical setting. The One Minute Preceptor is a learner-centered model for effective and efficient teaching in a clinical setting that can help to overcome these challenges. It consists of 5 microskills: get a commitment; probe for supporting evidence; teach general rules; reinforce what was right; correct mistakes. This article illustrates with case vignettes the use of these microskills for the busy Pediatric and Adolescent Gynecology clinician.

Medical Student Performance on an Adolescent Medicine Examination

PURPOSE To examine the performance of third-year medical students on an adolescent medicine clinical practice examination. METHODS The participants were third-year medical students (2010 [n = 145] and 2011 [n = 134]) at the University of Colorado School of Medicine. Student performance on adolescent contraceptive management was measured in three domains following Accreditation Council for Graduate Medical Education (ACGME) competencies in professionalism, communication, and history-taking skills. RESULTS With regard to professionalism and communication skills, students performed very well, scoring >95% correct in both years. Students demonstrated relatively poorer performance in history-taking competency in 2010 and 2011 (66% and 67% correct, respectively). CONCLUSION In the adolescent Objective Structured Clinical Examination case, third-year medical students demonstrated extremely high performance in communication and professionalism skills. However, performance was lower for history-taking skill in contraceptive management.

Responding to the challenges of teaching cultural competency

Context and setting This study evaluates the effectiveness of a 2.5-hour introductory session on culture, health and illness delivered to Year 1 medical students. It examines the effectiveness of this session on students’ attitudes and compares it with that of prior efforts. The primary goal was to introduce the notion of culture and explore the interaction of cultures in a medical encounter. The session attempted to help students understand that both the patient and the doctor have a culture. A second objective was to provide a tool to help students to explore medically relevant aspects of a patient’s culture. Why the idea was necessary The need to include cultural competency education throughout medical school is widely accepted. However, introducing this topic in the context of the basic science curriculum presents many challenges. Student apathy and resistance are primary challenges that are gaining wider acknowledgement. This session attempted to overcome such resistance through student leadership and a focus on the clinical encounter. What was done During an interactive session in the Foundations of Doctoring course, upper-level students and a clinician jointly introduced the notion of culture to 156 Year 1 students (in groups of 50+). Each group then viewed a video of a medical situation involving culture and discussed their impressions of the doctor and family portrayed. The students were encouraged to reflect on the situation, the family’s culture, the medical culture and the interactions between the two cultures. Under the upper-level students’ leadership, group members then explored their own individual culture with a peer using structured dyads. Finally, the clinician and an upper-level student demonstrated the use of anthropologically oriented interviewing techniques in a role-play of a medical interview which the students then practised with their peers. Students completed the 15-item Health Beliefs Attitude Survey before and after participating in the session. A paired t-test was conducted for each attitudinal factor documented in the literature: whether the doctor should elicit a patient’s perspective, and whether knowing the patient’s perspective affects the quality of care the doctor provides. Evaluation of results and impact Students’ attitudes increased significantly (P = 0.001) on both factors resulting in large (d = 0.66) and moderate (d = 0.44) effect sizes for care and elicit, respectively. These results are remarkable when compared with those of prior studies with medical students in which attitudes declined or increased only on care. Asked to evaluate whether the session ‘advanced my understanding of the impact of culture on communication issues’, students rated the session significantly more highly than in the previous prior year (t = 3.4385, P £ 0.0007). We felt that the utilisation of upper-level students along with clinicians as instructors and the provision of opportunities to relate to culture personally and in a medical situation and to practise skills to address culture appeared to reduce resistance and improve students’ attitudes towards addressing cross-cultural communication in medicine.

Using Individualized Learning Plans to Facilitate Learner-Centered Teaching

Individualized learning plans (ILPs) are helpful tools that can facilitate learner-centered education and can be used with all levels of learners. We introduce the concept of ILPs, the rationale for their use in pediatric and adolescent gynecology education, and review the challenges that learners might face in creating ILPs, and describes how educators can support learners during this process.

Post-traumatic Stress Disorder After Sexual Abuse in Adolescent Girls

The sexual assault of girls and women in this country is estimated at approximately 20%. The development of post-traumatic stress disorder (PTSD) after sexual abuse and assault is one of the potential lingering aftereffects. In this article we describe PTSD after sexual abuse and its effect on presenting complaints, such as sexually transmitted infections, contraception, and chronic pain, for the pediatric and adolescent gynecology (PAG) clinician. Treatment approaches, including the use of antidepressants and anxiolytics, as well as evidenced-based psychotherapies, are highlighted. In addition, this article will assist the PAG clinician in identifying trauma-related concerns during clinic visits and will cover specific screening tools to aid in identification of PTSD. A better understanding of PTSD after sexual abuse will allow PAG providers to deliver better care to their patients.

Case of a Girl with Lower Abdominal Pain

The chapter aims to review differential diagnoses of an adolescent female with abdominal pain. It will examine risk factors in the adolescent to diagnose and treat different etiologies of abdominal and pelvic pain. Pregnancy, sexually transmitted infections, and long-term fertility preservation are vital components in these evaluations. Pelvic inflammatory disease is a clinical diagnosis of exclusion and requires a low threshold for treatment. CDC diagnostic and treatment guidelines in this population will be reviewed, as well as recommendations for follow-up. Providing comprehensive care including addressing issues of confidentiality and access to healthcare services will allow providers to impact long-term outcomes among youth.