Improving a Pediatric Residency Rotation in Adolescent Medicine

To guide our revision of an adolescent medicine rotation for pediatric residents, we conducted a learner and stakeholder needs assessment. Our objectives were to: 1) assess stakeholder perspectives on residents' needs and how well those needs are met by the current curriculum and; 2) assess residents' perspectives on their knowledge, needs, and expectations of the rotation. We conducted an iterative assessment of perspectives of faculty and learners on the previous resident rotation in adolescent medicine. Faculty interviews included the pediatric residency director, chief residents, outpatient clinic site directors, and the course director and staff for the adolescent medicine rotation. We assessed where residents receive formal education about adolescent health, as well as the content and quality of that information. We then reviewed adolescent health content of the residents' outpatient curricula and experiences, including the adolescent medicine rotation, outpatient continuity clinic, and the residency noon conference series. We asked faculty to discuss strengths and challenges of the rotation, and identify areas for update. Next, we developed a tool to compare entering interns versus graduating residents with respect to knowledge about reproductive health. We asked residents to self-rate comfort and competence in common adolescent medicine scenarios. Faculty interviews revealed that residents are exposed to adolescent medicine in many settings. Their perceived needs included contraceptive/gynecologic education and a focus on adolescent medicine content for the Pediatric Board exam. Faculty also noted that pediatric residents are particularly challenged by patients with substance use issues and those in need of gynecologic exams. Faculty identified several areas for improvement: residents 1) spent redundant time on inpatient rounds, 2) lacked materials focused on positive youth development, and 3) needed new community opportunities. We also found that rotation materials were disorganized and redundant. Through the pediatrics residency program, we surveyed 23 incoming interns and 18 graduating residents. The graduating residents felt more comfortable and competent than their first year counterparts in caring for adolescent patients. Program graduates answered the reproductive health knowledge questions more accurately than the first year residents, but there were notable gaps in their knowledge, e.g, about emergency contraception. The curriculum content assessment varied widely between the first and third year respondents. Interns reported broad interests in adolescent health ranging from history-taking to functional pain syndromes, whereas graduating residents felt well prepared, yet desired more reproductive health content. Based on these results, we made a number of changes to the rotation, including an electronic format organized by the ACGME requirements. We added online reproductive health content with self-study time in place of lower-yield activities, and a resident self-reflection exercise before and after the rotation. Curricular changes are now being implemented and evaluated. We plan a qualitative study of residents' pre- and post-rotation self-reflection data, and will examine adolescent medicine experiences of residents outside the adolescent medicine rotation. It is important to continually update institutional curricula in adolescent medicine as the field of adolescent medicine – and our learners - evolve.