The Current State of Pediatric and Adolescent Gynecology Residency Training in Canada: Summary of Educational Resources to Enhance the Achievement of Pediatric and Adolescent Gynecology Objectives

A previous study determined that Obstetrics and Gynecology (ObGyn) residency Program Directors (PD) endorse mandatory Pediatric and Adolescent Gynecology (PAG) training to achieve national PAG objectives. Although barriers exist that limit the achievement of PAG objectives, this paper presents existing PAG tools and curricula. These include the North American Society for Pediatric and Adolescent Gynecology (NASPAG) short and long curricula, a wide variety of PAG electives available across Canada, more than 25 online clinical cases, and a simulation curriculum. This paper details these resources and provides a 4-week PAG schedule to accommodate ObGyn residency training programs.     

Does the North American Society for Pediatric and Adolescent Gynecology Short Curriculum Increase Resident Knowledge in Pediatric and Adolescent Gynecology?

Study ObjectiveTo determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty.DesignProspective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire.SettingOb/Gyn residency training programs without PAG faculty.ParticipantsOb/Gyn residents in training from February 2015 to June 2015.InterventionsExposure to the NASPAG Short Curriculum.Main Outcome MeasuresImprovement in self-perceived knowledge after completion of curriculum.ResultsTwo hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Müllerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints.ConclusionSignificant 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 self-reported knowledge in PAG.     

Improving Resident Knowledge in Pediatric and Adolescent Gynecology: An Evaluation of the North American Society for Pediatric and Adolescent Gynecology Short Curriculum

Study Objective

Resident education in pediatric and adolescent gynecology (PAG) is challenging. It encompasses patients from neonates to young adults with different disorders involving multiple subspecialties. Residents have inadequate exposure to PAG topics and report lack of knowledge in this area. The objective of this study was to determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in PAG among obstetrics and gynecology (ObGyn), family medicine, and pediatric residents.

Residency Training in Pediatric and Adolescent Gynecology Across Obstetrics and Gynecology Residency Programs: A Cross-Sectional Study

Study ObjectiveTo estimate the prevalence of Pediatric and Adolescent Gynecology formal training in the United States Obstetric and Gynecology residency programs.DesignProspective, anonymous, cross-sectional study.ParticipantsUnited States program directors of Obstetrics and Gynecology residency programs, N = 242; respondents 104 (43%).Results104 residency programs responded to our survey. Among the 104 residency programs, 63% (n = 65) have no formal, dedicated Pediatric and Adolescent Gynecology clinic, while 83% (n = 87) have no outpatient Pediatric and Adolescent Gynecology rotation. There is no significant difference in the amount of time spent on a Pediatric and Adolescent Gynecology rotation among residents from institutions with a Pediatric and Adolescent Gynecology fellowship (P = .359), however, the number of surgeries performed is significantly higher than those without a Pediatric and Adolescent Gynecology fellowship (P = .0020). When investigating resident competency in Pediatric and Adolescent Gynecology, program directors reported that residents who were taught in a program with a fellowship-trained Pediatric and Adolescent Gynecology faculty were significantly more likely to be able to interpret results of selected tests used to evaluate precocious puberty than those without (P = .03).ConclusionsResidency programs without fellowship trained Pediatric and Adolescent Gynecology faculty or an established Pediatric and Adolescent Gynecology fellowship program may lack formal training and clinical exposure to Pediatric and Adolescent Gynecology. This information enables residency directors to identify deficiencies in their own residency programs and to seek improvement in resident clinical experience in Pediatric and Adolescent training.     

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 2.0

The degree of exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology and pediatrics. Nevertheless, these programs are responsible for training residents 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 resident 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 2014 publication with added content, resources, and updated references. Additionally, attention to the needs of learners in pediatrics and adolescent medicine is given greater emphasis in this revised North American Society for Pediatric and Adolescent Gynecology Short Curriculum 2.0.     

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0

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.     

Enhancing Postgraduate Training in Pediatric and Adolescent Gynecology: Evaluation of an Advanced Pelvic Simulation Session

Study ObjectiveTo describe and evaluate a Canadian simulation session designed to teach pediatric and adolescent gynecology (PAG) history taking, examination and operative skills, and an approach to the child and adolescent.DesignObstetrics and gynecology residents in a single academic center participated in a PAG simulation session and rated their gain in knowledge on 6 aspects of PAG care.SettingAcademic half-day at the University of Ottawa Skills and Simulation Centre.ParticipantsTwenty-four Obstetrics/Gynecology residents at the University of Ottawa.InterventionsParticipants completed 4 stations teaching PAG-appropriate history taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child/adolescent. Advanced pelvic models were used for procedure specific stations. Participants completed an anonymous evaluation form at the end of the session.Main Outcome MeasureSelf-perceived increase in knowledge and PAG specific skills after the simulation session.ResultsTwenty-four residents completed the simulation session and post-session evaluation. All residents (100%) agreed that they had gained knowledge in PAG history taking, examination techniques, office procedures, operative skills, approach to child, and approach to the adolescent. Qualitative feedback stressed the excellence of instruction, interaction, immediate feedback, and hands-on experience. All residents (100%) stated the PAG simulation session should continue.ConclusionsThis advanced PAG simulation session increased resident self-perceived knowledge. Other obstetrics/gynecology training programs should consider implementing advanced PAG simulation sessions to increase resident knowledge and confidence in delivering care to the pediatric/adolescent patient.     

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.     

Pediatric and Adolescent Gynecology Practices: A National Survey of Canadian Gynecologists

ObjectiveTo 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).MethodsObstetricians and gynecologists (OB/GYNs) across Canada who currently practice gynecology were asked to complete an anonymous, self-administered, Internet-based survey.ResultsOne-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%).ConclusionCanadian 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.     

Practice management in obstetrics and gynecology residency curriculum.

OBJECTIVE: To establish the current level of instruction in practice management in obstetrics and gynecology residency programs; review recommendations of medical school practice management executives and current and former residents on design of practice management instruction programs; and develop recommendations for future management instruction by residency programs in obstetrics and gynecology. METHODS: A questionnaire was sent to 101 practice plan executives of obstetrics and gynecology departments at medical schools in the United States and Canada. A modified version was sent to 44 current obstetrics and gynecology residents and 72 former residents from the University of Tennessee, Memphis. RESULTS: The response rates were 71% (practice executives), 93% (current residents), and 81% (former residents). There were no formal management programs at 87% of responding institutions, although most respondents (62%) thought there should be mandatory participation in management programs, probably given by organizations outside the university. Potential subjects that received high ratings were current procedural terminology and diagnosis coding, managed care, billing procedures, contractual agreements between medical doctors, patient record management, and practice economics. CONCLUSION: Residency programs should establish formal practice management instruction programs and make participation mandatory. Funding should come from the medical school and university. Instructional help should come from extradepartmental organizations and individuals.     

Pediatric and Adolescent Gynecology in Europe: Clinical Services,Standards of Care,and Training

Study ObjectiveTo identify current clinical services and training available across Europe within pediatric and adolescent gynecology (PAG) and establish the extent to which PAG services meet current European Board and College of Obstetrics and Gynecology (EBCOG) standards.DesignQuantitative and qualitative questionnaire.SettingEuropean countries that are members of the EBCOG and the European Association of Pediatric and Adolescent Gynecology.ParticipantsThirty-six countries that were approached beginning in September 2013; data were obtained from 27 countries.InterventionsQuestionnaires with 28 stems were sent to clinical leaders in 36 European countries.Main Outcome MeasuresNational society, national standards, legislation for female genital mutilation, protocols for transition to adult services, human papilloma virus vaccination programs, sex and contraception education, safeguarding, clinical leads for PAG, delivery of PAG services, and training available for PAG.ResultsOf 36 countries, 27 responded. Seventy-seven percent had a national PAG society but only 44% had national standards in PAG. There was agreement that PAG cases should be multidisciplinary but not all have clinical networks in place to facilitate this. Human papilloma virus programs are available in some European countries and not all have legislation against female genital mutilation. A significant proportion of cases continue to be seen in adult gynecology clinics as opposed to designated PAG clinics with only 41% with processes to transfer patients into adult care.ConclusionIn this article we provide a framework to explore areas for improvement within PAG services and training across Europe. The EBCOG standards of care are not being adhered to in many countries because processes and clinical networks are not in place to facilitate them.     

Operative note dictation: should it be taught routinely in residency programs?

OBJECTIVE: To determine the extent of formal education regarding operative dictation in U.S. Obstetrics and Gynecology residency programs and to prospectively evaluate the effectiveness of formal teaching regarding operative dictation. METHODS: A 1-page questionnaire was mailed to all U.S. Obstetrics and Gynecology residency program directors (n = 270). The operative dictations of all Obstetrics and Gynecology residents at the University of Iowa before and after a 30-minute formal teaching session were evaluated using a scoring system developed by the authors of this study (scale 0-20). RESULTS: A 73% response rate (n = 198) was obtained from the surveys. The results from the survey demonstrated that only 23% of programs provide formal teaching regarding operative dictations; however, 83% of the residency program directors felt that it is an important skill to teach. All 16 obstetrics and gynecology residents at the University of Iowa attended a 30-minute teaching session on operative dictation. The mean scores for all residents improved from 9.06 to 18.56 after a formal teaching session (P <.001). The preteaching scores comparing the 4 classes of residents also varied significantly (ranging from a score of 5.5 for first-year residents to 11.25 for the fourth-year residents, P =.009). There were no differences between scores among the residents after they attended the formal teaching session (P =.11). CONCLUSION: Formal teaching of operative dictation is uncommon in U.S. residency programs but felt to be important by most residency program directors. A brief teaching session is effective and may be useful during residency training. LEVEL OF EVIDENCE: II-3     

Pediatric and Adolescent Gynecology Learned via a Web-Based Computerized Case Series

Study ObjectiveTo increase resident knowledge in pediatric and adolescent gynecology via a Web-based self-tutorial.Study DesignProspective cohort involving 11 third- and fourth-year residents in a large university program. Residents were asked to complete a Web-based teaching series of cases involving common topics of pediatric and adolescent gynecology (PAG). A pretest and a posttest were completed to assess knowledge gained. Residents were asked to give feedback regarding improvements to the Web-based series for future case development.SettingUniversity-affiliated residency program in a major metropolitan area.ParticipantsResident physicians in the Department of Obstetrics and Gynecology.InterventionsIntroduction of a Web-based teaching series to enhance resident education.Main Outcome MeasuresImprovement of resident knowledge in PAG.ResultsAll residents improved their knowledge in PAG after reviewing the series of cases. The pretest group mean score was 50%. The posttest group score was 69% (P < .05). All (100%) of participants said that this tool was an effective way to improve resident knowledge in PAG.ConclusionA computer-based self-tutorial in pediatric and adolescent gynecology is a feasible and satisfactory teaching adjunct to PAG.     

A Canadian Survey of Postgraduate Education in Aboriginal Women's Health in Obstetrics and Gynaecology

ObjectiveTo assess Canadian obstetrics and gynaecology residents' knowledge of and experience in Indigenous women's health (IWH), including a self-assessment of competency, and to assess the ability of residency program directors to provide a curriculum in IWH and to assess the resources available to support this initiative.MethodsSurveys for residents and for program directors were distributed to all accredited obstetrics and gynaecology residency programs in Canada. The resident survey consisted of 20 multiple choice questions in four key areas: general knowledge regarding Indigenous peoples in Canada; the impact of the residential school system; clinical experience in IWH; and a self-assessment of competency in IWH The program director survey included an assessment of the content of the curriculum in IWH and of the resources available to support this curriculum.ResultsResidents have little background knowledge of IWH and the determinants of health, and are aware of their knowledge gap Residents are interested in IWH and recognize the importance of IWH training for their future practice. Program directors support the development of an IWH curriculum, but they lack the resources to provide a comprehensive IWH curriculum and would benefit from having a standardized curriculum available.ConclusionA nationwide curriculum initiative may be an effective way to facilitate the provision of education in IWH while decreasing the need for resources in individual programs.     

Exploring Faculty Perceptions of Competency-Based Medical Education and Assessing Needs for Implementation in Obstetrics and Gynaecology Residency

ObjectiveThe shift to competency-based medical education (CBME) is associated with changes in the way residents are taught and assessed. Although there are many purported benefits of CBME, an understanding of the preparedness of faculty to meet the needs of this new paradigm is lacking. The aim of this study was to characterize faculty needs to support the transition to CBME.MethodsAn online survey was designed with the aim of characterizing faculty understanding of the principles of CBME and common trainee assessment methods, as well as exploring barriers to the implementation of CBME in obstetrics and gynaecology residency programs across Canada. The survey was sent to faculty across Canada in English and French.ResultsA total of 284 responses were collected between September 2015 and December 2016. Although most faculty viewed CBME as a positive change, there were gaps in their knowledge about CBME and workplace-based assessment methods. Barriers to the implementation of CBME included lack of training in assessment of residents and feedback, financial implications, and time constraints.ConclusionTo facilitate the transition to CBME, institutions may need to consider establishing faculty training programs and implementing systemic change aimed at addressing faculty needs and barriers during this fundamental shift in the structure of residency training.