Pediatric and Adolescent Gynecology Experience in Two Michigan OB/GYN Residency Programs

Abstract

Background Pediatric and Adolescent Gynecology (PAG) is an important but long neglected field. While interest has grown tremendously over the past few years, training is still limited, with only two fellowship programs in the United States in 1997–98. The purpose of this study is to assess training and experience in PAG at the OB/GYN resident level. Methods Two programs were studied: in Detroit, MI, Hutzel Hospital (HH), one of the largest academic inner city programs in the country, and William Beaumont Hospital (WB), a community based program in Royal Oak, MI. 71 questionnaires were distributed to OB/GYN residents. Descriptive analysis of answers to demographic, training, attitude, and knowledge based questions in PAG was perlbrmed. Results 57 questionnaires were returned. The majority of respondents reported no experience in PAG with no rotations or clinics and only limited teaching with 0–2 lectures. 97% of HH and 92.3% of WB residents requested more PAG training. Comfort levels regarding sexual history, sex, sexual abuse, physical abuse, substance abuse, and birth control in PAG patients were assessed on a 5 paint scale (1=low, 5=high); HH scored 3.21/5 in pediatric and 4.22/5 in adolescent issues, and WB scored 4.22/5 in pediatric and 4.55/5 in adolescent issues. The most commonly recognized differences in the care of PAG patients were attention to stage of mental development (38.6% in pediatrics/36.4% in adolescents at HH; 38.5%/46.2% at WB), cooperation strategies (38.6%/36.4% at HH; 0%/0% at WB), and parental involvement(15.9%/0.% at HH; 30.8%/7.7% at WB). Residents failed to note the important physical and anatomical differences in the PAG patient(0%/0% at HH; 0%/0% at WB). HH residents responded with familiarity 60.5% and WB residents 59.7% of the time to knowledge based questions (see table). % residents showing familiarity HH WB HH WB Treating imperforate hymen 89 77 Indications for 1st speculum exam 81 83 Treating labial adhesions 89 77 Normallabnonnal hymens 11/41 7/15 Etiology of vulvovaginitis 20 0 Initiation of OCPs 64 31 Etiology of vaginal discharge 63 85 Exam positions 86 69 Conclusions Residents of both academic and community programs report litt1e experience and scant training in PAG. The same residents expressed interest in formal PAG training. Moderate to high levels of confidence in discussing PAG issues reported by both WB and HH residents were not supported by complete answers to knowledge based questions. Many residents demonstrated some familiarity with PAG issues, but Done demonstrated proficiency. It is concerning that residents in OB/GYN lack the basic knowledge that is required in routine daily care of the PAG population. More emphasis to be placed on these issues in residency training programs.