ADOLESCENT MEDICINE TRAINING IN PEDIATRIC RESIDENCY PROGRAMS - ARE WEDOING A GOOD JOB

Objectives. To determine how pediatric residency programs are respondi ng to the new challenges of teaching adolescent medicine (AM) to resid ents by assessing whether manpower is adequate for training, whether A M curricula and skills are adequately covered by training programs, wh at types of teaching methodologies are used to train residents in AM, and the needs for new curricular materials to teach AM. Design. A 3-pa rt 92-item survey mailed to all US pediatric residency training progra ms. Setting. Pediatric residency programs. Participants. Residency pro gram directors and directors of AM training. Main Outcome Measures. AM divisional structure, clinical sites of training, presence of a block rotation, and faculty of pediatric training programs; training materi als used and desired in AM; perceived adequacy of coverage of various AM topics; competency of residents in performing pelvic examinations i n sexually active teens; and manpower needs. Results. A total of 155/2 11 (73.5%) of programs completed the program director and the AM parts of the survey. Ninety-six percent of programs (size range, 5-120 resi dents) had an AM block rotation and 90% required the AM block; those w ithout a block rotation were more likely to be larger programs. Only 3 9% of programs felt that the number of AM faculty was adequate for tea ching residents. Almost half of the programs reported lack of time, fa culty, and curricula to teach content in substance abuse. Besides phys icians, AM teachers included nurse practitioners (28%), psychologists (25%), and social workers (19%). Topics most often cited as adequately covered included sexually transmitted diseases (81.9%), confidentiali ty (79.4%), puberty (77.0%), contraception (76.1%), and menstrual prob lems (73.5%). Topics least often cited as adequately covered included psychological testing (16.1%), violence in relationships (20.0%), viol ence and weapon-carrying (29.7%), and sports medicine (29.7%). Fifty-e ight percent of 137 respondents thought that all or nearly all of thei r residents were competent in performing pelvic examinations by the en d of training; there was no difference between perceived competence an d the residents' use of procedure books. Seventy-four percent used a s pecific curriculum for teaching AM; materials included chapters/articl es (85%), lecture outlines (76.1%), slides (41.9%), videos (35.5%), wr itten ease studies (24.5%), computerized cases (6.5%), and CD-ROMs (3. 2%). Fifty-two percent used Bright Futures, 48% used the Guidelines fo r Adolescent Preventive Services, and 14% used the Guide to Clinical P reventive Services for teaching clinical preventive services. Programs that used Bright Futures were more likely to feel that preventive ser vices were adequately covered in their programs than those who did not (78% vs 57%). A majority of programs desired more learner-centered ma terials. Conclusions. Although almost all pediatric programs are now p roviding AM rotations, there is significant variability in adequacy of training across multiple topics important for resident education. Pro grams desire more learner-centered materials and more faculty to provi de comprehensive resident education in AM.