Perspectives on inadequate preparation and training priorities for physicians working with sexual minority youth.

OBJECTIVES: To understand pediatric and family medicine residents' and practitioners' perceived ability to work with lesbian, gay, bisexual, and queer (LGBQ) youth, assessment of their prior educational experiences, and recommendations for medical training to better prepare physicians to provide quality care to this population. METHODS: We conducted semi-structured individual interviews with 24 pediatric/family medicine residents (n=20) and practicing physicians (n=4) in the U.S. Recorded interviews were professionally transcribed. Data were analyzed using Grounded Theory and qualitative content analysis approaches. RESULTS: Most physicians did not feel adequately prepared to provide quality care to LGBQ youth, and many who felt knowledgeable obtained their knowledge from on-the-job experiences of caring for LGBQ patients. Findings regarding physicians' recommendations for implementing a formal training program revealed three themes: (I) medical school training (implemented earlier in medical school within a structured program as part of the normal curriculum), (II) training content (LGBQ-specific health needs, self-awareness of implicit biases, interviewing techniques, and resources), and (III) training strategies (panels of LGBQ patients, role-playing/standardized patients, and online modules). CONCLUSIONS: Understanding physicians' assessment of abilities and recommendations for training improvements based on their experiences is important for advancing the quality of healthcare for LGBQ youth. Guidance came mostly from residents who recently completed medical school. Thus, their perspectives are especially useful to improve medical education and, ultimately, the care provided to LGBQ youth. Findings suggest a multi-pronged approach that offers several training modalities encompassing individual, intrapersonal, and institutional/systemic/community levels can improve medical school curricula on caring for LGBQ youth.

Healthcare transition for patients with differences of sexual development and complex urogenital conditions.

Children with major congenital anomalies are able to obtain a high level of care in pediatric care settings. In contrast, adult care models emphasize patient responsibility in ensuring their health care needs are met. As patients make this transition, they may fall through the medical "safety net" and struggle to find quality care because of their lack of preparation. Transitional care, including tailored and purposeful medical and social support services, can serve as a bridge across systems and facilitate the safe and effective transfer of young adults with special health care needs from pediatric to adult care. Transitional care prepares youth to manage their own care, effectively use health services, and navigate the shift from distinctly different pediatric to adult models of health care. For unique patient populations such as those with disorders of sexual development and congenital genitourinary conditions, this preparation is vitally important to maximize lifelong functioning and well-being.

Adolescent growth and development.

Adolescence is a developmental stage defined by physical and psychosocial maturation. This article reviews normal pubertal development and the evaluation and management of adolescents with suspected pubertal abnormalities and provides an overview of adolescent psychosocial development.