Turning HEADSS: Utilizing Coached Role-Play to Increase Student Self-Efficacy with Adolescent Interviewing Skills.

INTRODUCTION: Adolescent patients make up a significant number of the primary care population, yet medical training specific to adolescents is inadequate and challenging. 2 Medical trainees report feeling less competent caring for adolescents compared to caring for infants and children. 3 Framed after an adolescent HEADSS (Home, Education/employment, peer group Activities, Drugs, Sexuality and Suicide/depression) interview role-play activity for pediatric clerkship students, 1,2 this study sought to investigate the impact that facilitated role-play would have on physician assistant (PA) students' self-perceived knowledge, skills, and comfort in interviewing adolescents. METHODS: A coached role-play focused on skills used during a HEADSS interview was used to demonstrate the communication skills inherently important to adolescent encounters. Pre- and postintervention surveys were administered. RESULTS: Data from 2 sequential cohorts (n = 88) showed statistically significant improvement in pre- versus postsession self-perception of knowledge ( p ≤ 0.0001) and skills ( p ≤ 0.0001), but not in comfort ( p = 0.1610). DISCUSSION: Teaching PA students how best to engage with adolescents can be done effectively via coached role-play.

Development and Evaluation of a Child Neurology Resident Curriculum for Communication Around Serious Illness.

Background: Communication around serious illness is a core competency for all residencies. One-fifth of neurology residencies have no curriculum. Published curricula use didactics or role-play to assess confidence performing this skill without evaluation in clinical settings. The SPIKES mnemonic (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary) outlines 6 evidence-based steps for communication around serious illness. It is unknown whether child neurology residents can incorporate SPIKES into communication around serious illness in clinical settings. Objective: To develop and evaluate a curriculum on communication around serious illness using SPIKES for child neurology residents that shows long-term skill retention in clinical settings at a single institution. Methods: In 2019, we created a pre-post survey and skills checklist based on SPIKES, with 20 total including 10 core skills. Faculty observed residents' (n = 7) communication with families and completed both preintervention and postintervention checklists for comparison. Residents underwent training in SPIKES during a 2-hour session using didactic and coached role-play. Results: All (n = 7) residents completed preintervention surveys, 4 of 6 completed postintervention. All (n = 6) participated in the training session. Following the training, 75% of residents reported improved confidence in use of SPIKES, though 50% were still unsure about appropriately responding to emotions. There was improvement in all SPIKES skills, with significant improvement in 6 of 20 skills up to 1 year following training. Conclusion: This is the first evaluation of the implementation of a communication around serious illness curriculum for child neurology residents. We identified improved comfort with SPIKES after training. Successful acquisition and utilization of this framework in our program suggests it could be incorporated into any residency program.

Student Clinical Experiences in Cross-Cultural Education.

OBJECTIVES: Education in cultural competence is critical to training medical students to care for patients from all backgrounds, but it is unclear what experience students have in the clinical learning environment. We describe the medical student experience in directly observed cross-cultural encounters within two clinical clerkships, and we identify areas of need for further resident and faculty training in providing high-quality feedback following these encounters. METHODS: We collected direct observation feedback forms from third-year medical students in the Internal Medicine and Pediatrics clerkships. The observed cross-cultural skill was categorized, and the quality of feedback given to students was quantified using a standardized model. RESULTS: Students were observed using an interpreter more frequently than any other skill. Positive feedback received the highest quality scores, averaging 3.34 out of 4 coded elements. Corrective feedback quality only averaged 2.3 out of 4 coded elements, and quality correlated with the frequency of cross-cultural skill observation. CONCLUSIONS: Significant variability exists in the quality of feedback provided to students following the direct observation of cross-cultural clinical skills. Faculty and resident training to improve feedback should focus on corrective feedback in less commonly observed cross-cultural skills.

An innovative approach to teaching cross-cultural communication among dental students.

Introduction There is a lack of concordance in demographics between dental professionals and their patients. Professional organisations have recognised the necessity of cultural competency training in dental education. This study sought to employ and evaluate a novel intervention in cultural competency training on cross-cultural communication for undergraduate dental students.Material and methods The session employed dyad training, roleplaying, Kleinman's Explanatory Model and introduced the new 'Model for Negotiating Across Cultures', applied to patients' cultures. Learners included 24 first-year and 27 third-year dental students. Evaluation compared pre- and post-intervention responses to the modified Health Belief Attitudes Survey (HBAS). Paired t-tests were conducted to determine difference in pre- and post-intervention scores.Results For first-year students, the mean difference improvement between the pre- and post-intervention surveys for each HBAS domain was statistically significant (p <0.05). For the third-year students, improvement was significant in all domains except for quality (p = 0.083).Discussion Dental students were found to have improved cultural competency scores by the HBAS. Implementation of this educational intervention demonstrates a paradigm that could be implemented for cross-cultural communication.Conclusion The intervention can be utilised as a resource for cross-cultural communication education for dental students and could be expanded for all health professional students.

Learner Levels of Supervision Across the Continuum of Pediatrics Training.

PURPOSE: To describe trajectories in level of supervision ratings for linked entrustable professional activities (EPAs) among pediatric learners in medical school, residency, fellowship. METHOD: The authors performed secondary analyses of 3 linked datasets of level of supervision ratings for the Core EPAs for Entering Residency, the General Pediatrics EPAs, and the Subspecialty Pediatrics EPAs. After identifying 9 activities in common across training stages and aligning the level of entrustment-supervision scales across the datasets, piecewise ordinal and linear mixed effects models were fitted to characterize trajectories of supervision ratings. RESULTS: Within each training period, learners were rated as needing less supervision over time in each activity. When transitioning from medical school to residency or during the first year of residency, learners were rated as needing greater supervision in activities related to patient management, teamwork, emergent care, and public health/QI than in earlier periods. When transitioning from residency to fellowship, learners were always rated as needing greater supervision than they had been accorded at the end of residency and sometimes even more than they had been accorded at the start of residency. CONCLUSIONS: Although development over training is often imagined as continuous and monotonically increasing competence, this study provides empirical evidence supporting the idea that entrustment is a set of discrete decisions. The relaxation of supervision in training is not a linear process. Even with a seamless curriculum, supervision is tightly bound to the training setting. Several explanations for these findings are discussed.

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. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Participants were 47 US ObGyn, family medicine, and pediatric residency training programs across a 4-month study window, from September to December 2016. The NASPAG Short Curriculum was distributed to them with a request to complete a retrospective pre- and post-test survey. Primary outcome measure was improvement in self-perceived knowledge after exposure to the curriculum. RESULTS: Forty-eight programs responded to the study comprising a total of 1130 residents. One program was excluded because of logistical barriers to the distribution of study incentive. In total, 1080 residents were invited and 103 chose to participate (10% response rate); 68 residents completed all survey questions to be included in the final analysis. After completing the curriculum, self-reported knowledge improved in all 10 learning objectives, across all 3 specialties (47% [32/68] to 82% [56/68]; P < .01). Pre-test knowledge correlated with previous clinical exposure to PAG patients, but did not correlate with year of residency training, type of residency, or previous PAG lectures. CONCLUSION: Significant deficiencies exist regarding self-reported knowledge of core PAG topics among ObGyn, family medicine, and pediatric residents. Use of the NASPAG Short Curriculum improves self-reported knowledge in PAG trainees across all 3 specialties.

Medical Students' Acquisition of Adolescent Interview Skills after Coached Role Play.

STUDY OBJECTIVE: To develop and evaluate an educational activity designed to teach the adolescent Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety (HEADS) examination. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Participants were third-year medical students in their pediatric clerkships. Students received an article on the HEADS interview and attended an adolescent medicine educational session. The session included individualized goal-setting and coached role play. Students' skills in doing a HEADS interview were evaluated through a standardized patient encounter (SPE) with a checklist and a retrospective pre- and post-test survey. The SPE checklist was used to assess whether the students included questions in 6 key areas of a HEADS interview. RESULTS: One hundred fifty-two students participated. During the SPE, 90% of students queried the adolescent's home life, 91% education, 82% activities, 84% drug/substance abuse, 95% sexual history, and 61% symptoms of depression. Pre- and postintervention data were compared using the Kruskal-Wallis Test and showed a statistically significant difference in the students' ability to list key topic areas of the HEADS exam (P < .001) and to use the skills needed for an adolescent interview using the HEADS exam (P < .001). CONCLUSION: After an introduction to the HEADS examination, most students covered almost all of the topic areas of this screening interview during a SPE. Only three-fifths of the students, however, included questions about symptoms of depression. Coached role play with goal-setting facilitated effective learning of this approach to adolescent interviewing.

Creation and Dissemination of a Multispecialty Graduate Medical Education Curriculum in Pediatric and Adolescent Gynecology: The North American Society for Pediatric and Adolescent Gynecology Resident Education Committee Experiences.

STUDY OBJECTIVE: The goal was to develop a multispecialty committee to address deficiencies in pediatric and adolescent gynecology (PAG) resident education through curricular development under the auspices of the North American Society for Pediatric and Adolescent Gynecology. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A multispecialty North American committee was organized to develop short as well as long curricula in PAG through a combination of conference calls and face-to-face meetings. Content was guided by objectives of national accrediting organizations. The curricula used print as well as interactive electronic resources. RESULTS: After publication of the short and long curricula, a dissemination strategy was developed to present the information at national meetings. A curricular study was performed after introduction of the curriculum to evaluate its efficacy. Long-term plans for further curricular components and expansion of educational tools are ongoing. CONCLUSION: We gathered a diverse multispecialty group of doctors to collaborate on a unified educational goal. This committee developed and disseminated resident PAG curricula using a variety of learning tools. This curricular development and implementation can occur with a minimal financial burden.

Missed Opportunities for Condom Counseling Among Adolescent Males.

The purpose of this study was to quantify the rate of condom counseling (CC) among adolescent males at preventive (PV) and non-PV (NPV) clinic visits in order to identify missed opportunities for contraception counseling. Adolescent males attending an outpatient clinic at a tertiary children's hospital from 2009 to 2013 were included. Patient demographics and provider responses to a postvisit electronic medical record questionnaire regarding CC were collected. Over 4 years, 2,439 males attended 6,123 visits; 33% were PVs. CC occurred at 92% PVs versus 43% NPVs ( p < .001). Those receiving CC were more likely to be older (16.1 vs. 15.9 years; p < .001) and minority (odds ratio = 1.43; 95% confidence interval = 1.28-1.61). In conclusion, in this single-center study among adolescent males, CC occurred routinely at PVs but infrequently at NPVs. CC was more likely among older, minority males. Providing CC at NPVs and ensuring younger, White males receive CC are two strategies to increase rates of CC among adolescent males.

Post-traumatic Stress Disorder After Sexual Abuse in Adolescent Girls.

The sexual assault of girls and women in this country is estimated at approximately 20%. The development of post-traumatic stress disorder (PTSD) after sexual abuse and assault is one of the potential lingering aftereffects. In this article we describe PTSD after sexual abuse and its effect on presenting complaints, such as sexually transmitted infections, contraception, and chronic pain, for the pediatric and adolescent gynecology (PAG) clinician. Treatment approaches, including the use of antidepressants and anxiolytics, as well as evidenced-based psychotherapies, are highlighted. In addition, this article will assist the PAG clinician in identifying trauma-related concerns during clinic visits and will cover specific screening tools to aid in identification of PTSD. A better understanding of PTSD after sexual abuse will allow PAG providers to deliver better care to their patients.

Contraception and Adolescent Males: An Opportunity for Providers.

PURPOSE: To examine young men's awareness of emergency contraception (EC) and its association with their contraceptive decision-making contributions within a relationship. METHODS: A convenience sample of English-speaking male patients aged 13-24 years were surveyed regarding their childbearing intentions, contraceptive awareness (including EC), perceived contraceptive knowledge, and communication about birth control with providers and within a relationship. RESULTS: An ethnically diverse sample of adolescent males was recruited with a mean age of 18.9 years. Most had previously been sexually active (75%) and felt it was important to avoid pregnancy (84%) and 61% reported ever having spoken to a health care provider about birth control (other than condoms), but only 42% had heard of EC. Participants who had heard of EC were more likely to have spoken to a health care provider about contraception in the past (51.5% vs. 29.8%; p = .050), to feel they should participate in contraceptive decisions in a relationship (97.4% vs. 76.5%; p = .006), and to have discussed contraception with a partner (76.9% vs. 29.2%; p < .001). CONCLUSIONS: Counseling young men about EC, as well as other methods of birth control, may empower them to become actively involved in contraceptive decisions within a relationship if they do not desire fatherhood.

Using Individualized Learning Plans to Facilitate Learner-Centered Teaching.

Individualized learning plans (ILPs) are helpful tools that can facilitate learner-centered education and can be used with all levels of learners. We introduce the concept of ILPs, the rationale for their use in pediatric and adolescent gynecology education, and review the challenges that learners might face in creating ILPs, and describes how educators can support learners during this process.

Applying the one minute preceptor model to pediatric and adolescent gynecology education.

There are multiple challenges to teaching in the clinical setting. The One Minute Preceptor is a learner-centered model for effective and efficient teaching in a clinical setting that can help to overcome these challenges. It consists of 5 microskills: get a commitment; probe for supporting evidence; teach general rules; reinforce what was right; correct mistakes. This article illustrates with case vignettes the use of these microskills for the busy Pediatric and Adolescent Gynecology clinician.

Measuring pediatric resident competencies in adolescent medicine.

PURPOSE: To compare third-year pediatric resident competence on an adolescent medicine with competence in treating younger children. METHODS: The participants were third-year residents (2010 [n = 24] and 2011 [n = 23]) at University of Colorado School of Medicine. Resident competence was measured in the domains of professionalism, communication, and history-taking skills in a multicase Objective Structured Clinical Examination. RESULTS: Percent correct scores in professionalism, history-taking, and communication skills on the adolescent case ranked in the bottom half of cases in both years. T-tests comparing mean score difference between the adolescent case and pediatric cases combined were statistically significant for professionalism (79.57 ± 4.15 vs. 89.51 ± 14.14, p = .01) and history taking (66.27 ± 11.02 vs. 75.10 ± 18.40, p = .05). CONCLUSIONS: Resident's history taking addressed immediate issues but not public health issues with adolescents. The professionalism findings suggest that residents engage in less patient-centered care when caring for adolescents, even while their communication skills remain on par.

Effective feedback strategies for teaching in pediatric and adolescent gynecology.

The clinical setting of pediatric and adolescent gynecology poses complex tasks for the physician with its numerous procedures and the communication demands of interacting with an adolescent and/or guardian. Needless to say, teaching within this setting is highly demanding. Regardless of the level of learner or the professional role (e.g., nurse, medical student, resident, physician assistant) represented, clinical teaching requires that the instructor provide feedback in ways that benefit the student. Recent research on feedback suggests a more complex understanding of feedback than in the past. This article highlights key research and its implication for effective feedback by presenting a three part framework; know your learner, understand what is to be learned, and plan for improvement.