YALE JOURNAL OF BIOLOGY AND MEDICINE 82 (2009), pp.129-141.
Copyright © 2009.
Adolescent Medicine: Attitudes, Training, and
Experience Of Pediatric, Family Medicine, and
Rebecca Kershnar, MDa*; Charlene Hooper, MD, MPHb; Marji Gold,
MDc; Errol R. Norwitz, MD, PhDb; Jessica L. Illuzzi, MD, MSb
aContra Costa Family Medicine Residency, Martinez, California;bDepartment of
Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine,
New Haven, Connecticut;cDepartment of Family and Social Medicine, Albert Einstein
College of Medicine/Montefiore Medical Center, Bronx, New York
Purpose: Several studies have documented a deficiency in the delivery of preventive serv-
ices to adolescents during physician visits in the United States. This study sought to assess
and compare pediatric, family medicine (FM†), and obstetrics and gynecology (OB/GYN)
resident perceptions of their responsibility, training, and experience with providing compre-
hensive health care services to adolescents.
Methods:A57-item, close-ended survey was designed and administered to assess resident
perceptions of the scope of their practice, training, and experience with providing adolescent
health care across a series of health care categories.
Results: Of the 87 respondents (31 OB/GYN, 29 FM, and 27 pediatric), most residents from
all three fields felt that the full range of adolescent preventive and clinical services repre-
sented in the survey fell under their scope of practice. Residents from all three fields need
more training and experience with mental health issues, referring teenagers to substance
abuse treatment programs, and addressing physical and sexual abuse. In addition, OB-
GYN residents reported deficiencies in training and experience regarding several preventive
counseling and general health services, while pediatric residents reported deficiencies in
training and experience regarding sexual health services.
Conclusions: Our results indicate that at this time, residents from these three specialties
are not optimally prepared to provide the full range of recommended preventive and clinical
services to adolescents.
*To whom all correspondence should be addressed: Rebecca Kershnar, MD, Contra
Costa Family Medicine Residency, Martinez, CA; Email: email@example.com.
†Abbreviations: FM, family medicine; OB/GYN, obstetrics and gynecology; STI, sexually
transmitted infections; NAMCS, National Ambulatory Medical Care Survey; NHAMCS, Na-
tional Hospital Ambulatory Medical Care Survey; AAP, American Academy of Pediatrics;
AAFP, American Academy of Family Physicians; ACOG, American College of Obstetri-
cians and Gynecologists.
Keywords: adolescent medicine; internship and residency; obstetrics; gynecology;
pediatrics; family practice
ity experienced by adolescents in the United
States can be attributed to preventable causes,
suicide, unintended pregnancy, accidents, and
obesity. However, only 39 percent of adoles-
(NAMCS) and National HospitalAmbulatory
Medical Care Survey (NHAMCS) in 1997-
2000 . Similarly, in the 1997 Common-
wealth Fund Survey of the Health of
Adolescent Girls, 71 percent of teens reported
at least one potential health risk, yet only 37
percent of these teens reported discussing any
of theserisks withtheirprovider.
The relationship between physician
training in adolescent health care and the de-
livery of comprehensive health services to
teenagers has been well documented [3-8],
and professional societies, including the
American Academy of Family Physicians
(AAFP), and the American College of Ob-
stetriciansand Gynecologists (ACOG), have
training in primary care residencies.
There is insufficient data to evaluate
health care has altered resident attitudes,
istering health care to adolescents. Addition-
ally, assessments of resident experience and
training in administering care to adolescents
pare pediatric, family medicine (FM), and
obstetrics and gynecology (OB/GYN) resi-
dent perceptions of their responsibility, train-
services and health care to adolescents.
We conducted a cross-sectional study
with convenience sampling of all residents
a given day at participating residency pro-
grams between February 19 and March 16,
Human Investigation Committee determined
that this protocol was exempt from review.
OB/GYN, FM, and pediatric residency pro-
grams in Connecticut were contacted to re-
quest participation of their residents in the
was contacted in order to increase the sample
size for family medicine. FM, pediatrics, and
OB/GYN were chosen since these specialties
see the greatest number of adolescent patients
versity of Connecticut and Montefiore/Albert
Einstein College of Medicine; the pediatrics
Yale-New Haven Hospital; and the OB/GYN
programs of Danbury Hospital, Bridgeport
Hospital, Stamford Hospital/Columbia Uni-
versity College of Physicians and Surgeons,
andYale-New Haven Hospital.
The questionnaire consisted of 57
close-ended questions about which adoles-
cent health services the residents considered
part of their scope of practice in their respec-
tive field; the perceived adequacy of training
they had received with regard to select ado-
lescent health services; and the experience
they had performing select clinical activities
with adolescents. The questions were not
based on any prior survey instrument, be-
cause a validated instrument addressing the
range and specific focus of these questions
does not exist.
Survey questions regarding scope,
training, and experience covered five main
topics in adolescent medicine, including
general adolescent health, mental health,
substance abuse, physical and sexual abuse,
and sexual health.Agreater number of sex-
ual health questions were included in each
category in deference to the recent national
survey of adolescents performed by the
Kaiser Family Foundation that demonstrated
Kershnar: Adolescent medicine in three residency specialties
limit the opportunities for experiences in
general health care available to OB/GYN
residents.This study suggests that residency
programs may need to broaden their training
and expectations of resident experiences in
general and psychiatric care in order to meet
the goals set out byACOG. Identifying bar-
riers to expanding this care is a subject for
Our study had several limitations, in-
cluding sample size; sample characteristics,
including small geographic location; inaccu-
racies possible with self-report; and incon-
sistencies in the manner in which different
fields interpreted survey questions. Our abil-
ity to analyze the effect of religious affilia-
tion and gender was limited by our sample
as discussed previously. Trends reported in
the study should be substantiated by sam-
pling residents from a greater diversity of
programs. Inconsistent patterns of accuracy
have been observed with physician self-re-
port; it is possible that the survey responses
provided an inflated view of the level of res-
a recent study focused on resident self-as-
sessment found good internal consistency
between resident self-report and external
chart review , suggesting self-report can
provide valuable information about general
ence was queried may have further con-
tributed to an inflated view of resident
experience, since a single experience of a
rience.This does not necessarily correlate to
the experience required for competency and
the incorporation of the given activity into
been some inconsistencies in the manner in
survey questions, in particular with regard to
sexual health items. OB/GYN resident train-
ing is focused on sexual health topics; thus,
of inadequate training for conducting pelvic
exams and counseling about and prescribing
contraception by upper level OB/GYN resi-
dents. While this may reflect real inadequa-
cies, it also could reflect a more specific in-
terpretation by OB/GYN residents in terms
Ideally, residents in the primary special-
ties who provide health care to teenagers
should receive training and experience that
prepares them to deliver comprehensive
health services to adolescents as indicated by
GAPS,AAP,AAFP, andACOG. While there
were some areas in which residents reported
training, and experience, there were multiple
a connection between inadequate physician
provision of preventive and clinical services
to adolescents and physician training and ex-
perience with such [3-8,33]. Therefore, it is
important to provide residents with training
comprehensive health care for adolescents in
adolescents in the future. This study has
helped identify areas within each of these
three training programs in which greater em-
phasis, training, and experience will benefit
that future practicing physicians from these
vide the full range of recommended preven-
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141Kershnar: Adolescent medicine in three residency specialties