Original StudyReliability Study for Pediatric and Adolescent Gynecology Case-Based Learning in Resident Education
Introduction
Obstetrician Gynecologists are frequently called upon to perform a gynecologic evaluation on a child or an adolescent female.1 The comfort level among Obstetrician Gynecologists may vary, depending on the degree of exposure to children and adolescents during residency training.2 Pediatric and Adolescent Gynecology (PAG) has been a part of residency training for many years in the fields of Pediatrics and Obstetrics and Gynecology (OB/GYN), but degree of exposure is not consistent in all programs. Standards for residency education in PAG have been outlined by the Council on Resident Education in Obstetrics and Gynecology (CREOG) as objectives for OB/GYN residents each year, including PAG learning goals.3 Ob/gyn training programs adhere strictly to these criteria as these are frequently criteria by which training can be objectively measured.3 Furthermore, competency may be required for credentialing forms following residency training.3
Some OB/GYN residency training programs have focused education in PAG, in part because of its increasing importance, but also due to increased need, as the population age burden has shifted to younger age groups.2 Traditionally, didactic lectures have been considered acceptable training substitutes. However, in the absence of an expert to provide organized teaching in this sub-specialty, didactic lectures may be inadequate. One study showed that only three hours of lecture time were dedicated to PAG in residency training within a 4-year program.4 The limitations placed on the work duty hours by the Accreditation Council of Graduate Medical Education (ACGME) further limit time allowed for teaching this subspecialty. Alternatives to lectures and direct patient care include simulated patient cases to enhance clinical learning.5 These simulated case experiences also meet the criteria set forth by the ACGME practice-based learning model. Simulated cases may occur in a variety of formats, one of which is an electronic-based modality.6, 7 This modality allows for flexibility in gaining exposure to PAG material without risking work hour violation, because this type of exercise can be completed at home, outside the parameters set forth by the ACGME.8
Section snippets
Methods
An electronic-based PAG case series was developed in 2005 at the Baylor College of Medicine in the Department of OB/GYN, based on criteria set forth by CREOG for in-training examinations.6 This case series was utilized as an adjunct to a formal one-month resident rotation in PAG. As a follow-up to the study in 2006, a second-look study was performed in 2007–2008. This second-look study was deemed exempt by the Baylor College of Medicine Institutional Review Board. Twelve third-year OB/GYN
Results
Twelve third-year residents (9 females and 3 males) between the years of 2007–2008 utilized the case-based teaching series throughout their PAG rotation. Six residents completed pre and post-tests. Three residents completed the pre-test only, one resident completed the post test only, and 2 residents failed to complete either test. One question on both pre and post-tests was discarded due to a problem with question validity. Therefore, scores were compared between pre-test and post-test groups
Discussion
The evaluation of children and adolescents is different than the evaluation of adult women and may be challenging to providers without formal training.1, 2, 10, 11 OB/GYNs caring for this population should be familiar with basic diagnoses and develop skill in managing common problems.5, 10, 11 Regardless of opportunities for formal training in PAG, residents can learn basic principles through teaching modules, similar to the one utilized for our residents.8
The future in medical education will
Conclusions
The description of our experience at Baylor College of Medicine is limited in that it represents the experience of only third year residents at one institution and may not be representative of other residents at other programs. Another limitation of the study may be that it is difficult to separate knowledge gained from this tool from other forms of interactive teaching and patient care over the course of the rotations. Additional centers need to document experience in teaching PAG as set forth
Acknowledgments
This study was undertaken at Baylor College of Medicine in Houston, Texas.
References (12)
History of pediatric and adolescent gynecology revisited
J Pediatr Adolesc Gynecol
(2002)- et al.
Pattern recognition in pediatric and adolescent gynecology–a case for formal education
J Pediatr Adolesc Gynecol
(2008) - et al.
Pediatric and adolescent gynecology experience in academic and community OB/GYN residency programs in Michigan
J Pediatr Adolesc Gynecol
(1999) - et al.
A simulated patient-based program for training gynecologists in communication with adolescent girls presenting with gynecological problems
J Pediatr Adolesc Gynecol
(2009) - et al.
Teaching pediatric and adolescent gynecology: a pilot study in one institution
J Adolesc Pediatr Gynecol
(1996) - et al.
The care of adolescents by obstetrician gynecologists: a first look
J Pediatr Adolesc Gynecol
(2009)
Cited by (16)
Project CARPE Diem: Curriculum and Assessment for Residents on Pediatric Epilepsy
2023, Pediatric NeurologyMultifaceted Approach to Evaluation in a Pediatric and Adolescent Gynecology Rotation for Medical Students
2022, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Our study builds on previous reports describing PAG education, although such research has focused almost exclusively on residents and involved educational interventions that differ from those used in our rotation. Similar to previously reported PAG teaching initiatives, including simulation-based instruction,22 didactic teaching,23 online case-based curricula,24-26 and independent study using the NASPAG Short Curriculum,3,4 our rotation was associated with improved knowledge in PAG. Our study adds to this literature because it demonstrated improvement in clinical skills relevant to the care of patients in a PAG setting, measured through direct observation.
Effect of case-based learning on the development of graduate nurses' problem-solving ability
2014, Nurse Education TodayCitation Excerpt :The results showed that the participants in the CBL program had higher scores in both subjective and objective problem-solving abilities compared to lecture-based education participants. This finding supports previous studies that claimed that CBL is a superior instructional method compared with didactic teaching in promoting a learner's problem-analysis, decision-making, and problem-solving abilities (Chan et al., 2008; Dietrich et al., 2010; Kaddoura, 2011; Kwak and Jang, 2009; Lumlertgul et al., 2009; Massonetto et al., 2004; Sprang, 2010; Thurman et al., 2009). A number of studies reported that universally graduate nurses in their first career role as registered nurses are facing a problematic transition into the workplace and difficult complex work environments all of which are disparate with their previous theoretically driven university world (Fero et al., 2009; Saintsing et al., 2011; Vittrup and Davey, 2010).
Residency Training in Pediatric and Adolescent Gynecology Across Obstetrics and Gynecology Residency Programs: A Cross-Sectional Study
2013, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Other studies evaluated various methods of teaching the PAG curriculum using novel techniques. For example, one study determined that using computer based learning tools can increase overall PAG knowledge and is a reliable method to teach this subject matter.1,3 Another study used a simulation model to teach pediatric gynecology and then residents were retested later, with improved post-training vs pre-training scores.4
Impact of a Pediatric and Adolescent Gynecology Curriculum on an Obstetrics and Gynecology Residency
2016, Journal of Pediatric and Adolescent GynecologyPerceptions Regarding Pediatric and Adolescent Gynecology Training among Obstetrics and Gynecology Residents in Hawai‘i
2021, Hawaii Journal of Health and Social Welfare