Adolescent Interview With a Medical Interpreter: A Standardized Patient Encounter for Pediatric Residents.

BACKGROUND: Pediatricians can cultivate a more trusting relationship with their non-English speaking patients by emphasizing the importance of upholding patient confidentiality in the presence of an interpreter. We designed a case for pediatric residents to increase comfort when conducting an adolescent interview using a medical interpreter, emphasizing the importance of upholding patient confidentiality, specifically when discussing sensitive health topics. METHODS: We developed a standardized patient encounter (SPE) for pediatric residents at a large academic institution that focused on exploring sensitive health topics with an adolescent, non-English speaking female patient using an interpreter. A validated survey was administered upon completion of the case, prompting participants to reflect on their comfort and skills with specific activities before and after the case, and was analyzed using paired t-tests. RESULTS: Eighty-nine residents participated; 66 were interns and 23 were in their second year of residency. The mean scores of all paired survey items significantly increased after the case (p<0.01), indicating perceived personal growth in all educational objective categories. The majority of the participants (97%, N=86) agreed that they built skills in understanding cultural humility and caring for future patients (mean Likert scores: 4.91 and 5.10, respectively). CONCLUSIONS: Upon completion of the case, residents reported increased comfort and skills using a medical interpreter for non-English speaking patients within the context of patient-centered care, discussing various sensitive health topics, emphasizing the importance of upholding patient confidentiality, and demonstrating skills in adolescent interviewing. Both medical confidentiality and cultural humility education can be integrated into simulation-based medical education to improve the quality of care for diverse patient populations.

Impact of COVID-19 on post graduate medical education and training.

PURPOSE: The novel Coronavirus Disease 19 (COVID-19) has had a significant impact worldwide that led to changes in healthcare. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on trainee's mental health and educational preparedness. METHODS: Trainees at the Indiana University School of Medicine were surveyed regarding the impact of the COVID-19 pandemic on their training. Using a Likert scale, participants were asked questions pertaining to educational preparedness, mental health, and clinical work during the pandemic. Data was analyzed using SPSS version 27. The study was approved as exempt by the Institutional review Board (IRB). RESULTS: 324 of the 1204 trainees responded to the survey. The respondents were 76% white with an equal distribution of males and females. A majority of the respondents were first year residents with an equal distribution of second, third, and fourth year residents. Twenty-three percent of respondents were in a procedural residency or fellowship program. Better perceived educational preparedness was associated with an improved home-work balance during COVID-19 (ß = 0.506, p < 0.0001) and having a department that advocated/supported focus on mental health during COVID-19 (ß = 0.177, p < 0.0001). Worse perceived educational preparedness was associated with being in procedural vs. non-procedural dominant training program (ß = - 0.122, p = 0.01). CONCLUSION: COVID-19 has had a significant impact on the training experience of residents and fellows. Departmental support increased mental well-being and perceived education preparedness in trainees. Trainees that felt they had a better home-work life balance had better educational preparedness compared to their peers. Also, trainees in procedural programs had less educational preparedness compared to their peers in non-procedural programs. This study highlights the importance for programs to find avenues to increase educational preparedness in their trainees while being attuned to the mental health of their trainees.

Contraception options and provision to adolescents.

Adolescent pregnancy is a significant cause of global morbidity and mortality. Adolescents who become pregnancy have lower educational attainment, are more likely to live in poverty, and have lower wellbeing. Increasing access to hormonal contraceptives and long acting reversible contraception is highly effective in reducing adolescent pregnancies. This narrative review covers key aspects of the provision of contraception to adolescents, including confidentiality, counseling, and data supporting expanded access to adolescents. We provide information for pediatric providers to start adolescent patients on contraceptives, including a detailed description of each method, including effectiveness, use, starting, side effects and benefits. Tools for counseling and prescribing are provided.

Common prepubertal vulvar conditions.

PURPOSE OF REVIEW: The purpose of this article is to provide an update for the GP on selected common vulvar concerns in prepubertal girls. Presentation, diagnostic criteria, and management of common vulvar conditions will be described. The following conditions are frequently encountered and may pose diagnostic or management challenges if unrecognized. RECENT FINDINGS: The article is a review of current literature on pediatric vulvar conditions and was conducted through searching PubMed and published books on this topic. Areas of interest frequently encountered by providers are presented, including vulvovaginitis, genital ulcers, lichen sclerosus, and labial adhesions along with the most recent North American Society for Pediatric and Adolescent Gynecology recommendations for diagnosis and management. SUMMARY: Vulvar complaints in prepubertal girls are common. Many present with nonspecific symptoms and consequently, the diagnosis may be missed or delayed. Prompt recognition improves long-term outcomes and importantly, provides a positive introduction to longitudinal women's health for young girls.

LEAH interdisciplinary training program.

This article describes the Leadership Education in Adolescent Health (LEAH) interdisciplinary training program in the United States. The Maternal and Child Health Bureau authorized by legislation provides monies to train leaders in adolescent health through a competitive grant process. Currently, seven academic medical centers have funding to provide leadership in adolescent health (LEAH) training in five core disciplines: medicine, nursing, psychology, social work and nutrition. LEAH training programs both ensure high clinical competence in core disciplines serving adolescents and prepare trainees for leadership positions in adolescent health and public health care realms. Together, these programs trained almost 1000 long-term trainees across these five disciplines, and graduates from these programs are working in 45 of the 50 states within the United States. About 90% of these graduates are working with maternal and child/adolescent health populations, and almost all have held leadership positions in the areas of public health, advocacy, public policy, academic medical centers and/or clinical care settings.

Premenarchal girls' genital examination experiences.

PURPOSE: To explore girls' experiences having an external genital examination during early adolescence. METHODS: Ten premenarchal girls were interviewed about their experiences receiving an external genital examination as part of a larger longitudinal study. Qualitative methods were used for analysis, looking for concepts based on themes and shared beliefs among the girls to create a model of the genital examination experience. RESULTS: Most participants could not remember ever having a genital examination before enrollment in the larger study. The examination was best characterized as "weird," and many aspects of the examination were novel. Overall, genital examinations were not experienced negatively because of moderating factors like having support from mothers during the examination and having examiner preferences toward gender and personal characteristics. With repeated study examinations in the larger study and for those participants who reported their provider performed genital examinations, the examination was viewed as a skill for growing up or routine. CONCLUSIONS: External genital examinations, although a new experience for many girls, can be experienced positively. Providers should address concerns about this important recommended examination and acknowledge that examiner attributes, mothers, and experience of having examinations all influence how genital examinations are experienced.

Prevalence, frequency, and associations of masturbation with partnered sexual behaviors among US adolescents.

OBJECTIVE: To assess masturbation prevalence, frequency, and associations with partnered sexual behaviors. DESIGN: Cross-sectional survey. SETTING: The United States of America. PARTICIPANTS: Nationally representative samples of adolescents aged 14 to 17 years. MAIN OUTCOME MEASURES: Solo masturbation, partnered sexual behaviors, and condom use. RESULTS: Across age groups, more males (73.8%) reported masturbation than females (48.1%). Among males, masturbation occurrence increased with age: at age 14 years, 62.6% of males reported at least 1 prior occurrence, whereas 80% of 17-year-old males reported ever having masturbated. Recent masturbation also increased with age in males: 67.6% of 17-year-olds reported masturbation in the past month, compared with 42.9% of 14-year-olds. In females, prior masturbation increased with age (58% at age 17 years compared with 43.3% at age 14 years), but recent masturbation did not. Masturbation was associated with numerous partnered sexual behaviors in both males and females. In males, masturbation was associated with condom use, but in females it was not. CONCLUSIONS: Sexual development is a dynamic process during adolescence, and masturbation is an enduring component of sexuality. Fundamental differences appear to exist between male and female sexual expression. Health care providers should recognize that many teens masturbate and discuss masturbation with patients because masturbation is integral to normal sexual development.