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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 (p0.05). 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.

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.

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.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.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.

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.

* Abbreviations: AM:STARs — : Adolescent Medicine: State of the Art Reviews SOAH — : Section on Adolescent Health The transition from childhood to adolescence is a major milestone, and the adolescent years (starting with puberty) represent a critical period when many changes occur: biologically (body and brain), cognitively, behaviorally, and emotionally. During this time, key areas of the brain are still developing and maturing with regard to structure, function, and connections. This provides opportunities for adolescents to explore their developing identity, form relationships with peers and adults, and navigate social and societal situations that will test the decisions they make. The transition to adolescence can be confusing and hard to navigate because adolescents are seeking more independence and might engage in risk-taking behaviors. They should not make this journey alone. Although risk-taking might be a normal experience for adolescents, some health risks can have significant, negative, and long-term health consequences. The leading causes of death among adolescents 15 to 19 years of age continue to be accidents, suicide, and homicide.1 Working to improve outcomes for adolescents and young adults is an important task for our society as a whole, not just … Address correspondence to Paritosh Kaul, MD, FAAP. E-mail: paritosh.kaul{at}childrenscolorado.org

Study Objective To determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty. Design Prospective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire. Setting Ob/Gyn residency training programs without PAG faculty. Participants Ob/Gyn residents in training from February 2015 to June 2015. Interventions Exposure to the NASPAG Short Curriculum. Main Outcome Measures Improvement in self-perceived knowledge after completion of curriculum. Results Two hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Mullerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints. Conclusion Significant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved self-reported knowledge in PAG.

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.

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.

The chapter aims to review differential diagnoses of an adolescent female with abdominal pain. It will examine risk factors in the adolescent to diagnose and treat different etiologies of abdominal and pelvic pain. Pregnancy, sexually transmitted infections, and long-term fertility preservation are vital components in these evaluations. Pelvic inflammatory disease is a clinical diagnosis of exclusion and requires a low threshold for treatment. CDC diagnostic and treatment guidelines in this population will be reviewed, as well as recommendations for follow-up. Providing comprehensive care including addressing issues of confidentiality and access to healthcare services will allow providers to impact long-term outcomes among youth.

Introduction: Village health workers (VHW)/Lay workers have been used effectively in HIV programmes in Zimbabwe and may potentially be useful in supporting caregivers of people with mental illness, if they are adequately trained and supervised by health professionals. Objective: To explore the training needs of VHW in supporting caregivers of persons with mental illness. Methods: Fifty two VHWs were conveniently selected from 5 out of 9 provinces in Zimbabwe and participated in focus group discussions (FGD) using a standardized study guide. Forty six health professionals completed a self-administered open ended questionnaire. Interviews were audio recorded and transcribed verbatim in Shona and translated into English. Data were analyzed thematically using Atlas Ti. Statistical Package for Social Sciences version 16 was used for sociodemographic data analysis. Results: The overall perceived training needs for VHW included training on counseling skills, psycho- education for caregivers, stress management, education on mental health conditions in order for them to effectively support caregivers of patients with mental illness in their communities in Zimbabwe. Conclusion: The needs analysis demonstrates perceived gaps in the knowledge of VHW in training caregivers of patients with mental illness. Designing a curriculum and assessing its impact on patient care and caregiver perceptions may go a long way in reducing caregiver burden in Zimbabwe.

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.

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 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.

1. Paritosh Kaul, MD* 2. Susan M. Coupey, MD† 1. *Postdoctoral Fellow in Adolescent Medicine 2. †Professor of Pediatrics, Associate Director, Adolescent Medicine, Children’s Hospital at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY After completing this article, readers should be able to: 1. Identify the percentage of United States high school seniors who have used an illicit drug and name the most common drug used. 2. Discuss coexisting mental health disorders and other findings that are prevalent among adolescents who have substance use disorders. 3. Describe the steps in diagnosing substance use disorder or dependence. 4. Characterize the effects of frequent prolonged use of most illicit drugs. 5. Describe the usefulness of laboratory testing for drugs of abuse. An 18-year-old man was admitted to the adolescent inpatient unit with a history of 2 days of abdominal pain, vomiting, and diarrhea. He was dehydrated and was treated with intravenous fluids. Over the following 2 days, the diarrhea and vomiting resolved, but the abdominal pain persisted. Approximately 48 hours after admission, the patient became irritable, complained of palpitations, and expressed a strong desire to leave the hospital. On the third day, his irritability increased, he developed chills but no fever, and he complained of aching all over his body. A detailed psychosocial history revealed that both of the young man’s parents were dead, and he felt responsible for his two younger brothers. He admitted to smoking between 5 and 10 “blunts” (large marijuana cigars) a day for “at least” the past year. He admitted that he sold drugs to finance his habit and help support his brothers, although he had never been arrested. His treating physicians agreed that the admitting diagnosis was gastroenteritis with dehydration, but a secondary diagnosis of cannabis dependence with acute withdrawal syndrome was made on the third hospital day, based on the psychosocial history and the timing of the “flu-like” symptoms. Substance use and abuse continue to threaten the health and well-being of adolescents and young adults. Whether sporadic intoxication leads to unintentional trauma or frequent …

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.

The degree of exposure to Pediatric and Adolescent Gynecology (PAG) varies across academic programs in Obstetrics and Gynecology, Pediatrics, and Adolescent Medicine. Nevertheless, these programs are responsible to train residents and provide opportunities within their training programs to fulfill PAG learning objectives. To that end, North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by disseminating the Short Curriculum with specific learning objectives and list of essential resources where key concepts in PAG can be covered.

With this paper, five key domains of advocacy, clinical care and health promotion, education and health services delivery, workforce and professional development, and research are identified. All five require attention in order to reach the overarching goal of health equity for adolescents and young adults. SAHM believes that achieving health equity is related to its organizational mission and vision and is a key factor in driving excellence in adolescent health and medicine. SAHM will continue to expand its capacity, being introspective as an organization as well as make recommendations to others, in an effort to be collaborative and inclusive of professionals, programs, and systems that represent and serve the diverse populations for whom the Society advocates.

Purpose To examine the performance of third-year medical students on an adolescent medicine clinical practice examination. Methods The participants were third-year medical students (2010 [n = 145] and 2011 [n = 134]) at the University of Colorado School of Medicine. Student performance on adolescent contraceptive management was measured in three domains following Accreditation Council for Graduate Medical Education (ACGME) competencies in professionalism, communication, and history-taking skills. Results With regard to professionalism and communication skills, students performed very well, scoring >95% correct in both years. Students demonstrated relatively poorer performance in history-taking competency in 2010 and 2011 (66% and 67% correct, respectively). Conclusion In the adolescent Objective Structured Clinical Examination case, third-year medical students demonstrated extremely high performance in communication and professionalism skills. However, performance was lower for history-taking skill in contraceptive management.

In 1998, the Centers for Disease Control and Prevention (CDC) changed their guidelines for treatment of adolescents with pelvic inflammatory disease (PID), no longer recommending hospitalization of all teenagers.(1) To determine the proportion of adolescents with PID who were admitted for failed outpatient treatment after the CDC guideline change. (2) To determine if adolescents admitted for PID after the guideline change needed longer hospital stays and/or were more likely to be "very ill" [as measured by inflammation markers, e.g. fever] or to have tubo-ovarian abscess (TOA) than those admitted before the change.Retrospective chart reviewAll 12-21-year-old females with the diagnosis of PID admitted to an adolescent inpatient unit in an inner-city teaching hospital during a two-year period before [T1=1995-1997 (54 cases)] and after [T2=1998-2000 (91 cases)] the CDC guideline change.NoneReason for admission (failed outpatient treatment; TOA; or admission at the time of diagnosis of PID); clinical toxicity at admission, and length of hospital stay (LOS).During T2, 22% of PID admissions were for failure of outpatient therapy. However, those admitted after failure of outpatient therapy (n=20) in T2 were less likely to be "very ill" than those who were admitted at the time of PID diagnosis in either T1 or T2 (n=123) [RR:0.30; 95% CI:0.09-0.94]. Mean LOS for females admitted to the adolescent unit with all diagnoses other than PID did not change between T1 and T2 but mean LOS for those diagnosed with PID decreased significantly from 6.3 +/- 3.7 days to 4.7 +/- 2.7 days, respectively (P = 0.002). LOS for PID was longer for younger (16 years; 8.20 +/- 4.5 days) than older (or =16 years; 5.0 +/- 2.8 days) girls (P = 0.02) and for adolescents with TOA (7.9 +/- 5.0 days) than for those without (5.3 +/- 2.9 days) (P = 0.05).At our medical center, after the CDC guideline change many adolescents with PID were admitted because of failure of outpatient therapy but they were not sicker than those admitted at the time of diagnosis and overall LOS for PID was shorter. These findings are reassuring because they suggest that an initial trial of outpatient therapy for PID is unlikely to harm adolescents and may lead to significant cost savings.