Study Objective Adolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study aimed to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes. Design Retrospective chart review. Setting Yale New Haven Hospital from 2013-2018. Participants Female patients ages 15-25 receiving cancer treatment, excluding those treated with only surgery. Interventions None Main Outcome Measures Outcomes of documented sexual health counseling and contraception use were assessed for frequency. Associations between patient factors and these outcomes were assessed using Pearson χ 2 and Fisher’s exact tests, and multivariate logistic regression was used to identify predictors of these outcomes. Results In this cohort (n=157), the median age was 20.5, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. 33.1% were documented as receiving sexual health counseling and 48.4% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P =.005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P =.009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P =.001) were significantly associated with contraception use. Conclusions Sexual health counseling was documented infrequently during oncologic care for AYA women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a need to improve rates of counseling in this high-risk setting, in which adolescents may be more vulnerable with regards to sexual health.

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In this pilot study, we sought to characterize the knowledge about fertility and attitudes about future parenthood in a sample of transgender and gender expansive (TGE) youth attending an academic, universityaffiliated adolescent gender program. Methods: A 22-item cross-sectional survey assessing knowledge of fertility issues and attitudes toward future parenthood was administered to 23 transgender adolescents, 12-22 years of age, who reported gender identity incongruent with birth-assigned sex, and who were seen at our university-affiliated clinic during an 11-month period between October 2016 and August 2017. Knowledge scores and ranked responses on selected topics in fertility and reproduction were evaluated. Results: Participants were well informed overall about fertility topics related to their gender care (mean score of 3.8-0.8 out of 5), but over half of participants lacked specific knowledge regarding basic fertility principles and overestimated the ability of physicians to predict the effects of gender-affirming hormone therapy on fertility. The majority of participants (15/23) preferred nonbiological parenthood in the form of adoption. Participants who ranked future parenthood as unimportant had the greatest concern about becoming a parent (p < 0.05), and over one-third were also concerned about interrupting their gender-affirming hormone therapy to preserve fertility. Conclusion: TGE youth would benefit from fertility-related counseling that both assesses baseline understanding of reproduction and also acknowledges the limitations of current data on gender-affirming hormones and future fertility. Counseling should also be comprehensive and explore both biological and nonbiological forms of parenthood.

Background Health system science (HSS) encompasses both core and cross-cutting domains that emphasize the complex interplay of care delivery, finances, teamwork, and clinical practice that impact care quality and safety in health care. Although HSS skills are required during residency training for physicians, current HSS didactics have less emphasis on hands-on practice and experiential learning. Medical simulation can allow for experiential participation and reflection in a controlled environment. Our goal was to develop and pilot three simulation scenarios as part of an educational module for resident physicians that incorporated core and cross-cutting HSS domains.  Methods Each scenario included a brief didactic, an interactive simulation in small-group breakout rooms, and a structured debriefing. The case scenario topics consisted of educational leadership, quality and safety, and implementation science. Learners from four residency programs (psychiatry, emergency medicine, orthopedics, ophthalmology) participated January – March 2021. Results A total of 95 resident physicians received our curricular module, and nearly all (95%) participants who completed a post-session survey reported perceived learning gains. Emotional reactions to the session were positive especially regarding the interactive role-play format. Recommendations for improvement included participation from non-physician professions and tailoring of scenarios for specific disciplines/role. Knowledge transfer included use of multiple stakeholder perspectives and effective negotiation by considering power/social structures. Conclusions The simulation-based scenarios can be feasibly applied for learner groups across different residency training programs. Simulations were conducted in a virtual learning environment, but future work can include in-person and actor-based simulations to further enhance emotional reactions and the reality of the case scenarios.