Adolescent Medicine Training in Pediatric Residency Programs

Fox, Harriette B.; McManus, Margaret A.; Klein, Jonathan D.; Díaz, Ángela; Elster, Arthur B.; Felice, Marianne E.; Kaplan, Deborah Abrams; Wibbelsman, Charles J.; Wilson, Jane E.

doi:10.1542/peds.2008-3740

Cited by 52 publications

(34 citation statements)

References 12 publications

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“…For example, the mandatory rotation requirements designed to improve adolescent medicine training in pediatric residencies over the past 2 decades have promoted high-quality pediatric care for more children through late adolescence and early young adulthood. 39 Multidisciplinary collaboration among the specialties caring for young adults could lead to improvements in the health care services offered to this group.…”

Section: Discussionmentioning

confidence: 99%

Changes in Young Adult Primary Care Under the Affordable Care Act

et al. 2015

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Objectives. We sought to describe changes in young adults’ routine care and usual sources of care (USCs), according to provider specialty, after implementation of extended dependent coverage under the Affordable Care Act (ACA) in 2010. Methods. We used Medical Expenditure Panel Survey data from 2006 to 2012 to examine young adults’ receipt of routine care in the preceding year, identification of a USC, and USC provider specialties (pediatrics, family medicine, internal medicine, and obstetrics and gynecology). Results. The percentage of young adults who sought routine care increased from 42.4% in 2006 to 49.5% in 2012 (P < .001). The percentage identifying a USC remained stable at approximately 60%. Among young adults with a USC, there was a trend between 2006 and 2012 toward increasing percentages with pediatric (7.6% vs 9.1%) and family medicine (75.9% vs 80.9%) providers and declining percentages with internal medicine (11.5% vs 7.6%) and obstetrics and gynecology (5.0% vs 2.5%) providers. Conclusions. Efforts under the ACA to increase health insurance coverage had favorable effects on young adults’ use of routine care. Monitoring routine care use and USC choices in this group can inform primary care workforce needs and graduate medical education priorities across specialties.

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Section: Discussionmentioning

confidence: 99%

Changes in Young Adult Primary Care Under the Affordable Care Act

et al. 2015

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“…This fi nding is consistent with those of other studies that describe pediatricians' contraception knowledge gaps and their interest in additional training in pregnancy prevention. 18,19 Other respondents, including some who inserted IUDs, had LARC-specifi c knowledge gaps and worried about non-evidence-based risk of the IUD device itself. Some gaps refl ected out-dated information from residency training.…”

Section: Discussionmentioning

confidence: 99%

New York City Physicians' Views of Providing Long-Acting Reversible Contraception to Adolescents

Rubin

Davis

McKee

2013

The Annals of Family Medicine

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PURPOSE Although the US adolescent pregnancy rate is high, use of the most effective reversible contraceptives-intrauterine devices (IUDs) and implantable contraception-is low. Increasing use of long-acting reversible contraception (LARC) could decrease adolescent pregnancy rates. We explored New York City primary care physicians' experiences, attitudes, and beliefs about counseling and provision of LARC to adolescents. METHODSWe conducted in-depth telephone interviews with 28 family physicians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, fi ndings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (attitudes and beliefs) conceptual model of behavior change. RESULTSEnablers to IUD counseling and provision include knowledge that nulliparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly infl uenced by a physicians' perception of adolescents' risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity).CONCLUSION Knowledge, skills, clinical environment, and physician attitudes, all infl uence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents' access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.

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“…Adolescent medicine is a recognized sub-specialty within pediatrics and all pediatricians and pediatric sub-specialists receive training in the care of this challenging group, in contrast to trainees in internal medicine and surgery. 17 Furthermore, there is a burgeoning literature, much of it in journals most likely to be read by pediatricians, on mechanisms of and treatment for adolescent non-adherence. [18][19][20] One potential and controversial implication of this study is the idea that there may be too many transplant centers performing pediatric LTxs.…”

Section: Discussionmentioning

confidence: 99%