Date of Award

3-25-2008

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Jessica Illuzzi

Abstract

Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. In many instances, a correlation has been noted between insufficient training and provision of adolescent medicine services in the practicing physician population. The American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology and Society for Adolescent Medicine recommend adolescent providers deliver comprehensive health services to teenagers. This study sought to assess and compare Pediatric, Family Medicine and Obstetric-Gynecology resident perceptions of their responsibility, training, experience and comfort with providing comprehensive health care services adolescents. We asked residents to identify the following: (1) adolescent health services they considered part of their scope of practice in their respective field; (2) the level of training they had received with regard to select adolescent health services; (3) the experience they had performing select clinical activities with adolescents; and (4) their comfort with aspects of adolescent care. We further asked two questions to test resident knowledge of an adolescents right to consent to contraception or an abortion without parental notification in the state of their residency. A total of 87 residents (31 Obstetric-Gynecology, 29 Family Medicine and 27 Pediatric) were surveyed. Most residents from all three fields felt the full range of adolescent preventive and clinical services represented in the survey fell under the scope of their practice. Most residents also reported high levels of comfort with examined aspects of adolescent care. In regard to some activities, the positive scope and comfort responses were matched by high reported levels of training and experience, including defining confidentiality; counseling about eating, exercise and obesity; counseling about substance abuse; and discussing STDs, sexual partners and contraception. However, for multiple key adolescent services, considerable discrepancies existed between reported levels of training and experience and the positive responses concerning scope and comfort. In particular the results of study suggested all residents need considerably more training and experience with mental health issues, referring teenagers for substance abuse treatment, and addressing physical and sexual abuse. Overall, there were also significant differences between fields. Family Medicine residents reported the greatest potential for providing comprehensive health care. However, they suffered from the overall deficiencies in training and experience noted above. Obstetric-Gynecology residents reported deficiencies in the provision of several preventive counseling and general health services. Pediatric residents reported multiple deficiencies in the provision of sexual health services. Our results indicate, at this time and in the near future, it is unlikely that adolescents will be able to obtain the full range of recommended preventive and clinical services in a single physician visit unless residencies programs actively incorporate increased training in the full range of adolescent preventive and clinical health services.

Comments

This is an Open Access Thesis.

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