APGO

Celeste O. Hemingway, MD
Vanderbilt University Medical Center, Nashville, TN

Objective: To develop a formal pediatric-adolescent gynecology curriculum to augment an existing clinical experience for residents.

Methods: The principles of backward design as outlined in "Understanding by Design" by Grant Wiggins and Jay McTighe were used to create a seven-week pediatric-adolescent gynecology curriculum to enhance an existing weekly one-on-one clinical experience with our faculty. Rather than start by crafting the learning experiences themselves, backward design requires first identifying desired outcomes and acceptable evidence for their achievement then modeling learning experiences to facilitate their realization. Our desired results for the pediatric-adolescent gynecology curriculum were outlined as 7 essential questions for the practice of pediatric-adolescent gynecology and 6 core understandings based on the CREOG objectives. For example, an essential question for the curriculum is, “How do health and behavioral trends among the adolescent population impact the care and guidance we offer young women in our care?” while an understanding is, "For the adolescent population, providers should know the most common causes of mortality and morbidity in order to identify patients at risk and provide guidance for risk-reduction." One of the goals of the curriculum is to revisit essential questions and understandings throughout the experience to ensure they are addressed by the resident learners. True to the backward design concept, once desired results were determined and acceptable evidence for their achievement were established, the learning experiences were crafted to address these needs. A case conference series to precede each clinical session was designed around core knowledge and skills. Six clinical topics (the pediatric examination, adolescent sexual history and contraception, menstrual abnormalities, disorders of puberty, special populations, preventive care) and a final mock oral boards session comprise the seven-week series. Residents prepare for these sessions with readings housed on our department’s blackboard website and are assessed on their participation and preparedness in addition to a proposed research question written each week in response to the day’s learning. The mock oral board session encapsulates the range of topics and serves as an additional assessment tool. Each clinic session is supervised by a faculty member who is tasked with observing at least one complete clinical transaction between the resident and a pediatric-adolescent patient every week. In addition to structured evaluations and feedback by the faculty member, patients and/or their family members are asked to evaluate the resident as well. Clinic documentation is reviewed by the faculty member, and the resident submits for review a portfolio of cases completed during the seven-week session. Finally, the resident evaluates his own performance with a self-efficacy questionnaire at the close of the experience.

Results: Residents are currently completing the pediatric-adolescent curriculum as part of their senior clinical experience. They receive faculty feedback from their case conference work, mock oral boards, their observed clinical interactions, and their documentation. They also receive feedback from their patients and/or their family members, depending on age. Lastly, they complete a self-efficacy questionnaire which assesses their perceived preparedness to provide pediatric-adolescent gynecologic care upon completion of training.

Conclusions: Using backward design to create a formal pediatric-adolescent gynecology curriculum for residents is a novel way to design learning experiences that target core knowledge and skills while addressing essential questions and understandings.