Of the 88 subjects approached during the resident education session, 87 (99 percent) agreed to complete the survey. Thirty-six percent of the residents were from an OB/GYN program, 33 percent from a FM program, and 31 percent from a pediatrics program. Table 1 displays demographic data by field using chi-square analysis. Across all three fields, 31 percent were interns, 31 percent were second-year residents and 38 percent were third- or fourth-year residents. The number of residents in each level was approximately equal between the three different fields. A greater number of females (63 percent) were represented compared to males (37 percent). A significantly (p = 0.037) greater percentage of OB/GYN residents (80 percent) were female compared to the number of female residents surveyed in FM (48 percent) and pediatrics (58 percent). More than half (58 percent) planned to practice as general physicians, and 42 percent planned to specialize. Intention to specialize differed across fields, with the majority of OB/GYN and pediatric residents planning to specialize, compared to the majority of family medicine residents who planned to practice as generalists (p = 0.002). Approximately 37 percent of residents were from programs with religious hospital affiliations; no OB/GYN residents were from programs with religious hospital affiliations.
Overall, residents from different fields were largely in agreement about what adolescent services they considered to be part of their scope of practice (Table 2). Prescribing emergency contraception to teens and referring adolescents to clinics where they could receive an abortion, along with counseling about pregnancy termination options, were the only practices that varied significantly between different fields. OB/GYN residents (97 percent) were the most likely to consider prescribing emergency contraception as part of their scope of practice and pediatric residents (78 percent) least likely, with FM residents (89 percent) falling in the middle. OB/GYN (100 percent) and FM (97 percent) residents most often considered counseling about pregnancy termination options their responsibility, while pediatric residents (85 percent) were less likely to consider such counseling their responsibility. In regard to providing teens information about where they could obtain abortions, OB/GYN residents unanimously felt it fell under their scope, while FM (79 percent) and pediatric (77 percent) residents were less likely to feel it was part of their responsibility.
Overall, counseling about STI risk and prevention was the only service for which greater than 90 percent of residents felt they had received adequate training (Table 3). Several significant differences exist between fields in regard to their reported level of training (Table 3). OB/GYN residents reported significantly less training than FM or pediatric residents in several preventive services, including counseling about diet/exercise, eating disorders/body image and substance abuse, screening for depression/suicide, and discussing sexual partners. Pediatric residents, on the other hand, reported significantly less training than OB/GYN or FM residents in several services pertaining to sexual health, including conducting pelvic exams; counseling and prescribing contraception; counseling and prescribing emergency contraception; and counseling about pregnancy termination. When interns are excluded from the analysis (Table 5), the difference in the training reported by pediatric residents in regard to pelvic exams and counseling and prescribing contraception is diminished, but the trend remains the same.
Significant differences by field were found for the majority of survey items (Table 4). Similar to the deficiencies noted in responses to training questions, OB/GYN residents were significantly less likely than FM and pediatric residents to have had at least one experience with an adolescent patient in defining confidentiality in the patient-doctor relationship; evaluating positive aspects of life; counseling about weight loss, depression, suicide, and alcohol or drug use; and discussing sexual partners. The significance of the difference noted for defining confidentiality, counseling a depressed adolescent, counseling about drug use, and discussing sexual partners is diminished when interns are excluded from the analysis but the trend remains the same (Table 5). While OB/GYN residents were significantly less likely to have counseled a teen about alcohol or drug use, they were significantly more likely to have referred an adolescent to a substance abuse program as compared to FM and pediatric residents.
Pediatric residents were significantly less likely than FM and OB/GYN to have had at least one encounter in which they counseled an adolescent who experienced physical abuse. Likewise, they were less likely to have counseled about pregnancy termination. Moreover, pediatric residents report significantly less experience than FM and OB/GYN residents in prescribing emergency contraception when interns are excluded from the analysis (Table 5). Pediatric residents also reported significantly lower rates of conducting pelvic exams and prescribing contraception compared to OB/GYN and FM residents. Around 15 percent of pediatric residents reported they had never conducted a pelvic exam on an adolescent, and 56 percent conducted fewer than 11. Approximately 26 percent of pediatric residents reported they had never prescribed contraception, and 70 percent had prescribed contraception fewer than 11 times. FM residents were more likely to have counseled adolescents about contraceptive options than OB/GYN or pediatric residents. However, this difference is diminished when interns are excluded from the analysis (Table 5). FM residents were less likely than pediatric residents but more likely than OB/GYN residents to have counseled a suicidal adolescent. In addition, FM residents were less likely than OB/GYN residents but more likely than pediatric residents to have counseled about pregnancy termination options.
Potential confounding variables
Survey items for which differences by field are altered by excluding intern level residents from the analysis are described in each section as appropriate and illustrated in Table 5. Interns in all three fields are less likely to have encountered the full breadth of training and experience in their training programs. Subsequent experience in later years may serve to even out these initial differences. However, for many survey items, trends and differences between specialties remain when interns are excluded from analysis.
Three other demographic variables (namely, gender, hospital religious affiliation, and intention to specialize) were noted to be significantly different between fields and thus had the potential to confound survey results by field. For the majority of survey items for which religious affiliation was identified as having a potential significant influence, the pattern among residents within non-religiously affiliated hospitals mirrored the patterns observed in the full data set. Nonetheless, careful consideration of the results of stratified analysis suggests a religious affiliation effect occurred with regard to FM residents and items concerning abortion. FM resident positive responses to abortion questions concerning scope and experience increased substantially, matching the level of positive response observed in OB/GYN residents, when FM residents in programs with religious affiliation were excluded.
Female providers have been documented to provide more preventive services in several studies [6
]. We did not observe this trend in our study. However, given the low number of male OB/GYN residents, we would need a larger sample size to fully evaluate the effect of gender. Stratified analyses by “intention to specialize” revealed no significant differences from the non-stratified analysis.