CommentaryEstablishing a Pediatric and Adolescent Gynecology Subinternship for Medical Students
Introduction
Although pediatric and adolescent gynecology (PAG) is an important and rapidly growing field, training opportunities in PAG are limited. At the graduate medical education level, fewer than 20% of residency programs had an outpatient PAG rotation as of 2013, and only 13 PAG fellowships exist in the United States and Canada in 2019.1,2 The North American Society for Pediatric and Adolescent Gynecology (NASPAG) Resident Education Committee was formed in 2012, with the primary goal of developing an educational curriculum and instructional materials to improve physician trainees' education in PAG. The committee created 2 key educational programs: Short Curriculum and Long Curriculum. The Short Curriculum, published in 2014, was designed as a 2-week reading assignment that could be adapted by individual programs to fit their needs.3 The Long Curriculum is a more comprehensive program in PAG resident education and is aimed at obstetrics and gynecology (OBGYN) and pediatrics trainees.4 The Short Curriculum has been studied prospectively and demonstrated improvement in residents’ self-reported knowledge and comfort in managing PAG patients.5, 6, 7, 8 In addition to these curricula, further tools have been developed, such as simulation, video conferencing, and other educational strategies such as individualized learning plans.9, 10, 11
Data about PAG training at the undergraduate medical education level is even more limited: in our initial search, we found only 3 dedicated PAG subinternships for medical students listed in the Association of American Medical Colleges Visiting Student Application Services and Visiting Student Learning Opportunities database, in addition to 3 other electives offering a focus on PAG within a broader OBGYN elective or subinternship.12 In comparison, we found many subinternships in other subspecialties of OBGYN: 113 in maternal fetal medicine, 82 in gynecologic oncology, 38 in reproductive endocrinology and infertility, 37 in urogynecology or female pelvic medicine and reconstructive surgery, 24 in family planning, 15 in obstetric ultrasound, and 12 in minimally invasive gynecologic surgery. Additionally, rotation in a PAG clinic is not typically included as part of standard medical student OBGYN clerkship, although there might be limited exposure to PAG clinical experiences through clinic assignments in reproductive endocrinology and infertility. The Association of Professors of Gynecology and Obstetrics have laid out several clinical learning objectives within the scope of PAG for the clerkship year.13 Without adequate opportunities to see patients on a PAG service, students are left to master these objectives through lectures and independent reading or by chance on a pediatric rotation.
There are several important benefits to providing medical students with clinical experiences in PAG, including: (1) exposure to PAG as a subspecialty, which can be valuable for students interested in OBGYN and pediatrics; (2) opportunities to practice entrustable professional activities (EPAs) under direct supervision, which can build medical knowledge and clinical skills that prepare students for residency and beyond14; and (3) opportunities to participate in gynecologic care for female adolescents, which the American College of Obstetricians and Gynecologists recommends as routine visits starting between the ages of 13 and 15 years.15
At our institution, the idea to create a PAG subinternship for medical students was initiated by PAG faculty and encouraged by the OBGYN Clerkship Director, the Manager of Medical Education in OBGYN, and the Director of Electives at our institution's Office of Medical Education. Collaborating as a team, we created a PAG subinternship that has been well received by medical students. In this publication, we aim to report on: (1) the process of creating our PAG subinternship; (2) the principles underlying the creation of the subinternship; and (3) the practices (content and structure) of the PAG subinternship. Because of the inconsistent training in PAG available at the medical student and residency level, we believe that expansion of formalized PAG training opportunities for medical students is an important issue deserving of our community's attention.
Section snippets
1. Process: How to Create a PAG Subinternship at Your Institution
We suggest reaching out to educational faculty and staff to gauge feasibility of establishing a new subinternship or elective. At our institution, the Division Chief approached the Director of Medical Studies and the Manager of Medical Education within the Department of Obstetrics, Gynecology, and Reproductive Sciences to inquire about the logistics of establishing a new course (Fig. 1). This team collaborated to develop goals and objectives for the subinternship (Table 1), reflecting on the
Base Objectives and Learning Activities on Established Standards
In pedagogy, an accepted principle is that learning objectives and activities should be based on established standards and values shared by the educational community.16 In our case, our learning objectives were developed leveraging the NASPAG Short Curriculum and Long Curriculum, which have broad support within the PAG community and which have been shown to be effective at the resident level (Table 1).3,4 Because the expectations of a subintern include functioning close to or at the level of an
3. Practices: The Content and Structure of Our Institution's PAG Subinternship
The structure of our subinternship, including course length, prerequisites, and learning activities, is described in Table 2. The subinternship provides hands-on experience in inpatient and outpatient clinical settings. Students spend approximately 40-45 hours per week in structured activities, and only 1 student is enrolled in the subinternship at any given time. Students do not take night call, although call can be included in subinternships to enhance surgical experience in emergent cases.
Conclusions and Next Steps
We have successfully developed and implemented PAG training opportunities for medical students in the form of a 4-week subinternship and 2-week elective. We strive for continuous improvement of the curriculum and learning activities through student feedback, continued assessment of student knowledge, and further integration with other multidisciplinary programs, such as solid organ transplant, child abuse, gender, DSD, and pediatric endocrinology. With the establishment of our institution's
Acknowledgments
The authors thank Drs Julia Cron, Jessica Illuzzi, Amanda Kallen, and Shefali Pathy for their invaluable contributions to the development of the Pediatric and Adolescent Gynecology subinternship. Additionally, we gratefully acknowledge the support of Alyssa Grimshaw, MSLIS in conducting background research.
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Multifaceted Approach to Evaluation in a Pediatric and Adolescent Gynecology Rotation for Medical Students
2022, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :This rotation is offered as a 4-week experience and provides students with learning in outpatient and inpatient settings, including operative experience. We previously described the pilot stage and content of this rotation,8 which is designed to provide students with opportunities to master educational objectives pertaining to female adolescent care recommended by the Association of Professors of Gynecology and Obstetrics (APGO) and with exposure to the field of PAG.9 Because there are so few existing clinical rotations in PAG, there is no current standard of rotation design.
Pediatric and Adolescent Gynecology: What's It all About?
2020, Journal of Pediatric and Adolescent Gynecology
Alla Vash-Margita is a nonpaid Etonogestrel subdermal implant instructor for Merck Global Human Health. The remaining authors indicate no conflicts of interest.