(104) Sexual and Reproductive Health Care in Children’s Hospitals: Are We Adequately Preparing Pediatric Residents, and Are Adolescents Getting the Care They Need?

Background: Pediatricians are expected to provide sexual and reproductive health (SRH) care to adolescents assigned female at birth (AFAB), yet there is significant variability in their comfort level and knowledge base. Additionally, infrastructure to provide SRH care may be limited in children’s hospitals where pediatric residents spend much of their training. These studies assess training opportunities in SRH for pediatric residents and availability of SRH services at children’s hospitals.

Methods: We conducted two independent cross-sectional surveys. One surveyed third year pediatric residents’ training and perceived competency in SRH; the other surveyed children’s hospitals’ inpatient clinical leaders in the availability of equipment and workforce to provide SRH care. Descriptive statistics were used to characterize demographics and chi-squared tests to determine associations. Institutional review board (IRB) approved both studies.

Results: One-hundred eleven pediatric residents at 11 residency programs completed surveys (35% response rate). Of 11 programs, 8 (73%) were free-standing children’s hospitals. The majority of residents identified as female (74%) and white (61%). Only 40% reported pelvic exam training; 46% had training in contraceptive implant insertion and few residents (8%) had intrauterine device (IUD) insertion training. The most cited barrier to providing SRH care was insufficient training (57%) and lack of inpatient pediatric attending comfort (64%, p< 0.01). Similarly, for 52% of residents it was very or extremely challenging to perform inpatient pelvic exams compared to in other clinical sites (p < 0.001), more so in free-standing children’s hospitals (p < 0.001). The inpatient clinical leader survey included 52 Pediatric Hospital Medicine or Adolescent Medicine specialists (33% response rate), 22 (42%) from free-standing children’s hospitals. Seventeen (33%) clinicians reported no inpatient access to specula and 31 (60%) reported no exam tables with footrests for pelvic exams. Only 11 (21%) hospitals offered IUDs or contraceptive implants for inpatient adolescents.

Conclusions: Our findings suggest pediatric residents may not receive sufficient training to provide SRH care to AFAB adolescents, and children’s hospitals are not adequately equipped to provide this care to their AFAB patients. Implementation of enhanced SRH curricula in all training settings and increased buy-in from hospital leadership to procure appropriate equipment and trained clinicians may increase resident competence while improving SRH care for AFAB adolescents.