Oriaku Kas-Osoka, MD, MEd
Cincinnati Children's Hospital Medical Center
Purpose: One focus of resident education in adolescent medicine is contraception and it is difficult to assess how effective this education is on patient knowledge. Competencies, including interpersonal and communication skills, and evaluation continue to be a focus of the American Board of Pediatrics (ABP) and Accreditation Council on Graduate Medical Education (ACGME). There is no literature assessing real-time education and communication between residents and patients regarding contraception. The purpose of this study was to (a) describe patient characteristics and contraception knowledge in adolescents, (b) describe resident characteristics and contraception education provided to adolescents, and (c) identify what factors associated with resident-patient interaction contributed to higher patient contraception knowledge, after accounting for patient- and resident-level factors, in an urban teen health center.
Methods: In this IRB approved study, resident physicians (n=33) and adolescent girls aged 14- 21 years (n=33) were recrnited from an urban primary care clinic to complete surveys regarding demographics, contraception knowledge and education, and resident interpersonal/ communication skills. Data were analyzed using descriptive statistics for adolescent- and resident-level factors. Bivariate analyses were utilized to determine potential association between adolescent- and resident-level factors and patient contraception knowledge (SPSS 21.0). Findings were used to inform a multivariable linear regression model to determine if contraception education, patient- or resident- level factors, and resident interpersonal and communication skills significantly impacted patient contraception knowledge.
Results: 94% of the female adolescents were Black/African-American. Patients chose Combined Contraceptive (n= 15) and Depo-Provera (n=l 8) as their form of conh·aception. For the
Combined Contraceptive group, 13% recognized Combined Contraceptive association with decreased cancer risk, 53% of the patients knew what to do if pills were missed, and 53% knew that they did not need to take a break every few years. For the Depo-Provera group, 44% knew its relationship to bone health and 56% recognized its relationship to getting pregnant after injection discontinuation. The reliability statistic for the scale for percentage of resident-patient visit spent on contraception education was 0.85 for Combined Conh·aceptives, 0.76 for Depo Provera. For the Combined Contraceptive group, 80% of the residents did not discuss its relationship to cancer; 60% did not discuss its relationship to getting pregnant after stopping Combined Contraceptives; 47% did not discuss that this method could be used for years without stopping. For the Depo-Provera group, 83% of residents did not discuss its relationship to getting
pregnant after injection discontinuation; 39% did not discuss its relationship to bone health. The reliability statistic for the scale for resident interpersonal/communication skills was 0.97. Residents were rated perfectly for their interpersonal/communication skill items 58-76% of the time, but 55% of residents were less than perfect at discussing confidentiality. At Ps0.05, the regression models showed that a previou s use of birth control and the birth control method positively impacted patient conh·aception knowledge. No relation ship was found between resident interpersonal/communication skills and patient contraception knowledge.
Conclusions: This study was limited by sample size. Despite resident report of education provided, patient conh·aception knowledge was lacking regarding relationship between stopping contraception and getting pregnant, Combined Contraceptives and cancer, Combined Contraceptives and missed doses, and Depo-Provera and bone health. Adolescents reliably assessed resident interpersonal/communication skills but felt residents did not discuss confidentiality perfectly compared to other skills. Promising factors that may lead to increased contraception knowledge include previous history of bitth control use, while other patient- and resident-level factors were not statistically significant.
