Jayamaha Dharshinie, Finocchario-Kessler Sarah, Giovanni Joan, Michael Jeffrey, Moffatt Mary E, Sherman Ashley K, Miller Melissa K
Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS.
Pediatr Emerg Care. 2019 Jun;35(6):397-402. doi: 10.1097/PEC.0000000000001670.
The aim of this study was to evaluate a novel educational intervention for physician trainees to improve sexual health care provision, including condom distribution, in the pediatric emergency department.
Resident physicians and medical students in an urban pediatric emergency department viewed an evidence-based educational video on sexual health care provision. It featured role-plays and a description of the condom distribution process, and targeted trainees who provide health care to patients aged 14 years or more with potential genitourinary complaints. Trainees completed pre- and postintervention surveys to assess attitudes, motivation, and confidence for 4 recommended practices (Likert scale, 1 = not at all to 4 = extremely). We used Wilcoxon signed rank tests to assess differences in paired responses to motivation and confidence statements. A subset of 33 trainees completed a brief survey to assess condom distribution during emergency department clinical encounters.
Of 56 trainees, 51 (91%) participated: 53% female, 58% from pediatrics. At baseline, participants reported high levels of confidence and motivation to provide sexual health care. Postintervention, there were significant increases in the proportion of participants who reported greater motivation and confidence to (1) ask a parent to step out of the room, (2) obtain sexual history, (3) discuss condom use, and (4) offer condoms (all P < 0.05). Postintervention, fewer participants "agreed/strongly agreed" that there is inadequate time to obtain sexual histories (22% vs 45%; P < 0.05). Most (60%) sexually active patients accepted condoms during clinical care.
In this pediatric emergency department, a low-cost intervention showed promise to improve trainee attitudes, motivation, and confidence toward adolescent sexual health care provision. These data may inform strategies to improve access to care for this population.
本研究旨在评估一种针对医师培训学员的新型教育干预措施，以改善儿科急诊科的性健康护理服务，包括避孕套发放。
城市儿科急诊科的住院医师和医学生观看了一段关于性健康护理服务的循证教育视频。视频中有角色扮演以及避孕套发放过程的描述，目标受众是为14岁及以上有潜在泌尿生殖系统问题的患者提供医疗服务的学员。学员在干预前后完成调查问卷，以评估对4项推荐做法的态度、动机和信心（李克特量表，1 = 完全不，4 = 极其）。我们使用威尔科克森符号秩检验来评估对动机和信心陈述的配对反应差异。33名学员的子集完成了一项简短调查，以评估急诊科临床诊疗期间的避孕套发放情况。
56名学员中有51名（91%）参与：53%为女性，58%来自儿科。在基线时，参与者报告提供性健康护理的信心和动机水平较高。干预后，报告在以下方面有更大动机和信心的参与者比例显著增加：（1）要求家长离开房间，（2）获取性病史，（3）讨论避孕套使用，（4）提供避孕套（所有P < 0.05）。干预后，较少参与者“同意/强烈同意”没有足够时间获取性病史（22%对45%；P < 0.05）。大多数（60%）性活跃患者在临床护理期间接受了避孕套。
在这个儿科急诊科，一项低成本干预措施有望改善学员对青少年性健康护理服务的态度、动机和信心。这些数据可为改善该人群获得护理的策略提供参考。
