Board #113 - Research Abstract Pediatric Resident Interactions in Clinical Simulation With an LGBTQ Patient (Submission #8531)

Hypothesis Obtaining a confidential social history with a teenage patient, including a discussion of sexuality, is an important skill for pediatric residents to acquire. In 2013, the American Academy of Pediatrics Committee on Adolescence published “Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth. ” This policy statement highlighted the importance of creating an inclusive environment for LGBTQ youth in the pediatrician’s office, emphasizing patient confidentiality and the use of inclusive language. However, pediatric residents at our institution have limited educational experiences focused on caring for LGBTQyouth. To bridge this educational gap, we created a simulation experience that would allow residents to discuss sexuality with a teenage patient. Our hypothesis was that clinical simulation would be useful not only in the assessment of resident abilities to discuss sexuality, but also as teaching tool to improve resident comfort level and competency. Methods A clinical scenario was created with a standardized patient playing the role of an adolescent questioning his sexuality. Surveys were completed before and after the experience that assessed resident skill level in discussing sexuality, as well as the acquisition of new skills. Eight residents participated in an initial pilot project to test the clarity of the scenario design. Sixteen residents were randomly selected for the study group, consisting of eight intern (PGY-1) and eight senior (PGY-3) residents. Participants were given ten minutes to interview the patient, followed by a face-to-face debriefing session. Debriefing focused on identifying areas of discomfort, alternative phrasing for use in future encounters, and included feedback from the standardized patient. The simulation session was videotaped to allow investigators to compare resident interactions during key components of the interview as well as responses to specific statements from the standardized patient. Results Videos of the clinical scenarios were analyzed to assess interactions at specific portions of the interview, and responses to set questions and statements from the patient. Survey responses and video results were summarized as a group, and compared between PGY-1 and PGY-3 classes. We found that 63% of residents did not discuss adolescent confidentiality prior to asking personal questions in the social history. Also, 38% of residents used the phrase “Are you sexually active” as the opening question in discussing relationships and sexuality. A referral to a psychologist or counselor to discuss sexuality was recommended by 43% of residents. When asked to describe their skill level in discussing sexuality with patients who are LGBTQ, 63% of PGY-1 residents and 25% of PGY-3 residents stated an improvement in their skill level after completing the simulation and debriefing. All surveyed residents stated the experience would change their discussion of sexuality in clinical practice. Conclusion This project supported our hypothesis that clinical simulation could help assess how residents discuss sexuality with adolescent patients, and assist in skill development. While a majority of residents in our scenario stated that same-sex attraction was a normal variant of sexual development, some wanted to refer the patient to a psychologist. This suggests that residents were not comfortable or competent discussing these issues on their own. Many residents did not properly address adolescent confidentiality, nor use age-appropriate language to discuss relationships and sexuality. This showed that residents had yet to develop scripts to help facilitate such common discussions. The Pediatric Milestones Project includes the use of such scripts in the assessment of patient care competency, giving clinical simulation a unique role in both assessment and education. Therefore, clinical simulation should be a considered in curriculum development focused on the care of LGBTQ youth. References 1. Committee on adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics. 2013; 132: 198-203. 2. The Pediatrics Milestone Project. Available at: https://www.abp. org/abpwebsite/publicat/milestones.pdf Accessed June 1, 2014. Disclosures None