O2184: Evaluation of a Curriculum in Adolescent Pregnancy Options Counseling Through an Observed Structured Clinical Exam

Background: We evaluated the effect of a curriculum in adolescent pregnancy options counseling on pediatric residents’ skills in pregnancy options counseling using an Observed Structured Clinical Exam (OSCE).

Methods: We developed a two-hour curriculum in adolescent pregnancy options counseling for pediatric residents in 2019. The curriculum objectives were to empower residents to provide unbiased, evidence-based pregnancy options counseling with pregnant adolescents. The curriculum consisted of a brief didactic followed by experiential cases with standardized patients. We updated the curriculum in 2022 to incorporate recommendations from people who experienced pregnancy during adolescence and other key community partners. The most notable update was the addition of a values clarification exercise. The updated curriculum debuted in April 2022 and was required of all PGY-1 pediatric residents in our institution.

To evaluate the curriculum, we developed an OSCE where pediatric residents performed pregnancy options counseling with a standardized patient acting as a pregnant adolescent. The OSCE was graded using a 15-item rubric with possible scores ranging from 0-15. The rubric included items addressing communication skills, appropriate language and content related to pregnancy options, and provision of appropriate referrals and/or discussion of next steps. Half of the pediatric resident participants completed the OSCE prior to the curriculum and half afterward. Mean scores on the OSCE were calculated for the two groups and compared by an independent samples t-test with two-tailed significance set at p < 0.05. Demographic characteristics were compared between pre/post groups using t-tests or chi-square analysis.

Results: 25 PGY-1 pediatric residents completed the OSCE (13 before the curriculum, 12 after the curriculum). Two participants had received prior training on pregnancy options counseling (8%) and both completed the OSCE prior to the training. The mean age of the participants was 29 years old. Sixty-four percent identified as women (n=16), and 76% identified as white non-Hispanic (n=19). There were no significant differences between the pre/post groups in terms of age, gender, or race and ethnicity. Mean score on the OSCE for those who completed it before the curriculum was 8.54 (standard deviation (SD)=4.60). Mean score on the OSCE for those who completed it after the curriculum was 13.25 (SD=1.36). Participants completing the OSCE after the curriculum performed significantly better than those completing the OSCE before the curriculum, p < 0.001.

Conclusion: In a pilot analysis, pediatric residents who completed a curriculum in adolescent pregnancy options counseling performed better on an OSCE assessing skills in pregnancy options counseling compared to pediatric residents who had not received this training. An OSCE is a feasible method to assess skills in adolescent pregnancy options counseling that may be used in clinical skills assessments or curriculum evaluations. This curriculum can serve as a replicable model to improve pediatric residents’ skills in adolescent pregnancy options