Pregnancy Options Counseling for Pediatric Residents and Fellows: Effectiveness, Acceptability, and Appropriateness

Abstract

BACKGROUND: Pediatricians are likely to encounter a pregnant adolescent in their lifetime of practice, yet many do not obtain clinical experience in pregnancy options counseling during residency.

OBJECTIVE: To assess the effectiveness and perceived acceptability and appropriateness of a 2-hour interactive training in pregnancy options counseling including role-play simulation.

METHODS: Pediatric residents on their adolescent medicine rotation participated in a required training in options counseling for adolescents each month between July-December 2022. Pediatric fellows were invited to participate if desired. Participants completed anonymous surveys on Redcap before and after training. We utilized 4-option Likert-scale measures ranging from “1= not at all important” or “1= strongly disagree” to “4 = very important” or “4 = strongly agree” looking at knowledge and attitudes related to pregnancy options counseling. The post-training survey also included the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) which each utilize a mean of 4 different questions with 5-option Likert scale responses ranging from “1=completely disagree” to “5=completely agree.” This study was deemed exempt by the Indiana University Institutional Review Board. We used IBM SPSS (28.0) to perform descriptive statistics and Wilcoxon sign tests to analyze baseline and post-training data.

RESULTS: 145 individuals completed the baseline survey. Of 33 participants who completed the training, 75% (n=25) filled out the post-participation survey. These were 3 pediatric fellows, 13 categorical pediatric residents, 8 combined pediatric residents, and 1 who did not disclose. Baseline demographics did not differ significantly between those who did or did not complete the post-test.

Only 60% (n=15) of post-test completers correctly selected “parenting, adoption, abortion” as the three options to discuss during options counseling pre-training, but 92% (n=23) selected the correct answer after the training. Only 52% of participants (n=13) knew about judicial bypass requirements compared to 76% (n=19) post- training.

Median AIM-Acceptability and IAM-Appropriateness scores post-intervention were high at 5.00 (IQR 1.00) and 4.75 (IQR 1.00). 85% (n=22) of participants endorsed the 2-hour training period as having “just the right amount of time. 81% (n=21) strongly agreed with the training’s value to their medical education.

There were statistically significant improvements in attitudinal measures: participants’ perceived ability to discuss parenting (p<.001), adoption (p=.002), and abortion (p<.001); feeling knowledgeable about pregnancy-related resources (p<.001); and confidence making prenatal referrals for prenatal services (p<.001), abortion services (p=.002), and adoption services (p<.001).

Participants rated some measures highly at baseline, with no significant change between pre-test and post-test: the importance of pregnancy options counseling training for pediatric residents, discussing all options as consistent with professional medical practice, and endorsement of referring to another colleague if they could not discuss all options. These measures all had a median of 4.00 and a mean of 3.88 on the pre-test.

CONCLUSIONS: Pediatric residents showed gains in knowledge in and confidence around pregnancy options counseling for adolescents after completing a 2-hour interactive training. This format of training was rated highly in value to medical education, acceptability, and appropriateness by participating pediatric residents.