Residency Training in Pediatric and Adolescent Gynecology Across Obstetrics and Gynecology Residency...

Poster Abstracts / J Pediatr Adolesc Gynecol (2013) e55ee71e70

Comments: Ovarian germ cell tumors occur in adolescents and youngwomen. Yolk sac tumors are an aggressive malignancy subtype. Pediatri-cians and emergency room physicians are the first to encounter thesepatients. Given the rapid growth of these malignancies, patients presentwith a brief duration of symptoms as demonstrated by our case series.Patients had a palpable pelvic mass and imaging studies reveal a complexsolid mass with cystic components. Serum AFP is a highly sensitive markerfor yolk sac tumors and critical to preoperative diagnosis and counseling. Adetailed history, clinical exam and high index of suspicion can yield timelyimaging and intervention.

35. Residency Training in Pediatric and Adolescent Gynecology AcrossObstetrics and Gynecology Residency Programs: A Cross-Sectional Study

Ellen R. Solomon MD, Tyler M. Muffly MD, Carrie Hood MD,Marjan Attaran MDObstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic,Cleveland, OH

Study Objective: To estimate the prevalence of Pediatric and AdolescentGynecology formal training in the United States Obstetric and Gynecologyresidency programs.

Table 1Demographic Comparison of Programs With PAG Rotation vs. No PAG Rotation

Total(N ¼ 105)

PAG rotation(N ¼ 18)

No PAG rotation(N ¼ 87)

n % n % n % P

Location (N ¼ 102)Region 1 21 21 3 17 18 21 0.134Region 2 20 20 3 17 17 20Region 3 21 21 5 28 16 19Region 4 27 27 6 33 21 25Region 5 12 12 0 0 12 14Other 1 1 1 6 0 0

Type of obstetrics andgynecology residencyprogram (N ¼ 102)

0.411

Community 27 27 3 17 24 29Military 3 3 0 0 3 4University 69 68 15 83 54 64Other1 3 3 0 0 3 4

Affiliated with a children’shospital (N ¼ 104)

Yes 61 59 16 89 45 52 0.004No 43 41 2 11 41 48

# faculty who practicePAG (N ¼ 105)

0 faculty 26 25 2 11 24 28 0.4271 faculty 32 31 6 33 26 302 faculty 17 16 3 17 14 163 faculty 15 14 5 28 10 124 to 10 faculty 13 12 2 11 11 13More than 10 faculty 2 2 0 0 2 2

PAG fellowship trainedfaculty (N ¼ 105)

Yes 18 17 6 33 12 14 0.079No 87 83 12 67 75 86

PAG fellowship atinstitution (N ¼ 104)

Yes 7 7 6 33 1 1 <0.001No 97 92 12 67 85 99

PAG clinic where residentssee patients (N ¼ 104)

Yes 39 37 18 100 21 24 <0.001No 65 63 0 0 65 76

# Residents apply for PAGfellowship (N ¼ 104)

0 residents 96 92 14 78 82 95 0.0041 resident 6 6 2 11 4 52 residents 0 0 0 0 0 03 residents 0 0 0 0 0 04 to 10 residents 2 2 2 11 0 0More than 10 residents 0 0 0 0 0 0

1 Identified as an independent-university affiliated practices

Design: Prospective, anonymous, cross-sectional survey study.Participants: United States program directors of Obstetrics and Gyne-cology residency programs (N¼242; Respondents 108 (45%).Results: Among 104 residency programs, 63% (n¼65) have no formal,dedicated Pediatric and Adolescent Gynecology clinic, while 83% (n¼87)have no outpatient Pediatric and Adolescent Gynecology rotation. There isno significant difference in the amount of time spent on a Pediatric andAdolescent Gynecology rotation among residents from institutions witha Pediatric and Adolescent Gynecology fellowship (p¼0.359); however, thenumber of surgeries performed is significantly higher than those withouta Pediatric and Adolescent Gynecology fellowship (p¼0.0020). Wheninvestigating resident competency in Pediatric and Adolescent Gynecology,program directors reported that residents who were taught in a programwith a fellowship-trained Pediatric and Adolescent Gynecology facultywere significantlymore likely to be able to interpret results of selected testsused to evaluate precocious puberty than those without (p¼0.03).Conclusions: Residency programs without fellowship trained Pediatricand Adolescent Gynecology faculty or an established Pediatric andAdolescent Gynecology fellowship program have a lack of formal trainingand clinical exposure to Pediatric and Adolescent Gynecology. This infor-mationmay enable residency directors to identify deficiencies in their ownresidency programs and to seek improvement in resident clinical experi-ence in Pediatric and Adolescent training.

36. Presentation Patterns of Adolescents With Platelet FunctionDisorders Affected With Heavy Menstrual Bleeding

Lawrence S. Amesse MD, PhD, MMM1,2, James French II MD 2,Nancy Duffy RN 2, Teresa Pfaff-Amesse MD1

1Department of Obstetrics and Gynecology

2Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton,OH, 45434

Background: Platelet function disorders (PFD) are a common etiology ofheavy menstrual bleeding (HMB) in young adolescents. Clinicians caringfor these patients should be aware of the presentation profile in order toeffectively screen and treat this disorder.Materials and Methods: Retrospective study of post-menarcheal teenswith documented PFDs seen at a hemophilia treatment center anduniversity faculty practice.Results: Of 63 post-menarcheal adolescents with documented PFDsidentified, HMB was the most common bleeding symptom (43; 68%).Of the 43, 86% were diagnosed with a PFD after menarche based onmenstrual dysfunction, compared with only 14% that were diagnosed withPFD prior to achieving menarche. In these patients, platelet studies wereinitiated based on associated bleeding symptoms, including easy bruis-ability, epistaxis, etc. A total of 20 patients were diagnosedwith a PFD priorto achieving menarche with only 30% manifesting HMB after themenarche, while 70% had normal menstrual periods. The average age-at-PFD diagnosis was 14.5�3.5yrs in patients affected with HMB where laterage at diagnosis was based on HMB the only bleeding symptom in 35%.This significantly differed from age-at-PFD diagnosis, mean 10.9�3.5yrs,observed in PFD patients that did not develop HMB after commencementof menarche (P<.01). The menarche-to-menorrhagia interval was 1.79�1.4yrs. Of interest, a largemajority,74%, of PFD girls affected with HMB had thestorage pool deficiency (SPD) compared with 45% of PFD teens that did notmanifest HMB after menarche was achieved (P<.007).Conclusion: HMB is the primary bleeding symptom in adolescents withPFDs, while in one-third it is the only bleeding symptommanifested. Theseyoung adolescents will often present with HMB 1-2yrs followingmenarche. A majority of PFD girls will have the SPD.

37. Congenital Venous Lymphatic Malformation as an Unusual Sourceof Premenarchal Vaginal Bleeding

Lori D. Homa MD, Yolanda R. Smith MD, Joseph Gemmete MD,Elisabeth H. Quint MDUniversity of Michigan Health System, Ann Arbor, MI