Pediatr Emerg Med J.  2024 Jul;11(3):99-106. 10.22470/pemj.2024.00955.

A modified Delphi study for development of an adolescent medicine curriculum for emergency medicine residents

• Williams ES
• Bretz LA
• Fisher KM

• KMID: 2557047
• DOI: http://doi.org/10.22470/pemj.2024.00955

Abstract

Purpose
More than 1,500,000 adolescents in the United States report using emergency services for the majority of their medical needs. Although the American Council for Graduate Medical Education offers some guidance on the inclusion of pediatric topics in an emergency medicine (EM) residency curriculum, it does not specifically address adolescent-related competencies. We aimed to develop a consensus on which adolescent health topics are most important to cover in a didactic curriculum for EM residents.
Methods
Physicians from multiple specialties, such as EM, pediatric EM, and adolescent medicine, were invited as panelists in a modified Delphi process. In round 1, the panelists were asked to determine which competencies in adolescent medicine are most important for a graduating EM resident to master. In round 2, they were asked to specify the competencies that should be included in an EM residency didactic curriculum. In round 3, they prioritized the most critical competencies for curriculum inclusion.
Results
Consensus was reached on a total of 26 topics that were found crucial to be included in a didactic curriculum for EM residents. Of these, the panel prioritized the following: (1) “manage a patient presenting after reported sexual assault,” (2) “accurately diagnose ovarian torsion,” and (3) “manage a patient presenting for symptoms of sexually transmitted infection.”
Conclusion
The modified Delphi process yielded recommendations to guide the development of an adolescent medicine curriculum for EM residents. Sexual and reproductive healthcare issues were identified as the most important topics.

Keyword

Adolescent Medicine; Curriculum; Delphi Technique; Education, Medical, Graduate; Emergency Medicine; Internship and Residency

Figure

• 

  Fig. 1. An overview of the Delphi process.

Reference

References

1. Zink BJ. Preface. In: Zink BJ. Anyone, anything, anytime: a history of emergency medicine. Mosby Elsevier; 2006. p. 6-11.

2. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018; 2:223–8.

3. Weiss AL, D’Angelo LJ, Rucker AC. Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? J Adolesc Health. 2014; 54:416–20.

4. Mitzman J, King AM, Fastle RK, Hopson LR, Hoyle JD Jr, Levasseur KA, et al. A modified Delphi study for development of a pediatric curriculum for emergency medicine residents. AEM Educ Train. 2017; 1:140–50.

5. Goyal M, Zhao H, Mollen C. Exploring emergency contraception knowledge, prescription practices, and barriers to prescription for adolescents in the emergency department. Pediatrics. 2009; 123:765–70.

6. Northern Ireland Commissioner for Children and Young People (NICCY). Still waiting: a rights based review of mental health services and support for children and young people in Northern Ireland [Internet]. NICCY; 2018 [cited 2021 Nov 13]. Available from: https://www.niccy.org/wp-content/uploads/media/3114/niccy-still-waiting-report-sept-18-web.pdf.

7. Alele FO, Emeto TI, Callander EJ, Watt K. Non‐urgent paediatric emergency department presentation: a systematic review. J Paediatr Child Health. 2019; 55:271–7.

8. Beeson MS, Bhat R, Broder JS, Gaeta TJ, Janssen A, Karl ER, et al. The 2022 model of the clinical practice of emergency medicine. J Emerg Med. 2023; 64:659–95.

9. Society for Adolescent Health and Medicine (SAHM). Adolescent medicine resident curriculum [Internet]. SAHM; 2020 [cited 2023 Mar 23]. Available at: https://adolescenthealth.org/training-and-cme/adolescent-medicine-resident-curriculum/.

10. Williams ES, Guerrero N, Sisson A, Fisher KM. Assessing the gap in adolescent emergency care training for emergency medicine residents: a systematic review. Cureus. 2023; 15:e40814.

11. Ludlow J. Delphi inquiries and knowledge utilization. In: Linstone HA, Turoff M, editors. The Delphi method: techniques and applications. Addison-Wesley Publishing Co.; 1975. p. 97-118.

12. Humphrey-Murto S, Varpio L, Wood TJ, Gonsalves C, Ufholz LA, Mascioli K, et al. The use of the Delphi and other consensus group methods in medical education research: a review. Acad Med. 2017; 92:1491–8.

13. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42:377–81.

14. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019; 9:95103208.

15. Witkin BR, Altschuld JW. Specialized survey and group techniques for data gathering and analysis. In: Witkin BR, Altschuld JW. Planning and conducting needs assessments: a practical guide. Sage Publications, Inc.; 1995. p. 186-208.

16. Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Inf Manag. 2004; 42:15–29.

17. Boel A, Navarro-Compán V, Landewé R, van der Heijde D. Two different invitation approaches for consecutive rounds of a Delphi survey led to comparable final outcome. J Clin Epidemiol. 2021; 129:31–9.

18. Balingit M. ‘A cry for help’: CDC warns of a steep decline in teen mental health: more than 4 in 10 told the health agency they felt ‘persistently sad or hopeless’ [Internet]. The Washington Post; 2022 Mar 31 [cited 2024 May 8]. Available from: https://www.washingtonpost.com/education/2022/03/31/student-mental-health-decline-cdc/.

19. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010; 49:980–9.

20. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62:617–27.

21. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000; 32:1008–15.

22. Hsu CC, Sandford BA. Minimizing non-response in the Delphi process: how to respond to non-response. Pract Assess Res Eval. 2007; 12:17.