Pediatric and adolescent gynecology (PAG) is a lesser-known subspecialty within gynecology that focuses on the care for adolescents aged 10-19, in line with the World Health Organization definition.2

In Malaysia, with a population of 33.5 million, 4.44 million of whom are adolescent girls,3 there were only 7 PAG specialists and 5 trainees under the Ministry of Health at the time of this survey, resulting in a ratio of 1:370,000 girls.

Therefore, it is crucial to educate general health care providers (HPs) about this specialty to facilitate appropriate referrals to the limited PAG service. This underscores the importance of training and education in improving the system. A survey was thus essential to assess the current level of awareness and to support budget planning for future training programs.

Malaysia's health care system comprises dichotomous public-private sectors. The government-funded public health care system forms the backbone, and the private health care sector complements the system for those who can afford it. Due to the high patient volumes, the public sector employs a structured referral system to triage patients. Patients are initially assessed by HPs before being referred to specialists. This system ensures appropriate triaging, on the basis of the patient needs, highlighting the importance of competency among referring HPs.

To date, no study has examined the level of awareness among HPs regarding the availability of the PAG subspeciality in Malaysia, which was established in 2008. Furthermore, there are no clear referral pathways for adolescents, creating a practical clinical dilemma, particularly among junior HPs and those working in settings without access to specialists. Consequently, many decisions are made on the basis of personal judgements and the availability of expertise.

Only a few studies have examined PAG knowledge and training programs, primarily in Western countries.4., 5., 6. A recent publication by Cosgrave et al demonstrated a deficit in PAG knowledge among pediatric and general practitioner trainees in Ireland, recommending the inclusion of PAG training in their curriculum.4 We hypothesized that our population would similarly show a deficiency, especially considering that this gap is evident even in developed countries.

A cross-sectional survey was conducted nationwide among registered Malaysian HPs using an online platform. The survey, written in English, consisted of 5 questions developed by the investigators on the basis of their clinical experience. To establish content validity, the questions were reviewed for clarity, readability, and comprehension by 20 HPs. All participants were able to understand and complete the survey within 5 minutes.

This study was registered under the National Medical Research Register, Ministry of Health. Ethical approval was obtained from the Medical Research Ethics committee, 23-02642-MYT(2). Data were analyzed using SPSS 25.0 for Windows (SPSS, 2017). Descriptive statistics were reported by median and interquartile range (IQR), for continuous variables and by frequency and percentage for categorical variables. Inferential analysis was performed using the χ2 or Fisher's exact test, with a P value of .05 or less considered statistically significant.