PURPOSE: To evaluate an adolescent-centered pregnancy options counseling curriculum for pediatric residents. METHODS: In 2022, we assessed the curriculum in one residency by randomizing half the residents to a pretraining or posttraining Observed Structured Clinical Exam (OSCE). We scored the OSCE by 15-item rubric and analyzed results by Wilcoxon Rank-Sum tests. From 2022 to 2023, we implemented the curriculum across 3 residencies. Surveys assessed knowledge and self-rated abilities before, immediately after, and 6-month posttraining. Two residencies also surveyed controls. We analyzed results using mixed-effects and ordinal logistic regression. RESULTS: 2022: 25 residents participated in the OSCE (13 pregroup, 12 post-group). Median score increased from 9/15 (interquartile range 8/15, 10/15) pretraining to 13/15 (13/15, 14/15) posttraining (p <
.05). 2022-2023: Residents in the training arm completed presurveys (n = 79), immediate postsurveys (n = 65), and 6-month postsurveys (n = 40). Median baseline knowledge score was 57% (24%, 83%), which improved immediately posttraining [90% (81%, 95%), p <
.05] and was sustained at 6 months [86% (57%, 90%), p <
.05]. Median baseline self-rated ability to discuss pregnancy options was 8/12 (7/12, 9/12) and increased immediately posttraining [12/12 (10/12, 12/12), p <
.05] with sustained improvement at 6 months [9/12 (8/12, 11/12), p <
.05]. Median baseline self-rated ability to provide pregnancy-related referrals was 6/12 (5/12, 8/12) which improved posttraining [10/12 (9/12, 12/12), p <
.05)] with sustained improvement at 6 months [8/12 (6/12, 9/12), p <
.05]. Control residents completed presurveys (n = 140) and 6month postsurveys (n = 94). Trained residents performed better at 6 months on all measures (p <
.05). DISCUSSION: Pregnancy options counseling training for pediatrics residents led to improved knowledge, abilities, and behavior.