Adolescent Medicine Training in Pediatric Residency Programs

ArticleinPEDIATRICS 125(1):165-72 · December 2009with10 Reads
DOI: 10.1542/peds.2008-3740 · Source: PubMed
Abstract
The aim of this study was to provide an assessment of pediatric residency training in adolescent medicine. We conducted 2 national surveys: 1 of pediatric residency program directors and the other of faculty who are responsible for the adolescent medicine block rotation for pediatric residents to elicit descriptive and qualitative information concerning the nature of residents' ambulatory care training experience in adolescent medicine and the workforce issues that affect the experience. Required adolescent medicine topics that are well covered pertain to normal development, interviewing, and sexual issues. Those least well covered concern the effects of violence, motor vehicle safety, sports medicine, and chronic illness. Shortages of adolescent medicine specialists, addictions counselors, psychiatrists, and other health professionals who are knowledgeable about adolescents frequently limit pediatric residency training in adolescent medicine. Considerable variation exists in the timing of the mandatory adolescent medicine block rotation, the clinic sites used for ambulatory care training, and the range of services offered at the predominant training sites. In addition, residents' continuity clinic experience often does not include adolescent patients; thus, pediatric residents do not have opportunities to establish ongoing therapeutic relationships with adolescents over time. Both program and rotation directors had similar opinions about adolescent medicine training. Significant variation and gaps exist in adolescent medicine ambulatory care training in pediatric residency programs throughout the United States. For addressing the shortcomings in many programs, the quality of the block rotation should be improved and efforts should be made to teach adolescent medicine in continuity, general pediatric, and specialty clinics. In addition, renewed attention should be given to articulating the core competencies needed to care for adolescents.
    • "These providers also play an important role in supporting their transition to adulthood. While these issues were challenging prior to the ACA [19], they are further exacerbated by the demands of the large influx of newly insured adolescents. Fourth, the prevention focused health care model will also likely need to involve a cultural shift in how youth conceptualize health care that includes placing greater value on preventive care services. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this commentary is to highlight some of the key policy changes under the Patient Protection and Affordable Care Act (ACA) that have the potential to improve health care services for adolescents as well as to draw attention to challenges that have yet to be addressed. This commentary stems from our prior policy research, which examined the extent to which the health care needs of adolescents were being considered in the early implementation phases of the ACA. This study was informed by a literature review and interviews with health care administrators, health policy researchers, and adolescent medicine specialists. The ACA has significantly expanded health insurance access; however, inequities in coverage and access remain. Primarily, the structure and financing of adolescent health care needs to be improved to better support the delivery of patient-centered, comprehensive care for this special population. Additionally, improvements in youths' awareness of their benefits under the ACA as well as a greater appreciation of preventive visits are critical. Furthermore, an unanticipated consequence of the ACA is that it exacerbates the risk of confidentiality breaches through explanation of benefits and electronic health records, which can compromise adolescents' access and utilization of health care services. Greater attention to improving and sustaining health promoting behaviors within the context of the ACA is critical for it to truly have a positive impact on adolescent health.
    Full-text · Article · Feb 2015
    • "Some studies in the literature have examined pediatric residents' and other trainees' clinical skills and/or knowledge of adolescent health care345678. Others have assessed pediatric residency training programs for the adolescent medicine training provided to their residents [9], and some have even looked at physicians' personal adolescent experiences or values and their subsequent effects on the delivery of health care to adolescent patients [10,11]. However, no studies to date have explored the experiences and perceptions of residents themselves during their postgraduate training in Adolescent Medicine and how such clinical experiences and exposure to different patient populations and patientprovider interactions may differ from the rest of their training in pediatrics. "
    [Show abstract] [Hide abstract] ABSTRACT: Although Adolescent Medicine is a pediatric subspecialty, it addresses many issues that differ from other aspects of pediatrics clinical training. The aim of this study was to explore the general experiences of pediatric residents during their rotations in Adolescent Medicine. Qualitative methods were applied. Semi-structured individual interviews were conducted with pediatric residents who had completed a rotation in Adolescent Medicine. Emergent themes were identified. Three key themes emerged: gaining exposure, taking on a professional role, and achieving self-awareness. Subcategories were also identified. There was particular emphasis on the multidisciplinary team and the biopsychosocial approach to adolescent health care. The experiences in Adolescent Medicine reflected residents' learning, notably gains in the "non-expert" as well as "medical expert" physician competencies. Future studies should explore how the interprofessional nature of an Adolescent Medicine team and the patient populations themselves contribute to this learning.
    Full-text · Article · Dec 2010
  • [Show abstract] [Hide abstract] ABSTRACT: he promise of health reform is not only that it will provide much needed health insurance for the 46 million Americans without coverage, but that it will also focus more resources on prevention and strengthen the delivery system to make it more effi cient and effective. Adolescents are an ideal target for health reform. They have signifi cant unmet physical, reproductive, and behavioral health needs associated with long-term personal and societal costs. Many low and moderate income adolescents are uninsured and have limited options for purchasing affordable, comprehensive coverage. Historic community-based provider arrangements, outmoded payment policies, and inadequate provider training and supply have resulted in health care delivery systems poorly structured to meet adolescents' health needs. Health reform offers an important opportunity to provide adolescents with appropriate and affordable coverage and to support a comprehensive primary care system that can respond earlier and more effectively to their needs. The National Alliance recommends that all low income children up to age 21 be considered a mandatory child eligibility group under Medicaid and CHIP and that all children up to age 21 have access to a benefi t package that places greater emphasis on prevention and offers comprehensive physical, mental, and oral health services to enable them to achieve and maintain optimal health and functioning. Reforming the delivery system for adolescents will require a variety of payment reforms for all primary care providers and new funding mechanisms for those interested in offering enhanced models of comprehensive, interdisciplinary care. In addition, federal support is needed to improve the training and supply of medical and mental health professionals with expertise in caring for adolescents.
    Article · · BMC Medical Education
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