Advancing Medical Education Training in Adolescent Health

Abstract

Providing comprehensive care to adolescents is a multifaceted undertaking, requiring not only routine medical services but also health education, risk reduction, mental health, behavioral health, and sexual health services. Yet, this vital spectrum of care is unavailable to most adolescents. Not only is there a paucity of adolescent medical specialists, but many pediatricians—the providers increasingly likely to care for adolescents—report that they lack training and confidence in diagnosing and managing adolescents' psychosocial and reproductive problems. Although this issue has not been the subject of much research, 1 national survey of pediatricians in 1998 found that 57% cited lack of training in gynecological care and 40% reported lack of training in mental health as significant barriers to providing needed services to adolescents.1 Incenter Strategies' recent national surveys of adolescent medicine fellowship program directors, pediatric residency program directors, and adolescent medicine faculty in pediatric residency programs show a high degree of support for new options to enhance clinical training in adolescent medicine. The response rates, ranging from 75% to 88%, underscore the salience of this issue for academicians. Currently, pediatric residency programs, like other primary care residency programs, are not structured to give in-depth attention to adolescent medicine. The required rotation for adolescent medicine is just 1 month, with that time allotment exceeded by only 5% of residency programs. During the rotation, residents receive at least some training on a wide variety of adolescent health issues. Yet, in our survey, a third or more of adolescent medicine faculty responsible for the one-month rotation report that, in terms of clinical practice and application, exposure to key adolescent medicine topics is limited. Faculty report that areas such as anticipatory guidance, health promotion, disease prevention, chronic illness, mental health and behavioral health are only somewhat covered or not covered at all. Residents generally train … Address correspondence to Harriette Fox, MSS, CEO, Incenter Strategies, 750 17th St, NW, Suite 1100, Washington, DC 20006. E-mail: hfox{at}incenterstrategies.org