Evidence For Educational Interventions For Adolescent Health Care

Evidence is accumulating for the benefits of educational interventions in adolescent health care particularly in higher rates of desired clinical practices such as confidentiality, screening for health risk behaviors. Marks et al. found that out of 101 general pediatricians surveyed those with some training in adolescent medicine during residency were significantly more likely to provide care and anticipatory guidance related to sexuality and substance abuse (23). Pediatric residents at a university children's hospital were also more likely to screen for these issues and record them if they had some postgraduate-level experience and had been on a prior adolescent rotation (24). Key et al. in a survey of Canadian pediatricians reported a greater number of adolescents seen and a greater tendency for engagement in continuing education in adolescent health if adolescent medicine training was received during residency years (25).

A randomized controlled trial has been published of a multifaceted educational program delivered weekly for 2.5 hours for six weeks on the principles of adolescent health care for GPs in Melbourne, Australia. This showed sustainable, large improvements in knowledge, skill, and self-perceived competency in the group randomized to the education program compared to the controls, with the exception of rapport and satisfaction rating by the standardized patients. Competence was measured objectively with videotaped consultations (26). At 5-year follow up, scores were all higher than at baseline, improvements were sustained and 54% of doctors had been involved in further training (27).

The European Training in Effective Adolescent Care and Health (EuTEACH; www.euteach.com) working group has developed a curriculum that covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender, and cultural issues) as well as specific themes (i.e., sexual and reproductive health, eating disorders, chronic conditions). It is a modular, flexible program, each module containing detailed objectives, learning approaches, examples, and an evaluation method. Evaluation after two summer schools was good overall, with most items surpassing three on a four-point Likert scale. However, some deficiencies were identified, and an increase in interactive sessions (role playing) and a better mix of clinical and public health issues were suggested as useful additional features of the course for future participants (28).

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