Practical Aspects Of Training Provision

While comprehensive theoretical knowledge of a field is important for appropriate practice, experiential learning is crucial for consolidating theoretical knowledge and for the development of interviewing, counselling and examination skills. It also allows development of experience in answering questions from patients and/or their carers and facilitates reflective learning. A consultation needs to be of adequate length so that it is effective and worthwhile for the patient and also allows the health professional to use all the resources/knowledge and experience to benefit the patient and gain further experience. The Royal College of Pediatrics and Child Health has recognized that longer consultation times are required for adolescent than for either children's or adult clinics (29). A comparison of pediatric and adult rheumatology clinics found that on average the pediatric clinic consultations were twice as long (30). This difference was maintained when young people older than 12 years were compared to the adult clinics (Robertson, and McDonagh, unpublished). However, Jacobsen et al. found that when comparing 119 consultations with young people aged 11 to 19 years, with 781 consultations with other age groups, the consultations with young people were actually shorter by 23% (31). This may have been for many reasons, including difficulty establishing rapport with young people, inadequate time allotted to explore issues fully, and organizational difficulties within the clinic workspace.

Young people themselves have been found to have difficulty with the experiential learning of health care professionals. The extent of their trust in the service provided for them may be reduced by the presence of strangers (e.g., students, trainees) in a consultation. However, young people do realize that professionals need to gain experience and training. Young people have suggested sessions separate from consultations where they are "case study" so that their clinic appointments are kept as their time rather than for the benefits of students (18).

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