In North America and Australia there are recognized training programs in adolescent health. In the U.K. provision of training in adolescent health is limited. In 2006, there were still no formal training programs outside mental health in the UK and only one consultant in adolescent medicine in the country. Within hospital practice in the U.K. surveys of clinics have found no adolescent service provision to be available in two thirds of pediatric gastroenterology clinics (32), 47% of pediatric diabetes services
(33) and 82% of rheumatology units seeing children (34). Therefore it is unlikely that the majority of trainee rheumatology professionals have had much exposure to adolescent health. The Royal College of Physicians in the United Kingdom has stated that training in adolescent health should be mandatory for both undergraduates and the trainees of all Royal Colleges whose members may be involved in the care of young people" (29). Adolescent health and transitional care have now been integrated into the training curricula in both pediatric and adult rheumatology in the United Kingdom.
From the undergraduate perspective the newer medical schools in the United Kingdom are defining adolescent health as a subject within their curriculum (35). However in a 2003 survey of general medical textbooks available to medical undergraduates in Birmingham, U.K., only 5 out of 12 pediatric books had a chapter on adolescent issues, which represented 2% of the total pages, and none of the adult medicine textbooks were identified (36).
Examples of web-based curricula readily available are detailed in Table 1. The EuTEACH program aims to train individuals to be able to deliver training themselves in adolescent health care and the web-site acts as a resource for this (28). A multidisciplinary modular program based on the EuTEACH curriculum has recently commenced at Birmingham University, U.K.
The National Training Initiative in Adolescent Health (NTIAH) is a Canadian-based comprehensive multidisciplinary training program for professionals working with youth. It aims to incorporate a youth health curriculum as an essential component of fully accredited training programs for graduates and practicing professionals in a variety of health-related fields. It was developed after a review conducted by the Canadian Pediatric
Table 1 Examples of Adolescent Health Curricula for Health Professionals
European initiative to provide web-based teaching resources for adolescent health www.repch.ac.uk/Education/Adolescent.Health-Project U.K. initiative to develop e-learning packages for adolescent health Canada
National Training Initiative in Adolescent Health http://www.cps.ca/english/prodev/NTIAH/index.htm Australia
Centre for Adolescent Health, Melbourne www.caah.chw.edu.au United States
University of Southern California http://www.usc.edu/adolhealth/
Society of the adolescent medicine content of pediatric resident training programs in Canadian medical schools revealed serious inadequacies (37)
Recruiting professionals who are keen to develop skills in the adolescent health historically has been difficult. Blum conducted the first U.S. national survey of primary care physicians' perceptions of their competency in dealing with adolescents' health concerns. This found that only 27% of doctors were interested in further training despite reporting deficiencies in many key areas of knowledge (38). In a survey of medical practitioners in a large, multi-specialty, group practice, Klitsner et al. found that only a third of those surveyed which included pediatricians, internists, obstetricians, and gynecologists, family doctors actually reported that they liked caring for adolescents (39). More recently, though, reports have suggested increased awareness and interest in improving skills (15,16,18).
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