Adolescent development: a biopsychosocial review

Training physicians in communication skills with adolescents using teenage actors as simulated patients

Role-play exercises with simulated patients may serve the purpose of training professionals to develop appropriate communication skills with adolescents. Authentic adolescent responses toward the physicians may be achieved by actors who themselves are in their teenage years. We describe our experience in continuing medical education programmes for primary care physicians aimed at improving their skills in communicating with adolescents, using simulation methodology with teenage actors. Eight 16-17-year-old actors from the drama department of a high school for the arts were trained to simulate 20 cases with characteristic adolescent medical problems, as well as confidentiality issues and home and school problems. The actors performed in front of large groups of 20-30 paediatricians, family practitioners, or gynaecologists in continuing medical education. Diagnostic issues as well as therapeutic and management approaches were discussed, while the actors provided feedback to the trainees about their understanding and their feeling regarding the issues raised during the exercises. Normally, smaller learning groups are more suitable for such training purposes; nevertheless the participants could appreciate learning the principles of careful listening, a non-judgmental approach and assuring confidentiality. A collaboration of medical schools and postgraduate programmes with high schools which have drama departments may be fruitful in the teaching of adolescent medicine with special emphasis on communication skills with teenagers.

Why adolescent medicine?

This article reviews the biologic, cognitive, and sociocultural changes that occur during adolescence. Providing appropriate health care to adolescents in an effective manner requires an in-depth understanding of these changes, both in terms of preventing the onset of health-risking behaviors and promoting a healthy lifestyle. As many chronic diseases of adults have their origins during adolescence, this approach holds promise for reducing morbidity and mortality in later life as well as during young adulthood. There is an emerging consensus regarding the scope and content of preventive services for adolescents. The approach to incorporating these services into the health maintenance visit for young people is reviewed.

Sexual concerns of adolescents with cancer

The sexually related concerns of adolescents with cancer were compared with those of healthy adolescents. Forty-one adolescents age 12 to 19 years participated. A sexual concerns questionnaire was used. The study had three primary objectives: (1) to identify concerns related to physical, emotional, and behavioral aspects of sexuality present among all adolescents in the study; (2) to determine if there were differences between sexual concerns of adolescents with cancer and those of healthy adolescents; and (3) to determine whether a relationship existed between age and the concerns adolescents had about sexuality. Results of the study indicate that although no age-linked trends in sexually related concerns existed for the adolescents studied, adolescents had concerns regarding sexuality. Adolescents with cancer did not seem to be any more concerned about common developmental aspects of sexuality than healthy adolescents. However, adolescents with cancer had numerous sexually related concerns not identified by healthy adolescents. These concerns seem to relate to being treated for cancer. They included worries about hair loss, feeling isolated, ability to have children, and children having genetic or congenital defects. Nurses who care for adolescents with cancer can provide education and support regarding sexual concerns to help adolescents cope with and resolve some of these treatment-related anxieties. Further research that includes in-depth, narrative interviews could give better insight into the concerns that both adolescents with cancer and healthy adolescents have about sexual issues.