Adolescent medicine: A new paediatric subspecialty in Canada

Adolescent medicine training in postgraduate family medicine education: a scoping review

INTRODUCTION

Adolescents and young adults require age-appropriate healthcare services delivered by clinicians with expertise in adolescent medicine. However, resident family physicians report a low perceived self-efficacy and under-preparedness to deliver adolescent medical care. We conducted a scoping review to map the breadth and depth of the current evidence about adolescent medicine training for family medicine residents.

CONTENT

We followed Arksey and O'Malley's framework and searched seven electronic databases and key organizations' webpages from inception to September 2020. Informed by the CanMEDS-FM, we analyzed the extracted data concerning basic document characteristics, competencies and medical topics using numerical and qualitative content analysis.

SUMMARY

We included 41 peer-reviewed articles and six adolescent health competency frameworks (n=47). Most competencies taught in family medicine programs were organized under the roles of family medicine expert (75%), communicator (11.8%), and professional roles (7.9%). Health advocate and leader were rarely included (1.3%), and never scholar.

OUTLOOK

The omission of multiple competency roles in family medicine resident education on adolescents is insufficient for family physicians to deliver optimal care to adolescents. The combined efforts of family medicine stakeholders to address adolescent medicine competency gaps may positively impact the perceived competence reported by family medicine residents.

Caring for adolescents in Guatemala: provider perspectives

Purpose Today's generation of adolescents is the largest in history, creating a major challenge for low and middle income countries faced with the necessity of addressing their growing healthcare needs. Our objective was to assess the extent to which health care providers in Guatemala are trained, knowledgeable and feel comfortable providing services to adolescents. Methods A sample of 20 medical providers were recruited from the School of Medicine at San Carlos University and its affiliated hospitals. Providers were interviewed face-to-face for 30-40 min using a semi-structured guide exploring their training, knowledge, skills and experience in adolescent health care. Recruitment continued until thematic saturation was reached. Interviews were recorded and transcribed verbatim, and then analyzed for emergent themes using principles of framework analysis. Results The provider's mean age was 33.7 years [standard deviation (SD) = 10.2]. Most were female (65%) and practiced medicine in a metropolitan location. Results revealed the presence of five major themes: (1) Need for dedicated adolescent health services; (2) Presence of a multitude of barriers to providing adolescent health care; (3) Perceived comfort level in communicating with adolescents; (4) Limited knowledge of current adolescent specific services, programs, and guidelines; and (5) Gaps in medical education and training. Conclusion Providers recognize the need for increased and dedicated adolescent health care services. There is strong support for the creation of a credentialed national adolescent health training program.

The status of adolescent medicine: building a global adolescent workforce

Remarkable public health achievements to reduce infant and child mortality as well as improve the health and well-being of children worldwide have successfully resulted in increased survival and a growing population of young people aged 10-24 years. Population trends indicate that the current generation of 1.8 billion young people is the largest in history. However, there is a scarcity of dedicated resources available to effectively meet the health needs of adolescents and young adults worldwide. Growing recognition of the pivotal roles young people play in the cultures, societies, and countries in which they live has spurred an expanding global movement to address the needs of this special population. Building an effective global workforce of highly-skilled adolescent health professionals who understand the unique biological, psychological, behavioral, social, and environmental factors that affect the health of adolescents is a critical step in addressing the health needs of the growing cohort of young people. In this review, we aim to: 1) define a global assessment of the health needs for adolescents around the world; 2) describe examples of current training programs and requirements in adolescent medicine; 3) identify existing gaps and barriers to develop an effective adolescent health workforce; and 4) develop a call for targeted actions to build capacity of the adolescent health workforce, broaden culturally relevant research and evidence-based intervention strategies, and reinforce existing interdisciplinary global networks of youth advocates and adolescent health professionals to maximize the opportunities for training, research, and care delivery.

Accreditation of Adolescent Medicine as a pediatric sub-specialty: the Canadian experience and lessons learned

The Royal College of Physicians and Surgeons of Canada (Royal College) has an extensive process for recognizing new specialties and subspecialties. Among other requirements, the process requests that the applicants demonstrate that sufficient scientific breadth and depth exists within the proposed field, that a unique field of clinical practice exists, and that there is a societal need for individuals with this distinct area of specialization. In 2004, a group of adolescent medicine specialists from across Canada started the application process for the field to become an accredited pediatric subspecialty. A 3-year process was undertaken to demonstrate the need for accreditation of this new and emerging discipline. In 2007, Adolescent Medicine became the 63rd discipline and a sub-specialty of Pediatrics. This paper provides an overview of the process that led to the accreditation of Adolescent Medicine by the Royal College and offers insights into the lessons learned from this Canadian experience.

Opportunities and challenges in adolescent health training abroad: trainees' experience and perspective

As the global adolescent population increases and as there is enhanced recognition internationally of the unique nature of the adolescent period, the need for specialized training in adolescent medicine for international physicians becomes more apparent. There are challenges in securing placement in an adolescent medicine fellowship program, as well as, on acceptance, challenges with acculturation to a new setting, socially, academically and clinically. During fellowship, international medical graduates (IMGs) are exposed to new opportunities such as learning best-practices and being mentored by experienced advocates and clinicians in the field of adolescent health and medicine. This paper considers recommendations for improving adolescent medicine fellowship programs with a focus on IMGs.