PubMed · 8880402
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G B Slap. 1996. SAM memory: a link between past and future.. https://doi.org/10.1016/s1054-139x(96)00168-1
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For some young people, adolescence is a time of experimentation with high-risk behaviors that can lead to significant morbidity and mortality. Providers of adolescent health care need to become comfortable screening their patients for involvement with sexual activity, drug and alcohol use, violence, and mental health issues. This includes taking into consideration not only the patient's age and development status, but their rights to confidentiality and comprehensive health care. Several tools such as HEADSS interview and the CAGE questionnaire can easily be used to screen for high-risk behaviors. By taking the time to get to know adolescent patients, it is possible to identify problems early and intervene while the adolescent is amenable to treatment.
OBJECTIVES: To determine how pediatric residency programs are responding to the new challenges of teaching adolescent medicine (AM) to residents by assessing whether manpower is adequate for training, whether AM curricula and skills are adequately covered by training programs, what types of teaching methodologies are used to train residents in AM, and the needs for new curricular materials to teach AM. DESIGN: A 3-part 92-item survey mailed to all US pediatric residency training programs. SETTING: Pediatric residency programs. PARTICIPANTS: Residency program directors and directors of AM training. MAIN OUTCOME MEASURES: AM divisional structure, clinical sites of training, presence of a block rotation, and faculty of pediatric training programs; training materials used and desired in AM; perceived adequacy of coverage of various AM topics; competency of residents in performing pelvic examinations in sexually active teens; and manpower needs. RESULTS: A total of 155/211 (73.5%) of programs completed the program director and the AM parts of the survey. Ninety-six percent of programs (size range, 5-120 residents) had an AM block rotation and 90% required the AM block; those without a block rotation were more likely to be larger programs. Only 39% of programs felt that the number of AM faculty was adequate for teaching residents. Almost half of the programs reported lack of time, faculty, and curricula to teach content in substance abuse. Besides physicians, AM teachers included nurse practitioners (28%), psychologists (25%), and social workers (19%). Topics most often cited as adequately covered included sexually transmitted diseases (81.9%), confidentiality (79.4%), puberty (77.0%), contraception (76.1%), and menstrual problems (73.5%). Topics least often cited as adequately covered included psychological testing (16.1%), violence in relationships (20.0%), violence and weapon-carrying (29.7%), and sports medicine (29.7%). Fifty-eight percent of 137 respondents thought that all or nearly all of their residents were competent in performing pelvic examinations by the end of training; there was no difference between perceived competence and the residents' use of procedure books. Seventy-four percent used a specific curriculum for teaching AM; materials included chapters/articles (85%), lecture outlines (76.1%), slides (41.9%), videos (35.5%), written case studies (24.5%), computerized cases (6.5%), and CD-ROMs (3.2%). Fifty-two percent used Bright Futures, 48% used the Guidelines for Adolescent Preventive Services, and 14% used the Guide to Clinical Preventive Services for teaching clinical preventive services. Programs that used Bright Futures were more likely to feel that preventive services were adequately covered in their programs than those who did not (78% vs 57%). A majority of programs desired more learner-centered materials. CONCLUSIONS: Although almost all pediatric programs are now providing AM rotations, there is significant variability in adequacy of training across multiple topics important for resident education. Programs desire more learner-centered materials and more faculty to provide comprehensive resident education in AM.