Training needs in adolescent and young adult health and transition in UK paediatric and adult higher specialist trainees in endocrinology and diabetes
DOI:
https://doi.org/10.15277/bjdvd.2015.049Abstract
Background: There is a concern that medical training contains insufficient emphasis on adolescent and young adult health and transition. Clinicians working in diabetes and endocrinology across paediatric and adult services need to have the skills to work effectively with this age group. The aim of the present survey was to ascertain the current state of training of paediatric and adult trainees in endocrinology and diabetes in the UK.Methods: A questionnaire assessing training in adolescent and young adult health was developed using existing questionnaire formats. An online survey was disseminated to UK trainees in paediatric and adult endocrinology and diabetes through the Young Diabetologists and Endocrinologists Forum (YDEF), the British Society of Paediatric Endocrinology and Diabetes (BSPED), and the Society for Endocrinology (SfE) to assess access and quality of adolescent and young adult health and transition training.
Results: 146 responses were received from 97 adult trainees, 38 paediatric trainees with a special interest and 11 paediatric sub-specialty trainees. All grades were represented from across the UK. Training in adolescent and young adult health and transition was rated as minimal or non-existent (65%); this was more marked in endocrinology (76%) than in diabetes (42%). The major barriers to achieving this experience and training were perceived to be limited clinic time and lack of training. Trainees reported unmet training needs, with paediatric trainees reporting higher learning needs despite reporting more exposure and training. Both seniority and number of clinics attended positively impacted on reported training experience.
Conclusions: This survey has highlighted the need for improvements in training in adolescent and young adult health. Trainees from paediatric and adult backgrounds feel under-trained and under-prepared to deliver this care. Given the importance of improving outcomes in adolescents and emerging adults with long-term conditions, this issue merits urgent attention.
References
Viner R. Adolescence. Annual Report of the Chief Medical Officer 2012, Our Children Deserve Better: Prevention Pays. Chapter 8: Life Stage: Available at https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2012-our-children-deserve-better-prevention-pays.
Children and Young People's Health Outcomes Forum. Report of the Children and Young People's Health Outcomes Forum. London: Department of Health 2012. Available at https://www.gov.uk/government/publications/independent-experts-set-out-recommendations-to-improve-children-and-young-people-s-health-results.
Sebastian S, Jenkins H, McCartney S, et al. The requirements and barriers to successful transition of adolescents with inflammatory bowel disease: differing perceptions from a survey of adult and paediatric gastroenterologists. J Crohns Colitis 2012;6:830-44. http://dx.doi.org/10.1016/j.crohns.2012.01.010
Allen D, Cohen D, Hood K, et al. Continuity of care in the transition from child to adult diabetes services: a realistic evaluation study. J Health Serv Res Policy 2012;17:140-8. http://dx.doi.org/10.1258/jhsrp.2011.011044
McDonagh JE, Southwood TR, Shaw KL. British Paediatric Rheumatology Group. Unmet education and training needs of rheumatology health professionals in adolescent health and transitional care. Rheumatology 2004;43:737-43. http://dx.doi.org/10.1093/rheumatology/keh163
Royal College of Paediatrics and Child Health (RCPCH). Not Just a Phase – a guide to the participation of children and young people in health services. London: RCPCH, 2010. Available at http://www.rcpch.ac.uk/what-we-do/children-and-youth-participation/not-just-phase-guide-participation-children-and-young-pe.
Department of Health. You’re Welcome quality criteria: making health services young people friendly. London: Department of Health, 2011. Available at https://www.gov.uk/government/publications/quality-criteria-for-young-people-friendly-health-services.
Gleeson H, Davis J, Jones J, et al. The challenge of delivering endocrine care and successful transition to adult services in adolescents with congenital adrenal hyperplasia: experience in a single centre over 18 years. Clin Endocrinol 2013;78:23-8. http://dx.doi.org/10.1111/cen.12053
Arlt W, Willis DS, Wild SH, et al. Health status of adults with congenital adrenal hyperplasia: a cohort study of 203 patients. J Clin Endocrinol Metab 2010;95:5110-121. http://dx.doi.org/10.1210/jc.2010-0917
Kipps S, Bahu T, Ong K, et al. Current methods of transfer of young people with Type 1 diabetes to adult services. Diabet Med 2002;19(8):649-54. http://dx.doi.org/10.1046/j.1464-5491.2002.00757.x
Healthcare Quality Improvement Partnership. National Diabetes Audit Mortality Analysis 2010-2011. Available at: http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2013-14/NDA2011-2012Report2ComplicationsMortalityINTERACTIVEPDF26-11-13.pdf
Amiel SA, Sherwin RS, Simonson DC, et al. Impaired insulin action in puberty. N Engl J Med 1986;315:215-19. http://dx.doi.org/10.1056/NEJM198607243150402
Schuster M, Bell R. Communication between adolescents and physicians about sexual behavior and risk prevention. Arch Pediatr Adolesc Med 1996; 150:906-13. http://dx.doi.org/10.1001/archpedi.1996.02170340020004
Nowell D, Spruill J. If it’s not absolutely confidential, will information be disclosed? Prof Psychol Res Pr 1993;24:367-9. http://dx.doi.org/10.1037/0735-7028.24.3.367
Ford C, Millstein S, Halpern-Felsher B, Irwin C. Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. JAMA 1997;278:1029-34. http://dx.doi.org/10.1001/jama.1997.03550120089044
Sebastian S, Jenkins H, McCartney S, et al. The requirements and barriers to successful transition of adolescents with inflammatory bowel disease: differing perceptions from a survey of adult and paediatric gastroenterologists. J Crohns Colitis 2012;6:830-44. http://dx.doi.org/10.1016/j.crohns.2012.01.010
Viner R. Barriers and good practice in transition from paediatric to adult care. J R Soc Med 2001;94:2-4.
Fox A. Physicians as barriers to successful transitional care. Int J Adolesc Med Health 2002;14:3-7. http://dx.doi.org/10.1515/IJAMH.2002.14.1.3
National Health Service Health Education England. Adolescent Health Project. Available at http://www.e-lfh.org.uk/projects/adolescent-health.
Adult Endocrinology & Diabetes Training Curriculum. Available at: http://www.jrcptb.org.uk/sites/default/files/2010%20Endo%20%26%20Diabetes%20%28amendment%202012%29.pdf
Royal College of Physicians and Child Health. General Paediatric training curriculum. http://www.gmc-uk.org/2010_General_Paediatrics__curriculum_July_20141.pdf_57546581.pdf
British Society for Paediatric Endocrinology and Diabetes. European Paediatric Subspecialty training curriculum. http://www.bsped.org.uk/training/training_eurosyllabus.html
Curriculum for Paediatrics with a special interest. Available at: http://www.gmc-uk.org/Paediatric_Diabetes_and_Endocrinology_NEW _curriculum_document_June_2010.pdf_34232022.pdf_56561962.pdf
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806-14. http://dx.doi.org/10.1001/jama.2014.732
Hagell A, Coleman J, Brooks F. Key Data on Adolescence 2013. London: Association for Young People’s Health. Available at http://www.ayph.org.uk/publications/457_AYPH_KeyData2013_WebVersion.pdf.
Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ 1995;152:1423-33.
Klostermann BK Slap GB Nebrig DM, et al. Earning trust and losing it: adolescents’ views on trusting physicians. J Fam Pract 2005;54:679-87.
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