As the new National Champion for the RCPCH Adolescent Health Programme (AHP) I was keen to find out just what our trainees feel about treating young people (aged 11-19). A survey of paediatric trainees in the North West Deanery identified a lack of training and communication issues as the major barriers to providing developmentally appropriate healthcare for young people. Forty-five percent of these trainees rated their current adolescent healthcare training as minimal or non existent and this was not associated with years of experience.
The need for training echoes findings in the recent Kennedy Report (2010). Kennedy described the “pockets of excellent practice” in children’s services as “islands in a sea of mediocrity, or worse”. With this theoretical seascape in mind one might describe services actually meeting the needs of young people as “ships passing in the night”. In six of Kennedy’s recommendations the need for training is highlighted.
Young people represent a significant and important group accessing primary, secondary and tertiary health services. Their particular health needs, confidentiality, appropriate communication and consultation skills and attention to transition to adult services haven’t always been well served within paediatric, adult or general practice. A UNICEF survey of young people (2007) ranked the UK as lowest out of 21 industrialised countries, having more health-compromising behaviours and rating their own perception of health as low.
When it comes to adolescent healthcare, the UK has lagged behind other developed countries such as the USA, Canada, and Australia. However the UK is beginning to catch up through strong national leadership from the RCPCH Young Person’s Health Special Interest Group (YPHSIG) which is actively encouraging cultural change across the NHS. To support this change training is required.
The AHP, launched in 2008, written by experts, provides health professionals with training in the knowledge, skills and attitudes required to improve their care of young people. The AHP received positive feedback from the North West paediatric trainees, expressing comments such as: ”very interesting way of learning and changing practice”; “good focus on current issues”; “very helpful in clinical practice and exam preparation”; “interactive”; “flexible, can do whenever I like”; “really helps to improve my understanding”. Trainees felt that it should be part of mandatory training.
For adolescent health to develop further in the UK more specific training is required. The RCPCH has been working with YPHSIG not only to develop generic competences in adolescent health for all paediatric trainees but also a Special Study Module which is designed for general paediatric and community trainees wishing to gain additional expertise in this area during their ST6-8 years. It is hoped that trainees undertaking this module will go on to provide strong leadership on young people’s health issues in their consultant posts, encouraging better adolescent services to be developed and remain a priority in the NHS. These initiatives in training are supported by the content of the AHP.
So finally, we must ask ourselves, “Is training in adolescent health coming of age in the UK?” Through the AHP and the development of specific training we are making important steps in the right direction and with it the ability to overcome cultural barriers in the NHS to better meet young people’s needs now and in the future.
Dr Helena Gleeson: AHP National Champion
