Adolescent Medicine at the Crossroads: A Review of Fellowship Training and Recommendations for Reform

This report examines the current state of adolescent medicine fellowship programs -- including the supply and recruitment of fellows; the nature and content of clinical, research, and leadership training; and the institutional and financial challenges facing training programs today -- and offers recommendations for building the field. The report is based on findings from the first comprehensive national survey of adolescent medicine fellowship program directors, conducted in the spring of 2007 by Incenter Strategies. The document also presents selected findings from two other Incenter Strategies’ surveys conducted in 2007: one of pediatric residency program directors and the other of adolescent medicine faculty responsible for the one-month pediatric residency rotation. In addition, the report presents findings from key informant interviews and an extensive literature review

Advancing medical education training in adolescent health

The time has come to consider the need for major reforms in adolescent medicine training. At least 4 reform options should be examined: 1) extending the length of the mandatory adolescent medicine rotation, 2) introducing more flexibility in residency programs to allow for formalized optional training tracks in adolescent medicine 3) creating a combined pediatrics/adolescent medicine residency, and 4) increasing the availability of one-year adolescent medicine clinical training programs after completion of categorical training in general pediatrics. Each option has distinct strengths and weaknesses

Adolescent medicine training in pediatric residency programs

OBJECTIVES: The aim of this study was to provide an assessment of pediatric residency training in adolescent medicine. METHODS: We conducted 2 national surveys: 1 of pediatric residency program directors and the other of faculty who are responsible for the adolescent medicine block rotation for pediatric residents to elicit descriptive and qualitative information concerning the nature of residents\u27 ambulatory care training experience in adolescent medicine and the workforce issues that affect the experience. RESULTS: Required adolescent medicine topics that are well covered pertain to normal development, interviewing, and sexual issues. Those least well covered concern the effects of violence, motor vehicle safety, sports medicine, and chronic illness. Shortages of adolescent medicine specialists, addictions counselors, psychiatrists, and other health professionals who are knowledgeable about adolescents frequently limit pediatric residency training in adolescent medicine. Considerable variation exists in the timing of the mandatory adolescent medicine block rotation, the clinic sites used for ambulatory care training, and the range of services offered at the predominant training sites. In addition, residents\u27 continuity clinic experience often does not include adolescent patients; thus, pediatric residents do not have opportunities to establish ongoing therapeutic relationships with adolescents over time. Both program and rotation directors had similar opinions about adolescent medicine training. CONCLUSIONS: Significant variation and gaps exist in adolescent medicine ambulatory care training in pediatric residency programs throughout the United States. For addressing the shortcomings in many programs, the quality of the block rotation should be improved and efforts should be made to teach adolescent medicine in continuity, general pediatric, and specialty clinics. In addition, renewed attention should be given to articulating the core competencies needed to care for adolescents

Five decades of terrestrial and freshwater research at Ny-Ålesund, Svalbard

For more than five decades, research has been conducted at Ny-Ålesund, in Svalbard, Norway, to understand the structure and functioning of High- Arctic ecosystems and the profound impacts on them of environmental change. Terrestrial, freshwater, glacial and marine ecosystems are accessible year-roundfrom Ny-Ålesund, providing unique opportunities for interdisciplinary observational and experimental studies along physical, chemical, hydrological and climatic gradients. Here, we synthesize terrestrial and freshwater research at Ny-Ålesund and review current knowledge of biodiversity patterns, species population dynamics and interactions, ecosystem processes, biogeochemical cycles and anthropogenic impacts. There is now strong evidence of past and ongoing biotic changes caused by climate change, including negative effects on populations of many taxa and impacts of rain-on-snow events across multiple trophic levels. While species-level characteristics and responses are well understood for macro-organisms, major knowledge gaps exist for microbes, invertebrates and ecosystem-level processes. In order to fill current knowledge gaps, we recommend (1) maintaining monitoring efforts, while establishing a longterm ecosystem-based monitoring programme; (2) gaining a mechanistic understanding of environmental change impacts on processes and linkages in food webs; (3) identifying trophic interactions and cascades across ecosystems; and (4) integrating long-term data on microbial, invertebrate and freshwater communities, along with measurements of carbon and nutrient fluxes among soils, atmosphere, freshwaters and the marine environment. The synthesis here shows that the Ny-Ålesund study system has the characteristics needed to fill these gaps in knowledge, thereby enhancing our understanding of High-Arctic ecosystems and their responses to environmental variability and change. Biogeochemical cycles; climate change; ecosystem structure and functioning; environmental change; High Arctic; human impacts; soi