a position paper of the European Academy of Paediatrics
Eighttraining goals(leftcolumn) andassessmentapproaches(right column),eachfollowedbya set ofrelatedobjectives withexample oftrainingmethods
1. GeneralGoal / ExamplesofAssessment
Demonstratehowtointegratetheadolescentbio-psychosocialdevelopmentalstagesin theirdaily healthcare,tacklingtheirvulnerabilitiesandresources. / Multiplechoicequestions.
Questionsbasedon a clinicalvignette.
Shortessay.
Commentsona video.
ObjectivesRelatedtoGoal1 / TrainingMethods
Understandthebio-psychosocialdevelopmentalstagesoccurringduringadolescence.
Demonstratehowtointegratethestagesinadolescentdailycare,focusingonbothvulnerabilitiesandresourcesofthepatient. / Discussion: ask participants to define adolescence, age limits; explore the learner’s experience and representations of (own) adolescence.
Use of two videos, one with a young and one with an older adolescent.
Discuss how the attitude, wording and content of the encounter changes over time (from ~ 12 to 19 years).
Use of screening tools such as the HEEADSSSa or the SHADEb.
Using vignettes, check patients’ stage of development using a developmental gridc.
2. GeneralGoal / ExamplesofAssessment
Identify stagesofpsychosocialdevelopment,with afocusonbraindevelopmentandtheissueofsexualorientationandgenderidentity. / Multiplechoicequestions.
Questionsbasedon a clinicalvignette.
Shortessay.
Commentsona video.
ObjectivesRelatedtoGoal2 / TrainingMethods
Identifyandinvestigatepatternsofgrowthdevelopmentduringadolescence,includingBMIandbodycomposition,bonegrowth,pubertyandbraindevelopment.
Indailycare,takeintoaccountthe processofidentity formationandthe role ofgenderissues in theadolescent’sdevelopmentanditsimpact onhealth;respectfullyexploretheyoung patient’ssexualorientationandgenderidentity.
Indeliveringadviceordiscussingadherenceissues,keepinmindandconsidertheprogressivematurationoftheadolescentbrain
(e.g.lackoflong-termperspective,impulsivity,denial). / Interactivelectureongrowth andpuberty,with a focusonhow toevaluatepubertalstages amonggirlsandboys.
Exerciseontheuse ofgrowth,weightandBMI charts.
Smallgroupwork:illustrate themeaningforparticipants ofbiological sex,genderidentity, genderexpression,andattractiontopartners.
Reviewarticlesdescribingthe formationofidentity.
InviteayoungpersonbelongingtoanyLGBTQgrouptotestify abouthow it was tobelongtothisgroup.
Roleplay:interviewaroundsexualorientation.
Interactivelectureon adolescentbrainfollowedbydiscussionontheimpactofthe adolescent’s brain development onhealth behavior, usingconcreteclinicalvignette
Groupsdiscusshowtoassess cognitive/affectivematuration.
3. GeneralGoal / ExamplesofAssessment
Establish a trustful, empathetic and respectful relationship withtheadolescent, securingconfidentialityandtakinginto account available
ethical guidelines.Involveparents orcaregivers asfar as possible. / ObjectiveStructuredClinicalExamination(OSCE).
Directobservationofanencounterwitharealorsimulatedpatient.
Evaluation basedona video withpatient.
ObjectivesRelatedtoGoal3 / TrainingMethods
Adopt effective communication approaches with the adolescent.
Inanyinterview,integrate basicethical principles suchasrespectingconfidentialityandthe adolescent’s righttoautonomy
(“shared decisionapproach”).
Obtainrelevantinformationandthen provide it tothe parents(caregivers)withtheagreementoftheadolescent
Involvethe parentsappropriatelyintheassessmentandplanningofintervention/treatment / Role play, if feasible with simulated adolescent patient.
Bedside observation and teaching, use of videos.
Ingroup,discuss how to expressthe issueofconfidentialitytoanadolescent.
Reviewofinternational (conventionontherightsofthechild)andnationallegalandethicalguidelines.
Role play,iffeasiblewithsimulatedadolescentpatient.
Presentanethicaldilemma usingaclinical vignette, and discuss insmallgroups howtochoosebetween differentoptions andhowtoinvolvethe adolescent andotherpotentialstakeholders inthedecision.
Reviewofdifferenteducationalstyles andhowtocommunicateeffectivelywithparentswhilegivingthe youngpersona voice(lecture,video,articles,groupdiscussion).
Usea video ofanencounterbetween ahealthcare provider,adolescentandparents todiscuss what went well orwrong.
Involvejuniorresidentsin discussionwith families(rolemodelling).
4. GeneralGoal / ExamplesofAssessment
Involveallpotentialstakeholders,suchasschoolhealthprofessionalsorsocialworkersin thecareofadolescents,whilerespectingtheyoungpatient’srights / Questionsbasedon a clinicalvignette.
Namestakeholdersoflocalnetwork.
Basedona clinicalvignette, askresidenthow he/shewouldsetupandrunadiscussionwithstakeholders.
ObjectivesRelatedtoGoal4 / TrainingMethods
Recognizetheroleof networking activities incaringforadolescents,especiallywhenconfrontedwithcomplex/chronicbio-psychosocialsituations.
Analyzeevidence-basedeffective,preventiveandhealth-promotingactivitiesthat canbedevelopedwithintheschoolandcommunitysetting.
Identifyinterventionsthatpromoteempowermentandresilienceamongschool pupils. / Groupwork:participantssharetheirexperienceswithliaisonactivities (school,social services),anddiscuss prosandconsofinterprofessionalapproach.
Participants reflect onthe added value ofnetworkinginanycomplexsituations(e.g.functionaldisorder)and list factorswhichenhanceor limitcollaboration.
Useofa clinicalvignette orvideo.
Interactive lecture.
Screeningtheliterature:reviewevidence-basedinterventionsfor healthpromotion(e.g.Cochrane library,Lancetseries).
Visitof schoolhealthservices andexchange ideaswithschoolhealthstaffandteachers;discusswiththe staff whatkind ofinterventions havebeen implemented andhowtheyworked.
5. GeneralGoal / ExamplesofAssessment
Elicit arelevant, concise andaccurate historyfrom the adolescentandother sources of information (parents, caregivers),while exploringbothresourcesandrisk/health-compromising(exploratory)behaviors.Offercounselling andpreventive responsesaccordingly. / OSCE.
Directobservationofanencounterwitha realorsimulatedpatientmini-ClinicalExaminationExercise(mini-CEX).
Evaluation basedona video withpatient.
Basedonaclinicalvignette,providesomequestions relatedto explorationoflifestyles(riskandresources).
ObjectivesRelatedtoGoal5 / ExamplesofTraining Methods
Inanyhistory-taking,reviewtheadolescent’slifestyleandpsychosocialbackground.
Inthe interview, include anexplorationofthe adolescent’s personalandenvironmentalresourcesandhealth-compromisingbehavior.
Providecounsellingactivities:supportpositivehealthlifestylesandaddresshealth-compromising behavior.Usesomebasicingredientsofmotivationalinterviewing.
Referto a colleaguewhenappropriate(e.g. afterhavingidentifiedabehavioralormentalproblemoranadverseenvironment. / Interactivelecture.
Useofthe HEADDSSSorthe SSHADESSorother tool.
Roleplaywithsimulatedadolescentpatient.
Observationofencounterwithrealpatient.
Supervisedconsultationwithapatient.
Discussionduringrounds.
Video ofaninterviewwithanadolescent
Interactivelectureon riskandprotective factors.
Groupdiscussion: lista seriesoftypicalquestionsthatcover resourcesandrisks.
Askresidents tointerviewyoungpeopleintheirownenvironmentregardingpotentialresourcesandrisks.
Shortlectureonmotivationalinterviewing.
Exercise2by2ontryingtochange one’sbehavior.
Groupdiscussion:reflectonhowone’sfeelingsdependonthe communicatingstyleused(paternalisticvs. motivational).
Roleplayexercisesbetweenlearners.
Supervisedconsultationwithapatient.
6. GeneralGoal / ExamplesofAssessment
Conductan effectivegeneralorfocusedphysicalexamination,includinganassessmentofgrowthandpubertalstages. / Directobservationofanencounterwitharealorsimulatedpatient(Mini-CX)
Questionsusingdrawingsofpubertalstagesandgrowthcharts.
Asktraineeto commenta video.
ObjectivesRelatedtoGoal6 / ExamplesofTraining Methods
Assessphysicalgrowthusingrelevantreferences,toolsandcharts.
Identifythestagesofpubertaldevelopment.
In theexamination,include(whereappropriate)assessmentofaspects suchasgrowth,skin,sensory organs, spine, joints andgenitals, whichare ofparticularrelevanceduringthisperiodoflife.
Adapttheflowofphysical examinationtothe adolescent’s stageofdevelopment,respectingthepatient’sprivacy.
Actively involve the adolescent in the examination and provide feedback on findings. / Interactivelectureusingclinicalvignette;asktraineestoplotpatient’s developmentongrowthcharts,BMIcharts,pubertalstages.
Usinga clinicalvignette, discuss withthe audience how they wouldsharetheirfindings withtheadolescentandthe parents.
Learners report onhowtheyfeltthelasttime they performeda physicalexamination.
Interactivelectureorvideoshowingthephysicalexaminationofanadolescent.
Directobservationofaphysicalexamination.
Bedsideteaching.
7. GeneralGoal / ExamplesofAssessment
Identifythemostcurrentphysicalandpsychosocialhealthproblemsthatadolescentspresentwith,andproposerelevantinvestigation, advice,recommendations,treatmentorreferral. / Multiplechoicequestions.
OSCE.
Directobservationofanencounterwitharealorsimulatedpatient(mini-CEX).
Underobservation,performashortmotivationalinterview(optional).
ObjectivesRelatedtoGoal7 / ExamplesofTraining Methods
Describesomenationalorregionalepidemiologicdatapertainingtoadolescents’healthproblemsandlifestyles.
Demonstratespecificskillsregardingassessmentofmentalhealthandsymptomssuchasanxiety, depression,self-harmorvictimization.
Providesupportforadolescentswithproblematicbehaviorand/ormood,organizereferralifneeded.
Reactappropriatelytoaggressive/violentbehavior.
Reviewadolescentgirls’andboys’sexualorientation,developmentandbehavior,aswellas potentialburdensordysfunction.
Discusssexualattitudesandbehaviorappropriatelywithanadolescent,andidentifypotential risk-takingor victimization.
Incorporate inthe consultation questionsandadvice intheareasof safesex,contraceptionandprotectionagainst STIs; provide concrete responses(e.g.prescribing oral contraception)or refer to specialistifneeded.
Appropriatelymanage the situation of anadolescentwithsuspected sexually transmitted infection(STI)andofanadolescent withunexpectedpregnancy.
Inanyconsultation,revieweatingandnutritionpatterns.
Assesstheadolescent’sself-image.
Identifyandinvestigate,ifappropriate,symptomsofminor dysfunctionaleatinghabits, obesity,bingeeatingdisorder andbulimia.
Referappropriatelyifneeded(e.g.anorexianervosa).
Assessuseand/ormisuseofsubstances(tobacco,alcohol,cannabisandotherdrugs.
Identifyandinvestigatesubstanceusedisorder/SUD.
Identifyand investigate otheraddictive behaviors(internet, gambling).
Providesupportforadolescentswithproblematicuse,refertospecialistifappropriate. / Interactivelecture.
Computer-basedexercise:findrelevantdatainvariousregional/national/internationalsources.
Interactivelectureonmentalhealthissues.
Useofvideos.
Roleplay.
Directobservationofaconsultation.
Listavailablelocal/regionalstructureswhichaddressmentalhealth problems.
Groupdiscussion:howtocopewithanaggressiveadolescent.
Interactivelecture onsexual development, howtoinvestigate menstrualdysfunction,STIs, howto providecontraception andprotection,adolescentpregnancy,howto reactto sexualviolenceandvictimization.
Groupparticipants’discussion onhowtodiscussthe issue of sexualityandsexualbehavior withmaleandfemaleadolescentsofdifferentages.
Videosdisplayingconsultationsonvarioussexualandreproductivehealthtopics.
Roleplay.
Discussionwithyoungpeople,familyplanningcounsellorsorsocialworkers.
Interactivelectureonnutritionalneedsandpotentialdeficiencyassociatedwithobesityandeatingdisorders.
Groupdiscussionontheimpactofnutritional habitsonself-image.
Reviewclinicalvignettetoaddresseatingdisorders,useofvideo.
Bedsideteachingandsupervisedconsultation.
Identifyavailablelocal/regionalstructureswhichassistwitheatingdisorders.
Interactivelectureon patterns oflegalandillegalsubstanceuse.
Roleplaywithsimulatedpatientorwithcolleagues,usingmotivationalinterviewingapproach).
Use,ifavailable,ofpracticalassessmenttools(questionnaires)andhowtointerpretthem.
Discussclinicalvignette.
Runasupervisedconsultation.
Discuss/identifyavailablelocal/regionalstructuresthatassistwith substanceuse problemsandaddiction.
Visit acenter dealingwith adolescentswithSUDs.
InviteyoungadultswithHIVtosharetheirexperience.
8. GeneralGoal / ExamplesofAssessment
Promotebio-psychosocialdevelopmentandautonomyinthecare ofadolescents withachroniccondition;planthetransitionto adulthealthcare. / Basedona clinicalvignette, askresidenttorespondtoopen questionsregarding(a)impact ofthe conditionon developmentand(b) developstrategiesforplanningtransition.
Interviewasimulatedadolescentpatientwith therapeuticadherenceproblems
ObjectivesRelatedtoGoal8 / ExamplesofTraining Methods
Recognizehowachronic conditioninterfereswiththe bio-psychosocialdevelopmentofanadolescent.
Foranadolescentwith achroniccondition,identifyhis/herneedsfor basichealthcareand carefor the condition,andhowto addressthembothinthe area ofphysicalhealthand psychosocialadaptation.
Maintainor improve adherence,takinginto accountthe patient’s cognitiveandaffectivestate(includingaspectslinkedwithbrainmaturation,impulsivityanddenial).
Supportadolescents’copingstrategies andassistthem inimproving their environment:support them inmaintaining anetwork offriends andanormalsociallife.
Anticipateandplanthetransitionfromthepediatric to theadulthealthcaresetting. / Interactive lecture.
Small group discussion working on vignettes: review how a chronic condition impacts on development and how development affects the course of the condition.
Interactive lecture (bio-psychosocial development of adolescent with chronic conditions; Videos with adolescents sharing their experience.
Interview of adolescents with chronic conditions and their parents.
Using clinical vignette, small group work to discuss strategies to improve adherence.
Bedside discussion with a senior staff member.
Review of a videotaped interview.
Role play: support young people of various ages and with various conditions in (1) improving therapeutic adherence, (2) socializing and engaging in activities with peers and (3) overcoming episodes of stress and depression.
Direct supervision.
Work with simulated patients.
Group discussions using clinical vignette.
Interview of an adolescent with a chronic condition.
Supervised consultation, bedside teaching.
Review (literature survey) effective models of transition.
Invite older adolescents with chronic conditions to report on how they coped with the transition.
Group work: list the steps to successful transition.
Organize a meeting with pediatric and adult specialists to review effective strategies.
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Used with permission: Pierre-André Michaud et al(2017) Eur J of Pediatr.