Evaluating the Educational Impact of Telehealth on Adolescent Medicine Trainees: a Qualitative Approach.

Purpose of Review: Telehealth has been swiftly incorporated into clinical practice since the onset of the COVID-19 pandemic, with limited understanding of how it affects trainees' educational experiences. Our study evaluates the impact of telehealth on clinical education in pediatric and Adolescent Medicine trainees during the pandemic. Recent Findings: Previous literature on telehealth focused on provider and patient perceptions in addition to clinical education for students, though none has evaluated the experiences of medical residents and fellows in Adolescent Medicine. Summary: Trainees reported enhanced opportunities for bidirectional observation with attending physicians, increased flexibility for the trainee and families, and the opportunity to engage with adolescents in their home environment. Drawbacks include decreased physical exam skill-building and technological difficulties that can interrupt the learning experience. Telehealth is a valuable tool in clinical education and innovative strategies are needed to refine and enhance these educational experiences for pediatric and Adolescent Medicine trainees.

The Impact of Telehealth on Clinical Education in Adolescent Medicine During the COVID-19 Pandemic: Positive Preliminary Findings.

Purpose: Following the start of the COVID-19 pandemic, much of clinical care rapidly transitioned to telehealth, shifting the clinical training milieu for most trainees. In the wake of this shift, educators have attempted to keep learners engaged in patient care and optimize medical education as much as possible. There is, however, limited understanding of the effect of telehealth on clinical education. The aim of our study was to better understand the educational experience of pediatric and Adolescent Medicine trainees participating in clinical encounters via telehealth in a specialty consultation Adolescent Medicine Clinic at a quaternary pediatric care hospital. Methods: Using a web-based anonymous questionnaire, we surveyed trainees rotating through the Adolescent Medicine Clinic between March and June 2020. We used descriptive statistics to evaluate their experiences with telehealth and identify techniques that were effective to facilitate learning during a telehealth visit. Results: Surveys from 12 pediatric and Adolescent Medicine trainees were received, a 75% response rate. Most trainees (83.3%) reported no prior experience with telehealth before the onset of the pandemic. By the end of their rotation, trainees identified techniques that helped facilitate learning during a telehealth visit. The majority of trainees (83.3%) rated their experience as effective or very effective, and all reported interest in incorporating telehealth into their future practice. Conclusions: Pediatric and Adolescent Medicine trainees reported overall positive experiences with telehealth in clinical education and an interest in incorporating this tool into future practice. Additional research is needed to refine techniques in engaging learners through telehealth.

Primary care from infancy to adolescence.

The use of complementary and alternative medical (CAM) therapies is increasing among well children and adolescents and in those children who have special health care needs. Integrative pediatrics, a holistic practice that includes an examined integration of CAM and conventional therapies, is ideally suited for primary care. This article describes how to integrate evidence-based CAM therapies for colic, atopy, ADHD, eating disorders, and other conditions commonly seen in primary care practice.

Clinical Hypnosis, an Effective Mind-Body Modality for Adolescents with Behavioral and Physical Complaints.

Mind-body medicine is a system of health practices that includes meditation/relaxation training, guided imagery, hypnosis, biofeedback, yoga, art/music therapy, prayer, t'ai chi, and psychological therapies such as cognitive behavioral therapy. Clinical hypnosis is an important mind-body tool that serves as an adjunct to conventional medical care for the adolescent patient. Clinical hypnosis specifically uses self-directed therapeutic suggestions to cultivate the imagination and facilitate the mind-body connection, leading to positive emotional and physical well-being. There are many similarities between clinical hypnosis and other mind-body/self-regulatory modalities such as visual imagery, mindfulness meditation, yoga, and biofeedback that incorporate experiential learning and mechanisms for change. They may be viewed as subtypes of the hypnotic experience and share the common experience of trance as the entrée into self-empowered change in physiologic and psychological states. Clinical hypnosis can be used by health care providers to teach adolescents coping skills to deal with a wide variety of conditions such as chronic headaches, recurrent abdominal pain, anxiety, depression, grief and bereavement, phobias, anger, family stressors, sleep disorders, or enuresis. Clinical vignettes are given to help illustrate the effectiveness of hypnosis in adolescents.

Alternative and complementary therapies.

The field of complementary and alternative medicine (CAM) is broad and diverse, comprising numerous therapeutic modalities. CAM therapies are viewed as either an adjunct or a complement to conventional treatment. As of 1997, 64% of United States medical schools included elective or required CAM courses. The number of CAM practitioners in the United States is projected to increase by 88% between 1994 and 2010, and the number of conventional physicians who incorporate CAM into their practices will increase by 16%. Patients and their parents can make various health care choices; doctors need to understand and respect these options, and to support them, if safe and effective.

Natural contraception.

This article discusses some complementary and alternative medicine options for contraception, including natural family planning and plant-derived hormonal contraception. Primary care providers are crucial resources for advice and recommendations about these options. The discussion will include medical evidence to support or refute these methods, potential dangers of these interventions, and additional resources for those who want to learn more.

The adolescent traveler.

Oh, to travel again with the carefree attitude of the adolescent! Yet most readers will think that this enormous list of precautions would merit never letting the adolescent out of the house. The traveler and his or her provider can be reassured that with appropriate (and confidential) forethought, the journeys that lie ahead can be joyful and healthy. The bottom line? The more information obtained before travel both for the traveler and his or her family, the less morbidity will be incurred. The primary care provider is in the perfect position to provide all of these services to the adolescent traveler.

Approaches to the difficult patient/parent encounter.

Most pediatricians have experienced uneasy interactions involving patients and/or their parents. The majority of literature on this topic reflects encounters in adult medicine, without providing much information for pediatricians who also face this challenge. Unique to the pediatric approach is the added quotient of the parent/family dynamic. Patients or their parents may have personality disorders or subclinical mental health issues, physicians may be overworked or have a lack of experience, and the health care system may be overburdened, fragmented, and inundated with poor communication. Recognizing the physical or emotional responses triggered by challenging patients/families may allow the provider to effectively partner with, instead of confront, the patient or the family. In this article we review existing literature on this subject and describe possible strategies for the pediatrician to use during a difficult encounter.

Complementary and alternative medicine use and quality of life in pediatric diabetes.

OBJECTIVES: The objectives of this study were to explore the association between complementary and alternative medicine (CAM) use as reported by youth, and parents' and children's reported quality of life in youth with diabetes. DESIGN: The study design was a cross-sectional survey. SETTING: Youth in Washington State participated in the SEARCH for Diabetes in Youth study, a national, multisite epidemiological study designed to assess the prevalence and incidence of diabetes in U.S. youth. Surveys assessing CAM utilization were mailed in January and April 2006. PARTICIPANTS: One thousand four hundred and thirty-nine (1439) youth were mailed a CAM survey. The final sample consisted of 467 youth with both CAM survey results and quality-of-life data. OUTCOME MEASURES: Difference in mean scores on Pediatric Quality of Life Inventory (PedsQL) between CAM users and nonusers overall, and specific CAM therapies were the outcome measures. RESULTS: Of the 1439 participants approached, 587 (40.8%) returned the CAM survey. In adjusted analyses, children reported any CAM use as associated with more barriers to treatment (difference in mean scores -3.48, 95% confidence interval [CI] -6.65, -0.31). Children following a CAM diet reported higher quality of life (PedsQL Core Total difference 4.01, 95% CI [0.10-7.91]; Core Psychosocial difference was 6.45, 95% CI [1.95 to 10.95]), but those using stress-reduction activities reported poorer quality of life (Diabetes Total difference -4.19, 95% CI [-8.35 to -0.04]). Parent-reported quality of life was lower for children who used "other supplements" (Core Total difference -6.26, 95% CI [-11.29 to -1.24]; Core Psychosocial difference was -5.92, 95% CI [-11.65 to -0.19]). CONCLUSIONS: CAM diets were associated with increased quality of life in youth with diabetes, whereas supplement use and stress-reduction activities were associated with decreased quality of life. The temporal sequence between CAM use and quality of life requires further study.

Factors related to school absenteeism in adolescents with recurrent headache.

OBJECTIVE: To examine possible risk and protective factors for school absenteeism among adolescents referred to a hospital-based behavioral treatment program. DESIGN: Data obtained from intake interviews, screening questionnaires, and baseline headache diaries of 283 consecutive adolescents referred for behavioral treatment of recurrent headache were reviewed for demographics, length of headache history, headache type, current headache activity, symptoms of anxiety and depression, perceived self-efficacy regarding headache control, school performance, participation in extracurricular activities, and school absenteeism. The study population was divided into 2 groups at the median number of days missed due to headache in the previous 6 months that school was in session. Adolescents who missed 2 or less days of school due to headache (low absenteeism) were compared with those who missed more than 2 days (high absenteeism). RESULTS: Compared with the low absenteeism group, the high absenteeism group had higher scores on the Children's Depression Inventory (8.7 +/- 6.5 versus 6.8 +/- 6.2, P <.05) and lower academic performance (2.1 +/- 1.0 versus 1.7 +/- 0.8, P <.0001). The 2 groups were not statistically different in age, sex, length of headache history, type of headache, current headache frequency or intensity scores, anxiety scores, self-efficacy ratings, or participation in extracurricular activities. CONCLUSIONS: In a referred population, students who missed more school due to headache had higher depression scores and lower academic performance than students who missed less school. A directional relationship, however, cannot be implied from these results. Future studies should investigate the complex relationship between recurrent adolescent headache, potential risk or protective factors, and school absenteeism.