|Home | About | Journals | Submit | Contact Us | Français|
The history of adolescent medicine in Canada dates back to the early 1960s. Its origins are closely linked to the discipline of paediatrics, and its early leadership –Peter Benjamin and Jean Wilkins in Montreal, Martin Wolfish in Toronto, Lionel Pearlman in Ottawa, and Peter Spohn in Vancouver – was comprised of paediatricians. These pioneers are associated with the struggles to establish adolescent clinics and adolescent in-patient units within various teaching hospitals.
The history of adolescent medicine within the Canadian Paediatric Society (CPS) is even more recent. It was July 1970 when the Adolescent Medicine Committee (AMC) of CPS was established under the chairmanship of Dr Martin Wolfish. Subsequent committee chairs were Jean Wilkins, Michael Westwood, David Sharpe and Miriam Kaufman. The AMC’s early history is not well documented (perhaps a challenge for subsequent Adolescent Health Notes). By the 1980s, its role seemed to have been confined to creating position statements, a sometimes time-consuming and energy sapping process. Only occasionally were topics on adolescent medicine included in the scientific program of the annual meetings of the CPS. Frustrated by this, Jean-Yves Frappier and Michael West-wood began, in 1988, to talk of holding a Ross Conference on adolescent medicine. Supported by Ross Labs (Suzanne Hendricks) and the CPS (Victor Marchessault), the conference finally happened in the spring of 1990. The Proceedings of that 8th Ross Conference, Adolescent Medicine: Challenge of the 1990s, were published in 1991 (1) and remain an important benchmark in the life of adolescent medicine in Canada.
The 1990 Ross Conference brought together about two dozen people, including the entire leadership in the field in Canada at the time. Prominent on the agenda were issues such as aboriginal health, ethics, eating disorders, sexuality and youth needs. The conference also addressed concerns about services and programs, teaching and research. More importantly, the conference helped set the AMC’s agenda for the remainder of the decade.
The AMC became much more active, writing position statements on key adolescent health issues. About 16 statements have now been produced by the committee, usually with two new ones added every year. The topics cover the adolescent spectrum including everything from age definition of adolescence to family-centered approaches to adolescent care. The AMC has tackled specific issues such as gun control, emergency contraception and adolescent sexuality. It has provided sound clinical guidelines on eating disorders and the care of special youth populations (such as those with chronic conditions and youth in custody), and offered tips on practical matters such as setting up a paediatric practice that will meet the needs of adolescents.
More recently, the AMC has assumed a greater role as advocate on behalf of youth health needs. It published an article on the health status of adolescents in Canada (2) and contributed a key address entitled, The Future Needs of Canada’s Youth: Meeting the Challenge, at the most recent Ross Conference. The AMC has worked within CPS Board and Scientific Program Committee to achieve greater adolescent medicine content in the annual meeting program, to establish a new Adolescent Health Section, and to distribute a newsletter. These efforts have fostered broader participation on adolescent issues by the CPS membership. An exciting recent collaboration between CPS and the College of Family Physicians of Canada (CFPC) has produced the Joint Action Committee on Child and Adolescent Health, which includes representation from our CPS adolescent medicine group.
The AMC, in reviewing the proceedings of the 1990 Ross Conference, realized that the issues of education in adolescent medicine raised then remained unaddressed. The AMC moved to tackle this issue by surveying Directors of Pediatric Residency Training, department heads and the Royal College of Physicians and Surgeons. What began as a survey has subsequently broadened to become an evolving project, the National Training Initiative in Adolescent Health (NTIAH). This educational initiative has resulted in a number of spinoff projects, including the development of a core syllabus.
As the NTIAH continues to progress, it has expanded its scope to include other medical and nonmedical disciplines. The result is a learner-centred, modular program that can be adapted to the training needs in any discipline and that focuses upon a community-based approach to learning about the needs of adolescents. When fully operational, the NTIAH will apply a ‘train the trainer’ concept and be backed up by a central educational resources centre. The CPS will serve as the official host for the NTIAH. The collaboration with the CFPC, plus the active involvement of the Royal College of Physicians and Surgeons of Canada, means that the NTIAH and AMC influence national standards of adolescent care and promote adolescent medical content in the accreditation of all physicians in Canada.
The AMC will continue its role as the author of clinical guidelines on critical contemporary adolescent care issues. We will contribute authoritative clinical guidelines and review papers to Paediatrics & Child Health and will take a regular turn at producing Adolescent Health Notes for the journal. As the AMC looks to the new millennium, we can confidently predict that adolescent and youth health issues will reach the national and international agendas. We recognize that only a minority of adolescents ever come in contact with fully trained adolescent medicine specialists. Our challenge is to ensure that no matter who the first contact with an adolescent is that professional is properly trained for the task at hand and is backed up by a cadre of skilled, experience adolescent health specialists. We will achieve this goal by continuing to do what we can within CPS and by exercising leadership on behalf of CPS on the national stage. In that way, the adolescent health agenda will be kept alive and the ideas and work of our earlier pioneers will be validated.