Do Adolescent Inpatient Wards Make a Difference?

Findings From a National

Young Patient Survey
Russell M. Viner
Pediatrics 2007;120;749-755
DOI: 10.1542/peds.2006-3293

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ARTICLE

Do Adolescent Inpatient Wards Make a Difference?

Findings From a National Young Patient Survey
Russell M. Viner, MB, PhD

Adolescent Medicine, General and Adolescent Paediatrics Unit, Institute of Child Health, University College London, London, United Kingdom

The author has indicated he has no financial relationships relevant to this article to disclose.

ABSTRACT
OBJECTIVES. There is little evidence to support the effectiveness of adolescent inpa-
tient wards. These analyses test the hypotheses that nursing young people in
www.pediatrics.org/cgi/doi/10.1542/
adolescent wards improves aspects of quality of care and patient satisfaction peds.2006-3293
compared with child or adult wards. doi:10.1542/peds.2006-3293
PATIENTS AND METHODS. Secondary analyses of the national English Young Patient Key Words
adolescence, inpatient, hospital, quality of
Survey 2004 were weighted to take account of variations in hospital size and care, health service research
response rate. Participants included 8855 subjects aged 12 to 17 years. Ward types Abbreviation
(adolescent, child, and adult) were compared. Patient-reported quality-of-care NHS—National Health Service
indicators included rating by young people of overall care, respect, safety, confi- Accepted for publication May 10, 2007
dentiality, communication, team-working, noise, and leisure facilities. Logistic Address correspondence to Russell M. Viner,
MB, PhD, Department of Paediatrics, University
regression models were adjusted for gender, disability, and previous hospital College Hospital, 250 Euston Rd, London NW1
admissions. 2PG, England. E-mail: r.viner@ich.ucl.ac.uk
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
RESULTS. Ten percent of 12- to 14-year-olds and 18% of 15- to 17-year-olds were Online, 1098-4275). Copyright © 2007 by the
American Academy of Pediatrics
nursed in an adolescent ward, 0.4% of 12- to 15-year-olds and 16% of 15- to
17-year-olds in an adult ward, with the remainder in a child ward. Compared with
being in an adolescent ward, 15- to 17-year-olds were less likely to report excellent
overall care in an adult ward and less likely to report feeling secure, having
confidentiality maintained, feeling treated with respect, confidence in staff, ap-
propriate information transmission, appropriate involvement in own care, and
appropriate leisure facilities. Compared with being in an adolescent ward, 12- to
14-year-olds were less likely to report excellent overall care in a child ward and
less likely to report feeling involved in their own care.
CONCLUSIONS. Dedicated adolescent inpatient wards improve aspects of quality of care
for young people compared with child or adult wards, particularly for older
adolescents. These data support the continued development of adolescent wards in
larger general hospitals and children’s hospitals.

PEDIATRICS Volume 120, Number 4, October 2007 749

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T HE SOCIETY FOR Adolescent Medicine advocates the
continuation and establishment of adolescent med-
icine inpatient units in both general and pediatric hos-
pitals as the “optimal approach to the delivery of devel-
opmentally appropriate health care.”1 Young people
repeatedly report a desire for dedicated adolescent ser-
vices in hospitals and in primary care.2–5 With changes in
pediatric practice, the proportions of adolescent patients
within pediatric services are rising.6,7 Indeed, children
older than 10 years now constitute nearly 30% of all
admissions at one of Australia’s leading children’s hos-
pitals.8 However, many general and pediatric hospitals in
the United States and internationally lack dedicated in-
patient wards for adolescents.
The number of adolescent medicine inpatient wards
in the United States is unknown. Estimates in 1978
suggested that ⬃45% of pediatric residency training sites
had inpatient adolescent medical services.9 In 1998, al-
though 72% of pediatric residency programs reported
providing exposure to inpatient adolescent medicine
training, these are likely to have included inpatient ser-
vices operating in pediatric wards, because only 39%
reported providing training in an inpatient adolescent
ward.10
In the United Kingdom, a national survey undertaken
by the Royal College of Pediatrics and Child Health in
2001 suggested that only ⬃12% of all hospitals had a
dedicated adolescent medicine ward.11 This is despite
repeated calls for the development of dedicated services
for adolescents by the Department of Health12 and the
joint medical colleges11 and data showing that the aver-
age general hospital serving a regional population of
250 000 people has at least 15 beds routinely occupied
by 12- to 19-year-olds outside of maternity and mental
health services.13
Development of adolescent inpatient services interna-
tionally has been hampered by a lack of evidence of
benefit.2,11 Existing arguments to support adolescent
wards rely on patient satisfaction and professional opin-
ion, with little or no published data on the impact of
adolescent medical wards on quality of care. Simple
surveys of patient satisfaction have been found to min-
imally influence health care quality,14 and evidence that
adolescent wards improve quantitative health care out-
comes remains elusive.
However, modern understandings of patient-cen-
tered care have placed patient-reported experiences at
the heart of assessment of quality of care. As noted by
Cleary, “[p]atients usually cannot assess the technical
quality of their care; however, examining a hospitaliza-
tion through the patients’ eyes can reveal important
information about the quality of care. Patients are the
best source of information about a hospital system’s
communication, education, and pain-management pro-
cesses, and they are the only source of information about
whether they were treated with dignity and respect.”15
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In fact, there is increasing evidence that processes of care
that are more patient centered lead to improved health
outcomes14; thus, the use of patient perceptions of care
for systems improvement may lead to better health out-
comes.16 Modern survey measures that elicit reports
about specific care experiences that reflect the quality of
care, not simply the amenities, are appropriate for qual-
ity improvement purposes.14
In this study we investigated the impact of dedicated
adolescent inpatient wards on quality of care compared
with nursing adolescents in child or adult wards and
used data from the English National Health Service
Young Patients Survey conducted by the Picker Institute
in 2004.17
METHODS
The Young Patients Survey 2004 is part of the English
National Health Service (NHS) patient survey program.
The survey was conducted by the NHS survey advice
center at the Picker Institute Europe and conducted in
participating NHS acute and specialist hospital trusts in
England.18 An NHS hospital trust is a publicly funded
management entity that may include 1 or more hospitals
in a city or locality providing inpatient care free at the
point of contact; this survey included general hospitals,
children’s hospitals, and specialist medical hospitals and
excluded psychiatric and chronic care facilities. All acute
and specialist trusts in England were invited to partici-
pate, with 150 (87%) of 173 providing data. Five (3%)
were stand-alone children’s hospital trusts.
Each trust identified a list of 850 eligible patients who
had been discharged from the trust from the last date of
either November 2003 or January 2004. Four of the
trusts identified a list of only 500 eligible patients be-
cause they had too few young patients. Patients were
eligible to take part if they had been treated as inpatients
or day cases in any part of the trust that included adult
wards, were aged 0 to 17 years, and were not maternity
or psychiatry patients. Patients were sent a postal ques-
tionnaire and a cover letter, and up to 2 reminder letters
were sent to nonresponders. Questionnaires were sent
to 125 827 young patients, and 62 277 completed ques-
tionnaires were returned; 59 815 of these patients were
within the appropriate age range. This represents a 50%
response rate once undelivered questionnaires and de-
ceased patients had been accounted for. Response rates
varied between trusts from 32% to 64%, and these rates
were equal for boys and girls.19 Subjects aged 12 and
older were encouraged to complete the questionnaire
themselves or with the assistance of their parents.
The questionnaire drew on previous Picker Institute
inpatient surveys of adults and children in the United
States16,20 and studies of the domains of care that matter
most to hospitalized patients internationally, which in-
clude respect for patient preferences, coordination of
care, information and education, physical comfort, emo-
tional support, involvement of family and friends, and (responses completed only by parents were excluded),
continuity and transition.21,22 The questionnaire was and (4) were not nursed in an “other” type of ward. Data
modified to enable assessment of each trust against the on ethnicity were not available for these analyses; in the
English NHS standards for hospital care for children and overall sample, 89% were white, 5% Asian, 3% black,
adolescents12 and also included questions about overall 3% mixed ethnicity, and 1% of Chinese or other eth-
quality of care, safety, and confidentiality and privacy. nicity.
Analysis of a similar instrument used to survey pediatric Proportions that responded positively to each ques-
inpatient populations in the United States showed high tion were examined according to type of ward. Subse-
reliability and validity.16,20 quently, logistic regression was used to examine the
Inpatient ward type was defined by the respondents. association of ward type with care variables. Following
Young people were asked, “For most of your stay, what the methods of Co et al,16 these analyses were adjusted
type of ward were you in: (1) a child ward; (2) an adult for factors that were considered likely to influence the
ward; (3) an adolescent or teenager ward; or (4) another reporting of care, including gender and presence of a
type of ward?” In the United Kingdom, adolescent wards chronic illness. Two variables were used as proxies for
include (1) a general ward for adolescents only, encom- chronic illness and previous contact with the health
passing a wide range of conditions and specialties, com- services: (1) whether a young person considered himself
monly comprising 12 to 18 beds; (2) a subsection of a or herself as disabled and (2) the number of previous
general hospital child ward, commonly 4 to 8 beds; or hospital admissions in the past 6 months.
(3) a single-specialty adolescent ward, such as for cancer
or cystic fibrosis. Detailed data on the type of adolescent RESULTS
ward were not available from this survey, and their A total of 16 707 patients (28% of 59 815 respondents)
differential impact on quality of care could not be exam- were aged 12 to 17 years. Of these, 13 727 had full data
ined. However, data collected by United Kingdom pro- on ward type, length of admission, number of admis-
fessional bodies in 2004 suggest that the great majority sions, person completing the survey (young person or
of units were small 4- to 6-bed wards embedded within parent), and the presence of a disability. For these anal-
a general child ward, with only 10 general adolescent yses, the following patients were excluded: (1) 3730
wards and 8 to 10 specialty adolescent wards (personal who did not stay overnight and (2) 1926 for whom the
communication, M. de Sousa, MA, written communica- parents completed the questionnaire without their in-
tion, 2006). volvement. Thus, the sample for these analyses was
For the question on overall rating of care, young 8071. Patient characteristics for this sample are shown in
people were asked to rate the general quality of hospital Table 1. Twelve- to 14-year-[r]olds were predominantly
care on a 5-point Likert scale (1 ⫽ poor, 5 ⫽ excellent). nursed in a child ward (89%), with 361 (10%) nursed in
For other items, following Co et al’s analyses of the an adolescent ward, and only 18 (0.5%) in an adult
Picker Institute’s pediatric inpatient survey in the United ward. Of 15- to 17-year-olds, 811 (18%) were nursed in
States,16 responses were dichotomized. For items with an adolescent ward, 74 (16%) in an adult ward, and
⬎2 response categories, we defined high-quality care as
being the most preferable 2 of 4 or 2 or 5 response
categories. For example, for questions with response
TABLE 1 Patient and Parent Characteristics (N ⴝ 8071)
categories of “poor,” “fair,” “good,” “very good,” and
Characteristic 12–14 y Old 15–17 y Old Total
“excellent,” responses of “very good” or “excellent” were
(n ⫽ 3596), (n ⫽ 4475), (N ⫽ 8071),
considered to indicate high-quality care. % % %
Data were obtained electronically from the United Gender
Kingdom Data Archive (www.data-archive.ac.uk). Data Male 54 47 50
were weighted for trust size by using patient population Female 46 53 50
weights19 calculated from the annual total inpatient bed- Ward type
days for 2003–2004 for each trust, which were obtained Adolescent 10 18 14
Child 89 66 77
from the Information Centre, NHS Hospital Episode Sta- Adult 0.5 16 9
tistics (www.hesonline.nhs.uk). Data were analyzed by Young person considers himself or 6 6 6
using the survey commands in Stata 8 (Stata Corp, Col- herself to be disabled
lege Station, TX) to obtain robust confidence intervals Previous hospital admissions in
that took into account unequal probabilities of selection past 6 mo
0 46 71 74
attributable to the differences in trust size and response 1–2 19 23 21
rate. For these analyses, subjects were included if they ⱖ3 6 5
(1) were aged 12 to 17 years inclusive, (2) were hospi- Questionnaire completion
talized overnight or longer, (3) completed the question- Adolescent alone 44 69 58
naire themselves or in combination with their parents Adolescent with parent 56 31 42

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2960 (66%) in a child ward. When asked about ward
preference in the abstract, an adolescent ward was the
preferred inpatient option of the majority of respon-
dents; it was the preferred option of 95% of young
people who were actually in an adolescent ward, 51% of
those in a child ward, and 59% of those in an adult
ward.
The proportions that responded to each question ac-
cording to ward type and adjusted odds ratios for the
associations between ward type and quality-of-care vari-
ables are shown in Table 2. For those aged 12 to 14 years,
data are not shown for adult ward type because of the
very small sample.
Twelve- to 14-Year-Olds
Young people aged 12 to 14 years rated overall care in an
adolescent ward significantly superior to that in a child
ward (P ⬍ .05). This was also the case for the great
majority of variables; however, this reached significance
only for noise and involvement in own care.
Fifteen- to 17-Year-Olds
Young people aged 15 to 17 years were more likely to
rate their overall care as excellent if nursed in an ado-
lescent ward rather than in an adult ward (P ⬍ .0001), a
pattern that was also seen for each individual variable
aside from timing of discharge (all P ⬍ .001). Older
adolescents nursed in an adolescent ward were also sig-
nificantly more likely to report satisfactory information-
giving by nurses and involvement in own care and less
likely to report being bored or bothered by noise than
those nursed in a child ward.
DISCUSSION
These data from a nationally representative sample show
that aspects of quality of care, particularly core quality
issues such as confidentiality, communication, informa-
tion-giving, partnership, and respect, were rated signif-
icantly higher by young people nursed in inpatient ad-
olescent wards compared with peers nursed in either
child wards or adult wards. Although these data relate
only to patient-reported aspects of care, such aspects are
central to modern understandings of health care quality.
Overall care was more likely to be rated as excellent in
an adolescent ward for both younger (12- to 14-year-
old) and older (15- to 17-year-old) adolescents. Differ-
ences in quality of care were particularly striking for
those nursed in adult wards, where care was rated sig-
nificantly more poorly in 14 of the 16 domains studied.
Indeed, adolescents in adult wards were approximately
half as likely to report that they received excellent over-
all care, felt safe, received comprehensible information,
or felt they were treated with dignity and respect than
those who were nursed in an adolescent facility. Al-
though they were rated by young people as providing a
higher quality of care than adult wards, child wards were
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rated as significantly poorer in terms of overall care
(younger adolescents only) and in terms of young peo-
ple in their care, information-giving by nurses, noise,
and boredom. It is important to note that there were no
areas in this survey in which adolescent wards were
rated as performing less well than child or adult wards.
These findings provide an evidence base to support
guidelines on the provision of age-appropriate hospital
facilities in the United States,1 United Kingdom,11,12 and
elsewhere. These findings strongly support the develop-
ment of adolescent facilities in hospitals where adoles-
cents would otherwise be nursed in adult wards. There
were fewer significant differences and smaller effect sizes
when adolescent wards were compared with child
wards, although there was a consistent pattern for
young people to rate adolescent wards as providing a
higher quality of care than child wards. This may suggest
that child wards go some way toward offering adoles-
cents a developmentally appropriate health care setting
if staff members are trained appropriately. However, it is
important to note that the adolescent wards in this sur-
vey were a heterogenous mix, with the majority being
small units embedded within child wards. It is perhaps,
therefore, not surprising that mean differences from
child wards were not large. Additional research is
needed to test the likely conclusion that stand-alone
adolescent wards provide greater patient-reported qual-
ity of care than child wards, because this could not be
studied in the present data set. However, the pattern of
differences revealed between child wards and the heter-
ogenous mix of adolescent wards in this study suggest
that dedicated adolescent facilities improve quality of
care, even if these facilities are restricted in scope.
Comparison With the Literature
These are the first data, to our knowledge, to show a
clear benefit for quality of care from adolescent medical
inpatient wards. Other studies of pediatric inpatients
that used comparable methodology were confined to
parents and did not examine outcomes according to
ward type.16 The findings presented here are consistent
with a large literature, which shows that young people
repeatedly report a desire to be treated within dedicated
adolescent facilities that respect their rights as young
people, maintain confidentiality and privacy, and pro-
vide age-appropriate educational and leisure activi-
ties.2,3,11 These findings also confirm reports from small
specialist studies that young people’s satisfaction with
many aspects of care is higher when they are nursed in
an adolescent specialist ward (eg, adolescent cancer
wards compared with pediatric or adult cancer
wards).23,24
Overall ratings of quality of care regardless of ward
type seem similar to those reported from US surveys of
inpatient pediatric care16,25 (eg, in most domains, includ-
ing safety, information-giving, trust, privacy, and confi-
 TABLE 2 Associations Between Ward Type and Quality of Care in 12- to 14-Year-Olds and 15- to 17-Year-Olds
12- to 14-y-Olds 15- to 17-y-Olds
Proportions, % OR (95% CI) a P Proportions, % OR (95% CI)a P
Rated overall care as “excellent”
Adolescent 51 1.0 39 1.0
Child 45 0.8 (0.6–0.99) .049 38 1.0 (0.8–1.1) .6
Adult — — 27 0.6 (0.5–0.7) ⬍.0001
Felt ward was safe and secure place
Adolescent 85 1.0 78 1.0
Child 83 0.9 (0.7–1.3) .6 80 1.1 (0.9–1.4) 0.3
Adult — — 60 0.4 (0.3–0.5) ⬍.0001
Given information by doctors about care in a comprehensible way
Adolescent 64 1.0 66 1.0
Child 59 0.8 (0.6–1.0) .08 63 0.9 (0.7–1.0) .12
Adult — — 55 0.6 (0.5–0.8) ⬍.0001
Had confidence and trust in doctors
Adolescent 80 1.0 73 1.0
Child 75 0.8 (0.6–1.0) .07 72 0.9 (0.8–1.1) .4
Adult — — 65 0.7 (0.6–0.8) ⬍.0001
Doctors talked in front of young people as if they were not there
Adolescent 29 1.0 33 1.0
Child 29 1.0 (0.8–1.3) .9 35 1.1 (1.0–1.3) .16
Adult — — 41 1.4 (1.2–1.7) ⬍.0001
Given information by nurses about care in a comprehensible way
Adolescent 82 1.0 71 1.0
Child 79 0.9 (0.7–1.2) .6 66 0.8 (0.6–0.9) .004
Adult — — 53 0.5 (0.4–0.6) ⬍.0001
Had confidence and trust in nurses
Adolescent 68 1.0 76 1.0
Child 67 0.8 (0.6–0.96) .03 76 1.0 (0.8–1.2) .8
Adult — — 64 0.5 (0.4–0.7) ⬍.0001
Involved in own care as much as desired
Adolescent 63 1.0 59 1.0
Child 57 0.8 (0.6–0.96) .03 55 0.9 (0.7–1.0) .05
Adult — — 53 0.8 (0.6–0.9) .009
Confidentiality maintained when discussing condition
Adolescent 72 1.0 67 1.0
Child 70 0.9 (0.7–1.1) .4 67 1.0 (0.8–1.2) .7
Adult — — 61 0.7 (0.6–0.9) ⬍.001
Given adequate privacy when treated or examined
Adolescent 85 1.0 78 1.0
Child 82 0.8 (0.6–1.1) .11 77 0.9 (0.8–1.1) .5
Adult — — 75 0.8 (0.7–1.0) .10
Felt they were discharged at the right time
Adolescent 82 1.0 78 1.0
Child 83 1.0 (0.7–1.3) .9 78 1.0 (0.8–1.2) .9
Adult — — 77 0.9 (0.7–1.1) .3
Felt treated with dignity and respect in the hospital
Adolescent 81 1.0 75 1.0
Child 79 0.8 (0.6–1.1) .3 72 0.9 (0.7–1.0) .11
Adult — — 61 0.5 (0.4–0.6) ⬍.0001
Felt that the doctors and nurses worked well as a team
Adolescent 83 1.0 77 1.0
Child 80 0.8 (0.6–1.0) .09 75 0.8 (0.7–1.0) .07
Adult — — 63 0.5 (0.4–0.6) ⬍.0001
Rated leisure/entertainment facilities as “good” or “very good”
Adolescent 76 1.0 70 1.0
Child 75 0.9 (0.7–1.2) .6 67 0.9 (0.7–1.1) .3
Adult — — 36 0.3 (0.2–0.3) ⬍.0001
Bothered by noise from other patients
Adolescent 33 1.0 35 1.0
Child 43 1.6 (1.2–2.0) ⬍.0001 46 1.6 (1.4–1.9) ⬍.0001
Adult — — 46 1.7 (1.4–2.0) ⬍.0001
Bored during admission “most of the time”
Adolescent 12 1.0 19 1.0
Child 13 1.2 (0.8–1.7) .4 24 1.3 (1.1–1.6) .004
Adult — — 43 3.2 (2.6–4.0) ⬍.0001
OR indicates odds ratio; CI, confidence interval; —, not applicable.
a Odds ratios were adjusted for gender, self-rated disability, and number of previous hospital admissions.

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dentiality, staff team-working, and dignity and respect).
Between 60% and 85% of all young people reported a
high quality of care regardless of where they were
nursed.
Although those who were nursed in adolescent wards
were more likely to report a high quality of care in
almost every domain, it is disappointing to observe that
care in some areas fell short of what is recommended.
Providing care in partnership with young people is a core
skill in adolescent medicine, yet only 63% of younger
adolescents and 59% of older adolescents felt involved
in their care as much as they desired. It is unclear
whether this particularly relates to the English health
care system, because comparative data on partnership
working with adolescents from other countries are not
available. These findings highlight the work that needs
to be performed in the training of health care profession-
als to ensure that all young patients experience a high
quality of care in terms of information-giving, privacy,
and confidentiality regardless of setting.
Strengths and Limitations
These findings were drawn from nationally representa-
tive data from a recent survey in which subjects were
unaware of the hypotheses under study. Survey meth-
odology was designed to be appropriate for quality im-
provement purposes.14 Analyses were weighted to take
into account variations in trust response rates and trust
patient populations, and robust confidence intervals
were calculated. Questionnaires were completed (with
or without their parents) by 72% of those aged 12 to 14
years and 90% of those aged 15 to 17 years.
These data have a number of limitations. Patient re-
port of quality of care is accepted as an important mea-
sure of quality in patient-centered systems of care14,15;
however, patient rating cannot inform other important
aspects of care. Although the overall response rate was
⬃50%, this is unremarkable in postal surveys of this size
and, indeed, was highly similar to the 48% response rate
obtained in a recent US inpatient pediatric survey.16
Furthermore, we believe it unlikely that response bias
influenced the findings concerning ward type reported
here. Type of ward was identified by young people, and
it is possible, although unlikely, that young people mis-
identified the type of ward to which they were admitted.
However, the finding that 13% of young people re-
ported being nursed in an adolescent ward is consistent
with the finding from a national survey in 2001 that
12% of trusts have dedicated adolescent medicine
wards.11
Because of limitations in the available data, we could
not examine which elements of adolescent care were
responsible for improved quality of care (eg, whether
benefits related to milieu issues for young patients or,
rather, to differences in staff numbers, skills, or training).
Analyses could not be controlled for ethnicity or so-
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cioeconomic status, because these data were not avail-
able, and it is likely that response rates were higher in
those from white subjects and those from higher socio-
economic backgrounds.
CONCLUSIONS
Dedicated adolescent medical wards improve aspects of
quality of care across a wide range of domains for young
people compared with child or adult wards. Young peo-
ple nursed in adult wards were approximately half as
likely to rate their care highly across many domains.
Child wards generally performed well in looking after
young people, particularly younger adolescents; how-
ever, adolescent wards performed significantly better in
terms of overall care and in a small number of domains.
These data further support the development of adoles-
cent medical inpatient wards in general and children’s
hospitals, and where this is not possible, the provision of
dedicated adolescent facilities in child wards. Additional
work is needed to examine the impact of adolescent
wards on clinical outcomes and resource use.
ACKNOWLEDGMENT
Dr Viner was funded by the English NHS.
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Med. 1999;153:1123–1129

FORCED TO PICK A MAJOR, 4 YEARS BEFORE CHOOSING A PROM DATE

“Ninth graders often have trouble selecting what clothes to wear to school
each morning or what to have for lunch. But starting this fall, freshmen at
Dwight Morrow High School here in Bergen County [New Jersey] must
declare a major that will determine what electives they take for four years
and be noted on their diplomas. For Dwight Morrow, a school that has
struggled with low test scores and racial tensions for years, establishing
majors is a way to make their students stay interested until graduation and
stand out in the hypercompetitive college admissions process. Some parents
have welcomed the requirement, noting that a magnet school in the district
already allowed some students to specialize. But other parents and some
educators have criticized it as preprofessionalism run amok or a marketing
gimmick. ‘I thought high school was about finding what you liked to do,’ said
Kendall Eatman, an Englewood mother of six who was president of the
Dwight Morrow student body before graduating in 1978. ‘I think it’s too early
to be so rigid.’ Debra Humphreys, a spokeswoman for the Association of
American Colleges and Universities, called high-school majors ‘a colossally
bad idea,’ saying youngsters should instead concentrate on developing a
broad range of critical thinking and communication skills. ‘Today’s economy
requires people to be constantly learning and changing,’ Ms Humphreys said.
‘A lot of jobs that high-school students are likely to have 10 years from now
don’t yet exist, so preparing them too narrowly will not serve them well.’
Despite such naysayers, a number of school districts around the country are
experimenting with high school majors.”
Hu W. New York Times. August 16, 2007
Noted by JFL, MD

PEDIATRICS Volume 120, Number 4, October 2007 755

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Do Adolescent Inpatient Wards Make a Difference? Findings From a National
Young Patient Survey
Russell M. Viner
Pediatrics 2007;120;749-755
DOI: 10.1542/peds.2006-3293
Updated Information including high-resolution figures, can be found at:
& Services http://www.pediatrics.org/cgi/content/full/120/4/749
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