Education Columns

Nicole Chaisson, MD, Smiley’s Residency, University of Minnesota Department of Family Medicine and Community Health; Francesco Leanza, MD, Beth Israel Residency in Urban Family Health, New York; Alison Warford, MD, University of Minnesota Department of Family Medicine and Community Health

Adolescence is a normal developmental stage but one often feared or misunderstood by adults in general and sometimes physicians in particular. It is a period of complex physical, cognitive, social, and emotional development. During these years, teens often establish habits and refine beliefs that remain with them throughout much of their adult lives. These habits and beliefs are influenced by parents, peers, religious and ethnic communities, and society at large. The changes that accompany adolescence may be alternately exciting, challenging, and/or frightening for teens, their families, and their physicians.

Many health issues that physicians encounter in their adolescent patients are the result of risky behaviors or poor choices. These risk-taking behaviors (eg, alcohol, drugs, speeding, unprotected sexual activity) and poor choices (eg, diet and inactivity) can have a dramatic and lasting impact on these teens and their future health. For this reason, adolescence is a prime time to promote healthy behaviors—both as a doctor for a teen and as a support for the teen’s family. Realizing that behaviors affect the health of teens, many professional organizations, including the American Academy of Family Physicians, have established guidelines for adolescent preventive care. These guidelines include appropriate tools to screen adolescents for risk and protective factors.

As family physicians, we are in a unique position to support the family system in preparing for and navigating adolescence. We can promote healthy behaviors throughout childhood and then become a trusted resource as a child matures into a young adult.

What is your department doing about teaching adolescent medicine? In a recent survey of family medicine residency programs only 25% of those who responded had a formal adolescent curriculum. Many programs relied solely on the experience that residents received in their continuity clinic as the “access” to adolescent training through precepting. But, as noted in the literature, the majority of adolescent patients access care in acute visits and rarely have planned health maintenance visits. Less than one third of adolescents receive anticipatory guidance around reproductive health, chemical use, and mental health. ¹

While there are many models for excellence in the care of adolescent patients and guidelines for curriculum development, currently there is no existing comprehensive, competency-based adolescent curriculum that can be used to streamline training in family medicine or other primary care residency programs. Through an STFM Foundation grant, The STFM Group on Adolescent Health designed a Web-based adolescent curriculum based on the AAFP curricular guidelines. This curriculum is meant for point of care teaching and provides a Web-based resource for the entire community of adolescent clinicians and educators.

The curriculum web site was launched at the STFM Annual Spring Conference in Vancouver and can be found HERE in the STFM Resource Library. We welcome feedback on this living curriculum.

Reference
1. Ma J, Wang Y, Stafford RS. US adolescents receive suboptimal preventive counseling during ambulatory care. J Adolesc Health 2005;36(5):441.e1-441.e7.