The family physician, as a broad specialist in the health care profession, needs to develop knowledge and skills to manage the social, psychological and physical problems of all age groups of patients, regardless of age or sex. The care of the adolescent is as unique and specific as pediatrics or geriatrics; therefore, the adolescent requires special attention in family practice. Nearly two-thirds of all physician office visits made by adolescents are to family physicians. This affords the family physician an opportunity to intervene at an early age to correct any health behavior patterns of the young person and to counsel appropriately regarding the specifics related to adolescent growth and development.

The third and fourth week of the Neonatology/Adolescent rotation will focus on the adolescent portion incorporating scheduled times for the outpatient requirements. This ensures that the resident will not miss out on these experiences as has happened in the past because of confusion over scheduling and conflict with neonatology.

For the times scheduled for school-based clinic, the resident could also incorporate a home visit (particularly relevant if a newborn, teen, or pregnant teen).

In the Summer, the school-based clinic can be substituted by an ambulatory pediatric experience to be scheduled by the resident. We are currently contacting people and compiling a list of sites which would be receptive to having residents. The following is a short but by no means complete list of possible pediatricians to work with:

As the population of the United States becomes more conscious of health and exercise activities, family physicians and family practice residencies should develop knowledge, skills, and attitudes appropriate to sports medicine. Family physicians often function as the "team physician" to the communities in which they practice. This often involves the provision of physical examinations appropriate to the age of the athlete as well as assessment of and care of the injured athlete. Attention to principles of exercise physiology and the relationship of exercise to optimal functioning of many organ systems is important in the training of family practice residents.

Learn the normal anatomy and physiology associated with puberty and adolescent years.

Growth and development

Become familiar with appropriate interviewing skills for each stage of adolescence.

Pre-puberty

Early adolescence (10-13 years)

Middle adolescence (14 - 17 years)

Late adolescence (over 17 years)

Become familiar with the psychological growth and development for each stage of adolescence

Preoccupation with body image

Sexuality and physical changes

Mood and behavior swings

Peer pressure

Feelings of invulnerability

Accidents

Family/parental relationship attitudes

Concrete versus abstract thinking

Become proficient in routing adolescent health care:

Health evaluation/screening

Patient education

Gynecological care of the adolescent

Legal / ethical considerations such as right to consent, confidentiality, etc.

Learn how to diagnose and treat a variety of common adolescent problems through direct management with faculty preceptors

Infectious diseases (such as pneumonia)

Orthopedic problems

Reproductive system problems (such as amenorrhea, dysfunctional uterine bleeding)

Breast disorders

Skin disorders (such as acne and atopic dermatitis)

Chronic illnesses (such as reactive airway diseases)

Psychological problems

Substance abuse

Physical and sexual abuse

Teenage pregnancy and parenting

Eating disorders

School and learning problems

The adolescent athlete

Pre-participation evaluation/sport specific pre-participation evaluation

Injury prevention

Acute musculoskeletal trauma

Health problems of athletes

School screening examinations

Sports nutrition

Overuse syndromes

Specific injuries seen in running, football, basketball, tennis, baseball, racquetball, soccer, swimming, cycling.

Injuries in women including: the female triad-amenorrhea, osteoporosis, anorexia

Injuries in children

Rehabilitation

Exercise

Role of exercise in health promotion

Fitness evaluation

Exercise prescription including understanding guidelines, aerobic strength, and flexibility training

Exercise in pregnancy

Goals  

1. To become familiar with the normal development and common health concerns of adolescents.

2. To gain proficiency in the evaluation and management of adolescent health problems.

3. To understand the adolescent sense of invulnerability

5. To gain confidence in one's abilities to care for the adolescent patient both as a part of and separate from the family.

7. To familiarize residents with the medical and social management of incarcerated youth.

 

8. To gain understanding of the epidemiology and etiology of runaway / street youth and to discover innovative means of providing health care to this population.

 

9. To learn the role of team physicians by providing on-site supervision of the athletes and post-game follow-up.