June 2000 • Volume 6 • Number 6
Residents head back to school for training in adolescent health
After eight years of college and medical school, many family practice residents are clamoring for more time in school. But this time around, they're heading to elementary, middle and high schools to learn more about adolescent health and provide community-based care for children.
Elizabeth Feldman, M.D.
"We're really focused
on health career training
in a broad way."Since 1996, residents at the Ravenswood/University of Illinois Family Practice Residency in Chicago have trained in school-based health centers, said Elizabeth Feldman, M.D., medical director of the Ravenswood School-Based Health Center Initiative and assistant clinical professor in the UIC family medicine department. The program sponsors two health centers in high schools bordering poor inner-city neighborhoods.
"The mission was not only to provide good-quality health care to adolescents in a way that was accessible for them, but also to provide the training site for family practice residents so they would have a lot of exposure to the types of issues that adolescents bring," said Feldman, who is collaborating with other FPs to draft curriculum guidelines for residency training in adolescent health.
Residents work with physical therapists, nurse practitioners, psychologists and other health care providers, as well as students, interns and residents in various fields and specialties. "We're really focused on health career training in a broad way," Feldman said. "The residents see the multidisciplinary team in action. In the schools, the NPs run the show. The doctors are less important, which is just fine for giving the FP resident a dose of humility."
In their first year at Ravenswood, residents spend half a day each week at one of the centers during the pediatrics rotation. "That's a small amount of time, but it's enough for them to get a flavor of community-oriented medicine," said Feldman. The focus is on taking a thorough health history, improving communication skills and helping teens make informed lifestyle decisions. Residents also learn about confidentiality and what types of care require parental consent.
In year two, residents work in the centers for half a day each week during the pediatrics and community medicine rotations. They start providing more care on their own with input from a preceptor and other team members.
In the third year, residents spend three or four half-days in the centers as part of the adolescent medicine rotation. They get more autonomy in directing care and may have more involved cases such as sports injuries or prenatal care, Feldman said. "We work hard to make sure the residents get interesting patients and have time to get to know the kid."
The residency is adding opportunities for even more hands-on experience with youth. Starting in July, a third-year resident will spend half a day each week in a school health center for six to 12 weeks, developing her own patient panel. And starting next year, a resident will work with a clinical psychologist to co-facilitate a group that helps boys confront anger and learn conflict resolution skills.
The health centers and supplemental materials offer residents greater insight into adolescent health than traditional models do, said Feldman. "I think the residents are realizing what an artificial environment it is when they see an adolescent for care in their office. The school is where the kid lives; it's comparable to doing a home visit."
Involving residents in school health is a growing trend in family practice residencies, according to Deborah McPherson, M.D., AAFP Medical Education Division assistant director. "School nurses are so overburdened now that it's a great opportunity for partnership," she said.
In addition to working in school-based health centers, residents are presenting health education programs in the classroom, serving as team physicians and acting as mentors for youth, she said. An added benefit: Adolescents interacting with residents may also be inspired to pursue medicine as a career.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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