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Am Fam Physician. 1999;60(2):660-662

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Society for Adolescent Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

The ultimate concern of all physicians must be the welfare of the patient. The family physician, as a specialist with a breadth of knowledge in the health care profession, must develop skills appropriate to manage the social, psychologic and physical problems of all groups of patients, regardless of age or sex.

The care of the adolescent is as specific as the care of children or the elderly; therefore, the adolescent patient requires special attention in family practice. Nearly two thirds of all physician office visits made by adolescents are to family physicians. Thus, the family physician has an opportunity to intervene at an early age to correct any health behavior patterns the young person is forming and to counsel appropriately regarding the specifics related to adolescent growth and development.

The following outline specifies certain knowledge and skills basic to the diagnosis and management of adolescent patients. However, the family practice resident should understand that there are yet other areas of knowledge and skills that might be essential to the appropriate care of a given patient. Therefore, these guidelines are not intended in any way to limit the family practice resident's effort to acquire other important knowledge and skills relating to adolescent health.

Attitudes

The resident should develop attitudes that encompass an understanding of:

  1. The preoccupation of adolescents with their bodies

  2. The effects of peer pressure and peer support

  3. Adolescents' inquisitive and confrontational attitudes toward society, parents and others

  4. Adolescent sexuality, including physical, psychosocial, moral, heterosexual, homosexual, bisexual and gender identity issues

  5. The adolescent sense of invulnerability and the tendency toward high-risk behavior

  6. The issues of confidentiality in the physician-adolescent patient interaction

  7. The promotion of health, wellness and prevention habits

Knowledge

The resident should develop knowledge of:

  1. Normal anatomy and physiology associated with puberty and the adolescent years

    Growth and development

    Tanner stages

  2. Tasks and stages of adolescence

    Prepuberty

    Early adolescence (10 to 13 years of age)

    Midadolescence (14 to 17 years of age)

  3. Psychologic growth and development in each stage

    Life aspirations

    Preoccupation with body image

    Sexuality and physical changes

    Mood/behavior changes

    Peer pressure and support

    Feelings of invulnerability

    Accidents

    Family/parental relationship attitudes

    Concrete versus abstract thinking

  4. Adolescent health care

    Health evaluation

    History-taking techniques

    Physical examination

    Screening tests and interpretation

    Patient education information that is specifically intended for adolescents

    The adolescent athlete

    Preparticipation evaluation

    Injury prevention

    Acute musculoskeletal trauma and other trauma

    Health problems of athletes

    School screening examinations

    Prevention of risk-taking behavior

    Preventive health care

    Immunizations

    Healthy diet

    Exercise

    Safe sexual practices

    Smoking cessation

    Avoidance of recreational drug use

    Pregnancy prevention

  5. Variations in physical growth and development

    Short and tall stature

    Precocious puberty

    Delayed puberty

    Delayed menarche

    Menstrual irregularities

    Oligomenorrhea/secondary amenorrhea

    Excessive bleeding

    Primary dysmenorrhea

    Male gynecomastia

  6. Major threats to life and health in adolescence

    Violence

    Accidents

    Drowning

    Suicide

    Homicide

    Malignancies

    Cardiovascular diseases

    Congenital anomalies

    Infectious diseases

  7. Specific problems of adolescents

    Infectious diseases

    Respiratory infections

    Pharyngitis

    Sinusitis

    Otitis media

    Influenza

    Mononucleosis

    Hepatitis

    Urinary tract infections

    Sexually transmitted diseases

    Vaginitis

    Human immunodeficiency virus infection

    Psychiatric issues

    Depression

    Schizophrenia

    Eating disorders

    Learning disorders

    Attention-deficit/hyperactivity disorder

    Dyslexia

    Body image issues

    Acne

    Obesity

    Substance abuse

    Drugs

    Nicotine

    Alcohol

    Performance-enhancing agents

    Sexuality and adolescent pregnancy

    Sexual concerns (identity, orientation, body image, masturbation, contraception, sexually transmitted disease, human immunodeficiency virus infection)

    Pregnancy (prevention, health risks, psychologic and educational issues, family and parenting issues)

    Cultural, class, ethnic and gender differences that affect adolescent health care

    Interpersonal violence as a health issue

    Gang violence

    Family violence

    Sexual violence

    Particular health risks of homeless/runaway adolescents

    Effects of family, social and cultural environment on growth and development

    Media influence

    Poverty

    Violence/firearm safety

    Family problems

    School problems

    Spirituality

    Medicolegal issues of adolescents

    Consent/confidentiality

    Legislative/regulatory

Skills

The resident should develop skills in:

  1. Evaluation

    Taking a history and sexual history and performing a physical examination with emphasis on interviewing techniques specific to adolescents

    Confidentiality and legal rights

    Determining patient's parental relationship during interview and physical examination

    Performance of specific procedures and interpretation of results

  2. Management

    Formulating a plan of management, investigation and further consultation, if appropriate

    Providing patient education for preventive measures appropriate for adolescent health care needs

    Interpersonal relationships with an open-minded attitude toward adolescent patients

    Counseling specific for adolescents

    Dealing with adolescents in the context of their family and community (i.e., awareness of their interactions with parents, siblings, peers, teachers, etc.)

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