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Adapting the Approach: Internal Medicine
Adapting these cases for teaching internal medicine residents will
vary by program and will depend greatly on the prior experiences
of the resident learners. The residency accreditation guidelines
for internal medicine residency training programs state that "residents
should be formally instructed in adolescent medicine,"1 and
programs will thus emphasize adolescent medicine education to varying
degrees. This is in contrast to the pediatrics residency accreditation
guidelines which require a one-month block experience in adolescent
medicine. For the most part, residents in internal medicine will
not have had the same depth of didactic or clinical experience with
teens as pediatric residents. Indeed, many internal medicine residents
may complete their training without having cared for teenagers.
Because of this potentially wide variation in experience, facilitators
using these written teaching cases with internal medicine residents
should begin with a brief assessment of the learners’ previous
exposure to adolescents. Have they ever taken care of teens? In
what type of setting? How recently have they provided medical care
to teens? Do they have any adolescents in their continuity clinics?
How comfortable are they caring for these patients?
The need for establishing a learner-centered agenda is particularly
important with internal medicine residents because their educational
needs may be quite different from what the facilitator anticipates.
Without establishing an appropriate agenda, facilitators may direct
the session towards more advanced behavioral interventions of risky
behaviors, when what the learners really desire is information about
the basic approach to teenagers, including how to ask questions
about sexuality, alcohol, family relationships, and school performance.
Conversely, internal medicine residents should not be assumed to
know nothing about adolescent medicine. Various training programs
may provide different learning opportunities, and the residents
themselves may have widely varying interests and knowledge in adolescent
medicine. Use the learners to help guide the discussion, and use
the more experienced learners to teach the others in the group.
Terrill Bravender, M.D., M.P.H.
Reference:
1. Residency Review Committee for Internal Medicine, effective:
July, 1998. Chicago, IL: Accreditation Council for Graduate Medical
Education, June 1997.
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