Residency Subspecialty Education

Adolescence is characterized by unique biological, social, and emotional changes. The adolescent's perception and interpretation of health and illness are closely interwoven with these maturational changes. Adolescents therefore require diagnostic and therapeutic approaches that differ from other age groups. A teenager's ability to cope with illness is complicated by the many as yet uncompleted developmental tasks such as: establishment of independence and identity, development of a moral code, and career decisions.

Comprehensive adolescent health care should be provided with an understanding of the whole individual - biologically, emotionally, and socially. This approach to care should be performed in relation to the patient's particular level of maturation coupled with coordinated and integrated diagnostic and therapeutic services.

With this general approach in mind, some of the goals of care of the adolescent include: (1) the diagnosis and treatment of the presenting problem; (2) the assessment of any unmet medical and psycho-social needs; (3) the provision of preventative health care measures. Indeed, education and prevention of problems related to substance abuse, unwanted pregnancy, and sexually transmitted diseases including AIDS, may well represent areas of greatest need and greatest challenge for health care personnel caring for teenagers.

The Adolescent Medicine Division with its accredited Adolescent Medicine Fellowship Program runs two adolescent clinics in the pediatric outpatient area at Kings County Hospital (one afternoon and one evening) and two morning clinics at University Hospital of Brooklyn in Suite D. In addition, residents attend several sessions of the Health and Education Alternative for Teens (HEAT) Clinic at KCHC which has a particular focus on teens with HIV or at increased risk for HIV. During these experiences, the resident is directly responsible for patient care under the supervision of Dr. Suss (General Adolescent and Adolescent Gyn) or Dr. Birnbaum (HEAT). The division teaches pelvic examinations as well as comprehensive gynecologic care for teens. In 1995, there were 540 adolescent outpatient visits. In addition, nearly 100 consultation requests were answered on such diverse problems as endocrinologic problems, dysfunctional uterine bleeding, pelvic inflammatory disease, contraception, rape, suicide attempts, chronic disease, substance abuse, and ammenorrhea. Research in the division includes risk factors for P.I.D., risk factors for Hepatitis B infection, and epidemiology of suicidal behaviors in urban youth.

Complementing the adolescent medicine experience at Kings County Hospital and University Hospital of Brooklyn is the adolescent program at Staten Island University Hospital. The education at SIUH occurs in outpatient settings including the General Adolescent Medicine Clinics at the Ambulatory Pavilion and the Bay Street Satellite, the Teen Risk Assessment Program (RAP) and the School Health Center at New Dorp High School. In addition to adolescent clinics, a modest adolescent inpatient area and consultation services are part of the SIUH Adolescent Medicine experience.