UNM FAMILY MEDICINE RESIDENCY

ROTATION INFORMATION -- ADOLESCENT MEDICINE

Rotation contact information: Dr. Melanie Baca, Dr. Molly McClain, and preceptors as in schedule below

Locations: See below

Pre-requisites: be in R3 year

Main Purposes (See below for longer list of Goals and Objectives)

Gain experience in the care of adolescents, and their specific, unique health needs
Exposure to school-based health: we have an important role in clinical care of school-aged patients, and in education and role-modeling for future healthcare providers!
Exposure to alternate practice locations, including school-based clinic, free/volunteer-run community clinic (One Hope), and clinic in youth detention center
Completion of an ABFM Knowledge Self Assessment (KSA)- "Care of Children." Log in to ABFM to complete this module https://www.theabfm.org/.
The One Hope Clinic experience is not an adolescent specific experience but find it to be a very valuable experience for residents that happens to fit well with this rotation's schedule. Please access the orientation packet to learn more about the experience and resident expectations

Process and contact for sick days: Please let Dolores Garcia, Dr. Melanie Baca and your preceptor for the day know if you need to take a day off for any reason.

Schedule:

Day	Mon	Tues	Wed	Thurs	Fri
AM	Youth Services Center "YSC" 8:00am-12:00pm Preceptors vary (e.g. Baca, Cano, Johnson, Leggott) Contact Baca with questions 5100 2nd St NW named "Bernalillo County" on Google Maps	Education/Admin Time (to work on your KSA, Modules, or Scholarly Project - see info below)	Atrisco Heritage High School Clinic 7:00am-11:00pm Melanie Baca, MD Elena Bissell, MD 10800 Dennis Chavez SW Check schedule before to verify when appts start! Schedule is "AHC Peds Resident"* - Plan time to drive - ~25min from UNMH.	Youth Services Center "YSC" *Have a copy of your PREA training certificate (email preferred) and a government issued ID* 8:00am-12:00pm Preceptors vary (e.g. Baca, Cano, Johnson, Leggott). Contact Baca with questions. 5100 2nd St NW named "Bernalillo County" on Google Maps	Continuity Clinic
PM	Deseo Clinic (all ages Gender Affirming Care) with Dr. Molly McClain at Southeast Heights Clinic every Monday PM of your rotation 8200 Central Ave SE	1st Tuesday of Rotation: "PREA Training" MUST BE COMPLETED THIS DAY 2nd-4th Tuesdays: Compensation for One Hope time. Complete ABFM Care of Children Knowledge Self-Assessment (KSA) Activity https://www.theabfm.org/ Send completion certificate to Dolores Garcia** 1:00pm-5:00pm	Resident School 1:00pm-4:00pm	Continuity Clinic	Continuity Clinic 2 Fridays per month will be ADOBE Clinic at the S.E.H Clinic. They are schedule bi monthly. If you aren't scheduled for PM clinic in QGenda then you would go to ADOBE.
Evening Schedule:			One Hope Clinic 133 Virginia Street NE 5pm-8:30pm Preceptors vary (Galicia, Kaufman, Bouquin, etc). Please follow this LINK to access the orientation packet

ADOLESCENT CLINICAL SITES & CONTACT INFO:

1. Bernalillo County Youth Services Center 'YSC' formerly known as Youth Detention Center:

5100 2nd St (2nd building from the entrance - enter at door next to multicolored Butterfly Mural)

Primary Contact: Melanie Baca, MD

Phone: 505-670-0560 (cell)

Email: mbaca@salud.unm.edu

Contact: Valerie Romero-Leggott, MD

Phone: 505-263-8469 (cell)

Email: VRomero@salud.unm.edu

General Information about site: Provide primary care and acute care services for detained youth.

2. Atrisco Heritage High School Clinic:

10800 Dennis Chavez Blvd, Albuquerque NM 87121

Primary Contact: Melanie Baca, MD (see contact info as above), or Tiger Connect

General Information about site: Visits for confidential reproductive health and mental health, sports physicals, WCC, and general health/acute care

Phone: 505-272-6009

3. UNM Deseo Clinic @ Southeast Heights clinic

8200 Central Ave SE

Primary Contact: Molly McClain, MD

Phone: 408-597-7322, or Tiger Connect

Park in gated lot at the front of the building. Let the front desk staff know you're working with Dr. McClain, and they will bring you to provider room. Dr. McClain will usually contact you about clinic start time - often the first patient is scheduled at about 2pm. There are often multiple learners scheduled on the same day. Look up "SEH Deseo Provider" in Powerchart

General Information:

Our "clinic within a clinic" is called Deseo. We work with gender-expansive folks of all ages. Trans and non-binary people can face discrimination, exclusion, and even violence from every institution, including the medical system. Dr. McClain hopes this experience will help residents to discover for themselves that providing gender-affirming care is easy, fun, and won't take too much time to feel comfortable providing. We hope that primary care providers learn appropriate aspects of gender care to increase access and decrease marginalization of gender-expansive people. It is important for primary care providers to increase familiarity with gender-affirming care terminology and treatments -- we want our graduates to be among the growing group of providers who are decreasing barriers to gender-diverse people seeking health care.

If you want to learn more before or after clinic, check out Deseo wiki page: http://unmfm.pbworks.com/w/page/126203630/Transgender Health Clinic

4. UNM ADOBE Clinic @ Southeast Heights Clinic

8200 Central Ave SE

Primary Contact: Kate McCalmont, MD and Melody Avila, FNP

Phone: Tiger Connect

Park in the gated lot in front of the clinic. Let the front desk staff know that you are working with the ADOBE clinic and they will bring you to the provider room. Please arrive by 1pm. The schedule is under "SEH ADOBE" in PowerChart.

General Information: The UNM ADOBE is an interdisciplinary team that includes primary care, psychiatry, community navigation, educational liaison, and legal support through the UNM Medical-Legal Alliance. Many patients come from low socioeconomic backgrounds, are from ethnic minority groups, and have a prior history or a family history of substance use and/or incarceration. Although these challenges often lead to poorer health and educational outcomes, many participants have strengths that allow them to overcome many of these barriers, particularly when paired with the interdisciplinary services available in ADOBE.

1.) Community Navigation support to assist the client and their family with access to community resources (e.g., SNAP benefits and housing for disabilities), clinic coordination (e.g., assisting with scheduling specialty appointments such as dental and vision), and access to MBH services (e.g., helping find inpatient drug treatment programs).

2.) Educational liaison to assist with customized placement of adolescents into the Albuquerque Public School (APS) system or GED programs, advocacy during Individualized Education Plan meetings, and vocational support for finding a job.

OTHER CLINICAL SITES & CONTACT INFO:

One Hope Center for Life

133 Virginia Street NE

Primary Contact: Ricardo Galicia, MD. Can reach out to Art Kaufman, MD if unable to get ahold of Dr. Galicia.

Phone: Tiger Connect or cell: (505) 440-4380

General Information about site: Provide primary care and acute care services for mostly immigrant uninsured population. The population is mostly Spanish speaking but there is an in-person interpreter if you do not speak Spanish. Your main role at this clinic is to precept medical & pharmacy students. You will act as the attending and sign off on plans, notes, and prescriptions. There will be an attending there for support and to run things by if needed. Please read the One Hope orientation packet for specifics about the clinic experience and expectations.

Rotation Requirements:

-**PREA Training: has to be done prior to working at YSC, so you MUST do it the first Tuesday AM. Below is the info you probably also received in rotation info email:

Access the internet and type in http://nic.learn.com
New Users Register (on the left tab), enter all information: Username (email), Password (one of your choice please remember your password)
Important: Upon registration, it may take 1-3 business days to review your application. Once the review is complete, you may receive an email with additional info. If you haven't received an email after 3 business days, try to log in anyway!! Users often are able to login the same day or next day even if they didn't get a follow up email.
24/7 Live Support may be accessed by clicking on Help & Support link on the Homepage.
After you log in, go to Course Catalog, choose “Medical Health Care for Sexual Assault Victims in a Confinement Setting” Below are the chapters in the course. There will be assessments at the end of each chapter that the participant is required to take and pass with a 70% or better.

Chapter 1: Course Introduction : Taking the course, PREA terms and definitions, PREA medical standards, Additional PREA standards
Chapter 2:Detecting, Assessing, and Responding to Signs of Sexual Abuse and Harassment: Sexual abuse in confinement settings, The dynamics and effects of sexual abuse, your role in responding to sexual abuse incidents
Chapter 3: Preserving Physical Evidence of Sexual Abuse: The Forensic Medical Exam (FME), Preserving Physical Evidence, Documentation Strategies
Chapter 4:Reporting Allegations and Suspicions: Reporting requirements, Your role in reporting allegations and suspicions, Documentation strategies

When you log back in you will see a link titled “CERTIFICATES” at the top right of the webpage.  You can go there to download your certificate.

-Childhood Illness Knowledge Self-Assessment (KSA) Activity: This is required for this rotation. This is also great boards prep. We've blocked the 2nd-4th Tues for you to do it!

Rotation FAQ

Q: Why does the rotation have so many different experiences?

A: We've selected a few sites that we think are high value experiences, but don't have lots of time available. We also prioritize experiences with FM docs interested in working with residents.

Q: Why are on-call residents handling phone calls from YSC?

A: This was decided after lots of thought and discussion. Please understand we wouldn't put more work on the residents if we didn't think it was striking an educational balance. In order for residents to experience YSC, our affiliation with YSC needs to continue, which requires support for call. The small number of providers working at YSC were not able to do call. Over the years we have removed un-educational calls that used to go through residents (e.g. residents used to be available overnight for clinic patients to call with questions).

Q: Do I really have to do the KSA on Childhood Illness?

A: Yes! You have to do 2 KSAs to sit for boards, so this will get one done. This is a topic that residents have said they feel less comfortable with, so consider this protected board prep time.

Q: Why do we have to do evenings at One Hope?

A: One Hope is an experience that many residents have felt was a valuable breath of fresh air during residency, so we wanted to build that in more formally. Wed evening is the best time for the clinic and our faculty. In exchange, we built in compensatory flexible time / time off in the rotation, as above.

Rotation Goals and Objectives

Competencies

At the completion of this rotation, a family medicine resident should:

Be able to develop patient-centered treatment plans for adolescents based on comprehensive risk-based assessments that take into account the cultural, linguistic, and socioeconomic backgrounds of adolescent patients (Patient Care, Medical Knowledge)
Optimize treatment plans based on knowledge of adolescent care resources including local, state, federal agencies (Systems-based Practice, Practice-based Learning & Improvement)
Be able to coordinate ambulatory, inpatient, and institutional care. Advocate for adolescents across health care providers, institutions, governmental agencies (Systems-based Practice)
Demonstrate ability to communicate effectively with adolescents and their families to establish and maintain therapeutic relationships in context of confidentiality (Interpersonal & Communications Skills)
Demonstrate sensitivity and responsiveness to the adolescent patient’s race, ethnicity, culture, language, gender, sexual orientation, gender identity, and disabilities (Professionalism)

Attitudes

The resident should demonstrate attitudes that:

Recognize that each adolescent has strengths that serve as protective factors and support his or her development during adolescence
Acknowledge that connection to parents, school, and community is essential to an adolescent’s successful development
Understand that adolescence is a time of experimenting, learning, and developing and offer guidance that encourages healthy behaviors and responsible decision making
Support confidentiality while also encouraging the adolescent to communicate with his or her parents (and other supportive adults)
Treat each encounter with an adolescent as an opportunity to act as a caring adult and to engage the adolescent in conversations about healthy living

Knowledge

In the appropriate setting, the resident should demonstrate the ability to apply knowledge of:

Normal growth and development in the adolescent years that includes physical, mental, emotional, and sexual milestones
Major health risks and behaviors of adolescents and methods to address them
Strategies for providing preventive services, immunizations, health promotion, and guidance to adolescent patients during annual wellness visits, routine care visits, acute care visits
Challenges facing adolescents to establish their identities and to learn responsible behaviors, including self-care and attention to mental health, sexual health, reproductive health
Core conditions affecting adolescent health, such as family problems, poverty, depression, school failure, obesity, eating disorders, violence, drug use, unintended pregnancy, STIs

Supplemental Reading: resources we think you will find helpful during this rotation

Helpful Web Links

Society for Adolescent Health and Medicine: https://www.adolescenthealth.org/Home.aspx

Contraceptive pearls: http://www.reproductiveaccess.org

Modules:

1) Adolescent Consent and Confidentiality

Minors and the Right to Consent to Health Care.pdf

Confidentiality Overview ppt.ppt

Details on Duty to Report.pdf

2) Puberty, Adolescent Development and Screening

Normal Growth and Development: https://hslic-unm-on-worldcat-org.libproxy.unm.edu/oclc/324993274?databaseList=1834,1920,1931,2236,2375,2507,2897,2977,2979,638
Biro, Frank M., MD
Adolescent Medicine, Chapter 1, Pages 1-1 Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. (**search through UNM Library**)

Adolescent Health Screening and Counseling.pdf

Adolescents and LARCs.pptx

Adolescent Headds Screening Article

USC-Adolescent Health Curriculum: Normal Growth and Development in the Adolescent.

Go to link to access reading, which includes questions, diagrams and two cases: http://www.usc.edu/student-affairs/Health_Center/adolhealth/content/a1.html

3) Common Adolescent Medical Problems

Osteochondrosis: Common Causes of Pain in Growing Bones - American Family Physician.pdf

Adolescent Idiopathic Scoliosis: Diagnosis and Management - American Family Physician.pdf

USC Adolescent Health Curriculum, Common Ortho problems: https://www.usc.edu/student-affairs/Health_Center/adolhealth/content/b4orth.html#references

USC Adolescent Health Curriculum, Common Medical problems: https://www.usc.edu/student-affairs/Health_Center/adolhealth/content/b4misc.html

4) Adolescent Mental Health

Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa - American .pdf

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Manage.pdf

Adolescent R3 Rotation

Helpful Web Links

Modules: