Adolescent Medicine Fellowship
The mission of this program is to develop, support and guide future adolescent medicine physicians to promote the optimal health and well-being of all adolescents and young adults through the advancement of clinical practice, care delivery, equity and inclusion, research, advocacy and professional development.
The aims of this program are to:
- Develop clinical excellence in care delivery to adolescents, including learning long acting reversible contraception skills, providing gender-affirming care through the GENECIS program, and providing primary care, subspecialty ambulatory services, variety of in-depth rotations and inpatient adolescent medicine consultative services.
- Support research and advocacy targeting adolescent medicine topics.
- Foster collaboration and relationships within the broader community focused on adolescent medicine initiatives.
- Mentor and guide fellows through their own professional development with integrity and high ethical standards, including respect for equity, justice and sensitivity that is employed by the fellow's day-to-day actions internally and externally with all individuals encountered in a workday.
The objective of this fellowship program will be to train one fellow a year to incrementally develop adolescent medicine teaching skills, prioritize patient care responsibilities, and lead scholarship, advocacy or quality improvement projects focused on adolescent health and medicine. Each rotation is carefully selected to occur at an appropriate interval based on expected development of the fellow to successfully manage the anticipated rotation over time.
There are four main clinical experiences that the fellow will participate in consecutively each year. The AYA clinical practice is a subspecialty service that provides consultative and follow-up outpatient / ambulatory visits. Most of the patients referred are for menstrual management or initiation of contraception for subspecialty care. The second experience is with GENECIS, the transgender program that offers an interdisciplinary approach (adolescent medicine physicians, adolescent gynecologists, and endocrinologists working together with psychology, social work, nutrition, pastoral services and legal) to affirm patients and families through hormonal gender transition support. The Rees-Jones Foster Center of Excellence sees adolescents in foster care for primary care services. All three of these experiences are at Children’s Health, in the same building, different floors and different staff/teams, with adolescent medicine core faculty providing oversight. Inpatient consults can be managed on the phone with brief documentation in the electronic health record, and a follow-up visit with AYA outpatient program arranged after hospital discharge. We plan to promote the fellowship program through outreach to the Division of Hospital Medicine to encourage high quality and face-to-face consults for questions coming from the inpatient team. Several of the phone-calls could be converted into in-person consults depending on the case. After the consult, most cases will follow-up in the ambulatory settings mentioned above depending on specific patient needs.
The first year fellow (60% clinical) will start with more continuous time spent directly with adolescent faculty in AYA and GENECIS (gender program) for the first year before tapering time at those sites and ramping up time with outside sites away from core faculty during the remaining years. For example, school-based and college-based rotations will only occur during the school season. Juvenile justice tends to be busier in the summer months, hence the rotating fellow will be scheduled at these sites to match the seasonality of the site. We are building relationships with adolescent medicine private practices in Dallas and hope to place third-year fellows there for a year-long exposure with a private practice setting once the fellow is near the end of training, and ideally, more self-sufficient as a third year. As seen in the block schedule, each continuity site duration (heavier in the start for closer oversight), rotation (primarily in the middle of training) and elective (weighted towards the end of training) was selected to match the progress of the fellow’s development, provide quality educational experiences based on the flow of each site, and allow for each fellow to develop longitudinal relationships with faculty members starting on day one. Each faculty member overseeing a fellow per site, rotation or elective will be expected to provide verbal mid-point and summative feedback as well as complete a written evaluation.
The second year (50% clinical) and third year (40% clinical) fellow will start to rotate through electives. These electives are for shorter amounts of time (ranging from 2.5% to 5% effort, or 0.3 to 0.6 calendar months, respectively) that include: Eating disorders, College Health, School-Based Health, Juvenile Justice, Young Women's Bleeding Disorder, Adolescent Gynecology, Teen Recovery (substance use program), REACH clinic (child abuse program), Developmental-Behavioral Pediatrics (neuropsychiatric evaluations), the ARMS clinic (HIV youth), sports medicine, and psychology didactics and rounds. Children's Health is the primary site for several of these experiences.
Scholarship Training will occur across all three years. Fellows must have a minimum of 12 months dedicated to research and scholarly activity and a minimum of 12 months of clinical experiences and be able to accommodate pediatric graduates across an educational program that is 36 months in length. We plan to equally divide clinical and research experiences across 3 years such that there is a total of 18 months dedicated to clinical experiences and 18 months dedicated to research and scholarship. Each fellow will be responsible for identifying a scholarship oversight committee that identifies mentors that match the content, methods and clinical expertise needed to support their project. Fellows will participate in Fellows Academic Circle of Enrichment monthly meetings to support and develop scholarship skills taught by fellowship directors of adolescent medicine, child abuse and developmental-behavioral pediatrics fellowship program, as well as a social epidemiologist from the Center of Pediatric and Population Health at UT Health School of Public Health. We are exploring options to offer advanced training degrees for interested candidates.
Diversity, Equity and Inclusion (DEI)
Recruitment, selection and retention of fellows will include various mechanism to ensure diversity, equity and inclusion. There are both University-level and Department-level attempts to achieve/ensure diversity that this program embraces.
Four initiatives to support diversity at the University-level include: 1) The Office of Diversity & Inclusion and Equal Opportunity, which is dedicated to implementing strategies and overseeing diversity and inclusion initiatives for UT Southwestern Medical Center. 2) The Office of Faculty Diversity & Development (FDD), which is responsible for enabling department chairs, center directors, and other academic leaders to recruit and retain the very best faculty to campus, while also implementing strategies to promote the careers of women and underrepresented minorities. Within this Office, House-staff Emerging Academy of Leaders (HEAL) for Underrepresented Groups was developed. HEAL is a networking and professional development program designed for historically underrepresented and/or discriminated groups that are assigned into different affinities and meet monthly, including HEAL for Underrepresented in Medicine (URMs), HEAL for Women, HEAL for LGBT & Allies, and HEAL for Muslims. 3) The Office of Student Diversity and Inclusion, which promotes services that will improve medical practice in underserved areas and enhance minority students' success in their medical school curriculum. 4) The Office of Women's Careers (OWC), which was founded in April 2012 as a division of the Office of Faculty Diversity & Development. OWC provides a coordinated approach to the recruitment, career advancement, and professional development of one specific UT Southwestern Medical Center constituency: women faculty.
Two initiatives to support diversity within the Department include: 1) The Office of Faculty Engagement, which is dedicated to assist the Department’s leadership in matters related to the career development and well-being of the faculty, promoting excellence and inclusion in teaching, discovery and patient care. 2) The Pediatric Faculty Advocate Committee, which the adolescent medicine fellowship program director helps to manage. This committee seeks to provide adequate representation from each division to raise faculty concerns, advocate for physician satisfaction, and provide recommended evidence-based solutions to the Office of Faculty Engagement.
On a program level, the adolescent medicine fellowship will take steps each year to incrementally increase our participation and integration within the above efforts to support diversity, equity and inclusion. We have developed a bias training series to be integrated into a three year program so that fellows and faculty, together, review movies, books, articles, podcasts over time and meet to review and discuss learning points in a safe space that encourages honesty and healing.