Curriculum for Adolescent Medicine Fellowship

• Trainees learn to address complex medical problems, including eating disorders, obesity, young women's healthcare needs, chronic fatigue, transition to adult-based care, sports medicine, and health needs of unhoused youth.
• The fellows will participate in a broad clinical curriculum that includes primary, secondary and tertiary care, inpatient and outpatient, in a medical center and community settings including a homeless shelter facility for 18-24 year olds, a family planning clinic, and a school-based clinic. Additionally, for electives our fellows rotate at other clinical and hospital-based sites.
• Fellows receive training in LARC placement and removal (IUD and Nexplanon)

• Through a comprehensive curriculum led by our LEAH Director of Education, Lauren Bretz, M.D., our fellows receive instruction on how to be an effective educator. This includes didactic based learning of educational skills and practical application via mentored opportunities to teach at multiple avenues.
• Some educational activities our fellows lead include:
  • Medical student lecture on interviewing adolescents, staging pubertal development and adolescent sexuality
  • Monthly interdisciplinary case conference
  • Bi-annual fellow didactic and journal club
  • Opportunities to present at community talks at the Girls Elevated conference, Rice University Sex week, and HISD nurse training among others.  
  • Weekly resident teaching didactic during the summer
  • Primary clinical supervision and bedside teaching for residents and medical students on the inpatient adolescent medicine service at Texas Children’s and at Covenant House Texas
• Fellows have opportunities to pursue a Masters in Health Science Education or a Certificate in Public Health during their fellowship.

• Our administrative curriculum includes teaching on how to be an effective leader including leading a productive meeting,  and human resource topics such as budget development, billing and effective communication
• Fellows are active members of the Eating Disorder Protocol Committee and encouraged to join local and state advocacy committees
• Fellows assist with formal resident and medical student evaluations
• Manage their own call and clinic schedules
• Schedule Division didactics during the summer
• Attend faculty meetings as a third year fellow

Our fellows receive training in how to conduct research via our research curriculum led by our Director of Research, Constance M Wiemann, Ph.D.

• All fellows complete a fellow led mentored project as outlined by the American Board of Pediatrics. In recent years, ongoing and completed research topics studied by our fellows include but are not limited to postpartum depression in adolescents and young adults (AYA), social media use in AYA, impact of debt on career decisions of pediatric trainees, HIV PrEP for unhoused youth, extragenital STI testing in pediatric settings, condom distribution in clinical setting, adolescent confidentiality during telehealth visits, and predictors of eating disorder relapse.
• Intramural funding is available for pilot research. Mentorship for extramural funding applications is provided.
• All fellows also participate in a rigorous project-based training in how to conduct quality improvement studies through LEAH and the BCM pediatric fellows’ college.
• Fellows have opportunities to collaborate in projects led by BCM adolescent medicine faculty and in research led by our LEAH faculty who are national leaders in adolescent health.
• Fellows have the opportunity to pursue a Master’s in Clinical Research or complete certificate courses in Public Health

Fellows will get specific training in advocacy methods and have the opportunity to apply these methods with a local organization dedicated to children’s advocacy. 

A few examples of activities our fellows have participated in are:

• Doctors for Change: A group of Houston physicians who host community seminars and other volunteer opportunities to address access to care, mental health, anti-human trafficking, and access to a healthy lifestyle
• The Texas Pediatric Society Committee on Adolescence and Sports Medicine: The Texas Pediatric Society is the largest AAP chapter in the country, and the Adolescence and Sports Medicine committee is very active, with many opportunities to participate in legislative advocacy and physician education at the state level.
• Through partnerships with state advocacy organizations, our fellows also participate in an “advocacy day” at Austin during which they meet with state legislatures and their staff.

The three-year didactic curriculum supports the fellows’ clinical practice and covers ABP content. Fellows participate in a teaching curriculum during the duration of their fellowship. Lectures are given by fellows, section faculty, BCM subspecialists, and experts from the greater Houston area. During the summer, our fellows participate in the Fellows in Adolescent Medicine Learning Initiative (FAMLI – a national curriculum for adolescent medicine fellows). From Sep – May of every year, fellows participate in LEAH interdisciplinary trainings. 

Content includes, but is not limited to: 

• Core adolescent medicine content as outlined by the American Board of Pediatrics
• Adolescent psychology and psychiatry
• Teaching skills (establishing goals and objectives, flipped classroom, and effective use of PowerPoint, providing feedback)
• Sports Medicine with hands-on skills training taught by one of 9 board-certified Primary Care Sports Medicine physicians in our Division
• Weekly interdisciplinary case conferences (inpatient and outpatient)
• Research skills

The didactic curriculum is augmented by:

• Attendance at the BCM Chronic Illness and Disability Transition Conference
• Annual attendance at a national meeting (e.g., SAHM meeting – during which all fellows are provided with protected time and funding to attend).

Per the American Board of Pediatrics guidelines, all fellows will participate in scholarly activities and have a Scholarship Oversight Committee (SOC). Fellows are expected to participate in scholarly activities resulting in local and national presentations and in academic publication.

Activities that lay the research foundation include, but are not limited to:

• Journal club presentations
• Developing an annotated bibliography
• Lectures on authorship, dissemination, ethics
• Statistics
• An annual research course sponsored by the Department of Pediatrics
• Workshops on grant writing and quality improvement projects within the division and via Fellows college

The Director of Research oversees clinical research activities in the division, guides fellow research training and assists with fellow research projects. Faculty research in the areas of reproductive health, weight management, eating disorders, nutrition, and medical transition into adulthood are ongoing. There are opportunities to collaborate with faculty through their individual projects and through eating disorders and transition research workgroups. 

In addition there are opportunities to do research with our LEAH faculty based at the UTHealth Houston School of  Public Health and the Cizik School of Nursing. 

There are opportunities to obtain additional certificates of qualification or do a master’s degree in clinical research, education, or public health.

• Our inpatient care consists of an Adolescent Unit where primarily patients with eating disorders/ malnutrition at Teas Children’s Hospital (TCH) Medical Center campus, caring for patients requiring medical stabilization and weight restoration. Adolescent Medicine is the primary care team for these patients. This is the epitome of interdisciplinary care, teaching, research, and professional development in our fellowship curriculum. We also provide inpatient consultations for mental health and reproductive health.
• The “on call” schedule is devised as an administrative function of the second-year fellow. Fellows evenly split the call year and are on call for 13 weeks per year.
• Call is from home and, occasionally, fellows have to come back in at night. First call is handled by a resident with fellows and attending backup.

• Each fellow has a continuity clinic in which they see their own panel of patients. The continuity clinic typically begins within6 months of starting fellowship. The clinic is at the TCH subspecialty adolescent medicine clinic on the Main TCH Campus where fellows see mental health, reproductive health, eating disorder, and weight management diagnoses, frequently with an overlay of other chronic illnesses.
• Other TCH outpatient clinics include adolescent faculty clinics and the Teen Working on Wellness adolescent weight management program at TCH medical center location.
• Additional 3-year longitudinal experience at Covenant House Texas, a homeless shelter.

Required electives during the first year are the Baylor Teen Health Clinic school-based health clinic and family-planning clinics.

Other elective training sites include:

• Federally qualified health center (Legacy Montrose)
• Juvenile Detention Center
• Child Advocacy Center
• BCM Transition Clinic
• Sports Medicine
• Covenant House and TCH Psychiatry clinics
• Long- Acting reversible Contraception (LARC) elective
• Opportunity to design individual learning elective