Case Based Teaching

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.

1. Residency Review Committee for Internal Medicine, effective: July, 1998. Chicago, IL: Accreditation Council for Graduate Medical Education, June 1997.

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