Core Competencies

3.02 Specialize Services: Adolescent and Young Adult Medicine

Introduction

Adolescents and young adults represent a unique population of patients cared for by pediatric hospitalists with a distinct set of medical conditions, ethical dilemmas, and legal considerations due to multiple factors beyond age alone. Puberty and sexual exploration put adolescents at risk for conditions related to abnormal uterine bleeding, acute ovarian and testicular issues, and complications from sexually transmitted infections which may require hospitalization for evaluation and management. This period of life is also associated with the deeper evolution of sexuality and gender identity. Pediatric hospitalists need to be skilled at caring for patients and advocating for a safe, sensitive, non-judgmental environment in the hospital. In addition, pediatric hospitalists must be competent in managing children with conditions typically first diagnosed in adulthood, as well as conditions diagnosed in childhood for which new therapies are supporting longer lifespans. These patients often continue to seek care from specialists at university/children’s hospitals well into adulthood. Pediatric hospitalists are well positioned to address the medical, social, and legal needs of these patients, including transition of care to adult healthcare systems where appropriate.

Knowledge

Pediatric hospitalists should be able to:

  • Identify common diseases of adulthood that have an increasing incidence in adolescents and young adults (including type II diabetes mellitus, hypertension, obesity and others), and list resources to guide the care of these diseases.
  • Identify healthcare disparities facing lesbian, gay, bisexual, transgendered, queer, or questioning (LGBTQQ) adolescents and young adults, including access to medical and psychiatric care, social determinants of health, screening and preventable illnesses, and domestic violence.
  • Identify risk factors associated with sexual violence, trafficking, and abuse in the adolescent and young adult population.
  • State interventions that can be applied for this population to identify and abate commonly encountered problems, such as prescription or street drug abuse, mental health disorders, school failures, and bullying.
  • Summarize the common sexually transmitted infections often seen in adolescents and young adults based upon local epidemiology.
  • Identify indications for hospitalization when a patient has a sexually transmitted infection.
  • Review common conditions resulting in hospitalization of this population, including toxic ingestion, suicide attempts, abdominal pain, eating disorder sequelae, trauma, and others.
  • Describe the treatment of various sexually transmitted infections, including pelvic inflammatory disease and tubo-ovarian abscess.
  • Compare and contrast typical menstrual patterns in adolescents and young adults with abnormal uterine bleeding.
  • Identify indications for hospitalization in a patient with abnormal uterine bleeding.
  • Discuss risk factors, epidemiology, clinical presentation, evaluation and management of emergent ovarian and testicular conditions (such as ovarian and testicular torsion).
  • Compare and contrast procedures for privacy, confidentiality, consent, and assent for this population.
  • Review standards around shared medical records as they apply to this population, including local state law.
  • Summarize the long-term complications and prognosis for children with chronic illnesses of childhood (such as cystic fibrosis, sickle cell, childhood cancers, asthma, and others).
  • Cite the benefits and limitations of adult versus pediatric hospital care for this population with chronic care needs, attending to access to specialists, equipment, support for the family/caregivers, neurodevelopmental needs, and other issues.
  • Describe the core elements necessary for transition to adult health care providers (such as a transition policy, assessment of transition readiness, transition tracking and monitoring, transition planning, successful transfer of care to completion, and others).

Skills

Pediatric hospitalists should be able to:

  • Diagnose and manage common diseases of adulthood that have an increasing incidence in young adults, including but not limited to type II diabetes mellitus, hypertension, and obesity.
  • Triage patient admissions accurately ensuring care needed is within the scope and skill set of local hospital and healthcare providers.
  • Consult other subspecialists and coordinate care efficiently and effectively.
  • Act as consultant or provide appropriate medical or surgical co-management for this population.
  • Provide a safe and sensitive clinical environment attending to special social, developmental, sexual identity, or other needs, for patients including LGBTQQ and others.
  • Document in the medical record in appropriate locations, using correct terms that meet requirements for confidentiality for this population.
  • Screen and provide care for sexually transmitted infections in hospitalized adolescents and young adults according to established guidelines based upon behavioral risk factors, signs, and symptoms.
  • Screen and provide medical resources for sexual violence and abuse in this population, and refer for legal and social resources as indicated.
  • Screen and provide resources for depression and other mental health disorders as available within the local context.
  • Diagnose abnormal uterine bleeding, perform a cost-effective evaluation, and institute a management plan.
  • Provide basic triage care for patients with complications of abnormal uterine bleeding and other common gynecologic and testicular conditions.
  • Initiate a cost-effective and timely evaluation of common ovarian and testicular conditions, in collaboration with other subspecialists as appropriate.
  • Counsel patients, the family/caregivers, and other healthcare providers about risk factors, etiologies, treatments, prognoses, and potential social and medical complications of identified conditions such as sexually transmitted infections, abnormal uterine bleeding, and emergent ovarian and testicular conditions.
  • Obtain informed consent from the patient or the family/caregivers, consistently adhering to legal guidelines and ethical principles and utilizing shared decision-making skills.
  • Demonstrate skills in providing safe transitions of care, using respectful and effective written and verbal communication with patients, the family/caregivers, and healthcare providers.
  • Counsel patients, the family/caregivers, and other healthcare providers about the importance of transition of young adults to adult providers and healthcare institutions.

Attitudes

Pediatric hospitalists should be able to:

  • Reflect on the importance of collaboration with subspecialists and adult hospitalists to build partnerships that facilitate transitions of care of these patients where appropriate.
  • Appreciate the value of a multi-disciplinary approach in the prevention, diagnosis, and treatment of common diseases of adulthood that have an increasing incidence in young adults.
  • Exemplify competent and non-judgmental care for this population, including those with special social, developmental, sexual identity, or other needs such as LGBTQQ adolescents and young adults.
  • Reflect on the importance of shared decision-making for this population.
  • Realize the importance of institutional policies that address self-advocacy, autonomy, and the ethical approach toward care for this population.
  • Recognize the complexity of how an individual develops sexuality and gender identity throughout childhood, adolescence, and young adulthood.

Systems Organization and Improvement

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

  • Collaborate with hospital administration and other healthcare providers to develop institutional policies, educational tools, and individual plans for safe transition of care from pediatric to adult healthcare systems for this population.
  • Lead, coordinate, or participate in institutional efforts to improve the care provided for common diseases of adulthood that have an increasing incidence in young adults.
  • Advocate for institutional policies that promote and ensure a safe, sensitive, and non-judgmental environment for LGBTQQ adolescents and young adults.
  • Lead, coordinate, or participate in institutional efforts to improve screening and care for sexually transmitted infections and mental health.
  • Collaborate with other subspecialists to develop cost-effective, evidence-based care pathways to manage emergent ovarian and testicular conditions.

References

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