Clinical Experience

This is the primary teaching service of the Adolescent Medicine Fellowship and forms the backbone of the subspecialty training in outpatient adolescent medicine. During the first and second years of fellowship, fellows spend two to three half days per week in this specialty consult clinic. Fellows provide consultative care to adolescents 10-21 years old who are referred to the Adolescent Specialty Clinic for a variety of issues including management of mood disorders, reproductive health services, menstrual concerns, disordered eating, substance use, acne management, and complex medical issues complicated by behavioral health concerns. Our main clinic is in the heart of Kansas City and serves as a Title X clinic for the surrounding community, allowing us to provide confidential reproductive health care for adolescent and young adult patients. We also have several satellite locations in the surrounding suburbs

The focus of this rotation is to provide care as part of a multidisciplinary team for adolescents with eating disorders. Throughout the first and second years of fellowship, fellows spend two half days per week in the Children’s Mercy Eating Disorder Center. Fellows work with a multidisciplinary team consisting of clinicians, nurses, child psychologists, child psychiatrists, dieticians, and a social worker to provide consultative evaluations and ongoing care for patients 10-17 years old with eating disorders. Fellows learn how to evaluate adolescents with potential disordered eating, assess and manage the physiological effects of disordered eating, establish and maintain a therapeutic relationship with patients and families, and work with and support the other members of the care team. Fellows become proficient at evaluating new patients and providing ongoing longitudinal care for these patients and their families.

The Eating Disorder Inpatient Consultation Service provides medical and psychological evaluation, supportive care, and nutritional rehabilitation for adolescents with eating disorders requiring short-term hospitalization for medical stabilization. At the beginning of fellowship, fellows complete a 4-week rotation on the Eating Disorder Inpatient Consultation Service. Fellows spend five half days per week working with an adolescent medicine specialist providing consultation on the evaluation, management, and disposition of hospitalized adolescents with eating disorders.

After the initial 4-week rotation, fellows are on call every sixth week. During their call week, fellows, in conjunction with one of the adolescent medicine physicians, are responsible for providing phone consultation to inpatient and outpatient providers on eating disorders and other adolescent issues. During their call weekend, fellows round on patients in the hospital who have been followed by the Eating Disorder Inpatient Consultation service during the week, as well as evaluate new consults.

During this 8-week rotation, fellows spend one half day per week performing subdermal contraceptive implant placements and removals and intrauterine device placements and removals under the direct supervision of a credentialed provider. At the end of this rotation, fellows are competent to perform these procedures independently with direct supervision immediately available.

During this 12-week rotation, fellows work with a multidisciplinary team consisting of an adolescent medicine physician, a pediatric endocrinologist, and a dietician. This experience focuses on the evaluation and management of adolescent and young adult patients with irregular menses and/or evidence of hyperandrogenism consistent with polycystic ovarian syndrome and related disorders.

During this 12-week rotation, fellows spend one half day per week working with a multidisciplinary team consisting of a pediatric endocrinologist, an adolescent medicine physician, a child psychologist, a chaplain, a social worker, and a nurse, delivering gender-affirming care to gender-variant, gender-questioning, and transgender children and teens. Fellows learn to assess gender identity and sexual orientation, manage reproductive health issues, and provide psychopharmacologic management of mood concerns in this population. Fellows are also taught the basics of prescribing gender-affirming hormone therapy based on current evidence-based guidelines.

During this 8-week rotation, fellows spend one to two half days per week working with pediatric and adolescent gynecologists. Fellows learn how to evaluate and manage complex gynecologic disease in adolescent patients including endometriosis and anatomic abnormalities. Fellows also learn how to provide routine gynecologic care for adolescents with severe developmental disabilities.

During this 16-week rotation, fellows spend one half day per month working with a multidisciplinary team of providers including a pediatric cardiologist, a child psychologist, and an adolescent medicine clinician. Fellows learn how to evaluate and manage adolescents and young adults with symptoms of orthostatic intolerance including patients with dysautonomia, POTS, NMH, chronic fatigue, and non-cardiac syncope/near syncope.

During this 16-week rotation, fellows work with clinical child psychologists two half days per week to consolidate the skills learned in Psychology Didactics and gain practical experience in behavioral intervention and motivational interviewing of older school-aged children and adolescents in a clinic setting.

During the second year of fellowship, fellows will continue to spend 2 half days a week on the Adolescent Medicine Outpatient Consultation service and 2 half days a week in the eating disorder clinic. During the second year, the fellow will continue to practice under the supervision of a credentialed adolescent medicine provider but will take increasing responsibility for the evaluation and management plans.

Fellows continue to take call an average of every sixth week.

During this 4-week rotation, fellows spend three half days per week working at Crittenton Children's Center, a community inpatient psychiatric unit for children and adolescents. Fellows work with a team of child psychiatrists, child psychologists, and social workers to perform evaluations and provide short-term medication management of acute psychiatric presentations.

During this 12-week rotation, fellows spend one day per week at the University of Kansas Health System’s addiction psychiatry medication assistance treatment program. Fellows work with an addiction psychiatrist to evaluate and treat teens and young adults with opioid use disorders.

During this 8-week rotation, fellows spend two half days per week at the Jackson County Juvenile Detention Center. The Juvenile Detention Center provides temporary and safe custody for juveniles who are accused of conduct subject to the jurisdiction of the Court who require a restricted environment for their own or the community's protection while pending legal action. Juvenile Detention provides detained adolescents with a wide range of services to support their physical, emotional, and social development, including education, communication training, counseling, continuous supervision, and medical services.

During this 4-week rotation fellows spend two half days per week at the Topeka High School school-based clinic. Working in a school-based health center gives fellows a better understanding of the impact of chronic disease, mental health issues, environment, and school resources on academic performance. Fellows also work with educators on evaluation of school failure, assessing learning problems, and maximizing classroom engagement for adolescents with acute and chronic medical issues.

During this 12-week rotation, fellows spend one half day per week providing medical care at a clinic associated with Synergy House, an emergency youth shelter for unhoused and runaway youth ages 12-18 years old in the Kansas City area. Fellows are exposed to the impact of homelessness on health, risk factors associated with homelessness among youth, health care risks associated with homelessness, and the impact of insurance coverage and the legal status of homeless youth on medical care for these individuals.

At the end of the second year of fellowship, fellows select a location or locations from a list of adolescent medicine practice locations for their Adolescent Medicine Subspecialty Practice during the third year of fellowship. Fellows spend two half days per week for the entire third year providing consultative care at their chosen location(s) under the supervision of an adolescent medicine physician.

Fellows refine their teaching skills by spending one half day per week supervising clinical care provided by residents and medical students in the Teen Primary Care Clinic at Children’s Mercy. This clinic is a patient-centered medical home for patients 10-21 years old and is part of the required adolescent medicine rotation for pediatric and med-peds residents. Fellows are also involved in creating and delivering didactic education on core adolescent medicine topics to learners at Children’s Mercy and in the community.

During this 8-week rotation, fellows spend four half days per week working with sports medicine physicians and athletic trainers at Children’s Mercy. This rotation focuses on the evaluation and management of non-operative orthopedic injuries in the adolescent age group.

During this 8-week rotation, fellows spend four half days per week working with psychologists and sleep medicine providers from the Sleep Medicine Fellowship at Children’s Mercy. This rotation focuses on the evaluation and management of sleep disorders in the adolescent age group.

In this 8-week rotation the fellow will spend 3 half days a week working with psychologists and specialists from the Infectious Disease Division at Children’s Mercy. This rotation will focus on the evaluation and management of HIV in the adolescent age group.

During this 8-week rotation, fellows spend three half days per week working with psychologists and headache specialists from the Child Neurology training program and the Headache Fellowship at Children’s Mercy. This rotation focuses on the evaluation and management of headaches in the adolescent age group using a variety of pharmacologic, behavioral, and alternative medicine treatment modalities.

During this 8-week rotation, fellows spend two half days per week working with a board-certified adolescent medicine physician in a community-based, solo practice associated with the University of Kansas School of Medicine. Fellows experience an adolescent medicine practice in a different system of care from Children’s Mercy. This rotation broadens fellows’ exposure to patients from various socioeconomic and cultural backgrounds and adds additional richness to discussions of clinic management, health care financing, and quality improvement initiatives.

Fellows have four weeks of elective time during their third year of fellowship to engage in activities to round out the fellowship training or to prepare for future career goals. Fellows may elect to spend more time on one of the previous rotations from fellowship or engage in other training experiences available at Children’s Mercy including:

Cystic Fibrosis Clinic

Inflammatory Bowel Disease Clinic

Renal Transplant Clinic

Dermatology

Orthopedics

Psychopharmacology

Toxicology

Clinical Pharmacogenomics

International Medicine

Integrative Pain Management

Advocacy

Research Block