When medical residents begin their rotations in Children's Hospital Boston's Division of Adolescent/Young Adult Medicine, they study with an unusual group of teachers: teenagers. Children's peer-resident training program helps new residents practice patient interviews through a series of mock appointments with peer leaders Dennisse Rorie, 17, Paoli Roman, 18, and Rahiem Crawford, 17, all of whom are current or former patients themselves and now work with the Center for Young Women's Health. Here, Rorie, Roman and the Director of Resident Training, Sara Forman, MD, talk about the resident training program and give their recommendations on how to talk to teens.
What is the focus of the peer-resident training sessions?
Dr. Forman: The focus of the program is to improve the interview skills of the interns with teenage patients. Up to this point in their residency, interns have had limited experience with teenage patients, especially in an adolescent clinic. Some of the topics and subject areas they will be dealing with-like sex and substance abuse-can be very awkward to talk about. These sessions are intended to make them feel more comfortable and prepared when they begin to have actual teen patient appointments.
What do you emphasize during these classes?
Dr. Forman: The peer leaders and I wanted to emphasize the more uncomfortable and serious subject areas, so we created characters for the peer leaders to play who have a history of problems with the issues we want to highlight. These include sexual activity, substance abuse, mental health, diet and violence.
How did you develop these characters?
Rorie: Our characters are a reflection of what we see among our peers almost every day. Many of our classmates have engaged in some form of alcohol abuse or dangerous sexual activity. The adolescent clinic serves the urban neighborhood that we live in, so much of what our characters convey are what the interns will probably really experience while seeing patients here.
Roman: As trained educators in young women's health, we sometimes get approached by our classmates for advice or counseling. They are usually worried they have done something wrong or damaging to their health, but are afraid to seek professional help. This apprehension is a common trait of the characters we create, which can make it more challenging for the interns to start open conversations.
How can physicians better engage teens?
Dr. Forman: The peer leaders and I created a check-list we use to evaluate the interns during interviews. It focuses on how they relate to the patient, their use of language and whether the
questions they ask are "teen-friendly." It also addresses counseling points intended to help the doctors clearly educate the teens.
Rorie: We always encourage the doctors to be genuine and compassionate when speaking with teens. Some of the subject matter teens discuss is personal and embarrassing, so it's important for teens to know that what they share about themselves will ultimately lead to them getting help.
Roman: We also advise them to remain non-judgmental and not talk down to teens like many authority figures do. Teens have enough authority figures in their lives; they need adults who can help them live a more healthful life.
What should physicians not do when speaking to teens?
Rorie: Bad body language, like crossing your arms or rolling your eyes in frustration, will only make us less likely to share important personal information.
Roman: How the physician reacts is important. If the patient talks about her sexual activity or alcohol consumption and the doctor jerks his head back in amazement, it can be very uncomfortable. Even questioning why she participates in these activities can come off as critical and authoritative. Maintaining a positive, welcoming demeanor will help patients be open.
What else might physicians experience with teens?
Dr. Forman: Since some of the doctors are so close in age to the patients, we address the possibility that teens might overstep their boundaries. For example, during mock appointments, the peer leaders sometimes ask interns personal questions about their lives. It can catch some of them off guard, and reinforces that physicians shouldn't let the teens infringe upon patient-physician boundaries.
What's most important when talking to teens?
Roman: We intentionally made the characters younger than 18 years old in order to help the interns practice outlining confidentiality agreements. Confidentiality gives teens the sense that they're in a safe environment and that doctors are there to help.
Rorie: Many adolescents are resentful and rebellious toward adults, and aren't going to share information about their personal lives with anyone. It's important to generate a level of trust. If we can relate to the physician and have an open conversation without fear of their authority, we'll be more likely to speak openly about aspects of our personal lives and health.
Dr. Forman: Getting teens to realize they have a problem is difficult to do without sounding preachy. When some of my patients are at risk, I talk about how I worry that what they are doing can lead to major health issues, and that we are always here to help.
What common errors do physicians make?
Dr. Forman: One is when physicians assure confidentiality beyond what they can provide. For instance, some say, 'Don't worry, I won't tell anyone.' In fact, doctors do have to share the information when the teen might be at risk for physical or mental harm. Another common mistake is when physicians make assumptions and phrase their questions in ways that are close-ended, like 'You aren't doing drugs are you?,' which doesn't give teens the opportunity to be open. This is sometimes a result of the physicians having a pre-conceived bias or feeling rushed.
Check-list to evaluate residents: childrenshospital.org/views