Adolescent Medicine Selective
Rotation Contacts and Scheduling Details
Rotation Director: Rebecka Peebles, M.D.
Contact information: email: rpeebles@stanford.edu
Office location: 770 Welch, 4th Floor
phone: 650-694-0600 cell: 650-248-9683
pager: 14870
Administrator: Ana Fraser
phone: 650-694-0660
email: ana.fraser@stanford.edu
Office location: Division office, Suite 250-A, Castro Commons, Mountain View
Positions Available: 2-3 residents/month. Four week blocks only. No residents are accepted over the December/January holiday season.
Introduction
When pediatrics was redefined by the American Academy of Pediatrics in the early 1970’s to span the years from birth to 21, pediatricians were
suddenly cast in the role of experts in the care of the adolescent patient. In a subsequent study by the Task Force on Pediatric Education (COPE),
it was found that the overwhelming majority of pediatricians in practice felt ill-prepared for this role. The high attendance rate at CME courses on
Adolescent Medicine given for pediatricians is evidence that this continues to be the case. Whether our residents become pediatric subspecialists
or generalists, enter practice or academia, they will have adolescent patients. It is therefore important that they be well-trained during their
residency training to feel competent in the management of this population.
Medical care has evolved rapidly in recent years, requiring new skills from pediatricians and changing the work environments in which they are
likely to practice. These changes have impacted our hospital and training program, influencing the types of patients we see and the settings in
which we treat them. These factors have been taken into consideration in developing our adolescent medicine rotation series. In addition, we
make changes in the rotations to reflect residents’ suggestions regarding ways in which they feel their training in adolescent health care could be
enhanced.
The outpatient rotation draws on a rich network established by our Adolescent Medicine division with both Stanford and community-based sites
serving very diverse populations of adolescents. The basic adolescent medicine out-patient rotation covers skills that are fundamental to
interviewing and assessing adolescent patients. This includes skills in the assessment of growth and pubertal development, and in the recognition
and management of common adolescent health problems. Residents on the rotation will develop basic skills in interviewing and conducting
physical examinations with adolescent patients. They will develop an understanding of normal growth and development and learn to recognize
aberrations in normal development. In addition, they will learn how to recognize and manage common adolescent health problems.
Updated 06.17.10
Weekly Schedule
This represents a typical schedule. Each resident’s schedule will vary. Schedule distributed at start of rotation is final.
Monday
Tuesday
8 – 8:30am
Morning Report
8 – 8:30am
Morning Report
(optional)
8:45-11am
TeachingH/Ward
Rounds on
LPCH
11am-12pm
Lunch
12-6pm
Eating Disorders
Clinic, Castro
Commons,
Mountain ViewC
-OR2-7pm
Mission
Neighborhood
Health Center,
San FranciscoD
Updated 06.17.10
9am – 12pm
Stanford
Gynecology
ClinicF
-ORWard Rounds at
CCPB
-ORTeen Health
VanE
Variable
Lunch
2-5pm
Sports Medicine
ClinicI
-OR12/1-6pmC
Eating Disorders
Clinic, Castro
Commons,
Mountain ViewC
-ORVariable
Teen Health
VanE
Wednesday
8:00-12:30
Pediatric
Gynecology,
Castro
CommonsC
9am-4:30pm
Juvenile Hall,
San JoseG
Variable
Lunch
1-6pm
Teen Clinic,
Castro
Commons,
Mountain ViewC
-ORJuvenile Hall,
San JoseG
Thursday
Friday
8 – 8:30am
Morning Report
8 – 9am
Grand Rounds
8:30-9:15am
Adolescent
Advocacy
9:30 – 2pm
Weight Clinic,
Castro
Commons,
Mountain ViewC
-OR-
9:15-11am
Teaching
11-12pm
Division
Educational
SeminarH
9am-4:30pm
Juvenile Hall,
San JoseG
12-1pm
Noon Conference
Variable
Lunch
1-6pm
Teen Clinic,
Castro
Commons,
Mountain ViewC
-OR2:30-8pm
Teen Health
VanE
2-6pm
Eating Disorders
Clinic, Castro
Commons,
Mountain ViewC
-ORJuvenile Hall,
San JoseG
 Notes on Schedule
 Key (driving directions follow)
A. Meet with Drs. Chamberlain, Carlson, Miller, 1st floor 770 Welch Road, General Pediatrics Suite
B. Packard at El Camino, 2500 Grant Road, Mountain View, 4th floor, Tower C of new hospital
C. Castro Commons, 1174 Castro Street, Suite 250, 2nd floor, Mountain View, admin: 650-694-0600, clinic reception: 694-0600
It takes THIRTY minutes to travel from LPCH to Castro Commons
* See customized schedule for block regarding start time
D. Mission Clinic is in the Mission, 240 Shotwell Street, San Francisco, CA 94110
map: http://www.sfccc.org/sfcccclinics/mnhc.htm
E. Six locations (see customized schedule distributed at start of rotation and refer to directions below); Seth Ammerman, M.D., pager: 13096
F. Gyn Clinic is in 2nd floor Blake Wilbur Bldg on Stanford Campus, 900 Blake Wilbur Drive, Stanford, CA 94305
Residents will only work with Dr. Jacobson. If she is unavailable when you arrive, call Rebecka’s cell phone.
G. Juvenile Hall, 840 Guadalupe Pkwy, San Jose, CA 95110, Jerry Klein, M.D. and Arash Anoshiravani, M.D., 408-299-4841
H. Adolescent Medicine Conference Room, 770 Welch Road, 4th floor
I. PAMF, 795 El Camino Real, Palo Alto, Department of Pediatrics, Sally Harris, 650-853-2943
 Our offices are at Castro Commons in Mountain View. Directions are listed below. This is the home of EDC, teen and weight clinics, as well.
 All Monday and Thursday mornings start at 8am in Palo Alto. The days start with Morning Report, which you attend with your teaching
attending, followed by LPCH ward rounds on any adolescent cases and teaching. Teaching sessions are held at 770 Welch Road, in the 4th
floor conference room. Occasional advocacy time is incorporated as well. You will be going over a variety of basic adolescent medicine
topics with the teaching attending during the month. Cases and articles are supplied to you in advance to guide your learning and it helps to
read those before the teaching session. If you are post-call, your morning starts at 9:15 and ends at 11 or 12. Otherwise, your morning usually
goes from 8-11 on Mondays, and from 8-12 on Thursdays.
 Some clinics (Mission, Health Van, EDC) are evening clinics that go until 6 or even 7:30. We try to give you a lighter day at another point in
the week when you have an evening clinic as we know those can be more tiring. Again, this is a real-life aspect of adolescent medicine since
teens have school and appreciate evening access to clinicians.
 Generally, residents do ½ day per week of Advocacy work and one full day equivalent per block at CCP
 Requests for Schedule Changes: if at any point questions arise, directions are needed, or a change must be requested during the rotation,
please email Rebecka Peebles, rpeebles@stanford.edu . It is not sufficient to speak with the attending at a given site if you are considering
changes to your schedule. You must also communicate with Rebecka and the Chief Residents. Please copy our Administrator, Ana Fraser,
ana.fraser@stanford.edu, on any approved schedule changes. Note that this block is a requirement of the ACGME; as such, few absences
are allowed and must be preapproved with good cause; multiple or unapproved absences for any reasons will likely need to be made
up later in the year to complete your requirement.
Updated 06.17.10
Driving Directions
 Juvenile Hall:
Take 280S to 87N (Guadalupe Parkway)
Take Taylor exit
Go right, 1 block
Left on San Pedro
Go through 2 lights
Pull into large lot on right
(based on reports from prior residents, your Valley C Permit applies here). Parking at juvenile hall is a tremendous
ticketing hazard. Be extra cautious when using that lot. Do not back into a space and make sure that they read all the signs about
where yout can and cannot park.
After parking, walk back down San Pedro to Hedding and turn right. Walk down Hedding. Pass Main Jail on left. Pass
overhead walkway. You'll see a driveway on your left and up the driveway is the Visitor Entrance to Juvenile Hall. If you get to
Guadalupe parkway, you've gone too far! Check in at front entrance and show Stanford ID. Tell them you are working at
medical clinic w/Drs. Klein and Anoshiravani. Get visitor pass and go in. Check in w/nurse and ask for tour.
 Van locations
 Alta Vista – 1325 Bryant Ave., Mountain View, CA 94303
280 South to Magdalena; L Magdalena; R Foothill expwy; L Grant; x Fremont; R Bryant; x Truman/pass Mountain View H.S.; R into parking lot
– Alta Vista on left
 Peninsula – 300 Piedmont Ave., San Bruno, CA 94066
280 North; San Bruno Avenue exit; L San Bruno Ave.; L Crestmoor Drive; L Piedmont Ave.; School at bottom of hill
East Palo Alto High School 475 Pope Street, Menlo Park, CA 94303
101 to Willow Road exit, Pass VA Hospital, (L) Gilbert Street, (L) Pope Street, At stop sign, turn left into driveway, then right into parking lot
 Tenderloin Playground 570 Ellis Street, San Francisco, CA 94109
101 N, Stay on 101 towards Civic Center, Exit Civic Center/9th St., (L) 9th St., (R) Larkin, (R) O'Farrell St., (R) Jones, (R) Ellis (playground on
the right)
The Tenderloin site varies with the month. Every other month we're at the Tenderloin Rec Center as before, which alternates with the Indochinese
Housing Development Corporation: 375 Eddy Street. The residents should call Dr. Ammerman (415-515-9473) to verify location.
Indochinese Housing Dev. Corp 375 Eddy Street, San Francisco, CA 94102
The Billy DeFrank Center 938 The Alameda,San Jose, CA 95126
Inn Vision 297 Commercial St, San Jose, CA 95112
Updated 06.17.10

Los Altos High School. You can call Rosa for the address and directions, as I don't have it with me. Hours are 9:30-3:30.

Mission Clinic – 240 Shotwell Street, San Francisco, CA 94110, map: http://www.sfccc.org/sfcccclinics/mnhc.htm
Parking: On Shotwell, between 16th and 17th Streets. Prepay (cash or credit card) $1.50/hr. Time: clinic goes until ~8pm
Where to go: Teen Clinic is on the 1st floor, in the back toward 17th St. (many signs). Ask for Gabby.
Directions:
US-101 N
Take the Cesar Chavez St exit - go 0.2 mi Bear L at Bay Shore Blvd - go 80 ft Bear L at Potrero Ave - go 1.2 mi
Turn L at 17th St - go 0.5 mi Turn R at Shotwell St Parking lot on R side
If you prefer the 280:
I-280 N
Take the San Jose Ave exit - go 1.4 mi
Bear L at Guerrero St - go 0.5 mi
Turn R at 24th St - go 0.4 mi
Turn L at Shotwell St - go 0.8 mi
Parking lot on R side, between 17th and 16th Sts
Rotation Specifics
Orientation
Contact Dr. Rebecka Peebles in Adolescent Medicine by phone or pager (listed above) PRIOR to beginning the rotation. She will orient you to the
rotation.






The structure of the rotation is meant to teach via five basic routes:
Clinical experiences
Teaching (case-based)
Advocacy
Reading
Online teaching and PREP questions
 This is partly a community rotation, which means:
Attendings off-site have worked out their schedules to accommodate residents only on specific half-days. These times are not usually
interchangeable. They set aside specific time to be able to teach you. Please understand that effort and do your best to respect it.

The rotation does involve multiple clinics and frequent driving
Updated 06.17.10
This is to give you a diverse, varied experience that you do not get elsewhere. Every effort has been made not to shuttle people to San Francisco
and then to San Jose in the same day, but there certainly is driving from San Mateo to Palo Alto, and sometimes to Mountain View in the same
day. This cannot be avoided if we wish to maintain the breadth of experience we think would be most useful to your training.
PLEASE know that we want you to get the most you can from each site. If that means that your clinical time is running “over” at one site and
you’re running late but want to finish up with the patients you’re already seeing, it’s ok to call Ana or me to let us know that you will be late to the
next site. Drive safely and do not rush – we have always intended to have 1 hour in between sites. Attendings do understand if you are late
coming from a morning site, as long as you call to let them know.
 The advocacy portion is a critical portion of the curriculum
You have been allotted approximately 3-4 hours most weeks for this purpose, away from clinical time. Read through the materials Lisa
Chamberlain, Jen Carlson, and Katie Miller supply you with, plan your time, and act on your goals for the rotation early. Advocacy is real-life,
real-time, and often it takes a while for letters to be received and phone calls to be returned; this is why it is critical to write and call people early in
your rotation. It also helps to communicate frequently amongst yourselves. This is a great opportunity to have “protected time” to get engaged!
 Post-call sessions and lunch time
You may have a teaching session or Advocacy time in the morning post-call. Many teaching sessions and clinics may extend into the lunch hour.
This also cannot be avoided, although we try. PLEASE bring your lunch on those days, as there rarely allotted time to drive purchase lunch.
Know that you can use post-call time for advocacy if needed.
 Finally…
We all enjoy working with the residents very much. We, in our division are committed to improving your ability to care for adolescents. We ask
for your active participation in all clinics and consideration of the above points in order to get the best exposure to this challenging age group.
This is probably the only time in your residency that you will be able to concentrate on improving your skills with teens and their health. Please
let me know if there is anything we can do to improve your experience.
Contact Information for Division Faculty
Note: the pager system does not work well at all the clinical sites where faculty members are located. Please contact the division administrator,
Ana Fraser, or the page operator if you are having difficulty reaching faculty at the numbers listed here.
Seth Ammerman, M.D.
Jennifer Carlson, M.D.
Cynthia Kapphahn, M.D., M.P.H.
Christian Pariseau, M.D.
Rebecka Peebles, M.D.
Catherine Miller, M.D.
Updated 06.17.10
pager: 13096
pager: 13896
pager: 13747
pager: page operator
pager: page operator
pager: 13790
Sophia Yen, M.D.
Elizabeth Farman-Farmaian
Fellows: Leslie Gee, M.D.
Anne Hsii, M.D.
pager: none
pager: none
pager: 14029
pager: 14559
Online Learning Resources
http://www.stdhivtraining.org/nnptc/start.cfm (STI case presentations)
http://www2a.cdc.gov/stdtraining/self-study/default.asp (STI disease-specific clinical training)
www.pedicases.org (cases on general adolescent medicine)
http://www.ahwg.net/resources/resources.htm#Toolkit (toolkits in Understanding Confidentiality & Minor Consent,
Adolescent Health Care 101: The Basics, Sexual Health, Body Basics)
Resident Roles and Responsibilities
Attend all clinics, teaching sessions, and activities as outlined in block schedule sent to you at the start of the rotation.
Evaluation and Feedback
The methods of evaluation for the Adolescent Medicine Rotation will consist of:
 Medhub Resident Evaluations, Faculty Evaluations, Rotation Evaluations
 An effort is made to obtain feedback on all residents from the community attendings and incorporate it in the resident evaluations
These evaluations will be included in each resident’s portfolio.
At the end of the rotation an end-of-rotation feedback session will be conducted by LPCH Adolescent Medicine Teaching Attending.
Updated 06.17.10
ACGME Competency-based Goals and Objectives
Goal 1. Develop skills in taking an appropriate history from an adolescent
Resident Objectives
Instructional Strategies
Assessment of Competence
1. Accurately and effectively
 Patient care
 Direct observation of discussion of
communicate the rights and limits of
 Observation of discussion of
confidentiality by attending
confidentiality to a patient and family
confidentiality by attending
(PGY 1, 2, 3)
with feedback
 Lecture
 Reading (California Minor
Consent Laws)
2. Take a history that incoporates a
 Patient care
 Direct observation with immediate
thorough HEADSS exam
 Observation of clinic visit
feedback
including but not limited to:
 Lecture
 Substance use
 Readings
 Sexual activity
 Psychosocial stressors and abuse
(PGY 1, 2, 3)
Goal 2. Develop and carry out appropriate patient care management plans for common adolescent issues
Resident Objectives
Instructional Strategies
Assessment of Competence
1. Verbalize an appropriate evaluation
 Patient visits with resident
 Discussion during lecture
and management plan for each of the
formulation of plan
 Discussion of resident’s patient
following conditions:
followed by discussion with
management plan with attending
 eating disorders
faculty
 PREP questions completed at end
 menstrual disorders
 Lectures
of rotation with attending review
 contraception
 Participation in care at CCP
for understanding
 sexually transmitted infections
and Weight Clinic
 Dictation review by faculty
 substance abuse
 acne
 obesity
(PGY 1, 2, 3)
Goal 3. Develop skills in the examination of adolescent patients
Resident Objectives
Instructional Strategies
Assessment of Competence
1. Prescribe and perform competently the  Resident examination of
 Direct observation of focused
following medical procedures essential
patients in gynecology
examination
for the care of the adolescent patient:
clinic
 Resident sign-out to attending and
 Sports physical examination of an
 Resident examination of
confirmation of findings by
adolescent
patients in adolescent
attendings
 Pubertal staging
clinics with attending
 Pelvic examination
teaching of exam
Updated 06.17.10
ACGME Competency Goals
PC - Provide effective health care services
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.
PC - Provide effective health care services
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.
ACGME Competency Goals
MK - Demonstrate knowledge evolving sciences
and apply this knowledge to patient care
PC - Provide effective health care
Services
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.
ACGME Competency Goals
PC - Provide effective health care services
MK - Demonstrate knowledge evolving sciences
and apply this knowledge to patient care
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.

Breast examination and teaching of
 Resident examination of
breast self-examination
patient in Juvenile Hall
 Male genital examination and teaching  Lecture on pubertal staging
of testicular self-examination
 Overweight patient
(PGY 1, 2, 3)
Goal 4: Apply information about adolescent physical and psychosocial development to the care for adolescent patients
Resident Objectives
1. Verbalize relevance of pubertal
staging and assessment of development
to patient management plan
(PGY 1, 2, 3)
2. Recognize the signs and symptoms of
depression and somatizing disorders
(PGY1, 2, 3)
Instructional Strategies
 Patient visits in adolescent
clinics with resident
formulation of plan
 Lecture on pubertal staging
 Teaching Module (Growth
Case #1)
 Patient visits in adolescent
clinics
 Participation in care at CCP
Goal 5. Demonstrate ability to work well in a multidisciplinary setting
Resident Objectives
Instructional Strategies
1. Communicate in an effective and
 Attending modeling
respectful manner with other members of  Experience working with
the health care team, including attending
multidisciplinary team at
physicians, nursing staff, receptionists,
CCP, eating disorders clinic,
social worker, and dietician (PGY1, 2, 3)
Teen Clinic, Weight Clinic
Assessment of Competence
 Discussion of resident assessment
and plan with attending
ACGME Competency Goals
PC - Provide effective health care services
MK - Demonstrate knowledge evolving sciences
and apply this knowledge to patient care

Discussion of resident assessment
with attending
PC - Provide effective health care services
MK - Demonstrate knowledge evolving sciences
and apply this knowledge to patient care
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.
Assessment of Competence
Direct observation by attending of
team interactions
ACGME Competency Goals
ICS - (a)Communicate effectively with
physicians, other health professionals, and
health related agencies; (b)Work effectively as a
member or leader of a health care team
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.

Goal 6. Demonstrate a commitment to life-long learning and ongoing professional development
Resident Objectives
Instructional Strategies
Assessment of Competence
1. Locate and follow practice guidelines
 Teaching Module (Case:
 Discussion at lectures with teaching
for adolescent conditions such as STI
Michael’s Disclosure)
attending
screening and prevention strategies for
 Review of the following
 Attending review of resident plan
risk-taking behavior (PGY1, 2, 3)
websites:
and patient counseling
http://www2a.cdc.gov/stdtra
ining/self-study/default.asp,
http://www.ahwg.net/resour
ces/resources.htm#Toolkit
Updated 06.17.10
ACGME Competency Goals
PBLI – (a) obtain and use information about
your own population of patients and the larger
population from which your patients are drawn
(b) locate, appraise, and assimilate evidence
from scientific studies related to their patients’
health problems (c) apply knowledge of study
designs and statistical methods to the appraisal
of clinical studies and other information on

2. Present a topic of personal interest
relevant to adolescent medicine to the
adolescent division members
(PGY 1, 2, 3)
Reading
Article: Diagnosis and
Management of Sexually
Transmitted Disease
Pathogens Among
Adolescents
 Review of current medical
literature
 Presentation of talk
diagnostic and therapeutic effectiveness (d) use
information technology to manage information,
access on-line medical information; and
support their own education

Attending observation and critique
of presentation
Goal 7. Advocate for the promotion of health and prevention of disease and injury in vulnerable populations
Resident Objectives
Instructional Strategies
Assessment of Competence
1. Formulate and carry out an individual
 Meetings with Advocacy
 Project planning with Advocacy
advocacy project
directors
directors
(PGY 1, 2, 3)
 Letter writing
 Review of project with Adovacy
 Phone calls to community
directors upon completion
leaders (e.g., legislators)
 Presentations of project when
 Education in Media
appropriate
Advocacy (e.g., meeting
with Robert Dicks)
2. Recite which immunizations are
 Discussion at Teen Clinic
 Discussion at Teen Clinic
indicated for adolescents and when they
 Individual reading
should be administered
(PGY 1, 2, 3)
PBLI = practice based learning and improvement
ICS = interpersonal and communication skills
P = professionalism
MK = medical knowledge
PC = patient care
SBP = systems based practice
Updated 06.17.10
PBLI - Locate, appraise, and assimilate
evidence from scientific studies related to their
patients’ health problems
ICS - (a)Communicate effectively with
physicians, other health professionals (b)Work
effectively as a member or leader of a health
care team
ACGME Competency Goals
ICS - (a) Communicate effectively with
physicians, other health professionals, and
health related agencies; (b) Work effectively as
a member or leader of a health care team
P - Demonstrate sensitivity and responsiveness
to a patients’ gender, age, culture, ethnicity,
disabilities, etc.
PC - Provide effective health care services
MK - Demonstrate knowledge evolving
sciences and apply this knowledge to patient
care