Source: Heather Collette and Jaideep Talwalkar; Yale School of Medicine 

The adolescent module will focus on techniques to promote a trusting provider-patient relationship and foster healthcare autonomy as teenagers approach adulthood. While most of the basic components of the physical exam in adolescents are similar to those in adults, there is added focus on pubertal development through the use of the Sexual Maturity Rating scale. Discussion of physical changes is accompanied by important adolescent psychosocial screening questions, including environmental safety, mental health, sexual activity, and drug/alcohol use. 

Adolescence is a time of significant physical changes as surges of hormones, such as estrogen and testosterone, cause growth in stature and the development of secondary sexual characteristics. These secondary characteristics at puberty include new hair growth, breast, and penile maturation that happen in a predictable series.

Adolescence is also a time of marked physical and emotional changes, which can be distressing and uncomfortable for adolescents. Pediatric providers can play a key role in relieving some distress by normalizing feelings and physical changes. To build a trusting provider-patient relationship, the provider needs to create an environment where the adolescent feels safe to disclose personal information and concerns. Adolescents should be treated as unique individuals, respectfully and without preconceived notions about their concerns or goals.

An eventual goal in the care of adolescents is to prepare them for navigating their health and healthcare as adults. The transfer to an adult-oriented care system typically occurs sometime after age 18, though the transition process for a successful transfer starts years before that.

 1. Promoting a trusting provider-patient relationship and fostering autonomy

1. First, set expectations at the beginning of the visit by explaining the provider's role as a source of confidential information and support. Explain that all adolescents are provided with opportunities to discuss their health privately with the clinician, which serves a dual purpose. In the short term, adolescents can bring up concerns they may be uncomfortable discussing in front of their parents. In the long term, ad