Original Publication
Open Access

But Tommy Likes It Here: Moving to Adult Medicine

Published: July 3, 2012 | 10.15766/mep_2374-8265.9190

Included in this publication:

  • Instructor's Guide.doc
  • MedED Transition Case.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


This five-page case scenario walks through a typical transition process for a teenager with a chronic illness growing into an adult. Barriers and resistance are highlighted on each page, and the physician models one way of handling that issue on the next page. The case allows a rich discussion of transition issues, including age-appropriate care, handling of intrusive parents, feelings of the patient and provider, and problem-solving skills. An outline for the discussion leader follows, setting out which issues are presented on each page to ensure adequate pacing and balance. Recognition of provider discomfort with transition issues became apparent in our division when we began discussing and studying the issue. The case was designed, based on many years of experience, to capture many key problems that can arise. It has been used successfully at a problem-based learning luncheon at the American Gastroenterology Association in 2011, with excellent feedback from participants. It was also presented at Gastroenterology Grand Rounds 2011 in our division. We have evidence that discussion of this topic, including this case, led to increased self-management by patients with inflammatory bowel disease.

Educational Objectives

By the end of this scenario, learners will be able to:

  1. Recognize barriers to age-appropriate care.
  2. Develop new strategies to enhance patient self-management.
  3. Reflect on emotions generated at the end of a long-term provider-patient relationship.
  4. Develop new strategies to improve provider-to-provider information during a transfer.

Author Information

  • Laurie Fishman, MD: Harvard Medical School

None to report.

None to report.


Fishman L. But Tommy likes it here: moving to adult medicine. MedEdPORTAL. 2012;8:9190. https://doi.org/10.15766/mep_2374-8265.9190