Behavioral Science Curriculum

Overview:

The behavioral science curriculum is longitudinal and consists of didactics, small group discussions, and experiential components across the continuum of training. The Behavioral Science Director, a full time member of the faculty, provides instruction, supervision and evaluation with the assistance of the Social Concerns Educator, Social Worker, and the medical faculty of the residency program as well as psychiatrists and other mental health professionals from the community.

Goals:

The behavioral science experiences shall train residents:

* to incorporate knowledge of human behavior, mental health and mental disorders into the daily practice of medicine
* in the relationship between the patient and his/her family and the impact of that relationship on health and illness
* in the biopsychosocial factors medicine
* in the ethical dimensions of patient care

Objectives:

While caring for patients in the Family Medicine Clinic and the hospital, the Family Medicine resident:

PGY 1:

* is able to establish a relationship and communicate with patients and families in order to effectively interview patients. (ICS, PC)
* is able to effectively provide health education and counseling related to health behavior. (PC)
* is able to diagnosis and assess readiness to change in alcoholism and other substance abuse. (MK,PC)

PGY2:

* is able to identify the role of life cycle development, biopsychosocial relationships, and normal and abnormal growth and development across the life cycle. (MK)
* is able to identify interrelationships among biologic, psychologic and social factors in all patients, including the role of the family. (MK,PC)
* is able to identify, assess and manage common psychiatric disorders in children and adults, including appropriate use of psychopharmacology. (MK,PC)

PGY3:

* demonstrates the ability to respond to concerns of the patient, and counsel patients and families. (PC)
* demonstrates competence in caring for patients with diversity of age, gender, race/culture, and spirituality. (P,PC)
* demonstrates competence in addressing ethical issues in medical practice, including informed consent, patient autonomy, confidentiality and issues of quality of life and end of life care. (P)

Implementation:

In order to accomplish the goals of this curriculum, a variety of approaches are utilized including:

Direct Observation of Patient Encounters:

* The Behavioral Science team directly observes residents during patient encounters at least twice per year in the Family Medicine Clinic
o A Patient Encounter Assessment Form (PEAF) is completed for each encounter, rating the quality of the encounter on dimensions including those specific to the post-graduate year objectives (See PEAFs attached)
o The results are summarized, including strengths and growth areas and are put in the resident file for review with the team leader.
o Residents are expected to obtain a minimum of “satisfactory” ratings on each objective by the end of each post graduate year.
* PGY1 residents are observed during one call shift on the inpatient Medicine rotation and during one Nursing Home rounds, including interactions with patients and other members of the health care team.
o Residents are given direct verbal feedback and case specific consultation.
* Residents are required to complete a minimum of two home visits with continuity patients, accompanied by one of the behavioral science team.
o Residents are given direct verbal feedback and case specific consultation at the time of the home visits.
o One of the home visits is with an elderly patient.

Didactics:

* Psychiatry noon conference is scheduled once per month with a focus on diagnosis and treatment of mental health disorders, including psychopharmacology and the biopsychosocial factors that influence patient dynamics common in Family Medicine. Presenters include psychiatrists, psychologists, and other mental health professionals with expertise in the subject area. A rotating two-year schedule of psychiatrist led noon conferences is attached.
* Small group conferences, led by the Behavioral Science team and medical faculty, are scheduled once per month and residents are grouped according to year of training for focused discussions on issues related to
o PGY1: interpersonal and communication skills, behavior change principles and addictions
o PGY2: life cycle development, counseling/therapeutic skills, treatment of mental health issues common to Family Medicine,
o PGY3: counseling/therapeutic intervention skills, professional and ethical issues and self care in practice
* The Behavioral Science Director attends rounds on Medicine and Peds services once per week to make brief presentations regarding issues related to current issues on the service and/or case specific consultations.

Other instructional methods :

* Global Behavioral Science: Noon conference is extended to two hours to allow for in-depth coverage of certain topics, such as ADD/ADHD assessment and treatment, domestic/family violence, balance in the practice of medicine, and family life cycle transitions
* Open agenda groups: PGY1s meet monthly and PGY2s and PGY3s meet quarterly as a group to discuss issues of concern to them either in the program or their lives in general. This promotes normalization of feelings, peer resource/consultation and physician wellness.
* Patient consultation: the behavioral science team is available on an as-needed basis to support residents in the care of their patients.
* Family Medicine Clinic curriculum provides a continuity panel of culturally diverse patients for each resident.
* A two-week required Psychiatry rotation, which focuses on the diagnosis and management of emotional disorders and psychopharmacology, is an adjunct to this curriculum. (See Psychiatry Curriculum)
* Rotation Performance Evaluations assess history taking/oral case presentation, communication/interpersonal skills, motivation/teamwork, professionalism, ethics, and sensitivity to issues of diversity.

Evaluation:

The PEAF Summary is placed in the resident file and available for review by the team leader at Periodic Review.

Logs of home visits are maintained by the Behavioral Science team.

During Faculty Review of Residents, the results of the PEAFs, Periodic Review, and Rotation Evaluations, as well as verbal input from the Behavioral Science Director are made available in the ongoing assessment of resident competence in the behavioral science goals.

Attachments: 1).PEAFs; 2). Small Group Didactics; and 3.)Psych Noon Conference Schedule

8/08