Behavioral Science (PGY-1)

Description of Rotation or Educational Experience

The Behavioral Science Curriculum component to Family Medicine residency education is designed as a longitudinal rotation with specific requirements of each house officer year as befits their development in the program. The rotation is designed to assist residents in acquiring knowledge and skills in behavioral science in an incremental fashion. The lessons and approaches are integrated with all disciplines throughout the residents’ total educational experience.

The goals of the Behavioral Science Curriculum are twofold and include the following:

(a) To contribute to the development of family physicians whose practice reflects recognition of the value, uniqueness and competence of each patient and family. These individuals will demonstrate a healthy curiosity about their patients as people, compassion, a nonjudgmental stance, and patience towards their patients, their colleagues, and themselves. They will utilize skills which will promote a caring, collaborative relationship with patients and colleagues.

(b) To contribute to the development of family physicians who incorporate knowledge of human behavior, cultural diversity, mental health and psychosocial disorders into their everyday practice, who are able to recognize interrelationships among biologic, psychologic, and social factors in their patients, and who demonstrate a sensitivity to, and knowledge of, the emotional aspects of organic illness.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

As the resident progresses through training, the resident is expected to be able to:

• Demonstrate competence in behavioral assessment through the completion and submission of written patient notes and assessments.
• Demonstrate competence in patient interviewing skills as appropriate for level of training.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• This rotation fulfills family medicine-specific training and educational requirements in Human Behavior and Mental Health.

Objectives

As the resident progresses through training, the resident is expected to be able to:

• Learning to listen actively to one’s patients aids in the collection of medically-relevant information, leading to asking more-relevant clinical questions, leading to more-active medical knowledge exploration to find good answers to patient-centered questions.
• Each month, one (1) formal didactic lecture is provided on a topic relevant to the residents’ current needs, often self-identified.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Set learning and improvement goals
• Identify and perform appropriate learning activities
• Incorporate formative evaluation feedback into daily practice

Objectives

As the resident progresses through training, the resident is expected to:

• Complete web-based Common Ground Curriculum modules, quizzes and clinical assignments for each of the following subscales: Rapport, Agenda Setting, Information Management, Active Listening, Addressing Feelings, Reaching Common Ground (when there is agreement) and Reaching Common Ground when there is disagreement or behavior change is being discussed. Completed and graded quizzes and clinical assignments are given to residents and placed in resident portfolios.
• Practice and utilize the lessons communicated throughout the rotation in both patient office visits and during in-patient interactions. Further, these lessons help communication in general, assisting in learning from peers and other co-workers.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Advocate for quality patient care and optimal patient care systems
• Work in interprofessional teams to enhance patient safety and improve patient care quality

Objectives

As the resident progresses through training, the resident is expected to:

• Work with behavioral scientist, behavioral health, social services, and other care providers to help assure the patient needs are met, in the context of precepting, in-patient teaching sessions, and family meetings.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Accountability to patients, society, and the profession
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

As the resident progresses through training, the resident is expected to:

• Attend Tuesday Intern Lunch sessions. Lessons include monthly behavioral science issues, typically revolving around basic interviewing skills, narrative writing, intern support group, and monograph review. This setting allows the group to form strong working bonds, air grievances, and move through their work-related and personal problems in a supportive environment of their peers.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies

Objectives

As the resident progresses through training, the resident is expected to:

• Demonstrate competence relevant to skill level in use of the following basic interviewing skills, demonstrated through tape-recorded pt interviews: Rapport Building, Agenda Setting, Information Management, Active Listening, Addressing Feelings, Developing a Plan (no disagreement).

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic lecture
• Case studies
• Role-playing
• One-on-one evaluative meetings
• Role-modeling of behavioral science concepts and techniques

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

• Residents are assessed based on submission of six (6) behavioral assessments, Common Ground quizzes and clinical assignments, and tape review. The goal is to demonstrate satisfactory development in terms of communication skills. Attention to psycho-social issues of patient care is discussed during quarterly evaluations.
• Residents are assessed based on submission of two (2) behavioral change interventions, and four (4) general psycho-social consults.

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Residents progress over time, in their ability to communicate with their patients, is measured by their overall Press-Ganey scores, their performance on tape review, and their ability to demonstrate relevant skills to their peers and residents. This is a longitudinal rotation, across three years, and progress is measured by comparing early performance to later.
• Feedback is actively sought on an on-going basis for improvements to the curriculum, lecture topics that would be beneficial, and more efficient ways to integrate this work with the residents’ other rotations.
• Six assessments & notes are evaluated. Written evaluations are given to residents and placed in resident portfolios.

Level of Supervision

How is the resident supervised on this rotation?

• While the behavioral scientist works directly with the residents on a routine basis, the other faculty are entrusted to assist residents as they interact with their patients to attend to a more holistic approach to medicine and to consider the importance of context, social and emotional, in their patients’ experiences.

Educational Resources

List the educational resources

• The IIHE.org website lists the Behavioral Science Longitudinal Rotation requirements, as well as links for the Common Ground training modules, behavioral assessment forms, and other resources.
• Behavioral assessments and other behavioral science forms are onsite at both clinics, in folders in each clinic room.