A new paradigm for teaching behavior change: Implications for residency training in family medicine and psychiatry

A Catalina Triana,Dorothy B Trevino,Michael M Olson

doi:10.1186/1472-6920-12-64

A Catalina Triana, Dorothy B Trevino + Show 1 more

Open Access

https://doi.org/10.1186/1472-6920-12-64

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Abstract

BackgroundPrimary care physicians (PCPs) provide ~50 % of all mental health services in the U.S. Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care. To begin to address this gap, a skills-based, interactive curriculum based on motivational interviewing (MI) as a teaching method is presented.MethodsThe curriculum described in this paper is a four-week block rotation taught in the second year of residency. Motivational interviewing (MI) is used as a teaching approach toward the goal of clinical behavior change. Residents’ strengths, personal choice and autonomy are emphasized. Each week of the rotation, there is a clinical topic and a set of specific skills for mastery. Residents are offered a “menu” of skills, role modeling, role/real play, practice with standardized patients (SP), and direct supervision in clinic.ResultsThirty-nine residents have completed the curriculum. Based on residents’ subjective reporting using pre-post scales (i.e., importance and confidence), all participants to date have reported substantial increases in confidence/self-efficacy using primary care counseling skills in their continuity clinic.ConclusionsThis paper presents an innovative, empirically based model for teaching the essential skills necessary for physicians providing care for patients with mental/emotional health needs as well as health-behavior change concerns. Implications for training in the broader context, particularly as it relates to multi-disciplinary and collaborative models of teaching/training are discussed.

Highlights

Primary care physicians (PCPs) provide ~50 % of all mental health services in the U.S Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care
A few contemporary issues discussed in the literature include, 1) training adequate numbers of residents to meet the needs of the population [4], 2) an evolving dominance of psychobiologic over psychodynamic influences on education and practice [5,6,7], and 3) the need for institutional support for psychotherapy training, in light of recent residency review committee (RRC) for Psychiatry requirements to demonstrate competency in psychotherapy [8]
This need is enhanced by recent trends in the field of Psychiatry with fewer medical students choosing psychiatry for residency, smaller numbers of practitioners, changes/shifts in state and federal equiparity to support provision of mental health/psychiatric services by psychiatrists, and perceived stigma by patients who are often more willing to visit with their PCP than a psychiatrist

Summary

Introduction

Primary care physicians (PCPs) provide ~50 % of all mental health services in the U.S Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care. The rates of chronic illness and disease related to health behaviors are on the rise among the US population, underscoring the need for effective counseling skills This need is enhanced by recent trends in the field of Psychiatry with fewer medical students choosing psychiatry for residency, smaller numbers of practitioners, changes/shifts in state and federal equiparity to support provision of mental health/psychiatric services by psychiatrists, and perceived stigma by patients who are often more willing to visit with their PCP than a psychiatrist. If this trend continues, the burden on PCPs to be a point of access for patient for behavioral, mental, and emotional needs will only increase

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