GOALS AND OBJECTIVES FOR THE BEHAVIORAL SCIENCE CURRICULUM

 

OVERVIEW: Behavioral science, or the broad area of science which includes human psychology, interpersonal relationships, and the interplay between a person and his or her environment, is a cornerstone of Family Medicine. Family physicians must be able to understand the patient within the context of their environment, be an effective communicator in the doctor-patient relationship, and understand normal psychological development as well as the diagnosis, evaluation, and treatment of psychological disorders. 

 

GOALS AND OBJECTIVES:

 

I. Patient care

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. Level specific goals and objectives for patient care in behavioral science are listed below:

 

Residency Year	Goals Residents are expected to:	Objectives Residents will be able to:
R1	1. understand the relationship of the patient to others	1. care for the patient within the context of their family and environment
	2. understand the relationship of the patient to the disease process	2. recognize the emotional aspects of organic disease
R2	1. have a sensitivity to and knowledge of the emotional aspects of organic disease	1. anticipate, identify, and respond to emotional aspects of organic disease
	2. understand the emotional impact of disease, including impact on work life, home life, and future outlook	2. provide compassionate care, with attention to impact of the emotional aspects of disease on patient’s life
R3	1. understand the emotional impact of disease on compliance/adherence to treatment plan	1. adjust treatment and follow up plan in response to emotional aspects of disease
	2. have a sensitivity to patient preference, emotional state, and readiness for change in relation to preventative care and health promotion	2. discuss the stages of change, and incorporate this knowledge into more effective health promotion

 

II. Medical knowledge

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences related to behavioral medicine, as well as the application of this knowledge to patient care. Specific methodology includes a monthly 2 hour didactic session on behavioral science topics, facilitated by Psychiatry and Family Medicine faculty. Psychiatry faculty are also available on site 3 ½ days per week to supervise mental health related patient visits, adding to the development of medical knowledge in this area. Second and third year residents are expected to prepare a behavioral science case presentation 1-2 times per year with a related evidence-based didactic session, for presentation to colleagues and faculty. Level specific goals and objectives for medical knowledge in behavioral medicine are listed below:

Residency Year	Goals Residents are expected to:	Objectives Residents will be able to:
R1	1. learn the normal psychological development across the life cycle	1. discuss normal psychological development
	2. learn abnormal psychological development across the life cycle	2. identify and evaluate abnormal psychological development
	3. become familiar with the disorders listed below	3. discuss, identify, and develop initial treatment plans for disorders listed below
R2	1. know diagnostic criteria for psychiatric disorders	1. list diagnostic criteria for psychiatric disorders
	2. understand the evaluation and management of psychiatric disorders	2. be able to evaluate, treat, and manage psychiatric disorders, including consultation and/or referral
	3. understand the impact of aging on mental health	3. discuss common mental health conditions among older adults, and be able to evaluate and treat mental illness in older persons
R3	1. understand the relationship of psychiatric disorders to medical comorbidity	1. adjust screening, evaluation, and management of psychiatric illness in relationship to medical comorbidity
	2. become facile with all aspects of psychopharmacology	2. manage psychiatric medications, including dose adjustment, cross-tapering, addition of medication, and drug monitoring
	3. know epidemiology, risk factors, screening, and management of suicidality in primary care	3. be able to identify, stabilize, and manage the suicidal patient in primary care, including consultation/referral as appropriate

 

Psychiatric and interpersonal disorders

ADD/ADHD

Eating disorders

Child abuse

Domestic violence

Organic brain disorders (Dementia, Delerium)

Chemical dependence and substance abuse disorders

Anxiety disorders

Dissociative disorders

Affective disorders

Psychotic disorders

Somatoform disorders

Psychosexual disorders

Factitious disorders and malingering

Adjustment disorders

Personality disorders

Disorders of impulse control

Emotional aspects of non-psychiatric disorders

III. Practice-based learning and improvement

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. We expect residents to develop practice based learning and improvement skills in behavioral science in a longitudinal fashion, across all years of residency. Specific methods include incorporation of feedback from videotaped patient sessions (described below in the interpersonal and communications skills section, occurring in each year of residency), and using evidence-based medicine for behavioral science case presentations (annually, participating in the education of fellow learners) and in a longitudinal fashion (in every day practice). In addition, residents will have one on one feedback from their faculty advisor regarding practice based learning and improvement in the area of behavioral medicine and patient communication, appropriate to the level of residency. Residents are expected to develop skills and habits to be able to meet the following goals:

           

Practice-based learning goals

Identify strengths, deficiencies, and limits in one’s knowledge and expertise

Set learning and improvement goals for behavioral medicine

Identify and perform appropriate learning activities in this curricular area

Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement

Incorporate formative evaluation feedback into daily practice

Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems

Use information technology to optimize learning

Participate in the education of patients, families, students, residents and other health professionals on mental health, illness, and other behavioral science topics

 

 

IV. Interpersonal and communication skills

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. We expect that first year residents will learn and exhibit effective communication skills with patients, families, and colleagues across the course of their first year. 2^nd and third year residents will be expected to be facile in doctor-patient and person-person communication, including the ability to communicate with consultants and colleagues in a professional and expert manner. 3^rd year residents will be expected to work effectively as a leader of a health care team, coordinating high levels of communication and team organization. All residents are expected to maintain comprehensive, timely, and legible medical records at all levels of training. Specific methodology includes videotaped patient sessions (reviewed with the resident by a faculty member), which occur in each year of residency. Balint sessions, which explore the doctor-patient relationship, are facilitated by Family Medicine faculty and occur monthly for all second and third years. Second and third year residents are health care team leaders during all inpatient Family Medicine rotations (coordinating a team of 3-4 junior residents with supervision of faculty). In general, residents are expected to:

 

Interpersonal and communication skills learning goals

Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

Communicate effectively with physicians, other health professionals, and health related agencies

Work effectively as a member or leader of a health care team or other professional group

Act in a consultative role to other physicians and health professionals

Maintain comprehensive, timely, and legible medical records

 

V. Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Professionalism goals are expected to be demonstrated at all levels of residency, at all times. Specific methodology includes: a yearly didactic on professionalism and bioethics, as well as longitudinal feedback from faculty and peers. Residents are expected to demonstrate at all times:

 

Professionalism goals

Compassion, integrity, and respect for others

Responsiveness to patient needs that supersedes self-interest

Respect for patient privacy and autonomy

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

 

 

VI. Systems-based practice

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 achieve systems-based practice goals at all levels of residency with increasing level of skill with advancing level of residency. Specific methodology includes longitudinal inpatient and outpatient learning regarding behavioral health systems issues, including the primary care management of mental illness, referrals and insurance problems and solutions, community-based mental health resources, and advocacy for quality mental health care. Residents will learn about and be able to help patients navigate through the complex mental health care system. They will also be able to identify and refer to local mental health resources, consultants, and psychiatric emergency referral services. In general, residents are expected to:

 

 

Systems-based practice goals

Work effectively in various health care delivery settings and systems

Coordinate patient care within the health care system

Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate

Advocate for quality patient care and optimal patient care systems

Work in interprofessional teams to enhance patient safety and improve patient care

Participate in identifying system errors and implementing potential systems solutions

 

 

METHODS:

Methodology specific to each core competency is listed above. In general, residents will achieve the behavioral science goals and objectives through a variety of methods. These include, but are not limited to, learning behavioral science in the inpatient and outpatient continuity practice. A dedicated behavioral science rotation occurs in the second year. This includes experience rotating on the inpatient psychiatry consult service and rotating at an outpatient substance abuse clinic. A monthly 2 hour dedicated behavioral science didactic is facilitated by psychiatry and family medicine faculty. The first hour is a case presentation and related didactic presentation, prepared and given by a resident. The second hour is a didactic presentation on one of the core behavioral science curricular topics (given by the psychiatry faculty). Other methods include additional didactic and grand rounds material related to behavioral science, as well as daily experience communicating with patients, colleagues, and faculty.

 

RESOURCES:

Learning will take place in dedicated patient care space the University of Pennsylvania, Penn-Presbyterian, and the outpatient offices at Penn Family Care, as well as on site at other health care facilities such as Children’s Hospital of Pennsylvania (CHOP), an outpatient substance abuse clinic, and other clinical sites on outside rotations. Dedicated faculty include Dr. Jim Stinnett (20% time dedicated to the behavioral science curriculum), Professor in the Department of Psychiatry. Dr. Stinnett will be facilitating the monthly behavioral science curriculum as well as supervising 2 ½ day sessions in the resident continuity clinic at Penn Family Care. Dr. Katie Margo (Assistant Professor, Department of Family Medicine) runs the monthly Balint group.

 

EVALUATION:

The behavioral science goals and objectives will be measured in the following ways: In service exam (medical knowledge), oasis resident evaluation from behavioral science rotation- completed by all supervising faculty (all core competencies), one on one feedback from supervising faculty in inpatient and outpatient settings (all core competencies), one on one feedback by faculty advisor (all core competencies), videotape patient session feedback (all core competencies- supervising Family Medicine and Psychiatry faculty), and case conference feedback (medical knowledge- supervising Family Medicine and Psychiatry faculty).