The Behavioral Science curriculum is based on the biopsychosocial-spiritual model (Engel, 1977; 1980 Wright, Watson, & Bell, 1996). Residency education in the Behavioral Sciences train residents to approach each patient as a complex but integrated system of many variables that can be organized under five domains: biological, behavioral, cognitive, sociocultural, and environmental. The curriculum is evidenced-based and designed so that every resident achieves the Accreditation Council for Graduate Medical Education (ACGME) milestones. Using the Curriculum Guidelines for Family Medicine Residents by the American Academy of Family Physicians (2011, p.2) to guide curriculum development, the interdisciplinary Behavioral Science faculty assist each resident to achieve the following competencies at the completion of their residency training:
- Understand normal and abnormal psychosocial growth and development across the lifecycle and be able to appy this knowledge to the care of the individual patient. (Medical Knowledge, Patient Care)
- Be able to recognize, initiate treatment for, and utilize appropriate referrals for mental health disorders to optimize patient care. (Systems-based Practice, Practice-based Learning and Improvement)
- Demonstrate the ability to effectively interview and evaluate patients for mental health disorders using appropriate techniques and skills to enhance the doctor-patient relationship. (Interpersonal and Communication Skills, Patient Care)
- Have sensitivity to and knowledge of the emotional aspects of organic illness. (Patient Care, Professionalism)
- Be able to intervene effectively and professionally in emergent psychiatric, domestic violence, child abuse, and disaster situations. (Professionalism, Systems-based Practice)
- Understand the impact of mental health disorders on the family unit.
Orientation
During orientation, first year residents are videotaped and communication skills reviewed to prepare them for out-patient clinical care. Second year residents are also videotaped during their orientation and on-call communication skills are reviewed.
Didactics
Didactic, interactive lectures on Behavioral Science topics include:
- Anxiety/Depression
- Biopsychosocial-spiritual model
- Communication skills
- Difficult encounters
- Doctor/Patient relationship
- Insomnia, grief/loss, end of life issues
- Mindfulness and clinical relaxation strategies
- Primary care counseling skills, e.g., Motivational Interviewing.
- Psychopharmacology of depression
- Substance use
- Direct Observation of Clinical Activity
- Suicidality
- Trauma
Videotape
Video review of primary care encounters
Didactics
Didactic, interactive lectures on Behavioral Science topics may overlap with the first year and include:
- Communication skills, e.g., Agenda Setting, Ask-Tell-Ask
- Primary care counseling skills, e.g., Motivational Interviewing, BATHE
- Family systems/genogram, e.g., Five Family-Oriented Questions, genogram interview
- Difficult encounters
- Primary care psychopharmacology
- Insomnia, grief/loss, substance use, personality disorders
- Direct Observation of Clinical Activity
Videotape
Live observation through closed-circuit video feedIntegrated Care
The Wake Forest Department of Family and Community Medicine was awarded a Primary Care Training and Enhancement by Health Resources and Services Administration (HRSA) for July 2015 – July 2020 to implement and sustain integrated care in the Wake Forest Family Medicine residency and the Federally Qualified Health Center (FQHC), United Health Center. Under this grant the, both clinics have a care manager and three behavioral health providers working alongside faculty and resident physicians to provide comprehensive care to patients. In addition, integrated care teaching clinics provide an opportunity for physician and Behavioral Science faculty to observe resident and behavioral health clinical encounters, and provide feedback in an interdisciplinary setting.
Educational Lectures
Behavioral science topics (e.g. social and behavioral considerations for common medical diagnosis, provider wellness, assessing suicide) are presented regularly at noon conferences and resident seminars throughout the three years of the residency. Topics in Behavioral Science presented include family systems, adherence to medical advice, sleep disorders, psychophysiological disorders, personality disorders, chronic pain, caregiver fatigue, among many others. Topics may also be discussed on the inpatient medicine teaching service when the Director of Behavioral Science is present.
Videotaping and Live Observation
Videotaping and shadowing (live observation of the clinical encounter in the room through closed-circuit video feed) begins the first year of the Behavioral Health Rotation (BHR) and continues throughout residency training.Support Groups
1st YearHO-Is attend a support group one to two times a week throughout the year to provide the skills and group support necessary to learn and to grow during the challenging internship year.
2nd Year
The HO-IIs meet once monthly to focus on the complexities of the Doctor-Patient relationship and explores all relationships as they contribute to the practice of medicine.
3rd Year
The HO-IIIs support group meets once a month and continues the format from the 2nd year. The group focuses on the residents' complex transition from residency to early career.
Consultation and Referral
Behavioral Science faculty is available to review patients, facilitate treatment planning, and access community resources.
References within this article can be found at the following sources:
American Academy of Family Physicians (AAFP). Recommended Curriculum Guidelines for Family Medicine Residents: Human Behavior and Mental Health. AAFP Reprint No. 270
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136. doi: 10.1126/science.847460
Engel, G. L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137, 535-544. doi: 10.1176/ajp.137.5.535
Wright, L. M., Watson, W. L., & Bell, J. M. (1996). Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.
