Roles and Responsibilities of Behavioral Science Faculty within Family Medicine

Residencies on Inpatient Medicine Teaching Service

Laura Sudano, MA, MFT intern, UCSD Family MedicineKeith Dickerson, MD, Faculty Physician, St. Mary’s Family Medicine

ResidencyMary Talen, PhD, Director, Primary Care Behavioral Health, Northwestern

University Family Medicine Residency Jeanna Spannring, Primary Care Psychology Fellow, University of

Massachusetts Medical SchoolCollaborative Family Healthcare Association 16th Annual Conference

October 16-18, 2014 Washington, DC U.S.A.

Session #D5aOctober 18, 2014

Faculty Disclosure

• I/We have not had any relevant financial relationships during the past 12 months.

Learning Objectives

At the conclusion of this session, the participant will be able to:

• Recognize what roles BSF fill on inpatient family medicine teaching service.

• Identify responsibilities within that respective role.

• Explore their own integration of BSF on inpatient medicine teaching service and learn about how others have integrated their own inpatient medicine teaching service.

• Implement a tailored curriculum to setting.

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Timeline of BS in FMR

Roles Responsibilities

Education 1. Resident Education2. Educational Activities3. Other Learner

Administration 1. BS curriculum and resident training• Developing/evaluating curriculum

2. Activities within depts/programs• Committees/development activities

Patient care 1. Consulting w/ residents & faculty2. Dx & Ax

Prof. Devel., Scholar., Research

1. Academic Development• Reading current literature• Attending conferences

2. Presentation & Publication• Presenting @ conferences• Publishing on topics in medical training/clinical practice

3. Research• Conducting research• Preparing grants

Community Service 1. Participating in community organizations, boards, and task forces focusing on health and social issues

2. Providing volunteer service

Family Medicine Inpatient Service

- BH Fellow assigned to each block- Available Tuesday & Thursday mornings- Round with one team each day- 2nd Thursday is BH Didactic:

Professor Chief & Seniors will suggest topics

University of MassachusettsMedical School

Utilizing BH Fellows

BH Fellows on FMIS• Provide real-time education to residents and

collaborative care to patients– Focus on patient-centered communication– Motivational Interviewing training– Teaching and learning strategies within teams

• Assist residents with patients presenting with:– Impaired mental status– Low-motivation for treatment– Chronic disease self-management– Undiagnosed and suspected psychiatric co-

morbidities, including substance abuse– Family meetings

Consult/Liaison ServicesPsychiatry x62148• Psychodiagnostic

evaluation• Psychotropic medication

recommendations and adjustments

• Capacity questions

Health Psychology x62148Provide bedside therapy, neurocognitive assessments, families of patients.Address:• depression/anxiety due to medical illness

or injury• exacerbation of psychological issue due

to medical condition• coping with pain • sleep disruptions• adjustment to hospital• addiction issues• cognitive decline/dementia• PTSD • end-of life issues• cultural issues that interact with medical

treatment plans• suicidal/self-harm behaviors

Goals for Fellows and Residents

- Dual Interviews- Health Behavior Change Duals- “Cross-fertilization”: 2 Fellows & 3x12 residents- End-block feedback

Residents- Team-based care: collaboration &

leadership- Psychosocial lens:

• wellness vs. disease exacerbation• discharge planning• intersection with medical presentations

- Team dynamics: effect on learning, patient care

- Development of leadership style • utilize specialist consultants on team • elicit feedback from BH Fellow

- Improve facility & competence with family meetings

BH Fellows- Exposure to medical inpatient & full

spectrum of residency training- Give timely, effective, and concise

feedback- Teach, model, assist:

• biopsychosocial lens development• communication (pt. and team)• leadership

- Practice priming as skill development tool

- Exposure to discharge planning and transition of care

INPATIENT MEDICINE TEACHING SERVICE (IMTS)Medical Family Therapy Fellowship

St. Mary’s Family Medicine Residency, Grand Junction, CO

1. Direct patient care2. Didactics/teaching for medical residents3. Feedback to residents on their

communication skills4. Development of skills for MFT fellows

MD and PhD Behavioral

Faculty

Behavioral FellowFamily Med Resident

Feedback

Patient Care

Importance of Behavioral Science to Family Medicine Graduate Medical Education

• Communication (C) and Professionalism (Prof) milestones explicitly point to need and benefit:C1: Develops meaningful therapeutic relationships; C2: Communicates effectively; and perhaps the

professionalism ones;Prof1: completes process of professionalization, Prof3: Humanism and cultures proficiency; andProf4: “Maintains Balance” between their health

and professional growth.

2014 ACGME Family Medicine Milestones

Find A Focus and Choose A Time

Focus• Patient Care

• Team Communication

• Professionalism

Timing• Phase I: Communication

Skills and Goal setting

• Phase II: Team Work

• Phase III: Professionalism and Self-Reflection

Proportion of Focus By Time

Phase I Phase II Phase III0

2

4

6

8

10

12

14

16

18

20

Patient CareTeam WorkProfessionalsim

Phase I: Patient Care

Focus• Patient Care

Examples• Patient-centered

communication in walk rounds

• Patient capacity for decision-making skills

• Family Conferences and Advance Directives

• Mental health diagnosis

Phase II: Team Work

Focus Examples• One-on-one feedback

(situation, behavior, impact)

• Clarify and modify team roles and expectations

• Identify lapses in teamwork

Phase III: Professionalism

Focus Examples• Narrative rounds

• ½ day for Wellness and Reflection: “ Why I wanted to be a doctor.”

• Food and flowers

• Review Goals and Progress

Contact Us

• Laura Sudano: laurasudano@gmail.com• Keith Dickerson: Keith.Dickerson@sclhs.net• Mary Talen: mary.talen@gmail.com• Jeanna Spannring:

Jeanna.Spannring@umassmemorial.org

ReferencesAmerican Academy of Family Physicians [AAFP] (2014). Family medicine specialty.

Retrieved from AAFP website: http://www.aafp.org/about/the-aafp/family-medicine-specialty.html

Accreditation Council for Graduate Medical Education [ACGME] (2013). The family medicine milestone project. Retrieved from ACGME website: http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/FamilyMedicineMilestones.pdf

Armstrong, P., Fischetti, L. R., Romano, S. E., Vogel, M. E., & Zoppi, K. (1992). Position paper on the role of behavioral science faculty in family medicine. Family Systems Medicine, 10, 257-263. doi: 10.1037/h0089032

Sudano, L., Reitz, R., Runyan, T., & Talen, M. (2014, May). The roles of behavioral science faculty within family medicine residencies on inpatient medicine teaching service. Poster presented at the Society of Teachers of Family Medicine (STFM). San Antonio, TX.

Koita, J., Riggio, S., & Jagoda, A. (2010). The mental status examination in emergency practice. Emerg Med Clin N Am, 28, 439-451.

American Psychological Association (2013). Guidelines for Psychological practice in health care delivery systems. American Psychologist, 68 (1), 1-6.

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!