Behavioral Science in Family Medicine Education

The Behavioral Science curriculum is based on the biopsychosocial-spiritual model (Engel, 1977; Wright, Watson, & Bell, 1996). Residency education in the Behavioral Sciences 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:

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.

Behavioral Science Facilitators

FirstYear Behavioral Science Rotation (two week block)

Didactics

Didactic, interactive lectures on Behavioral Science topics include:

Direct Observation of Clinical Activity

Noon Conference Lecture

Residents prepare and present a one-hour lecture on a behavioral health specialty topic to faculty, residents, and medical students.

Second Year Behavioral Science Rotation (one week block)

Didactics

Didactic, interactive lectures on Behavioral Science topics may overlap with the first year and include:

Direct Observation of Clinical Activity

Rotations

ThirdYear Behavioral Science Rotation (two half days)*

Didactics

Didactic, interactive lectures on Behavioral Science topics may overlap with the first and second year and include:

Direct Observation of Clinical Activity

Longitudinal Curriculum

Integrated 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), Southside United Health Center. Together, 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 are presented once a month at noon conferences and morning reports 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 & Live Observation

Videotaping & shadowing (live observation of the clinical encounter through closed-circuit video feed) begins the first year of the Behavioral Health Rotation (BHR) and continues throughout residency training.

Support Groups

1st Year

HO-Is attend a support group one totwo 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 fucus on the complexities of the in the Doctor-Patient relationship but also 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 but also includes a focus on the complex transition from residency to their early career.

Consultation & Referral

Behavioral Science faculty are available to review patients, facilitate treatment planning and accessing 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 retrieved at http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint270_Mental.pdf

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine.Science,196, 129-136. doi: 10.1126/science.847460

Wright, L. M., Watson, W. L., & Bell, J. M. (1996).Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.

* Anticipated for rotation to be offered for graduating class of 2019.

Laura Sudano, MA Director Behavioral Science Education

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Behavioral Science - Wake Forest School of Medicine