Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians.
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2019-05
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Abstract
Objective
Behavioral health services frequently delivered by primary care providers include care for mental health and substance abuse disorders and assistance with behavioral risk factor reduction. Internal medicine residencies in the United States lack formal expectations regarding training in behavioral health for residents. This qualitative study aimed to determine learners' and teachers' perceptions about appropriate behavioral health curricular components for internal medicine residents.Method
Focus groups and interviews were conducted with the following individuals from the Duke Outpatient Clinic: residents with continuity practice (n = 27), advanced practice providers (n = 2), internal medicine attending physicians (n = 4), internal medicine/psychiatry attending physicians (n = 2), and behavioral health clinicians (n = 4). A focus group leader asked regarding residents' successes and challenges in managing behavioral health issues and about specific learning components considered necessary to understand and manage these behavioral health conditions. Transcripts were coded using an editing analysis style to identify central themes and concordance/discordance between groups.Results
Regarding mental health management (Theme 1), residents emphasized a need for better care coordination with specialty mental health, while attendings and behavioral health clinicians gave priority to residents' skills in primary management of mental health. Residents, attendings, and behavioral health clinicians all emphasized advanced interviewing skills (Theme 2) with subthemes: eliciting the patient's perspective, managing time in encounters, improving patients' understanding, and patient counseling.Conclusions
Internal medicine residents, attendings, and behavioral health clinicians may differ significantly in their perceptions of primary care's role in mental health care. Future internal medicine behavioral health curricula should specifically address these attitudinal differences. Curricula should also emphasize interview skills training as an essential component of behavioral health learning.Type
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Hemming, Patrick, Jessica A Revels, Anh N Tran, Lawrence H Greenblatt and Karen E Steinhauser (2019). Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians. International journal of psychiatry in medicine, 54(3). pp. 188–202. 10.1177/0091217418802159 Retrieved from https://hdl.handle.net/10161/26753.
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Scholars@Duke
Anh Nhat Tran
Minority health inequities
Cross-cultural health interventions
Community based participatory research (CBPR) methods
Cancer health disparities
Sexual health promotion
Lay health advisor (LHA) interventions
Patient-provider interaction
Health inequities
Social determinants of health
Clinical leadership training
Community engagement
Lawrence Howard Greenblatt
Dr. Greenblatt focuses his professional efforts in 3 domains. First, he provides care to a busy general internal medicine panel utilizing an approach that is both patient-centered and evidence-based. Second, he is an active educator routinely providing clinical teaching to students and residents. He routinely regularly provides faculty development in teaching and other skills for medical educators across many professions both in Durham and in the Academic Medicine Education Institute in Singapore. Third, he has a community focus. He serves as Medical Director for Northern Piedmont Community Care which provides practice support, care management, and population management primarily for Medicaid recipients. He is currently working on developing systems and policy to improve opioid safety both for Duke Health System and the State of North Carolina.
Karen E. Steinhauser
Dr. Steinhauser's primary interests are end-of-life care, medical sociology and patient-provider relationships. Specifically, she investigates the composition and measurement of the quality of life for patients and their families at the end of life. Dr. Steinhauser is a Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham; Professor, Department of Population Health Science and Medicine; Senior Fellow with the Duke University Center for Aging; Associate Chief for Research, Duke Palliative Care, and Director, Duke Residency Professional Development Coaching Program.
Karen E. Steinhauser, PhD is a social scientist dedicated to improving quality of life of patients, families, and providers during serious illness. She is a Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham and Professor, Department of Medicine, Duke University Medical Center, Senior Fellow with the Duke University Center for Aging, and a former VA Career Development Awardee.
Karen Steinhauser, PhD, is Professor, Departments of Population Health Sciences and Medicine, Duke University Medical Center and Senior Fellow with the Duke University Center for Aging and Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham. Her research is dedicated to improving patient and family psychosocial and spiritual care, in serious illness. She has developed measurement tools to assess patient and family quality of life as well as psychosocial interventions to improve the experience of serious illness for patients and those who care for them. Dr. Steinhauser's research has used qualitative and qualitative methods, observational, trial and implementation research. Her latest work includes: developing a measure to assess the spiritual needs in palliative care, and addressing clinician resilience in palliative care. She serves as Associate Chief of Research for Duke Palliative Care, Director of the Duke Residency Professional Development Coaching program and Vice Chair of Faculty Development for Population Health Sciences. She has been a long-term member of AAHPM, having served on the research committee and being the 2015 Awardee for Excellence in Scientific Research in Palliative Care. She is the Director of Duke’s Residency Professional Development Coaching Program and Vice Chair for Faculty Development, Department of Population Health Sciences
Area of expertise: Palliative Care, Qualitative Research
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