The 37 th Forum for Behavioral Science in

The 37 th Forum for Behavioral Science in Family Medicine What We Are Doing and Where We Want to Go: Utilization and Priorities in Behavioral Science Curriculum Development Molly S. Clark, Ph. D, ABPP University of Mississippi Medical Center Kristine M. Diaz, Psy. D Georgetown University-Providence Hospital Family Medicine Residency Richard L. Brandt-Kreutz, MA, MSW Providence St. Peter Family Medicine Residency Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Disclosures There are no conflicts to disclose. Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Acknowledgements 2016 Forum in Behavioral Science Conference Planning Committee & Dr. Dennis Butler Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Goals and Objectives 1. Discuss topic prioritization in behavioral science residency education. 2. Discuss how behavioral medicine faculty is currently being utilized to incorporate behavioral science education in US residency programs. 3. Identify action strategies for behavioral science curriculum development with consideration to a residency program’s behavioral science faculty workforce and behavioral science curriculum needs. Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Current State of Behavioral Medicine Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Integration of Behavioral Health In Primary Care Behavioral Health • Shortage of Psychiatrist • Lack of behavioral health services Primary Care • Increase in behavioral health needs in patient population • Healthcare providers' concerns about ability to treat. • Increase in need for Workforce education and training in behavioral health. • Increase in healthcare providers to treat patients with behavioral health needs. Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Behavioral Health Education and Training Education BEHAVIORAL SCIENCE • Curriculum Development • Topic Prioritization Workforce Organizational Support • Behavioral Scientists • Allied Health Providers • Time Allocated • Institutional & Program Support Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Behavioral Science Curriculum Development Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine The perennial problem of prioritization every FM Behavioral Scientist struggles with Are we teaching residents what they need in practice? Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Behavioral Science Priorities in Residency Education: The Perspective of Practicing Family Physicians • Families, Systems and Health, December, 2015 • How do WA state FM physicians prioritize behavioral science? Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Behavioral Science Guidelines STFM ACGME AAFP • Very Broad • 256 pages • Very General • diagnose, manage, and coordinate care for common mental illness and behavioral issues… • Making Progress • Competencies, Attitudes, Knowledge, Skills Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Physician Behavioral Science Priorities • Kim Marvel, Ph. D, 1999 – 663 Colorado family physicians, 447 returned (71%) – 28 questions rating topics 1 = Lo, 4 = Hi • Kendall duplicated study in 2003 in Mississippi Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Topics Colorado (1999) Missisippi (2003) Depression 1 1 Anxiety 2 2 Lifestyle Counseling 3 6 Headaches 4 4 Difficult Patients 5 7 Interviewing 6 5 Stress-related Disorder 7 9 Geriatrics 8 3 Physician Well-Being 9 12 Patient Education 10 13 Chronic Pain 11 7 Substance Abuse 12 10 Death & Dying 13 10 Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine How do Washington state FM physicians set priorities? Strong Primary Care Weak Mental Health • Significantly higher than the national average • Among the bottom 4 in prevalence/access Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine How do Washington state FM physicians set priorities? Previous Studies • Compared to Colorado & Mississippi Curriculum Development • Topics more akin to psychiatry Location Demographics • Rural vs Urban Competency • Impact of physician perceived competency on topic prioritization Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Modifications To Study 8 Topics Added Well Child Skills Psychopharmacology Cognitive Disorders Mood Disorders Competency scale added: “Rate each topic according to your current perceived level of competence. ” Mental Status Autism Spirituality In Medicine Chronic Mental Illness Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Survey 2270 practicing family physicians, “active” members of the WAFP 486 replied 430 completed the survey = 19% response Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Topics Colorado (1999) Missisippi (2003) Washington (2015) Depression 1 1 1 Anxiety 2 2 3 Lifestyle Counseling 3 6 4 Headaches 4 4 11 Difficult Patients 5 7 10 Interviewing 6 5 2 Stress-related Disorders 7 9 11 Geriatrics 8 3 5 Physician Well-Being 9 12 13 Patient Education 10 13 7 Chronic Pain 11 7 6 Substance Abuse 12 10 9 Death & Dying 13 10 Sponsored by The Medical College of Wisconsin 8

The 37 th Forum for Behavioral Science in Family Medicine Priority Total Priority and Competence Scales Significant Medium Correlation Competence Total Sponsored by The Medical College of Wisconsin r =. 48, n = 430 p =. 001

The 37 th Forum for Behavioral Science in Family Medicine Take Aways for Behavioral Scientists Prioritize the top 13 Prioritize interpersonal processes Prioritize treatment of common mental illnesses Maintain breadth and variety Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Behavioral Science Workforce Administrative Clinical Research Teaching Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Work Distribution Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Study 134 RESPONDENTS DEGREE RESPONDENTS MD 10 DO 1 PHD/PSYD 88 LCSW/MSW 22 OTHER 13 Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine What is the population size of the area, in which your family residency program is physically located? 13% Less than 100, 000 (Rural, Nonmetropolitan) 27% 100, 000 -249, 999 (Rural-Urban, Small Metropolitan) 33% 27% 250, 000 -1 million (Urban-Rural, Medium Metropolitan) More than 1 million (Urban, Large Metropolitan) Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine In what setting is your family medicine residency? 1% Community Based, Medical School Affiliated 22% Community Based, Non Affiliated 49% Medical School Based Military Program 28% Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Formal Title In Residency Program Director of Behavioral Health/Medicine/Science Attending Physician Clinical Psychologist Licensed Social Worker Licensed Family Therapist Licensed Clinical Therapist Other Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Faculty Responsible for Behavioral Science Myself, solely Myself and one other person Myself and 2+ people Sponsored by The Medical College of Wisconsin Other

The 37 th Forum for Behavioral Science in Family Medicine Behavioral Science Team 25 20 15 10 22 20 15 12 5 11 8 0 Physician Licensed Clinical Psychologist Licensed Social Worker Licensed Therapist Health Trainee Sponsored by The Medical College of Wisconsin Other

The 37 th Forum for Behavioral Science in Family Medicine Please identify the approximate percentage for the following work responsibilities at your family residency program: 40 37. 89 35 30 25 26. 18 20 19. 27 15 10. 16 8. 22 5. 84 3. 45 0 Teaching Medical Teaching other Students Residents health trainees Direct Patient Care Research Grant Writing Sponsored by The Medical College of Wisconsin Administrative

The 37 th Forum for Behavioral Science in Family Medicine PERCEIVED ORGANIZATIONAL SUPPORT Most respondents felt supported by their residency program Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Strongly disagree Moderately disagree Slightly disagree Neither agree or disagree Slightly agree Moderately agree Strongly agree My residency program values my contribution to its wellbeing. 1 1 3 29 97 My residency program disregards my best interests when it makes decisions that affect me. 61 38 10 6 10 1 6 2 1 14 43 69 My residency program cares about my opinions. Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Summary Quantity Responsibility • Predominantly one person workforce • Interprofessional Approach to Behavioral Science Team • Varying titles & responsibilities Distribution • Varying percentage for work distribution Support • Organizational support to achieve work responsibilities Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Pulling These Threads Together Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Topics Depression Anxiety My residency program values my contribution to its wellbeing. Lifestyle Counseling Headaches Difficult Patients Interviewing Moderately disagree Slightly disagree Neither agree or Slightly agree disagree Moderately agree Strongly agree 1 1 3 29 97 61 38 10 6 10 1 6 2 1 14 43 69 WHAT ARE THE IMPLICATIONS? Stress-related Disorders Geriatrics Strongly disagree Physician Well-Being My residency program disregards my best interests when it makes decisions that affect me. Patient Education Chronic Pain Substance Abuse My residency program cares about my opinions. Death & Dying Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine Medical College Admission Test Undergraduate Medical Education Graduate Medical Education Patient Care Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine SMALL GROUP BREAKOUT 1. Of the core 13 topics, how many topics do you teach in your residency program? 2. How do YOU prioritize the core 13 topics in your curriculum? 3. How do YOU prioritize your overall behavioral science curriculum to be relevant and up-to-date? Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine LARGE GROUP DISCUSSION 1. How will the advocacy of behavioral science impact family medicine and its residency programs? 2. What future steps should be taken for behavioral science to be explicitly included in GME? Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine SUMMARY COLLABORATION • Include faculty and residents in curriculum development and evaluation. • Seek consultation from behavioral science colleagues. ADVOCACY • Identify Strategies for Inclusion as part of residency program • Articulate & Quantify Your Work in Behavioral Science INNOVATION • Identify novel instructional strategies to prioritize core 13 topics. • Use research to identify best practices in curriculum development and evaluation. Sponsored by The Medical College of Wisconsin

The 37 th Forum for Behavioral Science in Family Medicine THANK YOU! Sponsored by The Medical College of Wisconsin