Teaching Behavioral Science to Family Medicine Residents: Integrating Training into the Family Practice Unit
Walsh, Allyn, Davine, Jon, Kates, Nick, The Israel Journal of Psychiatry and Related Sciences
Allyn Walsh, MD, CCFF,1 Jon Davine, MD, CCFP FRCPC,1,2 and Nick Kates, MD, FRCPC1,2
Abstract: The teaching of behavioral science is an integral part of the education of family physicians. This paper presents a model of a program that integrates the teaching of behavioral science with residents' daily activities in their clinical placement. It outlines the format of the program, the curriculum, teaching methodologies, evaluation and funding. The authors stress the importance of collaboration between family physician and psychiatrist in planning and implementing the program.
Training in behavioral science is a essential component of the preparation of family physicians. It has been estimated that approximately 15%-50% of all patients encountered in the ambulatory setting have emotional problems that are either primary in nature or secondary to physical illness (1, 2, 3). Many of these patients are seen exclusively in the primary care setting (4), underlining the importance of family physicians being well trained in this area. Detection rates of mental illness by primary care physician appear, however, to be low (5, 6, 7). Based on these realities, Burns et al. have summarized the goals of behavioral science teaching in primary care as follows: 1) an emphasis on the physician-patient relationship as a therapeutic tool; 2) as awareness and understanding of the behavioral and psychosocial aspects of illness; and, 3) the recognition and management of psychiatric disorders and emotional problems (8).
Traditionally family medicine residencies relied upon rotations in psychiatric services to prepare their trainees for handling the emotional problems of their patients. The problem with many of those rotations, however, was that the cases seen - especially in in-patient settings - often bore little resemblence to the majority of problems family physicians would encounter in their practices. Increasingly, family medicine programs have looked at ways of providing alternative training experiences, primarily by integrating training in behavioral science within the family medicine unit, basing the learning on cases the residents are seeing in their daily practice (9).
This paper describes the behavioral science component of the family medicine residency program at McMaster University, which has successfully integrated behavioral science training with residents' clinical activities for over 25 years. It defines the term "behavioral science," outlines the administration of the program, curriculum content and evaluation methods, and discusses teaching methodology. While this model was initially developed in academic teaching units, it has also been applied to residents training in community teaching practices.
Definition of Behavioral Science
Behavioral science is the study of a patient's behavior, and the attempt to understand the behavior in terms of contributing factors, such as psychiatric and other medical illnesses, an individual's psychological development and the context in which he or she lives (e.g., family, culture or workplace). The resident learns to recognise and interpret these and intervene in ways which will change or eliminate problem behaviors and reduce the negative effects of the behaviors on the individual or others. It can address any aspect of a patient's mental and emotional health, including life cycle issues, psychiatric illness, substance abuse, family dysfunction, and situational adjustment reactions.
Behavioral science also involves an appreciation of the way the physician behaves with his or her patient, the factors that can affect this behavior and ways in which this understanding can be utilized to strengthen the doctor-patient relationship and the health of the patient. It requires the development of an appropriate therapeutic stance and role by the physician, recognising and dealing with personal reactions to patients and using these reactions therapeutically. …