Preparing residents to practice integrated behavioral health care: Multi-site feasibility study of a competency-based curriculum

Abstract

Objective

Workforce development is essential for the dissemination of team-based integrated behavioral healthcare. There is limited literature on training family medicine residents to function within an integrated behavioral health (IBH) system. The purpose of this pilot study was to assess the feasibility and value of an IBH competency-based curriculum for family medicine residents across multiple programs.

Methods

Residency programs were recruited using professional listservs and networks to test a competency-based, multi-modal curriculum for preparing residents to practice IBH in primary care. Faculty instructors who led the workshop were invited to complete semi-structured interviews to examine the feasibility and appropriateness of the curriculum. Interview data were analyzed using thematic analysis to identify, analyze, and report patterns. Residents completed a survey of perceived IBH skill and knowledge before and after training. A paired-sample t-test was used to determine significant differences pre- and post-training.

Results

All five instructors completed interviews. Results suggest IBH training is valuable. Instructors gave specific feedback on online modules, implementation flexibility, and adjusting faculty development to differing levels of experience. Nineteen of forty residents (48%) completed anonymous pre-, post-, and retrospective-training surveys. Residents reported an increase in competence after training.

Conclusion

The results of this pilot suggest that IBH training implementation is feasible, desirable, timely, and may improve resident ability to work on an IBH team. Training should accommodate variations in program structure and faculty expertise.

Keywords

behavioral health integration graduate medical education workforce development

Get full access to this article

View all access options for this article.

References

Peek

the National Integration Academy Council . Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. AHRQ Publication No.13-IP001-EF. Rockville, MD: Agency for Healthcare Research and Quality, 2013. Available at: http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf.

Miller-Matero

Dykuis

Albujoq

, et al. Benefits of integrated behavioral health services: the physician perspective. Families, Syst Health 2016; 34(1): 51, DOI: 10.1037/fsh0000182.

Balasubramanian

Cohen

Jetelina

, et al. Outcomes of integrated behavioral health with primary care. J Am Board Fam Med 2017; 30(2): 130–139, DOI: 10.3122/jabfm.2017.02.160234.

Kwan

Valeras

Levey

, et al. An evidence roadmap for implementation of integrated behavioral health under the Affordable Care Act. AIMS Pub Health 2015; 2(4): 691–717, DOI: 10.3934/publichealth.2015.4.691.

Archer

Bower

Gilbody

, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10: CD006525, Issue 10, DOI: 10.1002/14651858.CD006525.pub2.

Martin

Bauman

Allison

, et al. Integration as both standard of care and standard of training. Fam Med 2019; 51(8): 701–702, DOI: 10.22454/FamMed.2019.733470.

Accreditation Council for Graduate Medical Education (ACGME) . Family Medicine Milestones, 2019. Retrieved from, https://www.acgme.org/Portals/0/PDFs/Milestones/FamilyMedicineMilestonesDraft.pdf.

National Academies of Sciences, Engineering, and Medicine . Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: The National Academies Press, 2021, DOI: 10.17226/25983.

Martin

Allison

Banks

, et al. Essential skills for family medicine residents practicing integrated behavioral health: a delphi study. Fam Med 2019; 51(3): 227–233, DOI: 10.22454/FamMed.2019.743181.

10.

Landoll

Maggio

Cervero

, et al. Training the doctors: a scoping review of interprofessional education in primary care behavioral health (PCBH). J Clinical Psychology Medical Settings 2019; 26(3): 243–258, DOI: 10.1007/s10880-018-9582-7.

11.

Hoover

Andazola

. Integrated behavioral care training in family practice residency: opportunities and challenges. J Clini Psychol Med Set 2012; 19(4): 446–450, DOI: 10.1007/s10880-012-9353-9.

12.

Choi

Betancourt

DeMarco

, et al. Medical student exposure to integrated behavioral health. Acad Psyc 2019; 43: 191–195, DOI: 10.1007/s40596-018-0936-0.

13.

Reed

Crane

Svendsen

, et al. Behavioral health and primary care integration in Ohio’s psychiatry residency training. Acad Psyc 2016; 40: 880–886, DOI: 10.1007/s40596-016-0623-y.

14.

Martin

. Integrated behavioral health training for primary care clinicians: five lessons learned from a negative study. Families, Syst Health 2017; 35(3): 352, DOI: 10.1037/fsh0000278.

15.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77–101, DOI: 10.1191/1478088706qp063oa.

16.

Mauksch

Farber

Greer

. Design, dissemination, and evaluation of an advanced communication elective at seven US medical schools. Acad Med 2013; 88(6): 843–851, DOI: 10.1097/ACM.0b013e31828fd5ed.

17.

Osborn

Raetz

Huntington

, et al. A curriculum on care for complex patients: resident perspectives. Fam Med 2016; 48(1): 35–43, DOI: 10.22454/FamMed.2021.718541.

18.

Zubatsky

Brieler

Jacobs

. Training experiences of family medicine residents on behavioral health rotations. Fam Med 2017; 49(8): 635–639, DOI: 10.22454/FamMed.2018.639260.

19.

Simasek

Ballard

Phelps

, et al. Meeting resident scholarly activity requirements through a longitudinal quality improvement curriculum. J Graduate Med Edu 2015; 7(1): 86–90, DOI: 10.4300/JGME-D-14-00360.1.

20.

Jacobs

Brieler

Salas

, et al. Integrated behavioral health care in family medicine residencies: a CERA survey. Fam Med 2018; 50(5): 380–384, DOI: 10.22454/FamMed.2018.639260.

21.

Practice Integration Profile. University of Massachusetts. 2021. Retrieved from http://www.practiceintegrationprofile.com/

22.

Integrated Practice Assessment Tool (IPAT). Health Resources & Services Administration. 2021. Retrieved from https://www.hrsa.gov/behavioral-health/integrated-practice-assessment-tool-ipat

23.

Keen

Cawse-Lucas

Carline

, et al. Using the patient centered observation form: Evaluation of an online training program. Patient Edu Couns 2015; 98(6): 753–761, DOI: 10.1016/j.pec.2015.03.005.

24.

Page

Reid

Brown

, et al. Content analysis of family medicine resident peer observations. Fam Med 2020; 52(1): 43–47, DOI: 10.22454/FamMed.2020.855292.

25.

Hemming

Hewitt

Gallo

, et al. Residents' Confidence Providing Primary Care with Behavioral Health Integration. Center for Integrated Primary Care Publications. Retrieved from, https://escholarship.umassmed.edu/cipc/43.

26.

American Academy of Family Physicians . Match Results for Family Medicine, 2021. Retrieved from, https://www.aafp.org/students-residents/residency-program-directors/national-resident-matching-program-results.html.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.04 MB