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

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

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

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

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

The 37th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin 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. Workforce Increase in need for education and training in behavioral health. Increase in healthcare providers to treat patients with behavioral health needs.

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

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

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

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

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

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

The 37th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin TopicsColorado (1999)Missisippi (2003) Depression11 Anxiety22 Lifestyle Counseling36 Headaches44 Difficult Patients57 Interviewing65 Stress-related Disorder79 Geriatrics83 Physician Well-Being912 Patient Education1013 Chronic Pain117 Substance Abuse1210 Death & Dying1310

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

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

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

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

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

The 37th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin TopicsColorado (1999)Missisippi (2003)Washington (2015) Depression111 Anxiety223 Lifestyle Counseling364 Headaches4411 Difficult Patients5710 Interviewing652 Stress-related Disorders 7911 Geriatrics835 Physician Well-Being91213 Patient Education10137 Chronic Pain1176 Substance Abuse12109 Death & Dying13108

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

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

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

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

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

The 37th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin 134 RESPONDENTS Study DEGREERESPONDENTS MD10 DO1 PHD/PSYD88 LCSW/MSW22 OTHER13

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

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

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

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

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

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

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

The 37th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Strongly disagree Moderately disagree Slightly disagree Neither agree or disagree Slightly agree Moderately agree Strongly agree My residency program values my contribution to its well- being My residency program disregards my best interests when it makes decisions that affect me My residency program cares about my opinions

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

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

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

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

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

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

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

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

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