1. Roles and Responsibilities of Behavioral Science Faculty within Family Medicine Residencies on Inpatient Medicine Teaching Service Laura Sudano, MA, MFT intern, UCSD Family Medicine Keith Dickerson, MD, Faculty Physician, St. Mary’s Family Medicine Residency Mary Talen, PhD, Director, Primary Care Behavioral Health, Northwestern University Family Medicine Residency Jeanna Spannring, Primary Care Psychology Fellow, University of Massachusetts Medical School Collaborative Family Healthcare Association 16 th Annual Conference October 16-18, 2014 Washington, DC U.S.A. Session #D5a October 18, 2014

2. Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3. Learning Objectives At the conclusion of this session, the participant will be able to: Recognize what roles BSF fill on inpatient family medicine teaching service. Identify responsibilities within that respective role. Explore their own integration of BSF on inpatient medicine teaching service and learn about how others have integrated their own inpatient medicine teaching service. Implement a tailored curriculum to setting.

4. 1979 STFM attempts to define the roles of BS teaching activities 1982 Task force formed to describe the background and roles of BSF 1986 Core competency educ. goals & objectives in BS education 1992 Michigan Behavioral STFM Timeline of BS in FMR

5. Roles Responsibilities Education 1.Resident Education 2.Educational Activities 3.Other Learner Administration 1.BS curriculum and resident training Developing/evaluating curriculum 2.Activities within depts/programs Committees/development activities Patient care 1.Consulting w/ residents & faculty 2.Dx & Ax Prof. Devel., Scholar., Research 1.Academic Development Reading current literature Attending conferences 2.Presentation & Publication Presenting @ conferences Publishing on topics in medical training/clinical practice 3.Research Conducting research Preparing grants Community Service 1.Participating in community organizations, boards, and task forces focusing on health and social issues 2.Providing volunteer service

6. Family Medicine Inpatient Service -BH Fellow assigned to each block -Available Tuesday & Thursday mornings -Round with one team each day -2 nd Thursday is BH Didactic: Professor Chief & Seniors will suggest topics University of Massachusetts Medical School Utilizing BH Fellows

7. BH Fellows on FMIS Provide real-time education to residents and collaborative care to patients – Focus on patient-centered communication – Motivational Interviewing training – Teaching and learning strategies within teams Assist residents with patients presenting with: – Impaired mental status – Low-motivation for treatment – Chronic disease self-management – Undiagnosed and suspected psychiatric co-morbidities, including substance abuse – Family meetings

8. Consult/Liaison Services Psychiatry x62148 Psychodiagnostic evaluation Psychotropic medication recommendations and adjustments Capacity questions Health Psychology x62148 Provide bedside therapy, neurocognitive assessments, families of patients. Address: depression/anxiety due to medical illness or injury exacerbation of psychological issue due to medical condition coping with pain sleep disruptions adjustment to hospital addiction issues cognitive decline/dementia PTSD end-of life issues cultural issues that interact with medical treatment plans suicidal/self-harm behaviors

9. Goals for Fellows and Residents - Dual Interviews - Health Behavior Change Duals - “Cross-fertilization”: 2 Fellows & 3x12 residents - End-block feedback Residents -Team-based care: collaboration & leadership - Psychosocial lens: wellness vs. disease exacerbation discharge planning intersection with medical presentations - Team dynamics: effect on learning, patient care - Development of leadership style utilize specialist consultants on team elicit feedback from BH Fellow - Improve facility & competence with family meetings BH Fellows - Exposure to medical inpatient & full spectrum of residency training - Give timely, effective, and concise feedback - Teach, model, assist: biopsychosocial lens development communication (pt. and team) leadership - Practice priming as skill development tool - Exposure to discharge planning and transition of care

10. INPATIENT MEDICINE TEACHING SERVICE (IMTS) Medical Family Therapy Fellowship St. Mary’s Family Medicine Residency, Grand Junction, CO 1.Direct patient care 2.Didactics/teaching for medical residents 3.Feedback to residents on their communication skills 4.Development of skills for MFT fellows

11. MD and PhD Behavioral Faculty Behavioral Fellow Family Med Resident Feedback Patient Care

12. Importance of Behavioral Science to Family Medicine Graduate Medical Education Communication (C) and Professionalism (Prof) milestones explicitly point to need and benefit:  C1: Develops meaningful therapeutic relationships;  C2: Communicates effectively; and perhaps the professionalism ones;  Prof1: completes process of professionalization,  Prof3: Humanism and cultures proficiency; and  Prof4: “Maintains Balance” between their health and professional growth. 2014 ACGME Family Medicine Milestones

14. Find A Focus and Choose A Time Focus Patient Care Team Communication Professionalism Timing Phase I: Communication Skills and Goal setting Phase II: Team Work Phase III: Professionalism and Self-Reflection

15. Proportion of Focus By Time

16. Phase I: Patient Care Focus Patient Care Examples Patient-centered communication in walk rounds Patient capacity for decision-making skills Family Conferences and Advance Directives Mental health diagnosis

17. Phase II: Team Work FocusExamples One-on-one feedback (situation, behavior, impact) Clarify and modify team roles and expectations Identify lapses in teamwork

18. Phase III: Professionalism FocusExamples Narrative rounds ½ day for Wellness and Reflection: “ Why I wanted to be a doctor.” Food and flowers Review Goals and Progress

19. Contact Us Laura Sudano: laurasudano@gmail.comlaurasudano@gmail.com Keith Dickerson: Keith.Dickerson@sclhs.netKeith.Dickerson@sclhs.net Mary Talen: mary.talen@gmail.commary.talen@gmail.com Jeanna Spannring: Jeanna.Spannring@umassmemorial.org Jeanna.Spannring@umassmemorial.org

20. References American Academy of Family Physicians [AAFP] (2014). Family medicine specialty. Retrieved from AAFP website: http://www.aafp.org/about/the-aafp/family- medicine-specialty.html Accreditation Council for Graduate Medical Education [ACGME] (2013). The family medicine milestone project. Retrieved from ACGME website: http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/FamilyMedicineMilesto nes.pdf Armstrong, P., Fischetti, L. R., Romano, S. E., Vogel, M. E., & Zoppi, K. (1992). Position paper on the role of behavioral science faculty in family medicine. Family Systems Medicine, 10, 257-263. doi: 10.1037/h0089032 Sudano, L., Reitz, R., Runyan, T., & Talen, M. (2014, May). The roles of behavioral science faculty within family medicine residencies on inpatient medicine teaching service. Poster presented at the Society of Teachers of Family Medicine (STFM). San Antonio, TX. Koita, J., Riggio, S., & Jagoda, A. (2010). The mental status examination in emergency practice. Emerg Med Clin N Am, 28, 439-451. American Psychological Association (2013). Guidelines for Psychological practice in health care delivery systems. American Psychologist, 68 (1), 1-6.

21. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!