This is an inquiry directed to colleagues in residency settings.... We have a PGY3 resident that is interested in doing a two week elective with my behavioral health faculty colleague and myself. He wants to further develop his primary care counseling skills and management of patients with behavioral health issues.
Do any of you have residents work with you on encounters and patient visits?I am working on the structural pieces and am curious if any of you have residents as cotherapists?
I want him to have a really good, practical experience and know that many of you may have done similar things.
Any guidance appreciated.
Karla Hemesath, PhD, LMFT
University of Iowa Carver College of Medicine
I work in a pediatric residency training clinic and work closely with the medical residents. Being in the room with the resident is a really meaningful training experience and I have found it to be more effective than simply co-precepting with the medical attending. Previously, we have just identified cases when they come up. We are working to formalize the experience in our clinic during the residents "block month" where they are in clinic every day for a full month.
Together, we set specific goals and target skills to focus on and do a mixture of co-precepting, education (readings, discussions), observations, and co-leading appointments. We have found that setting realistic, pragmatic goals in the beginning of the experience is particularly important they often come into the experience with really eager expectations and sometimes an implicit assumption that they will master a whole field by seeing ONE, doing ONE, and teaching ONE. We tend to lean heavier on cross cutting skills (e.g., MI, behavioral change principles, solution focused approaches) with the understanding that it's easier for them to find out WHAT to tell patient to do, much harder to coach them on HOW to do it.
Happy to discuss more details if you would like.
Cody Hostutler, Ph.D.
Pediatric Psychology & Primary Care Red/Yellow
Nationwide Children's Hospital
Our family medicine residents have a two week behavioral medicine rotation with me their intern year. I created a "See One, Do One" checklist of some of the most common behavioral health concerns seen in primary care (including behavioral management of chronic conditions) where the intern is able to check off when they have seen and done various components of a BHC visit (brief eval, intervention) for different presenting concerns. The resident usually does straight shadowing the first day of the rotation. After that, they take a more active role in the visit. After receiving a handoff from another provider I turn to the resident and ask a variety of questions ("Based on the info we know, what are your differentials? What questions do you need to ask to clarify the problem/diagnosis? What are some brief interventions you could use if that is the problem/diagnosis?). Following the visit we can review patient's readiness for change and how the resident's intervention aligned/didn't align with the patient's readiness for change and level of engagement. I'm using a couple of different evaluation measures to guide feedback to the resident as well. During their rotation they also visit a 12 step meeting and create a patient ed handout on a topic of their choice (they must make the handout interactive using their knowledge of motivational interviewing/behavior change). Hope this helps!
We (Central Washington Family Medicine) have four, one month rotations throughout the three years w/ Behavioral Medicine components. During these rotations, we have a specific experiences:
1. BHCs observe residents during resident medical visits and provide feedback on patient centered communication
2. FM residents observe BHCs in their clinics. This experience is progressive throughout the three years in that interns' expectation is to complete the Contextual Interview with new BHC appointments. R2 and R3 build on that experience and actually start providing psychoeducation and interventions with BHC. It not uncommon for an R-3 resident to complete an entire BHC visit with the BHC obviously in the room.
3. Role-plays, which allows residents to practice the Contextual Interview, interventions, psycho-education and discuss philosophical concepts (e.g., what causes people to change, ACEs, etc.).
4. Coaching. Residents are chosen weekly to be "coached" by one of our BHCs. This is different from the normal shadowing that they receive in that the BHC primes the resident to look at their schedule and identify two patients they would like to practice doing a BH intervention/technique. The BHC then shadows them doing so and provides prompt feedback.
Let me know if you would want any specific information (e.g., curriculum, reading materials, evaluation materials, etc.)!