Faculty: Janet Hopkins, Psy.D. (Psychologist); Jonathan Wulf, Psy.D. (Psychologist)

Consultants: Jennifer Vincent, MD (Psychiatrist, First Hill and 45^th Street Clinic); Wendy Freed, M.D. (Psychiatrist, Downtown Family Medicine Clinic)

Counseling and Psychosocial Intervention Skills

Co-counseling sessions with the Behavioral Science faculty present unique learning opportunities for residents to advance their intervention skills. Behavioral Science faculty are available for short-term co-counseling with residents, either as co-counselor or supervisor, and will assist residents in recognizing patients who are appropriate to brief office counseling. Residents will discuss potential patients with the behavioral science faculty prior to scheduling appointments, and will meet briefly before and after sessions to strategize and debrief. Residents are free to choose their level of involvement in co-counseling sessions, from being an observer to taking primary leadership.

Diagnostic and Treatment Skills

In addition to co-counseling opportunities, residents may also consult with the behavioral science faculty by discussing the case or inviting her or him to observe a patient interview.

Personal Practice Style

The development of an effective and satisfying personal practice style is a primary goal of our Family Medicine residency. The development of such a style occurs gradually over the entire period of training and continues to be refined during one's professional career. R-1s are in the early stages of developing a practice style, and problems are often due to minimal experiences with difficult patients and an unfamiliarity with the clinic system. R-1s thus profit from prospective exposure to practice style elements and discussion of available options when facing common difficult situations. By the R-3 year, residents have familiarized themselves with the system and have dealt with nearly every type of patient situation several times. R-3's are ready to identify particular problem areas in their own emerging practice styles and to experiment with different approaches.

Behavioral Science Curriculum Conferences

The behavioral science faculty, the resident chairperson and the behavioral science curriculum committee are responsible for collaboratively planning and scheduling the Tuesday afternoon didactics designated for behavioral science topics. The chairperson for 2002-2003 is Carroll Haymon, MD.

Substance Abuse Education Experiences

a) Tuesday Lecture Series

Personnel from the Swedish Hospital Addiction Recovery Services (SHARS), or other experts from the community, may be asked to give lectures as part of the behavioral science curriculum conferences.

b) 2nd Year Behavioral Science Rotation

During the Behavioral Science Rotation in the R-2 year, residents will schedule one full day of educational opportunities at the SHARS Unit at the Ballard campus. Suggested activities include attending a staff conference meeting, case conferences, open family meetings and one-on-one didactics with SHARS personnel. Residents will contact clinical nurse manager, Jan Flom, at (206) 781-6207, prior to the rotation to make scheduling arrangements. For the geriatrics portion, residents schedule two half-days and will contact Mary Jane Lambert, MD at (206)326-4433; pager (206)994-3959

R-1 Group

The first year residents will meet as a group every week on Tuesday from 1:40 to 2:30. Dr. Hopkins and Dr. Wulf alternate weeks as group facilitators. Some of the goals of the group include providing assistance in the transition year from medical school to residency, aiding in stress reduction, and encouraging openness to self-discovery. This is a protected time on all services and only medical emergencies should keep an R-1 from being available. The sole exception is service obligations during the Pediatrics rotation at Children's Hospital Medical Center. Each week, one of the paired residents will be excused from all responsibilities in order to be able to attend the meeting.

Balint Seminars For R-2s and R-3s

These seminars will focus on the physician-patient relationship, not from the traditional case management perspective, but from an experiential and subjective orientation. The goal is to heighten self-awareness for the physician. Balint seminars will meet every week on Tuesday, from 1:40 to 2:30. Dr. Hopkins and Dr. Wulf alternate weeks as group facilitators. This is a protected time on all services for R-3s and on most services for R-2s; exceptions are Planned Parenthood and Ortho/Peds. These meetings are a time when residents can discuss issues and experiences challenging to their identity and confidence as a physician. When Balint is canceled for any reason, R-2s and R-3s meet in their respective class groups.

Didactics

The conference list for Family Medicine includes Behavioral Science didactics. The specific conference titles and speakers are chosen by the Behavioral Science Committee. Didactic sessions may include the following:

· Aging, Adult Development

· Anxiety Disorders

· Chronic Illness/Pain

· Cross-cultural Issues / Working with Interpreters

· Depressive Disorders

· Domestic Violence

· End of Life Issues

· Ethical Issues in Medical Practice

· Gay and Lesbian Issues

· Personality Disorders

· Sleep Disorders, Insomnia

· Somatoform Disorders

· Stress Management

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R-2 Rotation Information

Behavioral Science Rotation Overview

This rotation is paired with educational experiences in geriatrics and substance abuse.

Geriatrics

Multiple options are now available so residents can tailor this geriatric to their learning needs and interests. Two half days are required, more available on your request. Your options:

1. The geriatric fellows are available for outpatient experience at First Hill clinic on Monday afternoons or Thursday mornings. Previous residents have found working with the fellows to be a terrific experience.

2. Long Term Care with Mary Jane Lambert, MD at 206-326-4433. Plan on 2 half days, these are Monday afternoons and must be scheduled one month in advance.

3. Long Term Care with Eric Troyer, MD and the geriatric fellows at Bessie Burton Sullivan. Page Dr. Troyer at 405-7081 or e-mail on first class. Plan on 2 half days, these are Friday mornings.

4. Long Term Care with Pat Borman, MD and the geriatric fellows at Kline Galland. Page Dr. Borman at 405-7462 or e-mail on first class. Plan 2 half days, these are Wednesday afternoons.

5. ElderPlace with Assad Kazemi, MD at 5900 Martin Luther King Jr. Way, S. phone 320-5325. Plan at least 2 half days to learn about all-inclusive care for the frail elderly, times available include Tuesday mornings, Wednesday afternoons, and all day Thursdays.

6. Swedish Home Care Services schedule with Cindy Thompson at 386-6602. Residents can participate in Home Health Services or Hospice visits.

Addiction Recovery Services at Swedish/Ballard: contact the charge nurses, Maureen or Allen, or the new manager, Gary McCullough at 206-781-6209. You should have Thursdays free to split between time at ARS and to meet with us. You will likely work with a fellow for much of your time, and you may also round with the detox nurse and/or medical staff, observe an intake assessment, meet with Gary McCullough, and possibly participate in a clinical staffing and case management review session.

Behavioral Science R-2 Rotation Goals

Assess current level of involvement with psychosocial needs of patients.
Develop a plan for further development.
Increase interviewing and counseling skills.

Individual Didactics

You will be scheduling five hours for one-on-one or small group didactic sessions with Janet Hopkins and/or Jonathan Wulf. Please schedule those sessions before you schedule time with geriatrics and addiction services.

Topics We Will Cover -- Theme: “Working With Challenging Patients”

1. Patient interview management

2. Motivational interviewing skills

3. Using the change model

4. “Joining” with difficult patients

5. Parent education during brief office visits

Faculty Shadowing/Observation

You should have time during this rotation to schedule two half-days to shadow any faculty member(s) of your choosing, at any of the three sites. Please schedule this time after you have all the other pieces in place, and coordinate with the faculty prior to your half-day if at all possible.

R-2 Rotation Reading

You will be provided with the following materials to read as part of your rotation:

Journal of Family Practice article: "Levels of Physician Involvement" (provided)
Patient Care article: "Motivational interviewing: What, when, and why" (provided)
Chapters from "Motivational Interviewing" by Miller & Rollnick.
Contemporary Pediatrics article: "Discipline: Rules & Consequences" (provided)
American Academy of Pediatrics paper: "Guidance for Effective Discipline" (provided)

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Normal and abnormal psychosocial growth and development across the life cycle, and variants

Recognition of interrelationships among biological, psychological and social factors in all patients

Reciprocal effects of acute and chronic illnesses on patients and their families

Factors which influence adherence to a treatment plan

Family functions and common interactional patterns in coping with stress

Awareness of one's own attitudes and values which influence effectiveness and satisfaction as a physician

Stressors on physicians and approaches to effective coping

Ethical issues in medical practice; including informed consent, patient autonomy, confidentiality, and issues of quality of life.

Evaluations Skills

1. Interviewing skills which enhance data collection in short periods of time, and optimize doctor/patients relationship

2. Performance of mental status examination

3. Indications for special procedures in psychiatric disorders diagnosis, including psychological testing, laboratory testing and brain imaging testing

4. Capability to elicit and recognize the common signs and symptoms of the disorders in section I

5. Psychiatric consultations procedures

Therapeutic Skills

1. Management of emotional aspects of non-psychiatric disorders

2. Skills in enhancing compliance with medical treatment regimens

3. Initial management of psychiatric emergencies - the suicidal patient, the acutely psychotic patient

4. Proper use of psychopharmacological agents

Goals

· Promoting a biopsychosocial understanding of health and illness, and initiating treatment plans based on that model.

· Recognizing psychological, psychosocial, and psychiatric issues and disorders and initiating treatment or referral appropriately.

· Developing a range of counseling skills via co-counseling sessions.

· Developing an effective personal practice style and communication skills in all aspects of primary care.

· Collaborating and consulting with associated disciplines in mental health and social services.

· Gaining self-awareness and insight into one's own role in doctor-patient relationships.

· Recognizing and providing intervention for physician stress and impairment.

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