Psychosocial Medicine Curriculum

Studies estimate that 35% of patients in primary care practice have psychosocial, not biomedical, problems. Clearly, then, physicians must be grounded in the psychosocial, as well as the biomedical domains, in order to provide optimum care for their patients. The psychosocial domain encompasses 1) a patient-centered, as opposed to purely physician-centered, approach; 2) interviewing skills, including listening, empathy and an awareness of how one's own feelings, biases, responses, etc., affect the doctor-patient relationship; 3) a belief that all illnesses have psychosocial aspects that influence their cause, manifestation, course, and outcome; and 4) the skills to diagnose and treat common psychosocial problems, such as mood and anxiety disorders, somatoform disorders, substance abuse, domestic violence, and non-adherence. The psychosocial domain is complementary to the knowledge, skills, and attitudes of the biomedical domain. Incorporating both domains in clinical practice is the called the biopsychosocial approach, useful not only for patients with mental health problems, but for all patients.

Research shows that physicians who use a biopsychosocial approach to patient care have more satisfied and adherent patients, affect better health outcomes, are more professionally satisfied, and even have fewer malpractice suits! The Psychosocial Curriculum seeks to provide house staff with the knowledge, skills, and attitudes needed to be successful and fulfilled internists. This three-year curriculum includes didactic and experiential components led by internists, psychiatrists and psychologists. The didactic lectures in the ambulatory core curriculum are in the following areas: depressive disorders, anxiety disorders, somatization, post-traumatic stress disorder, obsessive-compulsive disorder, neuropsychiatry, psychosis, movement disorders, psychopharmacology, psychiatric epidemiology, organic brain disease, domestic violence, alcohol abuse, helping patients to change behaviors, dealing with difficult situations, primary care of gay and lesbian patients, helping patients improve adherence and spirituality in medicine.

Experiential components include 1) primary care psychiatry consultation clinic, 2) outpatient substance abuse center, 3) medical interviewing tutorials10, 4) behavioral change counseling consultation clinic, and 5) difficult patient workshop.

1 Green ML, Ellis PJ. Impact of an evidence-based medicine curriculum based on adult learning theory. J Gen Intern Med. 1997;12(12):742-750.
2 Green ML, Ciampi MA, Ellis PJ. Residents' medical information needs in clinic: are they being met? Am J Med. 2000;109(3):218-223.
3 Green ML, Ruff TR. Why Do Residents Fail to Answer Their Clinical Questions? A Qualitative Study of Barriers to Practicing Evidence-Based Medicine. Acad Med. 2005;80(2):176-182.
4 Green ML. Evaluating evidence-based practice performance (editorial). ACP Journal Club. Sep-Oct 2006;145:A8-A10.
5 Green ML, Reddy SG, Holmboe E. Teaching and evaluating point of care learning with an Internet-based clinical-question portfolio. Journal of Continuing Education in the Health Professions. 2009;29(4):209-219.
6 Holmboe ES, Prince L, Green ML. Teaching and Improving Quality of Care in a Primary Care Internal Medicine Residency Clinic. Acad Med. 2005;80(6):571-577.
7 Windish DM, Huot SJ, Green ML. Medicine Residents' Understanding of the Biostatistics and Results in the Medical Literature. Vol 298; 2007:1010-1022.
8 Windish DM, Diener-West M. A clinician-educator's roadmap to choosing and interpreting statistical tests. J Gen Intern Med. Jun 2006;21(6):656-660.
9 Kansagara DL, Holmboe ES, Carr K, Huot SJ. Establishing a diabetes disease management program in a resident clinic (Abstract). J Gen Intern Med. 2005;20 (Suppl 1):31.
10 Fortin AH, Haeseler FD, Angoff N, et al. Teaching pre-clinical medical students an integrated approach to medical interviewing: half-day workshops using actors. J Gen Intern Med. 2002;17(9):704-708.