Efficiency is not enough; you have to prove that you care: role modelling of compassionate care in an innovative resident-as-teacher initiative.

INTRODUCTION: The current emphasis on providing holistic competent and efficient healthcare has revealed a need to nurture providers' compassionate and relationship-centred care throughout the continuum of medical education. METHODS: Our resident-as-teacher programme trained 41 residents from core clerkships at six clinical sites in the United States of America (USA) to teach and practice compassionate care through role-modelling. The programme focused on resident's demonstrations or failures to demonstrate compassionate care with peers, students and healthcare providers, and engaged residents in disseminating their experience to their colleagues. A mixed-method evaluation assessed short-term outcomes at multiple levels through the collection of resident's: pre- and post-programme scores on empathy scale, performance on standardised patient (SP) exercise, and self-assessment of their performance on relationship-centred care skills; journal reflections; presentations delivered at their site and attendees' evaluation; evaluation of the programme. Quantitative data was analysed calculating descriptive statistics and paired sample t-tests, using SAS. Qualitative data was analysed performing open coding and code frequency counts to identify emergent themes. RESULTS: Residents had empathy scores within the average range, and high scores on SP assessments throughout the programme. The programme had a positive impact on resident's perceptions of their relationship-centred skills. Residents found the programme useful, and emphasised the importance of mindfulness, active presence and slowing down-and were concerned with addressing these needs in daily practice. Eighteen presentations were delivered across sites. Attendees found the presentations useful and necessary in their training. CONCLUSIONS: Residents successfully reflected on, embodied and disseminated the programme's core concepts on their rotations. This group required validation of their commitment to compassionate care, and sought strategies to embody their commitment while inspiring other providers, residents and students.

Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface.

BACKGROUND: In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use. METHOD: The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties. CONCLUSION: Psychiatrists who specialize in the treatment of medically-complex patients must now consider a transition from traditional consultation to proactive, value-added programs and bill for services from medical, rather than behavioral, insurance dollars, since the majority of health-enhancement and cost-savings from these programs occur in the medical sector. The authors provide the clinical and financial arguments for such program-creation and the steps that can be taken as psychiatrists for medically-complex patients move to the next generation of interdisciplinary service.