Advancing integrated care through cotraining of residents and psychology postdoctoral fellows.

INTRODUCTION: While integrated behavioral health (IBH) is growing as a primary care practice paradigm, there are gaps in developing the workforce needed. In particular, there are few examples of cotraining curricula in IBH for family medicine residents with postdoctoral psychology fellows. Furthermore, even fewer programs incorporate a colearning primary care practice environment featuring a targeted approach to care for patients with chronic illness using panel management and integrated care. METHOD: In this article, the authors describe a cotraining experience in an urban federally qualified health center supported by a 5-year Health Resources and Services Administration Title VII grant, within a social justice mission-driven academic department to prepare both family medicine (FM) residents and primary care psychology (PCP) postdoctoral fellows for IBH practice. The article will discuss the specific components of the shared/parallel curriculum, integration of social justice and population health principles and practices, and a structured approach for resident/fellow partnership. RESULTS: The authors share the clinical and educational impacts of this integrated cotraining curriculum model as described by the FM residents and PCP fellows. The article describes workforce results measuring the diversity of the trainees and their postprogram jobs serving vulnerable populations. DISCUSSION: The interdisciplinary cotraining between FM residents and PCP fellows presents an innovative approach to developing workforce capacity for integrated practice in medically underserved settings. This article describes the creation and implementation of a cotraining curriculum and provides recommendations for other programs and residencies preparing their residents and future PCP psychologists to practice and teach skills in integrated care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Internal Medicine Residents' Feelings of Responsibility, Confidence, and Clinical Practice in Opioid Overdose Prevention and Naloxone Prescribing.

OBJECTIVES: We assessed internal medicine residents' attitudes and clinical practices regarding opioid overdose prevention education and naloxone prescribing as a first step in developing curriculum to train residents on these topics. METHODS: We adapted a previously validated questionnaire to assess residents' feelings of responsibility, confidence and clinical practice in opioid overdose prevention and naloxone prescribing. RESULTS: Nearly all 90 residents (62% response rate) felt responsible and most felt confident in: assessing patients for risk of opioid overdose (95% and 57%, respectively), assessing patients' readiness to reduce risk of opioid overdose (95% and 73%, respectively), and advising behavior change to minimize opioid overdose risk (98% and 71%, respectively). Most felt responsible to refer patients for opioid use disorder (OUD) treatment (98%), and provide overdose prevention education and prescribe naloxone (87%). Most felt confident referring patients for OUD treatment (60%), and nearly half felt confident in providing overdose prevention education and prescribing naloxone (45%). In clinical practice, over a third reported assessing patients' risk of overdose (35%), assessing patients' readiness to reduce risk of overdose (57%), and advising behavior change to minimize overdose risk (57%). Only 17% reported providing overdose prevention education and prescribing naloxone. CONCLUSIONS: Despite feeling responsible and confident in addressing opioid overdose prevention strategies, few residents report implementing these strategies in clinical care. Residency programs must not only include curricula addressing overdose risk assessment and counseling, referral to or provision of OUD treatment, but also include curricula that impact implementation of opioid overdose prevention strategies.

Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program.

Background Errors in medicine are common and often tied to diagnosis. Educating physicians about the science of cognitive decision-making, especially during medical school and residency when trainees are still forming clinical habits, may enhance awareness of individual cognitive biases and has the potential to reduce diagnostic errors and improve patient safety. Methods The authors aimed to develop, implement and evaluate a clinical reasoning curriculum for Internal Medicine residents. The authors developed and delivered a clinical reasoning curriculum to 47 PGY2 residents in an Internal Medicine Residency Program at a large urban hospital. The clinical reasoning curriculum consists of six to seven sessions with the specific aims of: (1) educating residents on cognitive steps and reasoning strategies used in clinical reasoning; (2) acknowledging the pitfalls of clinical reasoning and learning how cognitive biases can lead to clinical errors; (3) expanding differential diagnostic ability and developing illness scripts that incorporate discrete clinical prediction rules; and (4) providing opportunities for residents to reflect on their own clinical reasoning (also known as metacognition). Results Forty-seven PGY2 residents participated in the curriculum (2013-2016). Self-assessed comfort in recognizing and applying clinical reasoning skills increased in 15 of 15 domains (p < 0.05 for each). Resident mean scores on the knowledge assessment improved from 58% pre-urriculum to 81% post curriculum (p = 0.002). Conclusions A case vignette-based clinical reasoning curriculum can effectively increase residents' knowledge of clinical reasoning concepts and improve residents' self-assessed comfort in recognizing and applying clinical reasoning skills.

Mobile mammography: An evaluation of organizational, process, and information systems challenges.

The purpose of this case study was to evaluate the information systems, personnel, and processes involved in mobile mammography settings, and offer recommendations to improve efficiency and satisfaction among patients and staff. Data includes on-site observations, interviews, and an electronic medical record review of a hospital who offers both mobile and fixed facility mammography services to their community. The optimal expectations for the process of mobile mammography from multiple perspectives were defined as (1) patient receives mammogram the day of their visit, (2) patient has efficient intake process with little wait time, (3) follow-up is completed and timely, (4) site contact and van staff are satisfied with van visit and choose to schedule future visits, and (5) the MMU is able to assess its performance and set goals for improvement. Challenges that prevent the realization of those expectations include a low patient pre-registration rate, difficulty obtaining required physician orders, frequent information system downtime/Internet connectivity issues, ill-defined organizational communication/roles, insufficient site host/patient education, and disparate organizational and information systems. Our recommendations include employing a dedicated mobile mammography team for end-to-end oversight, mitigating for system connectivity issues, allowing for patient self-referrals, integrating scheduling and registration processes, and a focused approach to educating site hosts and respective patients about expectations for the day of the visit. The MMU is an important community resource; we recommend simple process improvements and information flow improvements to further enable the MMU׳s goals.