Developing a Framework of Integrated Competencies for Adaptive Expertise in Integrated Physical and Mental Health Care.

Phenomenon: Despite the emergence of the integrated care (IC) model, IC is variably taught and is challenged by current siloed competency domains. This study aimed to define IC competencies spanning multiple competency domains. Approach: Iterative facilitated discussions were conducted at a half-day education retreat with 25 key informants including clinician educators and education scientists. Seven one-on-one semistructured interviews were subsequently conducted with different interprofessional providers in IC settings within a Canadian context. Data collection grounded in patient cases with a physical illness and concurrent mental illness (medical psychiatry) were used to elicit identification of complex patient needs and the key medical psychiatry knowledge and skills required to address these needs. A thematic analysis of transcripts was performed using constant comparison to iteratively identify themes. Findings: Participants described 4 broad competency domains necessary for expertise in IC: (a) extensive integrated knowledge of biopsychosocial aspects of disease, systems of care, and social determinants of care; (b) skills to establish a longitudinal alliance with the patient and functional relationships with colleagues; (c) constructing a comprehensive understanding of individual patients' complex needs and how these can be met within their health and social systems; and (d) the ability to effectively meet the patient's needs using IC models. These 4 domains were linked by an overarching philosophy of care encompassing key enabling attitudes such as proactively pursuing depth to understand patient and system complexity while maintaining a patient-centered approach. Insights: The study addresses how development of IC expertise can be fostered by integration of individual IC competency domains. The findings align with previous research suggesting that competencies from existing frameworks are being enacted jointly in expert capabilities to meet the complex needs of patients, in this case with comorbid physical and mental health concerns.

Mapping Evidence of Patients' Experiences in Integrated Care: A Scoping Review.

OBJECTIVES: Despite the established clinical and cost-effectiveness of integrated care (IC) models for patients with comorbid mental and physical illness, little is known about whether these models facilitate a better care experience from the patient's perspective. The authors conducted a scoping review of the literature to explore how IC influences patients' care experiences. METHODS: MEDLINE, EMBASE, PSYC INFO CINAHL, AMED, the Cochrane Library, and grey literature were searched to identify relevant articles. Eligible studies were systematically reviewed and analyzed, using thematic analysis approach, to identify patterns, trends, and variation in patient experience within IC settings. RESULTS: Search results yielded 5250 unique resources of which 21 primary studies met our eligibility criteria for analysis. Findings from this scoping review revealed variation in patients' experiences in IC settings. IC models enhanced patients' experience by creating theraputic spaces: improving patient access to care, developing collaborative relationships, and personalizing patient care to address individual needs. CONCLUSION: Productive interactions with care team were key to improve patient engagement and experience of centeredness in IC settings. Successful implementation of IC demanded purposeful alignment of IC structural components and care processes to create therapeutic spaces that address patient care needs and preferences.

Reconsidering Basic: Integrating Social and Behavioral Sciences to Support Learning.

PURPOSE: The integration of basic science mechanistic knowledge (pathophysiology and etiology) with clinical features (signs and symptoms) during learning leads to robust cognitive representations in novices and supports the development of clinical reasoning, including better diagnostic accuracy and later learning of related concepts. However, previous studies have used a limited scope of traditional biomedical sciences, including biochemistry, anatomy, and physiology. The use of extended forms of foundational knowledge, including behavioral and sociological sciences, that have been proposed to support learning and performance in complex health systems remains unexplored. METHOD: Thirty-three first-year medical students from the University of Toronto MD Program participated in the study. The effect of integrated extended basic science (EBS) learning was compared with that of clinically focused instruction on an initial assessment of diagnosis using clinical vignettes and a "preparation for future learning" assessment (PFLA) to assess learning of new related content in medical psychiatry (co-occurring physical and mental health conditions). RESULTS: Both forms of instruction supported the development of diagnostic ability on initial assessment (t[30] = 1.20, P = .24). On the PFLA, integrated instruction of extended forms of basic science led to superior performance on assessing complex patients' health care needs (t[30] = 2.70, P < .05). CONCLUSIONS: Similar to previous studies using integration of biomedical sciences, the integration of EBS can enhance later learning of new related concepts. These results have implications for curriculum design to support development of expert clinical reasoning.

Mapping Evidence of Patients' Experiences in Integrated Care Settings: A Protocol for a Scoping Review.

INTRODUCTION: Integrated care (IC) models have emerged to address gaps in care for individuals with complex healthcare needs. Although the clinical and cost-effectiveness of IC models are well-established, our understanding of whether IC models facilitate a patient-centred care experience from the patients' perspective is not well understood. This scoping review aims to comprehensively map the literature to provide a broad overview of patients' experiences in IC settings with a focus on the experiences of complex patients with comorbid mental and physical illnesses. It also aims to describe current gaps identified in the literature in our understanding of aspects of care that are often unrecognised. METHODS AND ANALYSIS: Using established scoping review frameworks and guidelines, we will perform a comprehensive search in the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, AMED and the Cochrane Library to identify relevant studies on patients' experiences in IC models. Grey literature sources and studies bibliographies will also be searched to identify relevant studies and documents. Data will be extracted and summarised using descriptive statistical and qualitative analyses. We will also consult with stakeholders from various backgrounds to enhance the comprehensiveness of this review. ETHICS AND DISSEMINATION: This review requires no ethical approval. Findings from this study will be disseminated through publication in a peer-reviewed journal, clinical conferences and in knowledge translation settings, aiming to improve clinical practice and care delivery.