Storylines of family medicine VIII: clinical approaches.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VIII: clinical approaches', authors address the following themes: 'Evaluation, diagnosis and management I-toward a working diagnosis', 'Evaluation, diagnosis and management II-process steps', 'Interweaving integrative medicine and family medicine', 'Halfway-the art of clinical judgment', 'Seamless integration in family medicine-team-based care', 'Technology-uncovering stories from noise' and 'Caring for patients with multiple long-term conditions'. May readers recognise in these essays the uniqueness of a family medicine approach to care.

Building an Equity-Centered Ecosystem: University of Utah Health as a Microcosm.

Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.

Current Practices in Clinical Supervision in Primary Care.

The purpose of this study was to examine current clinical supervision practices within primary care settings. We used a descriptive survey design, which blends quantitative and qualitative data, and examined the current state of clinical supervision practices and approaches in primary care and the type of training the behavioral health consultants received to provide supervision to pre-licensure level behavioral health trainees. Ninety-four participants completed the survey in 2022. Seventy-one percent of respondents felt they had adequate training to be an effective integrated behavioral health (IBH) supervisor; however, most training came from sources, such as workshops, continuing education, or supervision of supervision. Further efforts to establish universal competencies and formal training programs are needed to meet the growing need for IBH services in primary care.

Using a Delphi Technique to Define Primary Care Behavioral Health Clinical Supervision Competencies.

There is an increasing need for Primary Care Behavioral Health (PCBH) workforce development (i.e., increase in well-trained PCBH providers) given the growth of behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic (Kanzler and Ogbeide in Psychol Trauma 12(S1):S177-S179, https://doi.org/10.1037/tra0000761 , 2020). Therefore, it is imperative to provide current and future behavioral health clinical supervisors in primary care settings specific competencies, given there are no current competencies specific to clinical supervision within the PCBH Model. Using a Delphi process, the authors identified and reached expert consensus on competencies for BH clinical supervisors in primary care. A purposive sample (in: Patton, Qualitative evaluation and research methods, Sage, Newbury Park, 1990) of fifteen experts (n = 15) in PCBH clinical training and education evaluated quantitative and qualitative domains and specific competencies associated with PCBH supervision gathered during an initial in-depth qualitative interview. This was followed by two subsequent rounds of quantitative Delphi surveys to reach consensus. The response rates from our panel of experts were 100% (15/15) for all stages (interviews, round one and round two surveys). Three domains (Primary Care Knowledge, Clinical Supervisor Development, and Clinical Supervision Skills) were rated as essential for providing clinical supervision with PCBH for pre-licensure level learners. The development of competencies will further support BH clinical supervisor needs, professional development, and provide a concrete way to evaluate progress towards teaching and training excellence. This will also have a great impact on the development of the future BH workforce within primary care.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study.

BACKGROUND AND OBJECTIVES: Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax. METHODS: Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods. RESULTS: Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement). CONCLUSIONS: Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

Primary Care Supervision: A Community of Practice.

BACKGROUND: The goal of this project was to determine the feasibility of a Community of Practice (CoP) model to support behavioural health (BH) clinical supervisor professional development. APPROACH: Fourteen supervisors participated in 13 CoP-focused workshops focused on supervision within the Primary Care Behavioural Health (PCBH) model over a 4-year period. These workshops occurred twice a semester (in person and virtually) for supervisors hosting students participating in a Health Resources and Services Administration (HRSA) Behavioural Health Workforce Education Training (BHWET) grant. The program focused on preparing masters-level clinical mental health counselling students to function as Behavioural Health Consultants (BHCs) in primary care settings in rural and urban areas. Supervisors completed post-workshop surveys on their satisfaction with the content and the impact of the workshop content on building their PCBH supervision skills. EVALUATION: Supervisors were satisfied with the content presented during the CoP workshops as well as indicated improvements in their confidence with providing supervision within the PCBH model. Areas of improved confidence and competence included supervision in integrated health care settings, topics discussed in primary care, and telehealth visits. IMPLICATIONS: Overall, this demonstrates an approach to building supervisor confidence in working with pre-licensure trainees within the PCBH model. CoP workshops show promise as an approach that institutions of higher education and health care organisation can adopt to improve clinical teaching and supervision in primary care as well as support supervisors in the community who work with trainees in primary care.

Clinical supervision within the primary care behavioral health model: What we know and where we need to go.

Community-based primary care settings play an important role in the provision of health care to vulnerable populations, as well as in primary care education. Much attention has been given to medical education in community-based primary care and as the need for workforce development grows for behavioral health in primary care, clinical supervision of prelicensure psychology learners in primary care will also need greater attention. Clinical supervision not only impacts learner professional development but also impacts the patient care learners provide. The purpose of this article is to give attention to clinical supervision within the primary care behavioral health (PCBH) model in the context of community-based primary care. The intersection of supervision approaches in specialty mental health care and medical education will be presented, as well as how these approaches can be combined when working with learners within PCBH. Additionally, challenges to clinical supervision in primary care will be discussed as well as solutions to improve not only workforce development in PCBH but also professional development for clinical supervisors in primary care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing counseling student self-reported competencies in primary care behavioral health.

INTRODUCTION: Professional counselors are becoming increasingly represented in the Primary Care Behavioral Health (PCBH) workforce. Accordingly, models for training these professionals to work in integrated health care settings are needed. METHOD: This article presents the results of 34 master's level counseling students' self-reported competencies in PCBH as a result of a PCBH training program. RESULTS: Results indicated that students' self-perceived competence across all domains increased over time. DISCUSSION: Implications for the function of self-reported skill development in students training as behavioral health consultants in primary care are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comfort With Uncertainty in Medical Students and Their Residency Choice: A Residency Research Network of Texas Study.

BACKGROUND AND OBJECTIVES: Little is known about how comfort with uncertainty (CwU) influences career choice in medical students. The authors of this study examined the correlation between CwU and primary care career choice. METHODS: In academic years 2017-2018 and 2018-2019, the authors distributed surveys to third-year medical students from eight US medical schools, seven in Texas. The survey tool included two CwU scales and one comfort with ambiguity scale. Other questions covered career plans, family and personal background, and student debt. In the subjects' fourth year of medical school, authors obtained match data from the medical schools and the authors further communicated with the students where indicated. The primary outcome was the composite score of the three scales correlated to career choice, with a focus on primary care and family medicine. RESULTS: Among 642 participants, there was no difference in CwU scores between students who matched into primary care versus specialty fields (3.39 vs 3.37 average of three scales, P=.65, each individual scale NS) or family medicine (FM) vs all other fields (3.39 vs 3.37 average of three scales, P=.81). Other bivariate predictors of FM choice were more similar than different to previous studies, such as osteopathic more likely than allopathic, lower family income, planning to care for underserved populations, and had a primary care role model. Logistic regression found the two biggest predictors of FM were osteopathic training and the importance of educating patients about health promotion and disease prevention. CONCLUSIONS: We found no correlation between CwU and medical student career choice for primary care or FM. We discuss confounding factors that may impact results, as well as recommendations for medication education and public policy.

Treating Post-traumatic Stress Disorder with a Prolonged Exposure Protocol Within Primary Care Behavioral Health: A Case Example.

Posttraumatic stress disorder (PTSD) is a debilitating condition that impacts anywhere from 2 to 39% of primary care patients. Research suggests overall health, instances of hospitalizations, emergency room visits, and utilization of primary care services are impacted by a diagnosis of PTSD. Evidenced based treatments such as cognitive process therapy and prolonged exposure (PE) are available in specialty mental health but pose many barriers to treatment and implementation into primary care. This case study serves as the first known case example with an ethnic minority civilian, examining the treatment of PTSD within the Primary Care Behavioral Health Model using the brief (5 visits), PE protocol for primary care (PE-PC). PTSD was assessed using the PCL-5. Additional variables were assessed and tracked with the following tools: PHQ-9 (depressive symptoms), GAD-7 (anxiety symptoms), QLES-SF (quality of life), and the AAQ-2 (psychological flexibility) pre/post treatment, 6 months post-treatment and 9 months post-treatment. The patient reported clinically significant decreases in symptoms of PTSD, depression, and anxiety symptoms. Additionally, the patient's scores on quality of life and psychological flexibility improved. Brief, exposure-based treatment for PTSD can be delivered within the PCBH model. This treatment may result in improved quality of life and has the potential to reduce health care costs. This case encourages the treatment of PTSD within primary care, increasing access to care for patients. Future research is needed to further investigate this protocol in primary care with underserved, civilian populations and to explore patient attitudes toward brief treatment for PTSD in a primary care setting.

To go or not go: Patient preference in seeking specialty mental health versus behavioral consultation within the primary care behavioral health consultation model.

INTRODUCTION: Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined. METHOD: Two primary care clinic systems were examined in this study. The first was a primary care clinic predominately serving low-income patients: 100 individuals participated. The second was primary care in the context of military treatment centers: 539 individuals participated. RESULTS: Results show that 61% of the patients in the low-income primary care clinic would not attend a specialty mental health appointment versus 30% in the military population. DISCUSSION: This study suggests that primary care behavioral health is a patient-centered approach to care and reaches populations that otherwise may not receive behavioral health services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Review of Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (Second edition).

Reviews the book, Integrated Behavioral Health in Primary Care: Step-By-Step Guidance for Assessment and Intervention (Second Edition) by Anne C. Dobmeyer, Mark S. Oordt, Jeffrey L. Goodie, and Christopher L. Hunter (see record 2016-59132-000). This comprehensive book is well organized and covers many of the complex issues faced within the Primary Care Behavioral Health (PCBH) model and primary care setting: from uncontrolled type II diabetes to posttraumatic stress disorder. Primary care has changed since the initial release of this book, and the second edition covers many of these changes with up-to-date literature such as population health and the patient-centered medical home. The book is organized into three parts. The first three chapters describe the foundation of integrated behavioral consultation services. The next 12 chapters address common behavioral health issues that present in primary care. Last, the final two chapters focus on special topics such suicidal behavior and designing clinical pathways. This was an enjoyable read and worth the investment- especially if you are a trainee or a seasoned professional new to the practice of integrated behavioral health in primary care. (PsycINFO Database Record