Behavioural change as a theme that integrates behavioural sciences in dental education.

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

Roles and responsibilities of behavioral science faculty in inpatient medicine.

OBJECTIVE: Behavioral science faculty in family medicine residencies work on inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that behavioral science faculty fill while working in such settings. METHOD: Using a modified sequential explanatory study, researchers clarified the roles and responsibilities of behavioral science faculty. Participants completed a web-based survey (N = 60) on roles and a semistructured interview (N = 24) about the responsibilities on inpatient medicine teaching service. RESULTS: Results suggest that behavioral science faculty assume the roles of educator, patient care supporter, evaluator, mentor/advisor, and scholar/researcher and perform multiple responsibilities. CONCLUSIONS: Implications for this research inform the hiring process and training for behavioral science faculty and resident education.

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.

Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years.

Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled "LifeStages" to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.

Gaps in Training in Interdisciplinary Social and Behavioral Sciences and Applications Among Undergraduate and Graduate Students in the 22 Top-Ranked Schools of Public Health in China.

The next generation of public health professionals requires rigorous training in behavioral health, in order to design effective behavioral interventions to respond effectively to the epidemiological transition in China. This study aimed to investigate issues in training in social and behavioral sciences in public health in China. A cross-sectional survey was conducted among 1285 and 835 last-year undergraduate and graduate public health students in 2013. The results showed that (1) majority of undergraduate students but a minority of graduate students had enrolled in psychology, social medicine, and health promotion courses; (2) very few had enrolled in other social and behavioral sciences courses; (3) high percentages of students perceived significance, needs, and interests related to social sciences courses; (4) very few were familiar with commonly used behavioral health theories and constructs, or had applied such theories/constructs to their thesis. The situation deviates from international accreditation requirement. A timely review and benchmarking are warranted.

The Evolution of Psychology as a Basic Bio-behavioral Science in Healthcare Education.

For over a century, researchers and educators have called for the integration of psychological science into medical school curricula, but such efforts have been impeded by barriers within medicine and psychology. In addressing these barriers, Psychology has re-examined its relationship to Medicine, incorporated psychological practices into health care, and redefined its parameters as a science. In response to interdisciplinary research into the mechanisms of bio-behavioral interaction, Psychology evolved from an ancillary social science to a bio-behavioral science that is fundamental to medicine and health care. However, in recent medical school curriculum innovations, psychological science is being reduced to a set of "clinical skills," and once again viewed as an ancillary social science. These developments warrant concern and consideration of new approaches to integrating psychological science in medical education.

Using Reflections to Evaluate the STFM Behavioral Science/Family Systems Educator Fellowship.

BACKGROUND AND OBJECTIVES: A group of family medicine educators identified a need and developed a 1-year fellowship for early career behavioral science educators. This occurred in response to a reduction in previous opportunities and resources. The program was designed to shape and mentor new behavioral science faculty teaching in family medicine departments and programs. Quantitative data analysis from pre- and post-fellowship survey data from years 1-4 confirmed fellowship objectives were met. METHODS: The 1-year fellowship, developed by senior faculty in STFM features a blend of classroom style learning, mentored small-group interactions, reflective writing and a scholarly project requirement. As one aspect of program evaluation, reflective writings submitted by fellows and faculty were analyzed using qualitative methodology for themes related to curricular objectives. RESULTS: From 2010-2013, 44 fellows completed the program. Authors analyzed reflective writings from 15 fellows and 6 small-group mentors. Four overarching themes emerged: emerging professional competence, evolving professional identity, connectedness, and generativity. An unexpected finding was that the fellowship mentors benefited in ways parallel to that of the fellows. CONCLUSIONS: A qualitative analytical approach to examining the reflective writings of fellowship participants yielded confirmation that program goals were achieved. In addition, a commitment to "paying it forward" as ongoing and future leaders in family medicine education resulted for both fellows and faculty mentors.

BEHAVIOURAL SCIENCES AT UNIVERSITY OF HEALTH SCIENCES: THE WAY FORWARD.

BACKGROUND: The association of medical ethics with teaching and training and health profession has been informal, largely dependent on role modelling and the social contract of the physicians with the community that they abide by. This study was conducted to examine the effect, if any, of introducing the subject of Behavioural Sciences on students' performance in the clinical years' 'viva voce' and 'patient interactions' components of the examinations. METHODS: A prospective study on four cohorts of students at UHS from 2007 to 2012 (8,155 candidates). Reliability was calculated through Cronbach's Alpha. Linear Regression Analysis was applied to determine the relationship between the scores of Basic Medical Sciences, Behavioural Sciences and Forensic medicine with the viva voce and Structured Stations marks of the Clinical Sciences in OSCE. Gender and demographics analysis was also done. RESULTS: Cronbach's Alpha was 0.47, 0.63, 0.67 and 0.53 for the Papers of Behavioural Sciences from 2007 to 2010 respectively. Poor predictive value of Behavioural Sciences for performance in tlhe clinical years' viva voce and OSCE was identified. Basic Medical Sciences and Forensic Medicine were statistically significant predictors for the performance of female candidates in all four cohorts of the study (p < 0.05). In Central Punjab, Behavioural Sciences statistically significantly predicted for better performance in all four cohorts of the study (p < 0.05). CONCLUSION: It is premature to understand the results of Behavioural Sciences teaching at University of Health Sciences (UHS). We can still safely conclude that it can only have a positive sustained effect or the healthcare delivery systems and patient care in Pakistan if it is integrated within each subject and taught and learned not as a theoretical construct but rather an evaluation of one's values within the code of conduct of medical professionalism in the larger context of the societal and cultural norms.

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review.

PURPOSE: Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. METHOD: The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. RESULTS: Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. CONCLUSIONS: These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.

STFM Behavioral Science/Family Systems Educator Fellowship: Evaluation of the First 4 Years.

BACKGROUND: The discipline of family medicine has long valued the behavioral sciences. Most residency training programs employ a clinical psychologist, social worker, or family therapist to deliver behavioral science curriculum to their residents. However, the cultures and content of training for behavioral sciences and medical professions are quite different, leaving the lone behavioral scientist feeling professionally isolated and unprepared to translate knowledge and skills into tools for the family physician. In response to this need, a group of family medicine educators developed an STFM-sponsored fellowship for behavioral science faculty. The goals of the program were to improve fellows' understanding of the culture of family medicine, provide a curricular toolbox for the behavioral sciences, promote scholarship, and develop a supportive professional network. METHODS: Senior behavioral science faculty at STFM developed a 1-year fellowship program, featuring "classroom learning" at relevant conferences, mentored small-group interactions, and scholarly project requirements. Achievement of program goals was evaluated annually with pre- and post-fellowship surveys. RESULTS: From 2010 to 2014, 59 fellows completed the program; most were psychologists or social workers; two thirds were women. One month after graduation, fellows reported significant increases in understanding the culture of medicine, improved confidence in their curricula and scholarship, and expanded professional networks, compared to pre-fellowship levels. The program required many hours of volunteer time by leaders, faculty, and mentors plus modest support from STFM staff. CONCLUSIONS: Leaders in family medicine education, confronted by the need for inter-professional development, designed and implemented a successful training program for behavioral science faculty.

Interprofessional Education in U.S. Dental Hygiene Programs: A National Survey.

Although there are many benefits of interprofessional health care, no previous research has sought to define the status of interprofessional education (IPE) in U.S. dental hygiene programs. The aims of this study were to assess how these programs engage in IPE, the challenges they encounter, and the value they place on IPE. Additionally, the study explored how program characteristics are related to IPE. Data were collected with a web-based survey sent to all 322 U.S. dental hygiene program directors (response rate: 33% of the 305 successfully contacted). The majority of the responding programs were located at institutions with nursing (90%) and other allied health programs (85%). They were likely to collaborate with nursing (50%), other allied health (44%), and dental assisting programs (41%), but were less likely to collaborate with dental schools (28%). IPE was most likely to occur in volunteer activities (68%), basic science courses (65%), and communication training/behavioral science courses (63%/59%). The most frequently reported challenges for IPE were schedule coordination (92%) and curriculum overload (76%). The majority of the respondents agreed that IPE was a priority for the dental hygiene profession in the U.S. (59%) and for the program directors personally (56%). Programs granting bachelor degrees were more likely to have IPE as a priority than programs that did not grant such degrees (scale of 1-5 with 5=most important: 3.81 vs. 2.88; p<0.01). The longer the students spent in the programs, the more those programs engaged in IPE (r=0.21; p<0.05). The data collected in this study can contribute to future efforts to help dental hygiene programs engage in meaningful IPE and contribute to developing interprofessional care in the U.S. health care system.

Sailing smoothly across the cultural divide: Constructing effective behavioral science presentations for medical audiences.

Beginning behavioral science faculty, who are critical residency program contributors, face significant immediate challenges that often diminish their effectiveness and increase the time it takes to translate and reformat their expertise into relevant and meaningful educational presentations. Residency program culture and competency-based learning are quite different from the educational objectives and teaching environments found in most behavioral health training programs. The goal of this article is to provide beginning behavior science faculty, who are typically on their own and learning on the job, with a guide to the core educational perspectives and skills required as well as key resources that are available to them. Since a significant portion of behavioral science faculty's teaching time revolves around small and large group presentations, our guide focuses on how to incorporate key strategies and resources into relevant, evidenced-based and, most importantly, effective behavioral health presentations for the program's resident physicians. Specifically, our recommendations include selection of content, methods of content organization, techniques for actively engaging resident physicians in discussing the significance of the topics, and descriptions of numerous Internet resources for the primary mental health topics that concern family medicine trainees. Finally, it is emphasized that the relevant and effective use of these recommendations is dependent upon the behavioral science faculty educator's first understanding and appreciating how physicians' think, speak, and prioritize information while caring for their patients.

Behavioral science priorities in residency education: The perspective of practicing family physicians.

INTRODUCTION: The family medicine residency behavioral science curriculum is more effective if prioritized to match what is needed in practice after graduation. Two prior studies (Kendall, Marvel, & Cruickshank, 2003; Marvel & Major, 1999) identified physician priorities for behavioral science education. The present study extends this research to include topics from more recent curriculum guidelines and examines the extent to which size of community and perceived competence correlate with prioritization of Washington state family physicians. METHOD: Practicing family physicians in Washington state (N = 2,270) were invited to complete the survey. Respondents provided demographic and practice information. Respondents then rated, on a scale from 1 to 4, 35 behavioral science topics on 2 different scales including (a) priority to be given in residency education and (b) perceived level of competence. RESULTS: A total of 486 responded and 430 completed both priority and competence scales for a response rate of 19%. The top half of 35 topics of the present study included the top 13 topics found in the 2 prior studies. Priority and competence scales were moderately correlated (r = .48, n = 430, p = .001). There was a small significant correlation with size of community and priority ratings (r = .13, n = 435, p = .006). DISCUSSION: Family physicians in Washington state prioritize behavioral science topics in residency education similar to Colorado and Mississippi. The results of this study support recent ACGME guidelines, in that training should focus on common psychiatric illnesses, including depression and anxiety, and interpersonal processes. (PsycINFO Database Record