Original Research

A Curriculum for Training Medical Faculty to Teach Mental Health Care—and Their Responses to the Learning

Journal of Clinical Outcomes Management. 2020 July;27(4):166-173 | 10.12788/jcom.0016

Author(s):

Laura Freilich, MD

Judith S. Lyles, PhD

Mukta Sharma, MD

Shilpa Kavuturu, MD

Heather S. Laird-Fick, MD, MPH

Katelyn Grayson-Sneed, PhD

Robert C. Smith, MD

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References

1. Smith R, Gardiner J, Luo Z, et al. Primary care physicians treat somatization. J Gen Int Med. 2009;24:829-832.

2. Smith RC, Lyles JS, Gardiner JC, et al. Primary care clinicians treat patients with medically unexplained symptoms—a randomized controlled trial. J Gen Intern Med. 2006;21:671-677.

3. Smith RC, Lein C, Collins C, et al. Treating patients with medically unexplained symptoms in primary care. J Gen Intern Med. 2003;18:478-489.

4. Smith RC, Lyles JS, Mettler J, et al. The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med. 1998;128:118-126.

5. Smith R, Laird-Fick H, D’Mello D, et al. Addressing mental health issues in primary care: an initial curriculum for medical residents. Patient Educ Couns. 2014;94:33-42.

6. Smith R, Laird-Fick H, Dwamena F, et al. Teaching residents mental health care. Patient Educ Couns. 2018;101:2145-2155.

7. Cunningham PJ. Beyond parity: primary care physicians’ perspectives on access to mental health care. Health Aff (Millwood). 2009;28:w490-501.

8. US Department of Health and Human Services: Healthy People 2020: The Road Ahead. Washington, DC: US Governmant Printing Office; 2011.

9. US Department of Health and Human Services. Facing Addiction in America—The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: US Dept of Health and Human Services; 2016.

10. US Department of Health and Human Services. Mental Health and Mental Disorders. Washington, DC: US Government Printing Office; 2000.

11. Hogan MF. The President’s New Freedom Commission: recommendations to transform mental health care in America. Psychiatr Serv. 2003;54:1467-1474.

12. Morrisey J, Thomas K, Ellis A, et al. Development of a New Method for Designation of Mental Health Professional Shortage Areas. Chapel Hill, NC: University of North Carolina at Chapel Hill; 2007.

13. US Department of Health and Human Services. Mental Health: a Report of the Surgeon General. Rockville, MD: Dept. of Health and Human Services; 1999.

14. Wang PS, Lane M, Olfson M, et al. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:629-640.

15. Kern DE, Thomas PA, Hughes MT. Curriculum Development for Medical Education: A Six-Step Approach. Baltimore, MD: The Johns Hopkins University Press; 2009.

16. Fortin 6th AH, Dwamena F, Frankel R, et al. Smith’s Patient-Centered Interviewing: An Evidence-Based Method. 4th ed. New York, NY: McGraw-Hill; 2018.

17. Smith R, D’Mello D, Osborn G, et al. Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting. New York, NY: McGraw Hill; 2019 .

18. Smith R, Fortin AH 6th, Dwamena F, et al. An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Educ Couns. 2013;90:265-270.

19. Smith R, Dwamena F, Grover M, et al. Behaviorally-defined patient-centered communication—a narrative review of the literature. J Gen Intern Med. 2010;26:185-191.

20. Smith RC, Dwamena FC. Classification and diagnosis of patients with medically unexplained symptoms. J Gen Intern Med. 2007;22:685-691.

21. Schneider RK, Levenson JL. Psychiatry Essentials for Primary Care. Philadelphia, PA: American College of Physicians; 2008.

22. Dwamena F, Laird-Fick H, Freilich L, et al. Behavioral health problems in medical patients. J Clin Outcomes Manage. 2014;21:497-505.

23. Vidyo (Hackensack, NJ). http://www.vidyo.com/products/use/. 2014.

24. Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177:195-205.

25. Huffman JC, Niazi SK, Rundell JR, et al. Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the Academy of Psychosomatic Medicine Research and Evidence-Based Practice Committee. Psychosomatics. 2014;55:109-122.

26. Smith RC, Dwamena FC, Fortin AH 6th. Teaching personal awareness. J Gen Intern Med. 2005;20:201-207.

From Michigan State University, East Lansing, MI.

Abstract

Objective: We previously reported that training medical faculty to teach mental health care to residents was effective. We here describe the faculty’s training curriculum and their responses to learning and teaching mental health care, a unique focus in the educational literature.
Design: Qualitative researchers assessed the experiences of medical faculty trainees in learning and teaching mental health care.
Setting: Internal medicine residency training program at Michigan State University.
Participants: One early career medicine faculty learner and another faculty learner at mid-career, 4 faculty trainers, and 2 qualitative researchers.
Measurements: Typed qualitative research reports were evaluated by the authors from 4 time periods: (1) following didactic and interviewing training; (2) following training in a mental health clinic; (3) following training to teach residents mental health care; and (4) 8 months after training.
Results: Faculty expressed anxiety and low confidence at each of 3 levels of training, but progressively developed confidence and satisfaction during training at each level. They rated didactic experiences as least valuable, seeing these experiences as lacking practical application. Experiential training in interviewing and mental health care were positively viewed, as was the benefit from mentoring. Teaching mental health skills to residents was initially difficult, but faculty became comfortable with experience, which solidified the faculty’s confidence in their own skills.
Conclusion: A new curriculum for training medical faculty to teach mental health care was demonstrated to be acceptable to the faculty, based on findings from multiple focus groups.

Keywords: psychiatry; primary care mental health; medical education; curriculum; formative evaluation.

We previously trained general medicine faculty intensively in 3 evidence-based models essential for mental health care.^1-4 They, in turn, trained medical residents in the models over all 3 years of residency training.⁵ The results of this quasi-experimental trial demonstrated highly significant learning by residents on all 3 models.⁶ To address the mental health care crisis caused by the severe shortage of psychiatrists in the United States,^7-14 we propose this train-the-trainer intervention as a model for widescale training of medical faculty in mental health care, thus enabling them to then train their own residents and students indefinitely.⁶

This brief report details the faculty training curriculum in mental health care and its teaching, along with the responses of medical faculty to the training; no similar training experiences have been reported in the medical or psychiatric literature. While the residency training curriculum has been published,⁵ the faculty training curriculum has not. Additionally, faculty responses to the training are important because they can provide key information about what did and did not work. Even though demonstrated to be effective for teaching mental health care to residents,⁶ the training must also be acceptable to its new teachers.¹⁵

Methods

Design, Setting, and Participants

This descriptive study was conducted by 2 experienced qualitative researchers in the setting of a 5-year quantitative study of residents’ learning of mental health care.^5,6 They interviewed 2 general medicine faculty undergoing training in mental health care on 4 occasions: 3 times during training and once following training. Learners were taught by 4 faculty trainers (2 general medicine, 2 psychiatry). The setting was the internal medicine residency program at Michigan State University. The project was approved by the local Institutional Review Board.

Faculty Training Intervention

The 2 training faculty evaluated in this study were taught in a predominantly experiential way.⁵ Learning objectives were behaviorally defined (see Table 1, which also presents the teaching methods). Teaching occurred in 3 segments over 15 months, with a 10% weekly commitment to training supported by a research grant.