“Conversational Advice”: A mixed-methods analysis of medical residents’ experiences co-managing primary care patients with behavioral health providers

Abstract

Objective: When integrated behavioral health clinicians (IBHCs) and residents co-manage patients, residents may learn new approaches. We aimed to understand the effect of co-management on residents' behavioral health (BH) management learning. Methods: Residents completed a web-based survey enquiring: whether co-management included a shared visit and/or face-to-face meeting with an IBHC, whether residents received feedback from the IBHC, and what they learned. Qualitative responses were coded thematically using a constant comparative method. Results: Among 117 respondents (overall response rate 72%, 117/163), from five residencies recruited from 40 residencies with BH integration, residents were significantly more likely to receive feedback if they had a shared visit with the patient and an IBHC (yes 69% vs. no 33%; adjusted OR 3.0, 95% CI 1.2-7.6). Residents reported three major learning themes: interpersonal communication skills awareness, BH skills awareness, and newly adopted attitudes toward BH. Residents who received feedback were more likely to report themes of interpersonal communication skills awareness (yes 26.6% vs. no 9.4%). Conclusion: BH integration promotes increased feedback for residents practicing face-to-face comanagement with IBHCs, and a positive influence regarding residents' attitudes and perceived skills. Practical implications: Residency programs can meaningfully improve residents' learning by promoting face-to-face co-management with IBHCs.

Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study

“…17 Therefore, future studies incorporating learners' perspectives on team-based, interdisciplinary training in IBH is important to inform IBH implementation. 17,[55][56][57] However, the detailed information gained here from clinical teams on the frontline of care can inform the development of IBH playbooks and curricula to support the design and implementation of effective IBH in clinical practice and training environments.…”

Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians

“…[4][5][6]16 Smith et al 17 concluded that effective residency curricula in biopsychosocial teaching include the following: a structured multidimensional approach that is a required activity and that balances learner-centered and teacher-centered approaches. The advent of increased BH integration in primary care clinics may offer residents a platform to learn BH skills 18,19 ; however, even within an integrated clinic such as the one studied, residents' experience with addressing mental health conditions is insufficient. Our residents' perspectives further strengthen the case for addressing residents' attitudes-which may deemphasize active management of mental health disorders-through increased mental health training within IM curricula.…”