BEH PGY2

The BEH training aims to further advance residents’ skills in the following areas:

• Clinical Interviewing Skills:

Continue to advance time-sensitive, patient-focused interviewing skills to optimize physician-patient relationship and collaborative, patient-centered care.

• Bio-psycho-social Inquiry:

Assess and address emotional aspects of illness, stress, mind-body connection, family/role impact, and cultural beliefs, and contextual factors.

• Behavioral Medicine Interventions/Techniques:

Develop knowledge and skills in a range of behavioral medicine techniques to promote illness management and wellness across a range of medical and psychiatric conditions.  

• Differential diagnostic skills - Psychiatric Conditions:

Understand psychiatric diagnostic assessment per DSM-5 criteria, utilize symptom screening tools appropriately, understand components of mental status exam, manage psychiatric emergencies: safety plan and safety assessment.

• Integrated inter-professional behavioral health: 

Utilization of team-based care, interdisciplinary work (geriatric psychiatry, pediatric psychiatry, Behavioral Health Consultation - BHC). Understanding community referrals - processes, expectations, goals.

• Professionalism:

Self-reflection in clinical practices, impact of personal attitudes and behaviors on patient care. Ethical issues: informed consent, patient autonomy, confidentiality, quality of care factors. Punctuality, timely communication, and self-directed learning.

BEH curricula are based on the American Academy of Family Physicians (AAFP), Human Behavior and Mental Health Curriculum Guidelines can be found here AAFP_Curriculum_Behavior&MentalHealth.pdf and ACGME Program Requirements for Graduate Medical Education in Family Medicine (2023)

• Video Recording/ Video Review and Feedback 

• Rotation-Specific Didactics - review rotation-specific educational content (asynchronous), prepare for discussion with faculty (Q&A materials), meet faculty to review didactic content (Q&A and discussion/elaboration). 

• Psychiatric Diagnostic Presentation - Thursday PM lecture

• Interprofessional Learning and external site placements

- Self-directed learning - determine and discuss learning goals in line with BEH scope/focus/training opportunities available.

 - Responsiveness to feedback provided by the faculty. Be proactive in your communication about any schedule changes etc.

 - Discuss any personalized training-related needs as early as possible.

- Zoom meetings: ensure that the setting is conducive to discussion/learning i.e. noise, disruptions, presence of non-related persons should be minimized.

  - Timely attendance of all rotation-specific meetings. 

  - Prompt response to/acknowledgement of all email communication (within 2 workings days)

  - Completion of assigned readings, Q&A, and online training prior to scheduled review date(s). 

  - Follow instructions for BEH lectures/presentations, video recording, external site placements/clinics.

BEH evaluation can be found here: BehavioralMedicine_MedHub_2023.pdf

• Residents are responsible to complete all rotation-specific tasks and submit any completed documentation within 1 week following the end of the rotation or communicate about alternative timeline.

• Any didactic content (e.g. Q&A) which was not reviewed directly with the faculty during the course of the rotation should be submitted within 1 week following the end of the rotation.

NOTES

- Check Orange/EPIC Schedules. Discuss any inconsistencies and/or concerns as soon as possible.

- Please see FM residency' wiki page - under Behavioral Medicine 2 for Zoom meeting link information.

• At minimum, 2 sessions per week should be recorded

• Each recorded encounter will be reviewed. Residents are expected to actively participate in the review of own work.

• Feedback will be provided in line per Direct Observation/Video Review Form - see Google Drive

• Please ensure that you are familiar with the Direct Observation & Video Review: Comprehensive Form as it elaborates on key areas of assessment/observation - see Google Drive

• At the end of the rotation, summary feedback for all encounters will be provided and reviewed. This summary feedback will directly inform rotation evaluation.

Video recording 

Please use detailed instructions about process of video recording set up, consent process and storage - provided - see Google Drive.

Resident Responsibilities:

(1). Review, understand, and follow all technical aspects involved in observation via EPIC/video recording

(2). Documented patients' consent for recording/observation (using .VIDEORECORDINGGENERAL (in EPIC under N. Pilipenko)

  - Work collaboratively with faculty to ensure completion of video recordings and/or direct observations

  - Demonstrate familiarity with observed/recorded sessions at the time of the review meeting(s). Review recorded sessions prior to meeting with faculty, if needed.  

Use of Interpreter Services

- Completion of the Linguistic Clinical Communicator (LCC) Assessment certification is required for all clinicians who provide services in languages other than English. If you completed this training, please send your certificate to faculty.

Direct Observation - In Person or Via TH/Phone

- Will take place for TH sessions via phone, Doximity or EPIC Connect/Zoom

- Ensure that your Doximity access allows for 3-person visits. Contact Doximity IT support to address any issues.

- Faculty will join the visit together with the resident and will complete informed consent of the patient(s) to perform observation of clinical care for educational purposes

- For phone visits, residents should call faculty before reaching either the patient or the interpreter.

- Direct observation will only be scheduled under exceptional circumstances following discussion with the resident.

- Each resident will be randomly assigned a psychiatric diagnosis selected from DSM-5-TR 

- Resident will review diagnosis per DSM-5-TR and become familiar with the symptoms and differential diagnostics

- The goal of this activity is to develop in-depth knowledge about a common psychiatric diagnosis with focus on (1) symptoms and (2) differential diagnostic considerations.

Tasks

During Thursday PM didactics:

Resident will:

• Present to role play a patient suffering from the diagnosis (as assigned).Presentation should demonstrate understanding of symptoms and differential diagnostics and should begin with a brief self-introduction to the audience (name, background, presenting concern). 

• Prepare 2 slides outlining diagnostic criteria for the condition presented per DSM-5-TR and key differential diagnostics considerations. These slides should be reviewed at the end of the presentation and sent to the audience.

Instructions

1. Following sources should be used to prepare (for) the presentation:

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR): https://psychiatryonline-org.ezproxy.cul.columbia.edu/doi/book/10.1176/appi.books.9780890425787

DSM-5 Handbook of Differential Diagnosis: 

https://psychiatryonline-org.ezproxy.cul.columbia.edu/doi/book/10.1176/appi.books.9781615375363

Both sources are accessible as electronic versions via Columbia library. Please ensure that your access is active.

2. Do not share the target diagnosis with any other residents until the exercise is completed.

3. Only answer the questions posed by the audience. Do not disclose additional information, unless asked. However, avoid misleading and/or inaccurate statements which are not aligned with the diagnosis of focus.

4. Review diagnosis of focus with the faculty to ensure in depth understanding diagnostic criteria and symptoms

Supervising Faculty: Dr. Natalie Pilipenko

Location: Remote/TH

Schedule: Monday 2pm - 6pm 

Contact: Dr. Pilipenko (np2615@cumc.columbia.edu)

Service Description

BHC provides a broad range of services including assessment, education, and brief intervention for adult patients of Farrell CFCM. BHC is not a psychotherapy service, however it provides brief interventions that are beneficial and sufficient for many patients.

The overarching goals of the service: 

1. Help patients develop practical knowledge and skills to promote and improve overall health 

2. Assist with physician-patient communication 

3. Promote patient-centered care

Examples of BHC goals: Symptom clarifications, Improved adjustment to illness, Improvement of adherence to medical treatment, Symptom reduction, Improved health behaviors, Improved illness understanding, Stress management, More proactive participation in treatment/self- management of symptoms.

Conditions: Depressive disorders, Anxiety disorders, Somatic symptom disorders, Adjustment or stressor-related difficulties, Insomnia and sleep-related disorders, Chronic pain, Tobacco use disorder, Obesity, Physical inactivity, Chronic medical conditions.

Goals

• Improve understanding of integrated healthcare in line with Primary Care Behavioral Health (PCBH) model and its utility for primary care patients.

• Improve understanding of inter-professional collaborations, referral processes, access to care barriers.

• Increase knowledge of patient-centered care in line with the United States Preventive Services Task Force (USPSTF) 5As model (2004).

• Increase familiarity with screening and interventions (MI, CBT) for BHC-appropriate conditions.

Expectations

1. Please pre-read before each session - [FRL ADULT PSYCHOLOGY] - Dr. Pilipenko’s tally

2. Discuss learning goals and interests

3. Anticipate active participation in the clinic

Resource/Reference Materials

Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2017). Population health and the patient-centered medical home. In C. L. Hunter, J. L. Goodie, M. S. Oordt, & A. C. Dobmeyer, Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (pp. 11–16). American Psychological Association. https://doi-org.ezproxy.cul.columbia.edu/10.1037/0000017-002

Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2017). Introduction. In C. L. Hunter, J. L. Goodie, M. S. Oordt, & A. C. Dobmeyer, Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (pp. 3–8). American Psychological Association. https://doi-org.ezproxy.cul.columbia.edu/10.1037/0000017-001

Residents should review both chapters as soon as possible and be prepared to discuss key concepts/ideas. Both chapters are avaialble via Columbia library.

Supervising Faculty: Dr. Mark Nathanson

Location:

Geriatric Psychiatry Clinic at Associates in Internal Medicine

AIM East Specialty Clinic 

1150 St. Nicholas Avenue, Ground Floor, NY, NY 10032 T:212 305-6354

Schedule: Tuesday 9 am – 12 pm  (in person)

Contact: Email Dr.  Nathanson  (mn183@cumc.columbia.edu, cell 516 316-6678) on the 1st day of the rotation to confirm schedule and discuss any planned changes.

Goals:

-  Improve understanding of psychiatric care for older adults

-  Expand knowledge of psychopharmacology, psychotherapy and the importance of family assessment

-  Increase familiarity with brief interviewing/consultations including MSE, differential diagnostics and treatment planning

-  Improve understanding of complexities in geriatric mental health care 

Expectations:

1. Please pre-read before each session - AIM PSYCHIATRY 

2. Discuss learning goals and expectations as early as possible

3. Include rotation supervisor on any communication pertaining to scheduling changes

4. Anticipate active participation in the clinic – (co)-interviewing patients, documenting encounters, and precepting (Dr. Nathanson or psychiatry fellow). 

Resource/Reference Materials

-    Review DSM-5 diagnostic criteria for: Schizophrenia Spectrum and Other Psychotic Disorders, Bipolar and Related Disorders, and Neurocognitive Disorders

-    Read The 30-Minute Diagnostic Interview (The Pocket Guide to the DSM-5 Diagnostic Exam, pp 21- 31 - MSE)

Please access Materials via Columbia Library portal. Select E-Books (left panel menu) to access electronic versions of these documents.

Pediatric Psychiatry Training

Supervising Faculty: Dr. Jennifer Rahman 

Location: 21 Audubon Avenue,  Office #222, New York, NY

Schedule: Friday AM or PM - please discuss schedule with PP attending faculty

Contact: Email Dr. Rahman (jer9221@nyp.org, cell - 917-846-7994) on or before the 1st Wednesday of the rotation, to confirm schedule and discuss any planned changes.

Goals

Pediatric depression

A. Utilize effective techniques to elicit factors contributing to a change in patient’s safety profile

B. Demonstrate how to collaboratively create a safety plan with a patient in session

C. Discuss treatment barriers across individual, family, community, and systems levels

D. Describe socio-cultural patient/family issues that may influence help- seeking behavior and illness manifestation, and challenges of mosaic identity formation

E. Explain mechanisms of stressors related to prejudice/discrimination/stigma and effect on mental health (hesitancy/willingness in disclosing suicidal thinking)

ADHD

A. Understand prevalence of ADHD and Learning Disorders

B. Distinguish symptoms of ADHD vs. comorbid psychiatric disorders/medical illnesses

C. Identify stratification of evidence-based treatment modalities for children vs. adolescents

D. Enhance knowledge of medication management algorithms for stimulants vs. off-label medications

Learning and Developmental disorders

A. Identify medical and psychiatric co-morbidities of autism

B. Explain function/utility of evidence-based behavioral interventions for autism

C. Elaborate upon pharmacological interventions for aggression seen in developmental delays

Neuropsychological evaluation and Educational Advocacy

A. Understand when neuropsychological testing is indicated for possible learning disorders

B. Identify distinctive sections of neuropsychological evaluation for diagnosis and treatment

C. Describe process of advocating for 504 vs. IEP plan, components of school support

D. Differentiate between school supports in place for public vs. private vs. charter schools in 

NYC. 

Expectations

1. Please pre-read before each session - ABN 2 PED PSYCHIATRIC (Dr. Rahman’s tally)

2. Discuss learning goals with Dr. Rahman

3. Anticipate active participation in the clinic – (co)-interviewing patients, documenting encounters etc.

4.  Include rotation supervisor on any communication pertaining to scheduling changes

Resource Materials

ADHD

- NICHQ Vanderbilt Assessment Scales. National Center for Children’s Health Equality

NICHQ Vanderbilt Assessment Scale—PARENT Informant

- SNAP-IV Teacher and Parent 18-Item Rating Scale

SNAP-IV Teacher and Parent 18-Item Rating Scale James M. Swanson, Ph.D., University of California, Irvine, CA 92715

- American Psychiatric Association, American Academy of Child and Adolescent Psychiatry. Attention Deficit/Hyperactivity Disorder (ADHD). Parent’s Medication Guide. (2020)

Attention-Deficit/Hyperactivity Disorder (ADHD): Parents' Medication Guide

- Cohen Children’s Medical Center. Northwell Health. ADHD Medication Guide (2022). 

ADHD Medication Guide*

Depression

- BCGuidelines.ca: Major Depressive Issues in Adults: Appendix D (2013)

Appendix D: Switching Antidepressants

- Elmaadawi, A.Z. (2018). Disruptive mood dysregulation disorder: A better understanding. Current Psychiatry, 17(11), 23-27.

Disruptive mood dysregulation disorder: A better understanding

- Brown Stanley Safety Plan 

https://www.mysafetyplan.org/static/NationalSPA-c4a86b10761e54a2dd835519b48ff479.pdf

- Patient Health Questionnaire 

PHQ Screeners

Autism

- Kevelson, D.S., Rahman, J., Veenstra-VenderWeele, J. (2022).Autism Spectrum Disorders. In Dulcan’s Textbook of Child and Adolescent Psychiatry.

https://clio.columbia.edu/catalog/17048859?counter=2 

Neuropsychological evaluation and Educational Advocacy

- NYC Public Schools. The IEP Process. Starting the Process. (n.d.) Starting the Process

https://www.schools.nyc.gov/school-life/health-and-wellness/504-accommodations 

Prior to week #1 meeting:

Complete async Rotation-Specific Didactics (RSD)  

Complete pre-rotation survey 

• Both are located in the Google drive

Week 1 - Meeting Agenda:

(1). Review rotation plan/tasks: schedule, planned schedule changes, questions/concerns, 

(2). Discuss resident's learning goals - review PGY-1 feedback/progress/concerns

(3). Review pre-rotation survey:

(4). Identify diagnosis for Psychiatric Diagnostic Presentation

(6). Discuss SCID-5 pick up/use

(5). Q&A

Prior to week #2 meeting:

Complete async Rotation-Specific Didactics (RSD) - see Google Drive

Week 2 - Meeting Agenda

(1). Q&A

(2). Video/direct observation review

Prior to week #3 meeting:

Complete async Rotation-Specific Didactics (RSD) -  see Google Drive

Week 3 - Meeting Agenda

(1). Q&A

(2). Video/direct observation review

(3). SCID-5-CV - Alcohol Use Disorder (page 53-55)

Prior to week #4 meeting:

Complete async Rotation-Specific Didactics (RSD) - see Google Drive

Week 4 - Meeting Agenda

(1). Q&A

(2). Video/direct observation review

(3). SCID-5-CV (page 45-53)

When? Last Thursday of the month - following didactics 

Duration: 20-30 minutes

• Direct observation - summary review and feedback.

• Review of post rotation questionnaire - see Google Drive 

• Rotation feedback - review of learning goals, accomplishments, challenges, etc.