The BM Rotations (BEH-2, BEH-3) aims to advance residents’ skills in the following areas:

• Clinical Interviewing Skills: Use time-sensitive, patient-focused interviewing skills to optimize data collection. physician-patient relationship and collaborative care.

• Bio-psycho-social Inquiry: Assess and address emotional aspects of illness, stress, mind-body connection, family/role impact, and cultural beliefs.

• 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: Diagnostic assessment per DSM-5 criteria, mental status exam, initiation of treatment and referrals, management of psychiatric emergencies: safety plan and safety assessment, capacity evaluations, administration, and interpretation of brief cognitive screening tools.

• Inter-professional Collaborative: Symptom screening and management (ongoing), utilization of team-based collaborative care for the improvement of patient care.

• Professionalism: Self-reflection in clinical practices, the impact of personal attitudes and values upon patient care. Ethical issues: informed consent, patient autonomy, confidentiality, quality of care, and self-direction in learning. Punctuality, timely communication, and self-directed learning.

The American Academy of Family Physicians, Human Behavior and Mental Health curriculum guidelines can be found here: AAFP: Recommended Curriculum Guidelines for FM Residents 

Behavioral Medicine curriculum is delivered via the following:

• Video Recording/ Video Review or Direct Observation and Feedback 

• Rotation-Specific Didactics

• Longitudinal Didactics (lecture series)

• Independent Learning – case conferences, presentations, self-study, completion of online training modules

• External Site Placements

Rotation Expectations

1. Complete patient encounter video recordings and/or direct observation.

2. Attend all rotation-specific meetings, didactics, etc. Please be on time for all scheduled meetings.

3. Complete assigned readings, questions, and online training. 

4. Demonstrate self-directed learning and responsiveness to feedback.  

5. Please discuss any specific rotation-related needs and requests as early as possible. Proactively communicate about any delays, schedule changes, or other needs.

6. Promptly respond to email communication and discuss any schedule changes and any training-related needs as early as possible.

7. If you are requesting time away during the rotation, please follow the  Schedulechangepolicy_2017.docx

• Rotation evaluation can be found here: BehavioralMedicine_MedHub_July2021.docx

• Rotation evaluation will be completed within 1 week following the completion of the rotation (BEH-2 or BEH-3).

• 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 timelines. 

• All study materials  

Activity A - Direct Observation/Video Review and Patient Care Feedback 

• At minimum, 2 sessions per week should be observed/recorded. More sessions may be observed upon additional discussion between resident and faculty.

• Determination about observation/recording will be made based on the resident's schedule - TH versus in-person visits. 

• Each observed/recorded encounter will be reviewed. Feedback will be provided in line per Direct Observation/Video Review Form: DirectObservation&VideoReviewForm_6.2020.docx. At the end of the rotation, summary feedback for all observed encounters will be reviewed. This summary feedback will directly inform rotation evaluation.

• Direct Observation & Video Review: Comprehensive Form summarized key areas of assessment/observation: DirectObservation&VideoReviewComprehensiveForm.docx . Residents should review this form and be familiar with this form prior to the 1st observed session. 

• Direct Observation: Will take place for TH sessions via phone, Doximity or EPIC zoom. 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.

  1. 1. 1. 1. • Review: Multiple_Provider_Video_Visit_Tip_Sheet_(002) (1) (3) (1).pdf

              • Ensure that your Doximity access allows for 3 person visits. If experiencing difficulties - contact Doximity IT support.

              • Video recording: Please review the following guidelines: Video Recording Instructions_4.2021.pdf

              • Document consent for video recording using the following: .VIDEORECORDINGGENERAL (in EPIC under N. Pilipenko)

Resident responsibilities:

1.  Review, understand, and follow all technical aspects involved in observation via EPIC/video recording - including obtaining and documenting informed consent for video recording and following direction for video equipment management

2. Documented patients' consent for recording/observation 

Activity A-1 - Direct Observation and Patient Care Feedback - Spanish Language Care

• For residents providing care in Spanish, additional observation of clinical care will be performed by Dr. Esteban Gonzalez.

• The goal of the observation - provide feedback about use of Spanish language in clinical care in the domains of: oral comprehension, oral expression, and cultural appropriateness.

• Observation form can be viewed here: Direct Observation_ Medical Spanish_Evaluation Form.pdf

• Specifics of the observation will be discussed at the start of the rotation.

• Residents who did not achieve National Exam, ALTA CCLA score >80%, should be using medical interpreter service. 

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Activity B - Pediatric Psychiatric Consultation with Dr.  Jennifer Rahman

Weekly meeting (Wednesday 3-4pm) with Dr. Jennifer Rahman will aim to expand residents' knowledge about pediatric psychiatry and special considerations when working with pediatric patients and their families.

GOALS:

• Improve understanding of psychiatric medication management in children (and how they differ in dosing/algorithms from adult management guidelines)

• Expand upon ability to distinguish between medications in categories (half lives, side effects): antidepressants, antipsychotics, benzodiazepines, mood stabilizers, stimulants

• Improve understanding of different psychotherapies available for children

• Expand upon knowledge of evidence based behavioral interventions (positive rewards, behavioral charts, times outs)

• Improve understanding of school systems (different classroom settings, 504 plan, IEP, neuropsychological testing)

PLAN/SCHEDULE:

WEEK 1 - ODD, ADHD, Conduct Disorders

Goals/Objectives

A.  Appreciate 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

Meeting resources:

Week 1.ODD.pdf

Week1.CommonQsODD.pdf

Week1.ODD_Resource_Center.pdf

Week1.ADHD_medication_guide.pdf

Week1.DSM5_DiagnosticCriteria_ConductDisorder.pdf

Materials:

Vanderbilt Scales 

SNAP IV Scale 

WEEK 2 -  Pediatric depression

Goals/Objectives

1. Recognize differences between acute and chronic safety risk factors

2. Utilize effective techniques to elicit factors contributing to a change in the patient’s safety profile (i.e. if the patient is appropriate for outpatient or higher level of care)

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

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

5. Identify local and national resources in case of emergency situations

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

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

8. Identify impact of socioeconomic status, engagement of communities, and advocating for resources contributing to ongoing safety assessment

Meeting resources:

Week2.Antidepressants_appd.pdf

Week2.DMDD.pdf

Week2.GuidelinesSwitching-Antidepressants.pdf

Materials:

CSSRS: Suicide Risk Assessment 

Brown Stanley Safety Plan 

GAD-7/PHQ-9 Screeners 

Week 3 - Learning and Developmental disorders

Goals/Objectives

1. Appreciate changes in classifications of Neuro-developmental Disorders in DSM-V

2. Identify medical and psychiatric co-morbidities of autism

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

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

Meeting resources:

Week3.Autism, psychosis, or both.pdf

Week3.DSM-5 changes in ID.LD.pdf

Materials:

M-CHAT scale

Dulcan’s Child & Adolescent Psychiatry textbook-Autism chapter (will be shared during the meeting)

Week 4: Neuropsychological evaluation and Educational Advocacy

Goals/Objectives

1. Determine when neuropsychological testing is indicated for possible learning disorders

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

3. Describe process of advocating for 504 vs. IEP plan, components of school supports

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

Materials:

Neuropsychological testing report will be shared during the meeting

NYC School Website (IEP vs. 504)

OPWDD

Vignettes can be found here: Patient Vignettes_DrRahman.pdf

Contact: Email Dr. Rahman (jer9221@nyp.org) prior to the first meeting to confirm schedule and discuss any anticipated changes. Meeting via didactic's Zoom.

1 - Nursing Home visits may be suspended. Please discuss expectations with Dr. Paladine.

2 - Please note that while CHMPP and Q-Clinic are not mandatory during BEH rotations. However, attendance of these clinics may continue during BEH rotations. Please discuss attendance with faculty supervising these clinics.

3 - Join via Zoom: https://columbiacuimc.zoom.us/j/96086361656? pwd=VXFNQ0srMjNEZnlKNW1Fb0Mra1JQQT09 

Meeting ID: 960 8636 1656, Passcode: 931365