BEH PGY2

Overarchingly, BEH training aims to advance residents’ knowledge and skills in the following areas:

Clinical Communication: efficient, patient-centered, culturally-informed, bio-psycho-socially-grounded, and evidence-based interviewing skills for collaborative patient care

Behavioral Medicine Interventions/Techniques: brief, evidence-based behavioral medicine interventions/techniques for non-pharmacological illness management and wellness promotion across a range of medical and psychiatric conditions

Identification and Management of Common Psychiatric Conditions: brief screening, diagnostic assessment per DSM-5-TR, case conceptualization, pharmacological interventions, non-pharmacological interventions

Screening and Management of Suicidality: screening/assessment, safety planning

Interprofessional Practice: team-based care and interdisciplinary work

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)

Clinical Interviewing

By the end of the rotation, residents will demonstrate:

1. Following interviewing skills: collaborative agenda setting, EHR integration, interviewing techniques, bio-psycho-social/culturally-informed inquiry

2. Best practices for working with interpreters

3. Effective practices for working with patient companions

during routine clinical encounters, as demonstrated by video review of clinical care. See Direct Observation/Video Review and Patient Care Feedback section for further specifics.

Behavioral Medicine Interventions/Techniques:

By the end of the rotation, residents will:

1. Be able to discuss specifics the following interventions/techniques: relaxation techniques, goal setting, cognitive disputation, problem solving, stimulus control, assertive communication

2. Understand key principles and techniques of motivational interviewing 

as result of self-study and Q&A discussion/participation.

Identification and Management of Common Psychiatric Conditions:

By the end of the rotation, residents will:

1. Be able to name key screening tool(s) 

2. Perform diagnostic assessment per DSM-5-TR criteria

3. Summarize cognitive-behavioral case conceptualization

4. Outline non-pharmacological interventions

5. Demonstrate  in depth understanding of a. symptoms b. differential diagnostic considerations of 1 psychiatric condition

for depression and alcohol/substance use disorders,  as result of self-study,  Q&A participation, administration of SCID-5-CV interview and residency-wide lecture presentation (#5 only)

Screening and Management of Suicidality: 

By the end of the rotation, residents will:

1. Administer and interpret Columbia Suicide Severity Rating Scale (CSSR-S) (brief version) 

2. Differentiate between suicidal and non suicidal injury using CSSR-S nosology  

3. Outline key components of Safety Plan 

4. Discriminate between Safety Plan and Safety Contract

as result of self-study and Q&A discussion/participation.

Interprofessional Practice: 

By the end of the rotation, residents will:

1. Outline specifics pertaining to the delivery of integrated care services including: referral process, consent, delivery and follow up

2. Participate in case discussion

3. Participate in BHC interview(s)

via active participation in team pre/post discussion and patient inquiry as part of BHC and IMCC services

Along with the Learning Objectives, the following points will inform residents' performance evaluation: 

Practice Based Learning:

- Self-directed learning as demonstrated by:

1. Active discussion of the learning goals in line with rotation's scope/focus/training opportunities available

-Reflective practice as demonstrated by:

1. Openness to feedback as evidenced by participation in review of own clinical work

2. Discussing and implementing strategies for care improvement (as evidenced by subsequent video reviews) 

Professionalism:

 - Timely completion of tasks and responsibilities. Specifically:

1. During the rotation, acknowledge (and/or) provide response to all email communication within 24 work hours

2. Proactively communicate about schedule changes and access issues (i.e. identify relevant Zoom links and tallies prior to the start of the clinic/didactic meeting)

3. Attended rotation-specific meetings and activities, per schedule/on time

4. Complete assigned readings, Q&A, and online training prior to scheduled review date(s). 

5. Any didactic content (e.g. Q&A) that 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. SCID-5-CV should be returned to Dr. Pilipenko's mailbox at Farrell within the same timeframe.

-Accountability and conscientiousness, as demonstrated by:

1. Ability to engage in discussion/Q&A pertaining to assigned learning content 

2. Familiarity with own patient care/work at the time of the video review as demonstrated by clear patient identification and brief presentation

-Professional behavior. Specifically:

1. For remote meetings: use setting conducive to discussion/learning i.e. noise, disruptions, presence of non-related persons should be minimized

2.  Follow NYP policies regarding professional conduct and attire for all rotation-related activities.

3.  Follow instructions for BEH presentations, video recording guidelines, inter-professional clinics

• Please discuss any  personalized training-related needs or anticipated challenges as early as possible, so that these can be collaboratively navigated.

• If calling out sick for any external training sites: email the following: 1. Relevant faculty/preceptor 2. Dr. Pilipenko 3. Diana Suarez appraising them of your sick day and stating your anticipated return date. If calling out sick for FHC: call Farrell Sick line (646-317-2303, by 7:30 am), email farrellsickline@nyp.org and CC Dr. Pilipenko. Include instructions for any patient rescheduling.

• At minimum, 2 sessions per week should be recorded. Total of 6 during the rotation

• Each recorded encounter will be reviewed. 

• 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)

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.

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.

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.

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. (2024). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (3rd ed.). American Psychological Association.

https://www.apa.org/pubs/books/integrated-behavioral-health-primary-care-third-edition

Introduction and Chapter 1 are shared via Google folder. Please review and complete Q&A if there are no shows for BHC clinic.

Supervising Faculty: Dr.  Krishna Desai

Location: Remote/TH

Schedule: Friday AM/PM 

Contact: Dr. Desai/Dr. Pilipenko

Service Description

IMCC delivers integrative medicine services  to patients of Farrell CFCM using inter-professional team approach.

Expectations

1. Please pre-read before each session 

2. Discuss learning goals and interests

3. Anticipate active participation in the clinic

Please review Integrative Medicine Consultation Clinic (IMCC) FRIDAY SESSIONS for further information/session specifics

Prior to week #1 meeting:

Complete all asynchronous 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 

(3). Review pre-rotation survey

(4). Identify diagnosis for Psychiatric Diagnostic Presentation

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

(5). Week 1 Q&A & discussion

Prior to week #2 meeting:

Complete asynchronous 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 week of the month

Duration: 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.

- 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