BEH PGY3

The BEH training during PGY-3 focuses on advancing residents':

• Clinical Interviewing Skills Training  - advancement of equitable, collaborative, culturally-informed, and patient-centered approach to clinical interviewing with focus on the following communication skills: informed consent/documentation, agenda setting, interviewing techniques, electronic health record integration/documentation, working with interpreters, working with companions, culturally informed interviewing, and steps for completing the interview (i.e. teach back).

• Behavioral Medicine Interventions/Techniques- development of knowledge and skills for implementation of behavioral medicine techniques to promote illness management and wellness across a range of medical and psychiatric conditions.

• Psychiatric Condition Management -  with focus on the diagnostic criteria, assessment, and management strategies for the following: anxiety disorders, post traumatic stress disorder, obsessive compulsive disorder. Please note that substance use disorder management and depression management are integrated within PGY-2 training.  Please review relevant materials on these topics.

• Professionalism - including but not limited to the following:

• Self-reflection in clinical practices, impact of personal attitudes and behaviors on patient care

• Ethical issues: informed consent/documentation, patient autonomy/working with companions, confidentiality, quality of care,

• Punctuality, timely communication, and self-directed learning

Residents are expected to maintain professionalism during all in-person and remote components of the rotation. This includes but not limited to:

• Complete of assigned readings, Q&A, and online trainings prior to scheduled review date(s)

•  Demonstrate  self-directed learning - determining learning goals in line with rotation's scope/focus/training opportunities available

• Work collaboratively with faculty to complete patient encounter video recordings and/or communicate proactively about direct observations

• Demonstrating familiarity with observed/recorded sessions at the time of the review meeting(s)

• Complete and document patient care sessions for review in line with guidelines 

• Demonstrating responsiveness to feedback provided by the faculty 

• Timely attendance of all rotation-specific meetings, didactics etc is expected. Proactively communicate about any delays, schedule changes etc.

• Promptly respond to all email communication 

•  Discuss any schedule changes and any training-related needs as early as possible 

• For any meetings conducted remotely, residents need to ensure that they are located in a setting which is conducive to discussion/learning - private with any noise minimized

BEH training aims to deliver clearly defined, behaviorally-anchored skills as well as metrics for learners’ self-assessment. Training will be delivered via the following:

Self-Study and Completion of Q&A: 

Residents will complete weekly self-study materials and accompanying Q&A (See 'Weekly To Do List' section for specifics)

Format: Asynchronous/self study materials, Center for Practice Innovations (CPI) training modules

When? Self-study materials should be completed prior to each week's meeting with faculty (Wednesday am/pm - see schedule)

CPI completion certificates for relevant week(s) should be submitted to rotation faculty before the end of the second training block

Q&A Review/Didactic Meeting:

Q&A Review/Didactic Meeting will build on the completed self-study materials per week's training focus. Meetings aim to consolidate knowledge in each domain and discuss related topics and questions.

Format: In-Person (Wednesday am/pm - check schedule) or via Zoom

Video Review:

Weekly recording of patient care sessions is expected for review and feedback.  Each observed/recorded encounter will be reviewed. 

Feedback will be provided per Direct Observation/Video Review Form. Residents should be familiar with both Direct Observation/Video Review Form and Direct Observation/Video Review Comprehensive Form (see Google drive folder).

 At the end of the rotation, summary feedback will be reviewed. This summary feedback will directly inform performance evaluation.

Residents are expected to complete a minimum of 3 sessions for each FHC5 and FHC6 blocks.

Format:  Recording at Farrell CFCM

When? Check Orange schedule - any/all FHC sessions should be used for recording, until required number of recorded sessions is reached.

Self-Assessment of Performance:

#1  Complete pre rotation survey 

#2  Complete post rotation survey 

Format: Qualtrics Survey - links located in Google Drive folder- PGY3 - Behavioral Medicine

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 

Note: Training overview is presented in consecutive weeks and includes materials for both FHC5 and FHC6. Residents should anticipate completing Weeks #1 - 2 during the first block (FHC 5 or FHC 6, whichever comes first) followed by Weeks #3 - 4 materials during the 2nd block (FHC 5 or FHC 6, whichever comes last).

Week #1 Topic: Anxiety Disorders - Generalized Anxiety Disorder and Panic Disorder 

Prior to Week #1 Meeting:

Read:

• Gaudiano, B.A. (2017). Cognitive-behavioral therapies: achievements and challenges. EBMH, 11(1), 5-7. 

• Hunter, J. L. Goodie, M. S. Oordt, & A. C. Dobmeyer (2017). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. (pp 61- 72) Washington, DC, US: American Psychological Association 

• Borza, L. (2017). Cognitive-behavioral therapy for generalized anxiety. Brief Report. Dialogues Clinical Neuroscience, 19, 203-207. 

Review:

• The Fight Flight Freeze Response (2016). Braive. From: https://www.youtube.com/watch?v=jEHwB1PG_-Q

• Complete Week 1 Q&A 

• Complete CPI registration

• Complete pre-rotation survey 

All materials/documents are located in the Google drive folder

Week #1 Agenda:

• Establish learning goals in line with PGY-2 clinical interviewing feedback per MedHub

• Discuss scheduling - including changes/concerns, learning materials, CPI registration

• Week #1 - Q&A

• Admininter SCID-5 Anxiety section pp 63-72

• Review/confirm CPI module registration

Week #2 Topic: PTSD and OCD

Prior to Week #2 Meeting:

Read:

• Hunter, J. L. Goodie, M. S. Oordt, & A. C. Dobmeyer (2017). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. (pp 72- 75) Washington, DC, US: American Psychological Association. 

• Foa, E. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Clinical Research. Dialogues in Clinical Neuroscience, 12, 199-207. 

• Pampaloni, I., Marriott, S., Pessina, E., Fisher, C., Govender, A., Mohamed, H., Chandler, A., Tyagi, H., Morris, L., & Pallanti, S. (2022). The global assessment of OCD. Comprehensive psychiatry, 118, 152342. https://doi-org.ezproxy.cul.columbia.edu/10.1016/j.comppsych.2022.152342

Review: 

• PTSD Treatment: Know Your Options. National Center for PTSD. US Department of Veterans Affairs. https://www.ptsd.va.gov/appvid/video/index.asp

Complete Week 2 Q&A 

Week #3 Agenda:

• Administer SCID-5 PTSD and OCD sections pp 73-86

• Video review

• Week #2 Q&A

• Ensure that CPI registration is completed - module completion due Week #3 . See Registration guidelines in Google drive folder

Week #3: Pharmacotherapies: Depression, OCD, PTSD, GAD

Prior to Week #3 Meeting:

Complete following CPI modules:

• Treatment Resistant and Late Life Depression: An Update for Prescribing Clinicians

• Pharmacological Treatment of Obsessive-Compulsive Disorder: Nuts and Bolts

Read:

• Clinician's Guide to Medications for PTSD US Department for Veterans Affairs. 

https://www.ptsd.va.gov/professional/treat/txessentials/clinician_guide_meds.asp#evidence

• Carlat D. (2023). Pharmacotherapy  for Panic Disorder: What therapists need to know. Clinical Update. Carlat Publishing.  https://www.thecarlatreport.com/articles/4430-pharmacotherapy-for-panic-disorder-what-therapists-need-to-know

Listen to:

• Approaching a case of Generalized Anxiety Disorder: The basics (published 2019). Pharmacology Institute: https://psychopharmacologyinstitute.com/publication/approaching-a-case-of-generalized-anxiety-disorder-the-basics-2486

• Complete Week 3 Q&A here

Week #3 Agenda:

• Video review

• Week #3 Q&A

• Administer any outstanding SCID-5-CV modules

Week #4: Wrap Up

Prior to Week #4 Meeting:

Weiner S. J. (2022). Contextualizing care: An essential and measurable clinical competency. Patient education and counseling, 105(3), 594–598. https://doi.org/10.1016/j.pec.2021.06.016 Weiner_2022.pdf

Answer Week #4 Q&A

• Submit CPI module certificates via email

• Complete post-rotation survey 

Week #4 Agenda:

• Video review & summary

• Week #4 Q&A

• Feedback review

Follow instructions for video recording steps - all materials are in Google drive folder: Video Recording and Review

CONSENT:

1. All patients (and companions recorded) must sign consent forms before starting video recording. Consent form must be filled out fully, in pen, and include a session ID sticker in the top right hand corner.

2. File consent forms in a red folder next in the DVD filing cabinet (office #214). Do not remove completed consent forms off site. 

3. Statement of video recording consent must be included in your sessions' documentation using the following EPIC smart phrase: .VIDEORECORDINGGENERAL (under N. Pilipenko) . Please seek consultation if you are unsure about utilization of smart phrases in EPIC.

TROUBLESHOOTING ISSUES:

1. For any technical issues, contract rotation faculty via email the day of the event

2. Follow instructions for video recording - following documents in the Google folder

RECORDING FOR VISITS CONDUCTED IN LANGUAGES OTHER THAN ENGLISH

1.  Consent form and visit documentation must include interpreter ID #

2. Per NYP policy, only residents who achieved LLC certification in the respective language can see patients without an interpreter.

• Curriculum is designed based on the guidelines of the American Academy of Family Physicians: https://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint270_Mental.pdf

• Residents are strongly encouraged to review all portions of the evaluation and discuss concerns with faculty during Week #4 meeting. Evaluation can be found here:  BehavioralMedicine_MedHub_July2021.docx  (or PBWiki site)

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

• 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, via email.

• During Week #4 meeting, summative feedback will be provided and discussed.

Evaluation will include the following:

• Video review observation summary (commutative). Each recorded/observed session will be reviewed using standardized checklist. Any additional pertinent feedback will be noted.

• Participation in learning activities and completion of learning content (in line with expectations as outlined in Learning Goals Summary and Rotation Expectations sections)

• Participation in CL learning activity - along with feedback provided by Dr. Batta

•  Feedback will be submitted via MedHub