BEH PGY3

Behavioral Medicine (BEH) Rotation -  Training Goals

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 interviewing skills for patient-centered 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)

PGY-3 Behavioral Medicine (BEH) Rotation -  Learning Objectives

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

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. Understand pharmacological interventions 

for the following conditions: Generalized Anxiety Disorder, Panic Disorder, PTSD, OCD, as result of self-study,  Q&A participation, administration of SCID-5-CV interview, review of the relevant sections of the Waco Guide

Contextualized Care: 

By the end of the rotation, residents will:

1. Understand definition of contextualized healthcare

2. Be able to name key domains which should be considered for contextualized care

3. Review physician behaviors associated with contextualized care

4. Understand impact of contextualized care on patient outcomes

as result of self-study,  Q&A participation.

Interprofessional Practice: 

By the end of the rotation, residents will:

1. Participate in weekly case discussion of the Integrated Mental Health Program (IMP)

2. Participate in pediatric psychiatry service 

3. Participate in psychiatric consulation and liaison service

Professionalism and Practice Based Learning Expectations

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.

In PGY-3 year, Behavioral Medicine (BEH) training is delivered during FHC 5 and FHC 6 rotations

Schedule

Consulation and Liaison (CL) Psychiatry Service - Allen Hospital

Supervising Faculty: Kristina Jones MD

Location: The Allen Hospital, 3FE 157   

Schedule: Tuesday 1:30 - 5 pm  

Contact information: kj2016@cumc.columbia.edu, phone 646-899-9315

Contact Dr. Jones via email on the first day of the rotation to confirm schedule and discuss any planned changes.

Please read 1 article from either Capacity Assessment, Complex Patient Interactions, or Dementia Diagnosis and Management (Resource Materials sections) for each week of training, to support case-based discussion. All Resource Materials are provided via Google folder.

This learning experience will focus on improved knowledge and skills in the following:

-       Decision-making capacity assessment – including ethical considerations and discharge planning

-       Dementia assessment

-       Pharmacological management of behavioral issues in dementia

-       Navigating challenging patient and team dynamics within inpatient settings

Capacity Assessment

1. Assessment of decision-making capacity: examine tools and methodologies used to assess and evaluate a patient's decision-making capacity, considering both legal and ethical dimensions.

2. Ethical aspects of discharge planning

Resource Materials:

• Appelbaum P. S. (2007). Clinical practice. Assessment of patients' competence to consent to treatment. The New England journal of medicine, 357(18), 1834–1840. https://doi-org.ezproxy.cul.columbia.edu/10.1056/NEJMcp074045. https://www.nejm.org/doi/full/10.1056/nejmcp074045

• Appel J. M. (2022). A Values-Based Approach to Capacity Assessment. The Journal of legal medicine, 42(1-2), 53–65. https://doi-org.ezproxy.cul.columbia.edu/10.1080/01947648.2022.2162171

• Bao, G. C., Katz, S., Mukherjee, D., & Gabbay, E. (2025). A Clinician's Guide to Ethical Challenges in Discharge Planning: Proportionality, Risk, and Justice. The American journal of medicine, 138(11), 1502–1512.e8. https://doi-org.ezproxy.cul.columbia.edu/10.1016/j.amjmed.2025.06.032

Complex Patient Interactions

Understanding and effectively addressing patients presenting with trauma, substance use disorders and mood disorders

1. Psychodynamic perspectives on understanding and managing complex patient interactions

2. Therapeutic Approaches: Introduce therapeutic approaches tailored to management of complex dynamics with patients and treatment teams

Resource Materials:

• Appel, J.M. (2022). Taking care of the beloved patient. Clinical Ethics, 18(1), 13-17. https://doi.org/10.1177/14777509221094484

• Groves J. E. (1978). Taking care of the hateful patient. The New England journal of medicine, 298(16), 883–887. https://doi org.ezproxy.cul.columbia.edu/10.1056/NEJM197804202981605. https://www.nejm.org/doi/10.1056/NEJM197804202981605?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Dementia Diagnosis and Management

1.       Diagnostic Criteria: Differentiating Alzheimer’s dementia from Parkinson’s Dementia, Lewy Body Dementia and Fronto-Temporal Dementia.

2.       Understanding and recognizing cognitive symptoms – within context of depression, delirium, dementia.

3.       Common behavioral issues associated with dementia e.g.  agitation, disinhibition, irritability

4.        Understand utilization of pharmacotherapies for management of dementia symptoms.

Resource Materials:

• Tampi, R. R., & Jeste, D. V. (2022). Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management. The American journal of psychiatry, 179(8), 528–543. https://doi.org/10.1176/appi.ajp.20220508