Uniformed Services University, Bethesda, MD.
Fam Med. 2020 Feb 6;52(3):174-181. doi: 10.22454/FamMed.2020.681872.
Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams.
We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs' current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study.
Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content.
While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.
初级保健行为健康（PCBH）是一种整合照护服务模式，与患者和系统的多种积极结果相关联。然而，提供者培训和离职方面存在相当大的挑战。虽然对非医师行为科学家的培训已经成熟，但对于如何培训医生以在整合团队中高效工作知之甚少。
我们使用一系列 30 至 45 分钟的半结构化访谈，对军队卫生系统中的家庭医学住院医师进行了案例研究分析。我们对这些案例进行了定性模板分析，以了解与 PCBH 相关的项目当前的教育流程。研究共有 13 人参与，包括项目主任、行为和非行为教员以及来自五个项目的住院医师。
当前的教育流程包括各种关于 PCBH 的内容（例如，治疗抑郁症、临床转诊途径、以患者为中心的沟通），主要使用了讲座和实践相结合的方式。资源分配被认为是提高质量的关键因素。在整合行为健康提供者作为住院医师的程度上存在差异，因此报告了更多的有针对性的课程开发和医疗系统层面内容的项目，这些专家的参与程度更高。
虽然行为健康内容在家庭医学住院医师课程中得到了很好的体现，但内容的深度和整合程度不一致。更有针对性和整合性的课程伴随着教员的发展以及行为健康教员的整合。未来的研究应该评估教员发展计划和行为科学家的教员地位是否会导致不同的教育或医疗保健结果。
