Curriculum

Fellows receive focused training in clinical health psychology as it is practiced in primary care. They provide behavioral health treatment in the health centers and in other Family Medicine practices in the U.Mass/Memorial system. They provide behavioral science precepting (one on one observation and teaching) for residents in Family Medicine and join them in collaborative patient care. They teach selected behavioral science subjects in the health centers. Finally, they participate in a capstone project that might be an independent or collaborative research study, program evaluation, curriculum development, a clinical innovation or advanced teaching or training in integrated care.  

Fellows receive one hour per week of clinical supervision from the Director of the program and one from the site supervisor in their health center in both years of their program. In addition, they average one to two additional hours of supervision per week in live supervision and case discussions. During all their work, there is a medical faculty preceptor available on site for back up with decisions, adding a second layer of guidance and support. Often fellows have the opportunity to supervise a practicum student or clinical intern as well.                                                                            

Year One

The first year is spent refining skills that are necessary for the practice of clinical health psychology in primary care, becoming familiar with the routines, language, and issues of assessment and intervention in primary care. They learn how to develop a role as a caregiver in primary care medical practice. The weekly training time is roughly broken down into 10 half-days, with supervision and other learning opportunities such as grand rounds, chart rounds, pain rounds, and other relevant training and learning opportunities occurring over the lunch hour. Fellows can also take advantage of courses offered within the Center for Integrated Primary Care  such as the primary care behavioral health course, the motivational interviewing training course and others. A sample schedule for a first year fellow is below followed by additional descriptors of the various experiences. As some activates occur monthly or only for a portion of the half-day, more than one experience is represented in this schedule per half-day. 



Morning

Afternoon

Monday

Team Precepting

Clinic, Dual Interviews, Chart Rounds

Tuesday

FMIS, Dual Interviews

Finding Meaning in Medicine Group, Tuesday workshops

Wednesday

Clinic, Dual interviews, Health Center 
Lectures

Clinic, Dual Interviews, Chart Rounds

Thursday

FMIS, Supervision

Clinic, Dual Interviews, Chart Rounds

Friday

Clinic, Dual Interviews 

Clinic, Admin, Physican as Leader (PAL)


Clinical practice and consultation in primary care
The fellow spends the majority of his or her time as a member of primary care treatment team in one of the family practice residency clinics. This involves observing resident physicians in their practice, seeing patients jointly with physicians, and carrying a caseload referred by physicians in the practice. In the beginning of the year, the fellow’s time is fairly unstructured. They learn what the residents are doing by observing them as they see their patients. This leads quickly to dual interviews in which residents and fellows work together to treat patients. All family medicine residents have to complete a minimum number of dual interviews with the behavioral science faculty throughout their three year training and the post-doctoral fellow conducts the majority of these with the residents thereby having both the resident and the fellow experience true, collaborative, team-based patient care.

In their clinical work in this setting, fellows are most likely to see patients who are anxious, depressed, coping with illness, child behavior problems, having relationship or family problems, or are abusing substances. They also consult to physicians concerning patients with serious mental illnesses or in acute risk situations. As our clinics implement chronic care disease processed and protocols, the post-doctoral fellow is also likely to be called into cases to assist with lifestyle changes, adherence to a treatment plan, chronic pain management, smoking cessation, sleep disorders and other physical health conditions.

Fellows work closely with all members of the healthcare team, including case managers as well as the social workers and consulting psychiatrist available in each health center. They quickly become the “go-to” clinical resource in the health center for clinical issues and teaching.

Family Medicine Inpatient Service (FMIS) Hospital Rounding – Two half-days per rotation
When on this rotation (6 times per year), fellows spend two half-days per week rounding in the hospital with teams of residents and the hospitalist attending physician. The fellow is an integral part of the team, helping to highlight psychosocial issues and offering a psychologist’s perspective on the patients. This is a largely teaching role for the fellows rather than any direct patient care. Click here for more about FMIS.

Team Precepting – One half-day
Team Precepting involves a medical preceptor and a behavioral science preceptor working with one resident for one half-day patient session. The precepting team is behind a one-way mirror while the resident sees their usual schedule of patients in front of the screen. The purpose of team precepting is to provide medical and behavioral science precepting together so that residents do not have to dichotomize patients’ problems into “physical” and “psychosocial” domains in order to determine whether a particular problem should be presented to a medical or a behavioral science preceptor. Being with the team allows the fellows to observe primary care services and hear the feedback of faculty about what they are seeing. Fellows can observe or participate in the process as they gain confidence and experience.

Physician As Leader (Friday Afternoon Well-Being)
The FM Residency has a commitment to monitoring and enhancing the well-being of the residents. A longitudinal wellness curriculum, including medical humanities, has been adopted by the residency and this includes a Friday afternoon (3-5 pm) dedicated session for resident well-being for each PGY class at each health center over the course of the year. The fellows are involved with this in Year One, learning more about the curriculum and experiencing the wellness sessions along with the residents and then in Year Two, tacking charge of the curriculum and implementing it with the residents. These sessions take many forms but emphasize self-awareness, self-reflection, discussion, reflective writing, mindfulness, meditation, nature appreciation, social outings, and other activities designed to intentionally promote resident resilience and well-being.                                                                                                                                                                                          

In Addition.... 


The Tuesday Experience
Tuesdays are set aside and protected to provide special educational activities for fellows and residents. Family Medicine and Community Health Grand Rounds are held weekly on Tuesdays at noon at the Memorial Campus on a wide array of Family Medicine topics. Fellows participate alongside the family medicine residents in the Tuesday workshop curriculum, which is focused on a wide array of topics including communication skills, core family medicine outpatient knowledge and skill development, counseling skills, practice management, or current important medical and ethical topics like palliative care, abortion and options counseling, and chronic pain and addiction. Resident wellness sessions occur monthly to include sessions on mindfulness and medical humanities sessions, led by a faculty member in the residency. Fellows are participants in these sessions and may be asked to co-lead or lead a session depending on their interest.


Finding Meaning in Medicine Group (Delete Balint paragraph)
First year fellows join the second year family medicine residents in their weekly Finding Meaning in Medicine (FMM) group. FMM  is a group of clinicians who meet to discuss common topics associated with medical practice and to reflect upon the meaning and experience of these issues in one’s own patient care and personal history. Groups provide an opportunity for doctors to reflect on their work as well as an outlet for anxieties and frustrations generated by their work. It can arouse a doctors’ interest in patients whom they have previously found upsetting, annoying or “difficult” and open minds to other possibilities. This same group remains together in FMM the following year, allowing the fellow two years of group experience with the same family medicine residents. The fellow is not the leader of the group; he/she is a participant and is expected to remain in that role and so that the fellow can take maximum advantage of this training and professional growth opportunity. 


Chart Rounds and Noon Conferences
All of the health centers thrive in an atmosphere of perpetual learning. Conferences are an important part of the daily routine on rotations and in the health centers. Chart rounds, which occur daily, are case-based, learner-centered conferences focusing on the science and art of medicine and fellows are in attendance at these to offer a behavioral science perspective and input to case discussions. Fellows also give occasional lectures on mental health topics of interest to residents at. They usually give one Grand Rounds presentation to the Department of Family Medicine and Community Health. The fellows also help deliver structured behavioral and educational programs for identified groups of patients. 


Year Two


The second year is spent refining primary care psychology skills as well as creating opportunities for more advanced study in one or more area of interest. Additionally, second year fellows spend a fair amount of time in formal precepting with residents and in the development of a research project that is expected to be conducted throughout the second year of training. Whereas in the first year, the fellows are functioning more as peers and collaborators with residents, in the second year they take on more faculty-like responsibilities. Again, the training time is accounted for and described based on a 10 half-days per week. A sample schedule which depicts the various activities for a second year fellow is below followed by descriptors of any experiences not described above, or as they may differ for second year fellows. As some activates occur monthly or only for a portion of the half-day, more than one experience is represented in this schedule per half-day. 



Morning

Afternoon

Monday

Clinic, Dual Interviews, Supervision

Clinic, Dual Interviews, Chart Rounds

Tuesday

FMIS

FMM Group, Tuesday workshops

Wednesday

Clinic, Dual Interviews

Clinic, Supervision, Chart Rounds

Thursday

FMIS, supervision of Practicum Students

Clinic (new practice)

Friday

Clinic, Project Time

Project Time, Physician as Leader (PAL)


Fellow’s Capstone Experience – One half-day
Fellows pursue a capstone experience in their second year (although sometimes this begins in year one). The Department of Family Medicine and Community Health has developing and ongoing research in primary care in areas such as depression management, models of integrated care, physician wellness, and others – opportunities for fellows to become involved in existing research abounds. Opportunities to conduct independent research also exist. Other capstone experiences have included participating in the Global Health Medicine Track including international travel, teaching in the Doctoring and Clinical Skills Course for first year medical students, and providing technical assistance about integrated care to health centers across the state trying to change their models of practice to include behavioral health. Some fellows choose to do more than one of these experiences in their 2nd year and we try to accommodate this to tailor the training to meet both programmatic and individual goals.

In Addition...

The second year fellow still attends chart rounds, noon conference, weekly FMM group, and the Tuesday lecture series with the third year family medicine residents. Fellows are in charge of the well-being curriculum for the Friday afternoon session with residents. 

Evaluation
Fellows participate in a “360 degree” evaluation twice yearly. Feedback relevant to each group’s experience with the fellow is solicited from psychological and medical faculty, nursing and office staff members and residents. The fellows and immediate supervisors complete a rating of the fellows on the competencies identified by the program. A summary document, signed by the Fellow, Director, site supervisor and Residency Director is placed in the record. The Fellow is permitted to add a comment on the document if they choose. Feedback on Fellows' work is ongoing. Because Fellows view their supervisor's clinical work and are observed in their work, the process of exchange for mutual growth is ongoing, making formal evaluations usually enjoyable, and sometimes redundant in feel. A Due Process plan has been adopted for trainees. It is available on request. In areas that are relevant to fellows not covered by the Due Process plan, the Residency Policy Manual of residency of the fellow’s main placement is observed. 

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