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Curriculum

Fellows receive focused training in primary care psychology and medical education, while providing behavioral health treatment to patients in their designated health center. They train as medical educators in all of the department’s health centers, on the inpatient medical service, in the medical school, and in the graduate school of nursing.

The weekly training time is roughly broken down into 10 half-days, with supervision and other learning opportunities such as grand rounds, chart rounds, and other relevant training and learning opportunities occurring regularly. A sample schedule for a fellow is below followed by additional descriptors of the various experiences. 

The program includes two primary training locations, the Barre Family Health Center and the Hahnemann Family Health Center.  The training director serves on the Department of Family Medicine’s Senior Leadership Team which overseas clinical and training activities at both sites.

   Morning Afternoon
Monday   Team Precepting


Patient Care
Chart Rounds

Tuesday

FMIS or Patient Care
Grand Rounds

Didactics
Supervision

Wednesday Dual Interviews

Patient Care
Chart Rounds

Thursday

FMIS or Patient Care
Supervision

Patient Care
Chart Rounds

Friday Patient Care

Admin
Physician as Leader (PAL)

Core Experiences

Patient Care
The fellow spends between 4 and 6 half days each week providing patient care in one of the family medicine residency clinics. This involves seeing patients jointly with physicians, providing brief behavioral health consultations to patients, and providing longitudinal behavioral health services to patients. Fellows care for children, adolescents, families, and adults. Fellows are supervised in the delivery of evidence-based interventions including but not limited to: Behavioral Activation, CBT, Solution Focused Therapy, ACT, Motivational Interviewing, and Family Therapy.

Fellows routinely care for patients with anxiety disorders, mood disorders, substance use disorders, and child behavior problems. They also provide consultation to physicians concerning patients with serious mental illnesses or in acute risk situations. The fellow also cares for patients in need of health behavior change interventions, for example, those struggling with adherence to a medical treatment plan, chronic pain management, smoking cessation, sleep disorders, and other physical health conditions. Opportunities exist for fellows to participate in the design and delivery of innovate approaches to patient care such as group medical visits.

Supervision
Throughout training fellows receive one hour per week of clinical supervision from the Fellowship Training Director and one hour per week from their Site Supervisor in their health center. Both of these supervisors are licensed clinical psychologists.  In addition, they average one to two additional hours of teaching from educators in other disciplines (medicine, nursing, and pharmacy). Many years fellows have the opportunity to supervise a psychology practicum student or psychology intern as well. Fellows also take advantage of courses offered within the Center for Integrated Primary Care such as the Primary Care Behavioral Health course and an intensive Motivational Interviewing course.

Dual Interviews
Fellows participate in joint visits with patients and their PCP.  These are referred to as “Dual Interviews.” All family medicine residents are required to complete a minimum number of dual interviews with the behavioral science faculty throughout their two-year training. The fellow conducts the majority of these Dual Interviews as part of collaborative, team-based patient care.

Family Medicine Inpatient Service (FMIS)
When on this rotation, 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 to the care of patients. Fellows are frequently called on to provide instruction in doctor-patient communication skills on this rotation. Click here for more about FMIS.

Team Precepting
Most weeks the fellow will participate in live supervision of a family medicine resident, referred to as “Team Precepting”. 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 mirror. 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 to develop as a medical educator.

Physician as Leader
The Department of Family Medicine and Community Health has a commitment to monitoring and promoting the well-being of learners. A longitudinal wellness curriculum, including medical humanities, has been adopted by the residency and this includes a Friday afternoon session focused on resident well-being. The fellows are involved with this in Year One, learning more about the curriculum and experiencing the wellness sessions along with the residents. In Year Two fellows adopt responsibility for 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.

Didactics
Tuesday afternoons are protected to provide special educational activities for fellows and residents. Fellows participate alongside the family medicine residents in the Tuesday workshop curriculum. 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. Workshop topics include communication skills, core family medicine outpatient knowledge and skill development, counseling skills, practice management, palliative care, chronic pain, and addiction. Fellows are participants in these sessions and may be asked to co-lead or lead a session depending on their interest. The fellow also participates in bi-weekly didactic sessions with psychology and social work trainees across our training sites. Sessions focus on clinical behavioral health topics and alternate between a lecture-based didactic and a trainee-led case conference.

Chart Rounds
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. Fellows are in attendance at these to offer a behavioral science perspective and input to case discussions.

Medical Education
In addition to the activities described above, fellows regularly participate in diverse experiences designed to develop their skills as a medical educator. Fellows regularly lead trainings focused on topics such as those listed below:

  • Motivational Interviewing Lecture - Family Medicine Clerkship
  • Child and Adolescent Behavioral Health in Primary Care - Interclerkship
  • Post-Traumatic Stress Disorder in Primary Care - Veterans Health Interclerkship
  • Doctoring and Clinical Skills - First Year Medical Students

Evaluation
Fellows are evaluated twice each year. Faculty and residents in the fellow’s primary health center are asked to evaluate the fellow’s performance in the following domains:
- Availability and responsiveness to requests for consultation
- Quality of communication
- Quality of teaching
- Degree of helpfulness

In addition, the Training Director and Site Supervisors complete a rating of the fellow’s competence in the following domains:
- Assessment Knowledge and Skills
- Intervention Knowledge and Skills
- Ethics, Regulation, and the Law   
- Diversity
- Professionalism and Self-Care
- Quality Improvement, Scholarship, and Research
- Medical Education and Supervision

The Training Director and Site Supervisor meet with each fellow to review summary feedback from the evaluations. A Grievance Process Policy is available to fellows who have concerns with the evaluation or the fellowship program. The Due Process Policy governs the approach to managing concerns with the fellow’s behavior. These policies are distributed at the beginning of the fellowship and again upon request.