Integrative Medicine in Residency Psychiatry

Transcription

1 Integrative Medicine in Residency Psychiatry Noshene Ranjbar, M.D. Assistant Professor of Psychiatry University of Arizona

2 MDC1 Disclosure Statement Noshene Ranjbar has indicated no financial relationships with any commercial interest relevant to this activity.

3 Slide 2 MDC1 Attention Speakers: Please include this disclosure statement and add speaker names if no financial relationships. If there are financial relationshps, please add that on the Faculty Disclosure slide Megan Denhardt, CAE, 6/22/2017

4 Outline Psychiatry Residency ACGME Requirements Integrative Medicine Defined History of IMR to IMR Psychiatry Curriculum Development and Components Data Collection and Outcomes Measures Current Status and Future Directions

5 Psychiatry Residency Education ACGME requires training in: Self awareness Empathy Professionalism Knowledge of evidence base in CAM Knowledge of herb drug interactions Cultural competency

6 Integrative Medicine Lake J, Helgason C, Sarris J, MHSc. Integrative Mental Health (IMH): Paradigm, Research, and Clinical Practice. 2012; 8.

7 Integrative Medicine in Residency (IMR) Family Medicine Internal Medicine Preventive Medicine OB Pediatrics Psychiatry

8 History of IMR Psychiatry Pilot, University of Arizona Department of Psychiatry (2015 present) On line materials selected from IMR and IMR Pediatrics relevant to Psychiatry On site experiential activities designed to enhance online curriculum Research evaluation Curriculum development iterative design Provide pilot data in conjunction with a national needs assessment Support provided by Weil Foundation, UA Department of Psychiatry and Center for Integrative Medicine

9 IMR Psychiatry: An Iterative Design hours/week experiential didactics plus 1.5 hours/week online integrated more patient cases into year one; added Advanced course for those interested who completed year one Integrative Psychiatry Track (added 5 hours/week of clinic plus 2 hours/week clinical supervision; increased number of one way mirror intakes)

10 IMR Psychiatry Goals Enhance evidence based knowledge of integrative medicine in psychiatry practice Improve doctor patient relationship Enhance resident physician wellness, career satisfaction Improve patient care outcomes

11 IMR Psychiatry Participation Requirements Eligibility: 3 rd and 4 th year Psychiatry Residents and 1 st and 2 nd year Child & Adolescent Psychiatry Fellows Up to 10 residents and fellows selected per year One year curriculum with possible extension of a 2 nd year Certificate awarded upon program completion

12 IMR Psychiatry Participation Requirements, Cont d Application Process Letter of interest Interview with Integrative Psychiatry Faculty Approval of residency/fellowship Training Director Time Commitment One year commitment with possibility of extension to Advanced Integrative Psychiatry in year 2 10 hours a week 2 hours in person experiential didactics 1.5 hours interactive on line learning modules 7 hours outpatient clinical integration

13 IMR Psychiatry Online Course Content

14 IMR Psychiatry Online Syllabus

15 IMR Psychiatry Online Syllabus, Cont d

16 IMR Psychiatry Online Syllabus, Cont d

17 IMR Psychiatry On site Experiential Syllabus Mind Body Skills Groups 2 hour sessions for 10 weeks at beginning of the academic year, with 4 booster sessions Small group of up to 10 residents and fellows Includes: Meditation, biofeedback, guided imagery, movement, and selfexpression activities Lead by a community professional facilitator not in supervisory position Goals: Self care, self awareness, community building, experience tools before applying to clinical setting Model base: Center for Mind Body Medicine ( Demonstrated effectiveness on reducing burnout in medical students and physicians, and PTSD in adults and adolescents

18 On site Experiential Syllabus, Continued Nutrition and microbiome Supplements in Psychiatry CNT and Qi Gong Acupuncture Herbal medicine Environmental psychiatry Indigenous healing practices Exposure to therapy modalities Somatic Experiencing (SE) Accelerated Resolution Therapy (ART) Internal Family Systems (IFS) Therapeutic Yoga Biofeedback and Neurofeedback Integrative treatment of chronic pain Journal clubs, case discussions Community services (ITK, TCA)

19 On site Experiential Syllabus, Continued Role play how to advise patients on: Nutrition Physical activity Botanicals Supplements Mind body medicine skills Motivational interviewing skills Spirituality

20 Course Content, Continued Scholarly project Reflection paper Literature review paper Final exam

21 Clinical Integration Educational Intakes at Integrative Psychiatry Clinic Trainee and faculty interview patient One way mirror observation Case formulation and discussion Literature search Write up and feedback 1 2 intakes per month in Integrative Psychiatry Clinic as part of PGY3 training requirements

22 Advanced Integrative Psychiatry PGY4 Residents or Child and Adolescent Psychiatry Fellows Requirement: ½ day per week clinical commitment Participate in teaching residents and medical students Didactics and clinical case discussions Grand Rounds, case report, or other scholarly project Participate in quality improvement

23 Assessment Measures Pre and Post Knowledge Assessment Trainee wellbeing measures Baseline measure, at 3 months (after MBSG), and at one year Includes: Lifestyle and behavior measure Maslach Burnout Inventory CES D Empathy Scale Emotional Reactivity Scale Gratitude Scale Qualitative anonymous feedback on the curriculum Written Interviews

24 Participation To Date Now in year 3 of pilot 24 participants for IMR Psychiatry I 6 participants for IMR Psychiatry II 3 participants withdrew 87% attendance rate for experiential sessions 96% completed online curriculum requirements

25 Wellbeing outcomes from Baseline to Mid course Outcome Group N Baseline Mid Course Group*Time SIG MBI EE IM CONTROL MBI DEP IM CONTROL Mindfulness IM CONTROL Gratitude IM CONTROL PSS IM CONTROL SWLS IM CONTROL

26 Wellbeing outcomes from Baseline to Post course Outcome Group N Baseline Post Course Group*Time SIG Past Month IM CONTROL Current Moment IM CONTROL Physical IM CONTROL Emotional IM CONTROL Spiritual IM CONTROL Social IM CONTROL

27 Qualitative Results Interviews Interviewed 11 resident/fellows All agreed: They would recommend this elective to another psychiatry trainee. Participation in the elective is feasible (considering other requirements of Psychiatry residency) The online curriculum alone would be inadequate. In person experiential sessions were important for facilitating clinical application. On line curriculum contained helpful references to scientific evidence. Online and experiential components complemented and reinforced one another

28 Qualitative Results Interviews, Cont d Participant Outcomes Implementation into personal lives Several noted challenges for clinical implementation Recommendations: More clinical integration Time set aside for online learning Continue both components Response: Increased allotted time from 3.5 hours to 10 hours/week Clinical integration, time for online work, group supervision

29 Next Steps Continue UA pilot July 1, 2015 present Invite other sites to join pilot Pending publication of national psychiatry residency training director needs assessment results On going development of curriculum Bring together psychiatry faculty committed to expand Integrative Psychiatry for residency training programs

30 Thank you! Amelia Villagomez, M.D. (Co Director of Integrative Psychiatry Track) University of Arizona Department of Psychiatry Kathy Smith, M.D., Julie Demetree, M.D., Jason Curry, D.O., Saira Kalia, M.D., Ole Thienhaus, M.D. and support staff University of Arizona Center for Integrative Medicine Audrey Brooks, Ph.D., Mari Ricker, M.D., Patricia Lebensohn, M.D., Hilary McClafferty, M.D., Victoria Maizes, M.D., and web development staff Matt Erb, P.T. and Center for Mind Body Medicine The Weil Foundation

31 Bibliography Gordon JS. Mind body skills groups for medical students: reducing stress, enhancing commitment, and promoting patient centered care. BMC Med Educ. 2014;14: Gordon, James S., Staples, Julie K., Blyta, Afrim, Bytyqi, Murat and Wilson, Amy T. Treatment of Posttraumatic Stress Disorder in Postwar Kosovar Adolescents Using Mind Body Skills Groups: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 2008 Sep;69 (9): Lebensohn P, Kligler B, Brooks A, Teets R, Birch M, Cook P, et al. Integrative Medicine in Residency: Feasibility and Effectiveness of an Online Program. Fam. Med. 2017;49: Lebensohn P, Kligler B, Dodds S, Schneider C, Sroka S, Benn R, et al. Integrative medicine in residency education: developing competency through online curriculum training. J. Grad. Med. Educ. [Internet]. 2012;4: McClafferty H, Vohra S, Bailey M, et al. Pediatric Integrative Medicine. Pediatrics. 2017;140(3):e McClafferty H, Dodds S, Brooks A, Brenner M, Brown M, Frazer P, et al. Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum. Children [Internet]. 2015;2: Staples, J.K., Abdel Atti, J.A., Gordon, J.S., (2011). Mind body skills groups for posttraumatic stress disorder and depression symptoms in Palestinian children and adolescents in Gaza. International Journal of Stress Management. 18(3) West CP, Dyrbye LN, Rabatin JT, et al. Intervention to Promote Physician Well being, Job Satisfaction, and Professionalism. JAMA Intern Med. 2014;174(4):527.

32 Questions? Noshene Ranjbar, M.D. University of Arizona Department of Psychiatry