Integrative Medicine in Residency Psychiatry Noshene Ranjbar, M.D. Assistant Professor of Psychiatry University of Arizona
MDC1 Disclosure Statement Noshene Ranjbar has indicated no financial relationships with any commercial interest relevant to this activity.
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
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
Psychiatry Residency Education ACGME requires training in: Self awareness Empathy Professionalism Knowledge of evidence base in CAM Knowledge of herb drug interactions Cultural competency
Integrative Medicine Lake J, Helgason C, Sarris J, MHSc. Integrative Mental Health (IMH): Paradigm, Research, and Clinical Practice. 2012; 8.
Integrative Medicine in Residency (IMR) Family Medicine Internal Medicine Preventive Medicine OB Pediatrics Psychiatry
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
IMR Psychiatry: An Iterative Design 2015 2016 2 hours/week experiential didactics plus 1.5 hours/week online 2016 2017 integrated more patient cases into year one; added Advanced course for those interested who completed year one 2017 2018 Integrative Psychiatry Track (added 5 hours/week of clinic plus 2 hours/week clinical supervision; increased number of one way mirror intakes)
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
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
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
IMR Psychiatry Online Course Content
IMR Psychiatry Online Syllabus
IMR Psychiatry Online Syllabus, Cont d
IMR Psychiatry Online Syllabus, Cont d
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 (www.cmbm.org) Demonstrated effectiveness on reducing burnout in medical students and physicians, and PTSD in adults and adolescents
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)
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
Course Content, Continued Scholarly project Reflection paper Literature review paper Final exam
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
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
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
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
Wellbeing outcomes from Baseline to Mid course Outcome Group N Baseline Mid Course Group*Time SIG MBI EE IM 13 18.9 21.2 0.22 CONTROL 11 23.3 20.5 MBI DEP IM 13 8.1 6.7 0.86 CONTROL 11 8.1 6.4 Mindfulness IM 13 37.5 39.3 0.62 CONTROL 11 36.5 37.1 Gratitude IM 13 37.2 39.0 0.098 CONTROL 11 37.4 39.0 PSS IM 13 15.7 15.6 0.81 CONTROL 11 15.5 16.0 SWLS IM 13 26.1 26.2 0.72 CONTROL 11 22.8 23.7
Wellbeing outcomes from Baseline to Post course Outcome Group N Baseline Post Course Group*Time SIG Past Month IM 12 5.4 6.5 0.04 CONTROL 7 5.9 5.6 Current Moment IM 12 5.6 6.4 0.84 CONTROL 7 5.6 6.3 Physical IM 12 4.6 5.9 0.16 CONTROL 7 4.9 5.1 Emotional IM 12 5.3 6.7 0.002 CONTROL 7 6.4 5.0 Spiritual IM 12 4.3 5.6 0.15 CONTROL 7 5.3 5.4 Social IM 12 4.9 5.9 0.72 CONTROL 7 5.0 5.7
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
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
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
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
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Questions? Noshene Ranjbar, M.D. University of Arizona Department of Psychiatry noshene@psychiatry.arizona.edu 520 241 8677