Alpert Medical School of Brown University Clinical Psychology Internship Training Program Rotation Description

Transcription

1 Rotation Title: Location: Rotation Supervisor(s): Behavioral Medicine Obesity Clinical-Research Focused The Miriam Hospital Graham Thomas, Ph.D. (Primary Research Mentor) Carly Goldstein, Ph.D. Stephanie Czech, Ph.D. Julie Boergers, Ph.D Richard Millman, M.D. 1 Overview of the Rotation: The Obesity clinical-research rotation is a focused 12-month long experience providing concentrated clinical-research training in the specialty area of obesity. During the first eight months of training, time is spent as follows: 50% obesity clinical-research, 20% integrated primary care, 20% pediatric sleep training, and 10% didactics. In the last four months of training, time is spent as follows: 60% obesity clinical-research, and 40% behavioral medicine or out-of-track clinical experience. This research- focused rotation takes place primarily at The Miriam Hospital s Weight Control and Diabetes Research Center. The aims of the research within the Center are to expand knowledge of the causes and consequences of obesity, develop innovative and effective treatments for weight loss and weight maintenance, and offer quality obesity treatment to the community through ongoing clinical trials. The clinical psychology resident will participate in ongoing studies related to these areas, the development of grants and manuscripts and the facilitation of clinical research weight management groups. Clinical psychology residents on this rotation will also receive broad training in behavioral medicine areas through assessment, treatment and consultation activities within integrated primary care and pediatric sleep experiences. The clinical activities on this rotation are designed to provide training that can complement the resident s research in obesity while also enhancing the clinical psychology resident s exposure to broad based behavioral medicine training. Primary Care Behavioral Health in Family Medicine Behavioral health consultants on the primary care team at Memorial Hospital of RI (MHRI) provide brief behavioral health assessments and interventions directly in the Family Care Center, the primary care setting. Evaluations and consultations are either scheduled or occur as a "warm handoff" from a primary care provider who has identified the patient in need of behavioral health services. The approach to care is 1

2 brief and targeted. Although the Family Care Center serves patients of all ages, referrals to the Behavioral Health service has been traditionally focused on adolescents, young adults, and adults. The referral questions are for assessment, intervention, and/or care facilitation in context of a variety of problems including depression, anxiety, adjustment issues, and health behavior change, particularly in the context of chronic medical disease. Interventions emphasize evidence-based treatments such as cognitive behavioral therapy, ACT, motivational enhancement therapy, and as needed, family/group treatments. When appropriate, referrals to specialized behavioral health settings are made for longer term or more intensive intervention and management. Residents in this supplemental rotation will be expected to move toward clinical independence commensurate with their level of experience and expertise. The rotation includes the opportunity to participate in and lead provider wellness activities, such as mindfulness meditation, occurring on a weekly basis within the clinic. Didactic experiences (e.g., readings, on-line lectures) will be arranged on an individual basis in accordance with the resident's background and needs. Pediatric Sleep Disorders Program The Pediatric Sleep Disorders Clinic is a multidisciplinary program providing comprehensive assessment and treatment of child and adolescent sleep problems. The staff of the Sleep Disorders Center includes psychologists, pulmonologists and sleep technicians. Typical presenting problems include bedtime refusal, insomnia, difficulty maintaining sleep, delayed sleep phase, sleepwalking, sleep terrors, nighttime fears, excessive daytime sleepiness, snoring/breathing difficulties, and sleep problems comorbid with medical and psychiatric illness. Trainees will conduct both new patient evaluations and follow-up treatment visits each week. 2 Achievement of Competencies: Ethical and Legal Standards: Competencies in this area will be achieved through the demonstration of ethical practice within all clinical, research, and administrative/ professional activities, as well as discussion of ethical/legal issues during supervision. Professionalism and Self-Awareness: Competencies in this area will be developed by participating as a professional member of the multidisciplinary team, participating in ongoing educational activities, and reflecting on professional roles and responsibilities within the context of supervision. Interpersonal and Communication Skills: Residents will demonstrate competencies in this area through their participation as a professional member of the multidisciplinary team, including opportunities to communicate data, ideas, recommendations, and feedback to others. Assessment and Diagnosis: Competencies in this area will be developed through conducting comprehensive assessments of patients presenting in the integrated primary care and pediatric sleep settings. This may include conducting intake assessment, integrating information from medical records, and differential diagnostics using current DSM criteria. The resident is expected to be able to engage in case formulation, to present their case formulation to the treatment team, and document findings in a manner appropriate to treatment setting. The resident is 2

3 expected to be able to conduct a thorough lethality assessment. Effective Intervention: Competencies in this area will be achieved through conducting individual and/or group therapy within all treatment settings, including the integrated primary care, pediatric sleep, and Weight Control and Diabetes Research Center. Approaches include Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and/or Acceptance and Commitment Therapy (ACT). Treatment goals will be operationalized and evaluated over the course of individual and group-based treatments, and modifications to treatments made based on these results.treatment progress also will be monitored within the clinical research setting. Consultation: Competencies in this area will be achieved through experiences in the integrated primary care and pediatric sleep settings. The resident is expected to function as part of the multidisciplinary treatment team within all settings. Supervision and Teaching: Opportunities may be available for residents to discuss supervision styles, strategies, and important factors in the supervisor/supervisee relationship. The resident typically does not have opportunities to provide direct supervision to others during this rotation. Research and Scholarly Activities: Competencies in this area will be developed through resident participation in the development of grants and manuscripts and the facilitation of clinical research weight management groups. Cultural and Individual Diversity: Competencies in this area will be developed through exposure to diverse patients and families, supervision regarding assessment and treatment considerations relevant to work with diverse populations, and directed readings, when appropriate. 3 Time Commitment: Rotations are structured: First 8 months: 50% Obesity and Diabetes Management Clinical Research 20% Primary Care Behavioral Health in Family Medicine 20% Pediatric Sleep 10% Didactics (journal club, core seminar, Behavioral Medicine track seminar, Grand Rounds) Last 4 months: 60% Obesity and Diabetes Management Clinical Research 40% 3 rd rotation elective The minimum hour requirement is 40 hours per week. 4 Duties & Responsibilities: Regular duties and responsibilities include the following: Outpatient Obesity & Diabetes Management Clinical Research The clinical psychology resident is expected to utilize clinical research time to participate in activities related to expanding knowledge of the causes and consequences of obesity, developing innovative and effective treatments for weight loss and weight maintenance, and offering quality obesity treatment to the 3

4 community through clinical trials. The clinical psychology resident will participate in original and ongoing studies related to these areas, the development of grants and manuscripts and the facilitation of clinical research weight management groups. Primary Care Behavioral Health in Family Medicine: The clinical psychology resident evaluates and treats patients who are referred by the clinic s primary care providers (PCPs) and medical residents for mental health services, and also provides consultation services for medical staff when in the clinic. Residents are also responsible for co-leading an anxiety and stress management group, occurring twice per month. Trainees will complete written documentation of these clinical and group visits in the medical record in a timely fashion. Pediatric Sleep Disorders Clinical psychology residents are responsible for conducting both new patient evaluations and follow-up treatment visits each week during clinic time. Trainees will complete written documentation of these clinical visits in the medical record in a timely fashion. Research Fifty percent of the experience will occur in a research setting (Weight Control and Diabetes Research Center). At least 25% total time (10 hours) will involve clinical experience in the research setting and at least half that time (5 hours) will involve direct contact with patients/clients/participant in the research setting. The research experience outside of the described clinical activities will involve identifying and researching a topic that the clinical psychology resident chooses to study, developing a thorough background of the literature related to that topic and beginning to draft a grant application on that topic. The clinical psychology resident will also be expected to participate in a weekly journal club and write at least one empirical paper with other faculty members of the research group. 5 Time Table: The clinical psychology resident will spend one day per week at Memorial Hospital, and another day per week in Pediatric Sleep Clinic. The clinical psychology resident will spend 2.5 days per week in clinical and research activities at the Weight Control and Diabetes Research Center. Additionally the resident will attend all required seminars and meet with supervisors for weekly supervision sessions. 6 Methods of Teaching: The primary modalities of teaching include role modeling, feedback, and one-to-one didactic instruction. Reading material is provided on a case-by-case basis, when indicated. 7 Treatment Units of Programs Involved: Weight Control and Diabetes Center, Pediatric Sleep Disorders Program (Hasbro Pediatric Specialties satellite clinic at 900 Warren Ave. in East Providence), Memorial Hospital Department of Family Medicine (111 4

5 Brewster St, Pawtucket RI). 8 Supervision: Outpatient Obesity & Diabetes Management Clinical psychology residents receive supervision from Dr. Graham Thomas and Carly Goldstein. Clinical psychology residents co-lead groups with experienced weight loss interventionists and complete behavioral evaluations. Residents participate in staffing and receive individual supervision. There is at least 1 hour of supervision weekly with Drs. Thomas and Goldstein. The clinical psychology resident is also expected to attend a 1 hour weekly meeting with all faculty at the Weight Control and Diabetes Research Center. Primary Care Behavioral Health in Family Medicine Clinical psychology residents receive a minimum of one hour of individual direct supervision per week with Dr. Stephanie Czech. Additional supervision will include direct observation in conducting assessment and interventions, informal feedback before and after patient sessions, and co-leading therapy and group sessions. Pediatric Sleep Disorders Clinical psychology residents receive a minimum of one hour of individual supervision weekly with Dr. Julie Boergers. Additional supervision will be provided by Dr. Richard Millman. 9 Relationships to Core Programs: Training in this Rotation reflects the overall philosophy of the Brown Internship Program, which is based on the clinical science model. In addition to the outlined duties and responsibilities specific to the rotation, release time allows for attendance at various seminars, educational opportunities, additional clinical rotations, and a research placement. 10 Designation of Key Liaison Personnel: Graham Thomas, Ph.D., Primary Research Mentor Karen Oliver, Ph.D., Health Psychology/Behavioral Medicine Track Coordinator Elizabeth McQuaid, Ph.D., ABPP, Director, Clinical Psychology Internship Training Program 11 Criteria for Success: Successful residents will achieve ratings of Satisfactory Progress on all competencies that are available within this rotation. Plans will be made for residents to obtain further training, supervision, and/or remediation to address competencies that are rated as Needs Improvement or are otherwise identified as areas that 5

6 require additional emphasis in training. This rotation will be one of several that is considered in an overall determination of resident "competence" at the completion of the internship period. 6