Biological Mediators Between Psychological and Social Factors and Health |
Describe how behavioral and social factors and stress alter physiology to make disease more likely and the interconnectivity of homeostatic systems. |
Explain the relationship between chronic stress, affective illness, social support, and health. |
Psychological, Social, and Behavioral Factors in Chronic Illness |
Understand the interrelationship between psychological, social, behavioral, and lifestyle factors and particular chronic medical conditions (e.g., diabetes, coronary artery disease [CAD], arthritis, cancer). |
Understand and predict ongoing risky health behaviors. |
Describe how to recognize stress in chronically ill patients. |
Psychological and Social Aspects of Human Development That Influence Disease and Illness |
Recognize the various life cycle theories (Freud, Piaget, Erikson, Bowlby) in normal development and the Epigenetic Principle of Life Cycle Theory. |
Understand the interplay between stages of human development and disease states. |
Psychological Aspects of Pain |
Understand the wide range of psychosocial and cultural factors that influence the perception and expression of pain. |
Be familiar with the classic gate control and contemporary theories of pain. |
Perform a functional analysis of patients with chronic pain. |
Describe the multimodal treatments for pain control. |
Recognize the physician biases that influence the treatment of pain. |
Psychological, Biological, and Management Issues in Somatization |
Understand the definition, prevalence, common symptoms, and underlying affective illnesses associated with somatization. |
List the diagnostic criteria for somatoform disorders. |
Reflect on personal reactions to patients presenting with possible somatoform disorders. |
Interactions Among Illness, Family Dynamics, and Culture |
Understanding family and cultural influences on patient’s interpretation of illness and treatment decisions and the importance of eliciting such information. |
Domain: Patient Behavior |
Health Risk Behaviors |
Understand the psychological factors associated with the development and maintenance of behaviors associated with major causes of morbidity and mortality. |
Demonstrate the ability to assess patients for health risk behaviors. |
Understand key strategies for prevention and cessation of these behaviors. |
Reflect on the role of health care providers in instigating and maintaining changes in these behaviors. |
Apply principles of motivational interviewing and counseling for behavioral change to the patient care situations. |
Principles of Behavior Change |
Demonstrate the ability to apply the various models (classical conditioning, cognitive social learning theory, health belief model, theory of reasoned action, stage-of-change model) available for guiding behavior change. |
Understand how behaviors are acquired, maintained, and eliminated in the context of health risk. |
Understand patient, family, and sociocultural variables that impact motivation to change behavior. |
Impact of Psychosocial Stressors and Psychiatric Disorders on Manifestations of Other Illness on Health Behavior |
Recognize the association between, and co-occurrence of, chronic medical illness and mental disorders. |
Know and be able to discuss with patients the range of treatment options when medical and mental illness coexist. |
Know the role of a primary care physician and specialist in the treatment when medical and mental illness coexist. |
Demonstrate the ability to screen patients for depression. |
Understand the pathogenetic relationships between depression and comorbid conditions. |
Domain: Physician Role and Behavior |
Ethical Guidelines for Professional Behavior |
Analyze ethical and professional dilemmas faced by health care professionals. |
Identify and apply guidelines of ethical decision making. |
Personal Values, Attitudes, and Biases as They Influence Patient Care |
Describe how the effect of family of origin, cultural background, gender, life experiences, and other personal factors may influence your attitudes toward emotional reactions to patients. |
Identify methods for processing the highly emotional encounters that regularly occur in medical care. |
Physician Well-Being |
Recognize risk factors and warning signs for mental health issues in yourself. |
Develop personal wellness strategies. |
Social Accountability and Responsibility |
Engage in activities that foster the development of socially responsible leadership skills. |
Recognize the ever-changing health care needs of the community, region, and/or nation you serve. |
Work in Health Care Teams and Organizations |
Recognize the contribution that each member of the health care team has to offer. |
Identify ways to work effectively as a part of the team. |
Use of and Linkage With Community Resources to Enhance Patient Care |
Identify available community resources in the patient’s community. |
Demonstrate a working knowledge of the types of interventions offered. |
Domain: Physician–Patient Interactions |
Basic Communication Skills |
Demonstrate basic communication skills including, establishing rapport and building trust, eliciting adequate information to permit a robust differential diagnosis, understanding, and addressing patient. |
Understand how to engender (and potential barriers to development of) a therapeutic relationship. |
Demonstrate ability to express empathy, actively listen, elicit information about patients’ lives and reasons for medical visit. |
Demonstrate motivational interviewing techniques and the 5 A’s counseling skills. |
Complex Communication Skills |
Demonstrate ability to communicate effectively in contextual (cultural, translator, family) and developmental (pediatric, adolescent, geriatric) interview situations. |
Demonstrate ability to communicate effectively in assessment and counseling situations. |
Practice basic skills in communicating effectively in challenging situations using principles of patient-centered interviewing. |
Practice basic skills in communicating effectively with colleagues using principles of relationship-centered communication. |
Context of a Patient’s Social and Economic Situation, Capacity for Self-Care, and Ability to Participate in Shared Decision Making |
Demonstrate an awareness of the patient’s ability to participate in decision making. |
Identify necessary resources available to ensure access to care. |
Management of Difficult or Problematic Physician–Patient Interactions |
Describe approaches to working with patients in difficult situations. |
Identify taxonomy of difficult interviews (including personal or sexual history taking; abusive relationships; patients with HIV; breaking bad news). |
Identify key characteristics of difficult patient encounters, including personality types and stressful situations. |
Identify and use basic skills of patient-centered interviewing to ask sensitive questions and listen respectfully and nonjudgmentally. |
Domain: Social & Cultural Issues in Health Care |
Impact of Social Inequalities in Health Care and the Social Factors That are Determinants of Health Outcomes |
Analyze the intricate relationship that social factors (race, ethnicity, education, income, and occupation) have with patients’ health. |
Reflect on the impact your (students’/physicians’) own social views can have on the delivery of effective health care. |
Cultural Competency |
Describe the impact the cultural context of illness can have on a successful patient–physician relationship. |
Recognize ways that cultural competency encompasses language, customs, values, belief systems, and rituals. |
Role of Complementary and Alternative Medicine |
Describe complementary and alternative medicine treatments available in the local community and within local ethnic/cultural groups. |
Recognize and apply required skills for eliciting information from patients seeking or using alternative treatment methods. |
Describe to patients the efficacy and safety of alternative methods of treatment. |
Domain: Health Policy & Economics |
Overview of the US Health Care System |
Appreciate the magnitude of the investment in health care services made by individuals and organizations in the United States, the impact of these expenditures on individuals and on organizations, and the limited “return on investment.” |
Explain why competition and other “market forces” may not work in health care. |
Use state-of-the-art utilization controls within the TBL scenario in an attempt to allocate financial resources to critical sectors of care. |
Economic Incentives Affecting Patients’ Health-Related Behaviors |
Appreciate how patients’ values and life circumstances may affect their motivations for health-supporting behaviors, health care utilization, and preference for outcomes of health care. |
Use this understanding to predict a patient’s response to a complex and costly plan of care for several concomitant, chronic conditions, including the need to choose among therapeutic alternatives, adherence challenges, and patient-based assessments of risk. |
Outline potential physician actions in this situation that might preserve the essential ingredients of effective care. |
Costs, Cost-effectiveness, and Physician Responses to Financial Incentives |
Appreciate how “delivery system” income is allocated to sectors of cost, using a microsystem model as an exemplar. |
Apply this understanding, together with a statement of practice objectives, to develop the key elements of the practice in a financial context—staffing, services provided, in-office equipment, patients accepted, relationship to payers. |
Variations in Care |
Appreciate how large the variations in practice are, even in the presence of generally accepted evidence-based guidelines for care, and what some of the determinants of those variations might be. |
Apply this knowledge to a specific case example, decide what “unwanted” variation means in this situation, and design a plan of action to eliminate this variation. |