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Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training

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Abstract

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

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Data are available by contacting the corresponding authors.

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Funding

There is no funding associated with this research.

Author information

Authors and Affiliations

  1. Division of Hematology/Oncology/SCT, Department of Pediatrics, New York Medical College, 19 Skyline Dr, Rm1NH12, Valhalla, NY, 10595, USA

    Lila M. Pereira & Jaya L. Mallela

  2. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Allison J. Carroll & Jason J. Washburn

  3. University of Minnesota Medical School, Minneapolis, MN, USA

    William N. Robiner

Authors
  1. Lila M. Pereira
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  2. Jaya L. Mallela
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  3. Allison J. Carroll
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  4. Jason J. Washburn
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  5. William N. Robiner
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Contributions

LMP: conceptualization of study and methodology development, writing; JLM: data collection, data analysis, writing; AJC: conceptualization of study and methodology development, writing; JJW: data collection, data analysis, writing; WNR: supervision of work, writing, editing.

Corresponding author

Correspondence to Lila M. Pereira.

Ethics declarations

Human and Animal Rights

The study was considered exempt by the IRB at New York Medical College.

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Not applicable.

Conflict of interest

Lila M. Pereira, Jaya L. Mallela, Allison J. Carroll, Jason J. Washburn, and William N. Robiner declare that they have no conflict of interest to disclose.

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Appendix A: Simulation Training Survey

Appendix A: Simulation Training Survey

  1. 1.

    How would you best describe your training institution? (check all that apply)

    1. a.

      Allopathic Medical School

    2. b.

      Osteopathic Medical School

    3. c.

      Academic Health Center

    4. d.

      Private Hospital

  2. 2.

    What do you consider your institution size (based on a marker that is appropriate for your institution, e.g., number of trainees, faculty, and/or hospital beds)?

    1. a.

      Small

    2. b.

      Medium

    3. c.

      Large

  3. 3.

    What type of geographic area is your institution located in? (check all that apply)

    1. a.

      Rural

    2. b.

      Suburban

    3. c.

      Urban

  4. 4.

    What is your program?

    1. a.

      Academic/Medical School

    2. b.

      Residency (list type) (skip to 7)

  5. 5.

    If you listed Academic, which programs/students use your simulation center (check all that apply)

    1. a.

      Medical Students

    2. b.

      Nurses

    3. c.

      Allied Health Professionals (PT, Nutrition, etc.)

    4. d.

      Psychology

    5. e.

      Other Behavioral Health Professionals (Social Worker, Psychiatric NP, Psychiatrist, etc.)

    6. f.

      Residency Programs from affiliated medical center(s)

    7. g.

      Other (list)

  6. 6.

    What type of clinical faculty typically facilitate simulations for your program (check all that apply)

    1. a.

      Physicians within our training program

    2. b.

      Physicians outside of our training program

    3. c.

      Nursing

    4. d.

      Allied Health Professionals (PT, Nutrition, etc.)

    5. e.

      Psychologist

    6. f.

      Other Behavioral Health Professionals (Social Worker, Psychiatric NP, Psychiatrist, etc.)

    7. g.

      Other (list)

  7. 7.

    Do you have integrated team simulations?

    1. a.

      Yes, in person

    2. b.

      Yes, via computer simulation programs

    3. c.

      No

    4. d.

      Currently developing

    5. e.

      Previously had one, no longer offering this training

    6. f.

      Unsure

  8. 8.

    If these simulations take place in person, what faculty facilitate(d) the integrated team simulations (check all that apply)

    1. a.

      Physicians within our training program

    2. b.

      Physicians outside of our training program

    3. c.

      Nurses

    4. d.

      Allied Health Professionals (PT, Nutrition, etc.)

    5. e.

      Psychologists

    6. f.

      Other Behavioral Health Professionals (Social Worker, Psychiatric NP, Psychiatrist, etc.)

    7. g.

      Other (list)

  9. 9.

    Does your training program have behavioral health simulations?

    1. a.

      Yes, in person

    2. b.

      Yes, via computer simulation program

    3. c.

      No

    4. d.

      Currently developing

    5. e.

      Previously had one, no longer offering this training

    6. f.

      Unsure

If you answered “yes” to item nine to in-person behavioral health stimulation trainings, please complete the next set of questions …

  1. 10.

    What faculty facilitate(d) the behavioral health simulations (check all that apply)?

    1. a.

      Physicians within our training program

    2. b.

      Physicians outside of our training program

    3. c.

      Nurses

    4. d.

      Allied Health Professionals (PT, Nutrition, etc.)

    5. e.

      Psychologists

    6. f.

      Other Behavioral Health Professionals (Social Worker, Psychiatric NP, Psychiatrist, etc.)

    7. g.

      Other (list)

  2. 11.

    What types of trainees participate in behavioral health simulations (check all that apply)?

    1. a.

      Medical Students

    2. b.

      Medical Residents from our training program

    3. c.

      Medical Residents from outside our training program (note: if these trainees are from a Psychiatry program, please choose option “G”)

    4. d.

      Nursing Students

    5. e.

      Allied Health Trainees (PT, Nutrition, etc.)

    6. f.

      Psychology Trainees

    7. g.

      Other Behavioral Health Trainees (Social Worker, Psychiatric NP, Psychiatrist, etc.)

    8. h.

      Dental

    9. i.

      Genetics

    10. j.

      Rehabilitation Therapies (e.g., Speech Therapy, Occupational Therapy, Physical Therapy)

    11. k.

      Other (list)

  3. 12.

    Do psychology faculty contribute to the design of the simulation (Y / N / Possibly in future (PIF)/Unsure)

  4. 13.

    Do psychology faculty contribute to the implementation of the simulation (Y / N/PIF/ Unsure)

  5. 14.

    Do psychology faculty contribute to the evaluation of the simulation (Y / N /PIF/ Unsure)

  6. 15.

    How do faculty evaluate the simulation? (Check all that apply)

    1. a.

      Pre-post knowledge based test

    2. b.

      Qualitative feedback

    3. c.

      Standardized scoring as completed by facilitator of trainee behavior

    4. d.

      Questionnaire developed by training staff

    5. e.

      Questionnaire as obtained from simulation training literature (Write in Name)

  7. 16.

    Do psychology faculty contribute to research surrounding the simulation (Y / N/ PIF/ Unsure)

  8. 17.

    Does your training program have integrated behavioral health simulations (Note: Integrated as defined by behavioral health and medical providers working together to care for patients’ overall health and well-being)

    1. a.

      Yes

    2. b.

      No

    3. c.

      Currently developing

    4. d.

      Previously had one, no longer offering this training

    5. e.

      Unsure

If you answered “yes” to in-person integrated behavioral health simulation training, please complete the next set of questions …

  1. 18.

    What faculty facilitate(d) the integrated behavioral health simulations (check all that apply)?

    1. a.

      Physicians within our training program

    2. b.

      Physicians outside of our training program

    3. c.

      Nurses

    4. d.

      Allied Health Professionals (PT, Nutrition, etc.)

    5. e.

      Psychologists

    6. f.

      Other Behavioral Health Professionals (Social Worker, Psychiatric NP, Psychiatrist, etc.)

    7. g.

      Other (list)

  2. 19.

    What types of trainees participate in integrated behavioral health simulations (check all that apply)?

    1. a.

      Medical Students

    2. b.

      Medical Residents from our training program

    3. c.

      Medical Residents from outside our training program (note: if these trainees are from a Psychiatry program, please choose option “G”)

    4. d.

      Nursing Students

    5. e.

      Allied Health Trainees (PT, Nutrition, etc.)

    6. f.

      Psychology Trainees

    7. g.

      Other Behavioral Health Trainees (Social Worker, Psychiatric NP, Psychiatrist, etc.)

  3. 20.

    Do psychology faculty contribute to the design of the simulation (Y / N/ PIF/ Unsure)

  4. 21.

    Do psychology faculty contribute to the implementation of the simulation (Y / N/ PIF/ Unsure)

  5. 22.

    Do psychology faculty contribute to the evaluation of the simulation (Y / N/ PIF/ Unsure)

  6. 23.

    How do faculty evaluate the simulation? (Check all that apply)

    1. a.

      Pre-post knowledge based test

    2. b.

      Qualitative feedback

    3. c.

      Standardized scoring as completed by facilitator of trainee behavior

    4. d.

      Questionnaire developed by training staff

    5. e.

      Questionnaire as obtained from simulation training literature (Write in Name)

  7. 24.

    Do psychology faculty contribute to research surrounding the simulation (Y / N/ PIF/ Unsure)

  8. 25.

    Are you familiar with the NIMH/Center for Integrated Health Solutions Integrated Levels of Care (Y / N)

  9. 26.

    If you are a respondent from a residency program, using the guidelines (https://www.thenationalcouncil.org/wp-content/uploads/2020/01/CIHS_Framework_Final_charts.pdf?daf=375ateTbd56), what level of integration would you say your program has (Options are levels with title)

    1. a.

      1—Minimal Collaboration

    2. b.

      2—Basic Collaboration at a Distance

    3. c.

      3—Basic Collaboration Onsite

    4. d.

      4—Close Collaboration Onsite with Some System Integration

    5. e.

      5—Close Collaboration approaching an Integrated Practice

    6. f.

      6—Full Collaboration in a Transformed/Merged Integrated Practice

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Pereira, L.M., Mallela, J.L., Carroll, A.J. et al. Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training. J Clin Psychol Med Settings (2024). https://doi.org/10.1007/s10880-024-10015-7

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