Implementing a behavioral medicine program in an internal medicine residency: A description of curriculum content,resources and barriers encountered

Abstract

Many internal medicine training programs are currently developing curricula designed to teach the psychosocial aspects of patient care and doctor-patient communication skills. However, faculty may lack expertise regarding how to accomplish new educational goals in these areas. This article is designed to assist programs by describing in detail how a comprehensive behavioral medicine program was integrated into a general internal medicine program at a university-affiliated community hospital. It describes the program goals, resources needed, content included, obstacles to implementation and potential solutions to the problems encountered.     

Testing mediator variables in a resistance training intervention for obese adults with type 2 diabetes

A poor understanding of behaviour change mechanisms has hindered the development of effective physical activity interventions. The aim of this study was to identify potential mediators of change in a home-based resistance training (RT) program for obese individuals with type 2 diabetes. Obese individuals with type 2 diabetes (N?=?48) were randomly allocated to either an RT intervention (n?=?27) or a control group (n?=?21) for the 16-week study period. The study sample included 16 men and 32 women and the mean age of participants was 54.4 (±11.7) years. Participants in the RT group received a multi-gym and dumbbells and home supervision from a certified personal trainer. RT behaviour was measured using a modified Godin Leisure Time Questionnaire. Social-cognitive constructs were measured and tested in a mediating variable framework using a product-of-coefficients test. The intervention had a significant effect on RT behaviour (p?<?0.001) and muscular strength (p?<?0.001). The intervention had a significant effect on RT planning strategies (p?<?0.01), which mediated the effect of the intervention on RT behaviour. The home-based RT program successfully targeted participants’ RT planning strategies which contributed to their exercise adherence.     

Measuring Situation Awareness in Virtual Environment-Based Training

We evaluated the efficacy of a computer-based situation awareness (SA) measurement system for training dismounted infantry SA in an urban terrain virtual reality (VR) simulation. Based on past research, we hypothesized that the SA measures would be sensitive to individual (squad leader) differences, and that the frequency of specific probes would reveal differences in critical SA requirements among scenarios. Three infantry squads performed multiple trials across two different scenarios. A confederate platoon leader posed probes to squad leaders during trials and experts made ratings afterward. Results revealed squad leaders had similar responses to probes, despite differences in combat experience. Analysis of probe frequency revealed different high priority SA elements and decisions for each scenario. The SA behavior and communication ratings revealed differences among squads, which trended with experience. Measures of SA were also consistent across the test scenario as a result of similar mission types and task difficulties. We discuss the implication of our findings for future research and theory within this area.     

PC-Based Game Features That Influence Instruction and Learner Motivation

PC-based games are currently being used for military training, but the instructional and motivational features of such technology are not well understood. To identify features of training games that influence instruction and motivation, a popular first-person-perspective game with a military theme was analyzed empirically. Twenty-one participants played the “basic training” portion of the game, which included Army background information, virtual marksmanship training, an obstacle course, virtual weapons familiarization, and an urban terrain training mission. The results of this research provide useful information to individuals developing training games, desktop simulations, and interactive multimedia courseware to meet optimal training objectives and strategies.     

Transforming Training: A Perspective on the Need for and Payoffs From Common Standards

Standards today position the research community on the eve of scientific breakthrough. Efficiency and warfighter competency are likely to improve greatly as a result of the feedback and research studies enabled by the use of common standards for defining competencies, assessing performance, and enabling technologies to collect data. Such standards make it possible to evaluate warfighter performance across sites and across time. Standards also make it possible to do rigorous comparisons in the lab, operational simulator settings, and even live exercises. The standardized methods and leveraging of common data will yield unprecedented scientific power and opportunity to rapidly transform training.     

The partnership between the Early Intervention Institute,St Petersburg,and the Anna Freud Centre,London

The authors describe study and teaching links between the Early Intervention Institute in St Petersburg and the Anna Freud Clinic in London. Some brief clinical examples from a variety of settings are given as well as a longer case presentation. The impact of widespread institutional care, alcoholism and terrible housing conditions on child mental health are illustrated. This raises questions about the role of child psychotherapy when social conditions are so harsh. The case material indicates that, despite this, children can be helped in some measure to feel more secure, by the therapist providing constancy and reliability within an often frightening and dangerous external world.     

Immediate Effect of Training at the Onset of Reaching in Preterm Infants: Randomized Clinical Trial

The authors' aim was to investigate the immediate effect of a single specific training session (serial varied practice), of short duration on the kinematic parameters of reaching, in the period of the emergence of the skill in preterm and low birth weight infants. The study included 16 infants of both sexes, born at a mean gestational age of 32.13 (±1.36) weeks and mean birth weight of 1720.94 (±358.46) g. The infants were randomly divided into 2 groups: experimental and control. The experimental group was given a 5-min training session in reaching, while the control group received no training. The results showed significant differences in peak velocity in the intra (Z = –2.10, p = .036) and intergroup (U = 9.00, p = .016) evaluations, which decreased in the experimental group after training. Cohen's d test for clinical relevance suggested that the specific, short duration training proved effective in promoting slower reaches, with greater adjustment and lower number of units of movement. These results are positive for preterm infants given that these parameters more closely resemble the typical development of mature reaching behaviors in term infants, which suggests that this protocol of reaching training (serial varied practice) could be used as an evidence-based intervention strategy.     

A Girl's Loyalty to her Mother

This paper explores the alliance between the analytic couple and the analytic process. The patient doesn't ally only with the analyst, but also with the unfolding of an experiential world. The developmental origins of this alliance are described in terms of infant and child being inside a forming intelligence; womb, mother and family—transforming the mental state of the subject. The structure of the experience is pictured by the resemblance to a simple—experiencing—self being inside a dream, and a rhetoric “I” speaking in an internal dialogue to an unanswering, but present, “you”. The writer describes the negative therapeutic reaction as an attempt to break into this forming intelligence; as an attempt to see who is the creator of the experiential universe. Staying inside the unfolding process is further investigated through the experiences of aloneness and presential immediateness.     

Adaptive n-back training does not improve fluid intelligence at the construct level: Gains on individual tests suggest that training may enhance visuospatial processing

Short-term adaptive cognitive training based on the n-back task is reported to increase scores on individual ability tests, but the key question of whether such increases generalize to the intelligence construct is not clear. Here we evaluate fluid/abstract intelligence (Gf), crystallized/verbal intelligence (Gc), working memory capacity (WMC), and attention control (ATT) using diverse measures, with equivalent versions, for estimating any changes at the construct level after training. Beginning with a sample of 169 participants, two groups of twenty-eight women each were selected and matched for their general cognitive ability scores and demographic variables. Under strict supervision in the laboratory, the training group completed an intensive adaptive training program based on the n-back task (visual, auditory, and dual versions) across twenty-four sessions distributed over twelve weeks. Results showed that this group had the expected systematic improvements in n-back performance over time; this performance systematically correlated across sessions with Gf, Gc, and WMC, but not with ATT. However, the main finding showed no significant changes in the assessed psychological constructs for the training group as compared with the control group. Nevertheless, post-hoc analyses suggested that specific tests and tasks tapping visuospatial processing might be sensitive to training.     

On the costs and benefits of directing attention towards or away from threat-related stimuli: A classical conditioning experiment

In attentional bias modification programs, individuals are trained to attend away from threat in order to reduce emotional reactivity to stressful situations. However, attending towards threat is considered to be a prerequisite for fear reduction in other models of anxiety. We compared both views by manipulating attention towards or away from an acquired signal of threat. The strength of extinction and reacquisition was assessed with threat and US-expectancy ratings. We found more extinction in the attend towards threat group, compared to both the attend away from threat group and a control group in which attention was not manipulated. The results are in line with the Emotional Processing Theory and cognitive accounts of classical conditioning.