THE EFFICACY OF INTENSIVE BIOPSYCHOSOCIAL TEACHING PROGRAMS FOR RESIDENTS - A REVIEW OF THE LITERATURE AND GUIDELINES FOR TEACHING

Objective: To review research evaluations of intensive biopsychosocial training programs for nonpsychiatry residents, and determine whether this research showed sufficient rigor and consistent beneficial impact to allow initial research-based teaching guidelines. Data sources: An English-language literature search used MEDLINE (1966-93), Psychologi cal Abstracts (1967-93), and Educational Resource Information Clearing house ( 1966- 93) as well as bibliographic reviews from prominent peer -reviewed articles and consultation with an expert. Study selection: F rom among several hundred articles about biosychosocial training, only 12 studies met the selection criteria: at least 100 contact hours of training for nonpsychiatry residents and an evaluation of efficacy. Da ta extraction: The three authors independently assessed these 12 studi es and made a consensus decision based on explicit criteria. Successfu l and unsuccessful programs were distinguished from among those classi fied as quasi-experimental or experimental to identify programs of suf ficient rigor to meet the study objective; success was defined as lear ning beyond knowledge and residents' acceptance of teaching. Data synt hesis: Four successful quasi-experimental or experimental programs sho wed the following uniquely beneficial features: 1) protected time for residents; 2) teaching that was required, structured, multidimensional , and balanced between learner-centered and teacher-centered approache s; 3) teaching methods that used normal as well as psychosocially dist urbed patients, nonpsychiatrist teachers, and special teaching techniq ues; and 4) inclusion in the curriculum of interviewing, interpersonal skills, doctor-patient relationship, and patient education. Two unsuc cessful quasi-experimental or experimental programs were unidimensiona l and unstructured, and used predominant or isolated teacher-centered approaches. Features found in both successful and unsuccessful program s were experiential teaching, psychiatrist and other mental health pro fessional teachers, use of disturbed patients, training to manage pati ents' psychosocial problems, teaching directed toward knowledge acquis ition, teaching about treatment and university affiliation. Conclusion s: Four rigorously studied, successful programs showed a common patter n of intensive biopsychosocial teaching that produced, in aggregate, i mprovement in residents' knowledge, attitudes, skills, and self-awaren ess. Although there is need for more definitive research, these data a re sufficiently compelling and consistent to provide initial, research -based teaching guidelines.