Content area
Full Text
Objective; Since Engel introduced the biopsychosocial model, it has been extensively examined.The authors expect psychiatrists to formulate cases using the biopsychosocial model. However, resident psychiatrists' ability to generate formulations using this model has received little attention. Methods: The authors evaluated resident biopsychosocial formulations using biopsychosocial scores from trained, blinded raters across four institutions. Second, the authors determined if an intervention could improve biopsychosocial formulation. Design: This study included nonexperimental and pre-post components using resident portfolio scores to measure biopsychosocial. Participants/Setting: Residents from four postgraduate years (PGY) in four different programs participated. In one institution, faculty made a concerted effort to improve biopsychosocial formulation. There were 33 entries in 2000-2001 and 46 entries in 2001-2002. Results; Using the combined data from all institutions, no PGY level averaged a rating of 3.0 (competent) in either year. In the institution implementing an intervention, a significant improvement was noted. Conclusion: This pilot study indicates that we can improve resident competency in this area. (Academic Psychiatry 2004; 28:88-94)
Since Engel's 1960 publication of "A Unified Concept of Health and Disease" (1) and his 1977 publication entitled "The Need for a New Medical Model: A Challenge for Biomedicine" (2), psychiatry and other medical specialties have recognized the need to approach patient care in an integrative rather than reductionistic fashion, now known as the biopsychosocial model. The biopsychosocial model is a widely accepted style of synthesizing information to develop a case formulation. Over the years, numerous authors have discussed issues related to the model (3-5), teaching the model (6-10), and the model's application (11). Some authors have debated whether an actual model exists (12, 13), as opposed to a theory or an idea. To our knowledge, however, there are no publications that rebuff the concept of incorporating biological, psychological, and sociocultural factors to formulate cases and promote better health outcomes for individual patients as well as to gain better understanding of patients and more insight into the disease process. Indeed, few have or would dispute Len Sperry's assertion that "the ability to conceptualize and write succinct case formulations is considered basic to daily clinical practice" (14).
In addition to the benefits that competent case formulation brings to clinical practice, the American Board of Psychiatry and Neurology (ABPN) includes case formulation...