Family Medicine Residency Gains Federal Training Grant

By Dirk Hoffman

The five-year, $2.5 million award from the Health Resources & Services Administration (HRSA) is under the Primary Care Training and Enhancement - Residency Training in Mental and Behavioral Health (PCTE-RTMB) program.

The purpose of the PCTE-RTMB program is to train primary care residents in the prevention, identification, diagnosis, treatment and referral of services for mental and behavioral health conditions for pediatric, adolescent, young adult and other populations who are at-risk or have experienced abuse, trauma, or mental health and/or substance use disorders, including those related to the effects of gun violence.

The Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo was one of only two dozen entities nationwide to receive the award.

“The Department of Family Medicine has a long history of leveraging HRSA training grants to improve medical student and resident education in the field of family medicine and therefore in the provision of quality medical care to our patients,” says Andrea T. Manyon, MD, clinical professor and chair of family medicine. She is president and CEO of UBMD Family Medicine.

“This training grant serves to advance the skill set of family medicine residents to become fluent with integrating behavioral and mental health care into the everyday primary care practice,” she adds.

The grant effort will be led by project director Sarah Abdelsayed, MD, clinical assistant professor of family medicine and program director of the department’s addiction medicine fellowship; and co-director Andrew B. Symons, MD, clinical professor and vice chair for medical student education within the Department of Family Medicine.

Other project team members from the Department of Family Medicine, and their roles, are:

• Linda S. Kahn, PhD,  research professor in the PCRI —  program evaluator
  
• Jennifer A. Stoll, PhD, research assistant professor and senior research scientist in the PCRI — program coordinator
  
• Tildabeth Doscher, MD, clinical assistant professor — primary care/behavioral health integration specialist
  
• David M. Holmes, MD, clinical associate professor, director of global health education, associate program director, interim medical director and associate clinical chief for ECMC Family Medicine — Erie County Medical Center site lead
  
• Kimberly J. Wilkins, MD, clinical assistant professor —UBMD Family Medicine of Amherst site lead
  
• Robert W. Macek, MD, clinical associate professor and associate program director — family medicine residency program director
  

Health and mental health providers, including the American Academy of Pediatrics, have warned that U.S. children and adolescents are facing a mental health state of emergency that has been exacerbated by the COVID-19 pandemic — a fact that primary care teams are recognizing.

A 2022 report from the Centers for Disease Control and Prevention indicated that 37 percent of teenagers surveyed reported poor mental health during 2020, with 73 percent reporting at least one adverse childhood experience during that time.

UB’s project team will leverage existing mental and behavioral health expertise from UB and its clinical partners, especially for children, adolescents, and young adults, and for rural, underserved, and vulnerable populations to create an enhanced, cohesive, and didactic training curriculum and experiential learning experience for residents, says Steven M. Lamkin, associate director of development for the PCRI.

Team members will utilize evidence-based practice and their expertise in program evaluation, interprofessional education, rural health, health disparity, telehealth, behavioral interventions in primary care, and performance measures and statistical analysis.

The team will collaborate with community-based residency partners, the Universal Primary Care Community Health Center, Jericho Road Community Health Center, ECMC Family Health Center and UBMD Family Medicine of Amherst to develop family medicine resident rotations for a minimum of one month, focusing primarily on mental and behavioral health.

Manyon notes that each week the department’s residents “receive didactic programming that level-sets education across our four tracks: two urban, one suburban and one rural program. This training will be included in the didactics and skills will be refined at the individual sites.”

Abdelsayed says as project director, she “will work with the team to build an impactful training program for family medicine residents in integrated behavioral health practices.”

“The project brings together a collaborative group of minds from various backgrounds, including family medicine educators, community-based researchers, mental health counselors and social workers, and peer recovery specialists,” she notes. “Each team member’s expertise is valued as integral to creating an effective training program. Regular meetings, communication and evaluation for quality improvement will be essential.”

Abdelsayed also says that a host of community partners will be resources for the family medicine residents.

“Our Western New York area prides itself in community. Our partners at behavioral health agencies include BestSelf, DART, ECMC, Endeavor, Evergreen, Horizon Health Services, as well as the Erie County Department of Health and Drug Court system,” she says. “Family medicine residents will engage in interdisciplinary learning environments provided by our community partners.”

Lamkin says the grant will strengthen the Department of Family Medicine’s alignment with the Accreditation Council for Graduate Medical Education’s recent major revisions to program requirements for graduate medical education in family medicine.

“These entail increased training for residents in behavioral health that is integrated within primary care,” he says. “The HRSA reviewers of UB’s grant application noted that the proposed program’s alignment with these changes was a major strength.”

The project’s evaluation team, led by Kahn, will use the grant to advance UB’s research agenda.

Medical education research will focus on changes in family medicine residents’ attitudes toward interprofessional collaboration: teamwork, roles and responsibilities, patient-centeredness, interprofessional biases, diversity and ethics and community-centeredness.

“We will examine changes in residents’ cultural sensitivity and expertise in addressing behavioral health and substance use disorders in primary care patients,” Lamkin says. “An implementation science approach will inform research on the impacts of SBIRT (Screening, Brief Intervention, and Referral to Treatment) training on family medicine practices.”

Residents will also be involved in the research process by undertaking quality improvement projects. They will be mentored and encouraged to disseminate their findings at conference presentations and prepare manuscripts for peer-reviewed journals.

“Dr. Kahn’s expertise as an anthropology researcher in primary care offers an insightful perspective in the evaluation of this training program implementation,” Abdelsayed says. “Dr. Kahn’s role is critical in performing mixed-methods research to evaluate both the quantitative patient-centered outcomes and qualitative experiences of trainees.”

Manyon sees the potential for far-reaching effects of UB’s training program.

“The Primary Care Research Institute has for decades developed the scholarship of clinicians in family medicine and primary care,” she says. “Busy clinicians are not often able to initiate and independently craft research — but in our department, PCRI nurtures and assists in building the portfolio for all department team members.

“By defining, testing and repeating behavioral health training in Buffalo, this thorough dissemination of scholarship can influence residency programs across the country and better the health care for all.”