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Behavioral science curricula for general internal medicine: Leading the fearful and preaching to the converted
129s
Symposia
S22
S23
Structure quality ofmental health care systems in Europe Recent changes in the lIungarin menial health eire oystem.
How to teach psychosocial skills to general practitioners? TEACHING PSYCHOSOMATIC MEDICINE· A TWO YEAR CURRICULUM FOR POST·GRADUATE CLINICIANS
Furedy,Janos (Budapest/Hungary) Oaus Buddebcrg, ZurIch. Swltzer/and.
Hungary is with ist ca 10 millions of inhabitants one of the smaller Europeancountry With a glorious past. Allthoug according to its Imageas a rural country more than the half of the inhabitants live in the five biggest tOWIIS. Before the political change during the last decade because of the communistic ideology the mental health area was widely neglected by the Hungarian Government. Inpatient care was provided by bigger state hospitals. whereas the outpatients eare has been provided by governmental outpatients clinic. Since the political change and increasing number of psychiatristsbegin to work in private practice and postgraduate training IS improving. However, because of its famous psychoanalytical tradition for instance Ferency and Balint have been of Hunganan offspringpsychotherapeutic thinking has maintained in our county The orientation of Hungarian psychiatry has been directed more to Germany than to other countries. Now decentralization of hospital care as one form of reforms in Hungarian psychiatry is advancing, though the lack of finances 's tremendous and the main obstacle to promote reforms quicker. The main part of psychiatrists is concentrated in the tOWIIS with the result of poor outpatient facility equipment in the rural areas A concept of improving the situation WIll be presented.
How to teach psychosocial skills to general practitioners? 'tHAVIORAL SCIENCE CURRICULA PORCENERAL INTERNAL MEDICINE: LI.ADlNG THE P'EARnJL AND PREACHING TO THE CONVERTED
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S23
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2S to 30%of the patients seen in a general practitioner's office suffer from psychosomaticdisorden. In Swirzer1and there Is no slrUClured teaching of a psychosomatic approach to illness, neither in medical school nor during postgraduate training. In this presentation experiences with a two year training program in psychosomatic medicine for post-graduate clinicians arc reported. The training program has three parts: Part one consists of 12 training days over a two year period given in seminan with lecturesand case presentations using videotapes, one way mirror as well as role plays. Part two is case supervisionin small groups. In part dircc participantsarc taught and get experiences in a self relaxation technique. In our opinion the two year curriculum serves as a model and example for a certified training in ·Psychomatic Medicine·. The participanlS can benefitfrom their training in various ways: with regard to the organization and atmosphere of their practice, In respect of improvedcommunication skills when treating patients and advanced small group Interaction skills. We have just finished die second course and we received excellent feed-back from most of the participants.
S23
How to teach psychosocial skills to general practitioners? GETrING MEDICAL SPECIALISTS PSYCHOSOCIAL CARE: A ROLE INTERNISTS?
INVOLVED IN FOR GENERAL
P Cathebras Service de Medicine Interne. H6pltaux de SI Ellennt.
42055 St Etienne. France Intemalmedicine holdsa spccia1 positionin France. Confined 10 tertiary care settings, It is considered as a speciality among other medical specialities. In the rreantUre. intemislS favoura 'holistic'perspectivevery similar to the GP's approach.and opposed to most specialists' pointof view. Sinceconsultation-liaison psychiatry is poorly developed inmany hospitals. internists sometUres have to act as consultants for clinical problems situated outside the organ specialities domain, including 'psychosomatic' problems.This meansthat internistshave a specialrolc in educating their fellow specialists on emotional factors In physical disease, attentionto psychosocial context, patient-centred approach and emphasis on 'illness' vs. disease perspective In the management of symptoms. Our experience as internists as psychosocial specialists in the generalhospitalenvironment willbe brieflydiscussed.
Symposia
S22
S23
Structure quality ofmental health care systems in Europe Recent changes in the lIungarin menial health eire oystem.
How to teach psychosocial skills to general practitioners? TEACHING PSYCHOSOMATIC MEDICINE· A TWO YEAR CURRICULUM FOR POST·GRADUATE CLINICIANS
Furedy,Janos (Budapest/Hungary) Oaus Buddebcrg, ZurIch. Swltzer/and.
Hungary is with ist ca 10 millions of inhabitants one of the smaller Europeancountry With a glorious past. Allthoug according to its Imageas a rural country more than the half of the inhabitants live in the five biggest tOWIIS. Before the political change during the last decade because of the communistic ideology the mental health area was widely neglected by the Hungarian Government. Inpatient care was provided by bigger state hospitals. whereas the outpatients eare has been provided by governmental outpatients clinic. Since the political change and increasing number of psychiatristsbegin to work in private practice and postgraduate training IS improving. However, because of its famous psychoanalytical tradition for instance Ferency and Balint have been of Hunganan offspringpsychotherapeutic thinking has maintained in our county The orientation of Hungarian psychiatry has been directed more to Germany than to other countries. Now decentralization of hospital care as one form of reforms in Hungarian psychiatry is advancing, though the lack of finances 's tremendous and the main obstacle to promote reforms quicker. The main part of psychiatrists is concentrated in the tOWIIS with the result of poor outpatient facility equipment in the rural areas A concept of improving the situation WIll be presented.
How to teach psychosocial skills to general practitioners? 'tHAVIORAL SCIENCE CURRICULA PORCENERAL INTERNAL MEDICINE: LI.ADlNG THE P'EARnJL AND PREACHING TO THE CONVERTED
~
n. pi fIIlMCh,. P'Yd... " Md W.8WInI ~ 10,...." caN ph)'
boat,.. ~ . . ill" ~ 'n.. ,., .e:tIMIpNClioe '" debvery rI P'Ychwric 11UI"'" .11 1M .-.1"11 medK:IM Idllna I I . . Mechcal ,..den'" INl faculty', .Inlh
iI,.........
'*..........
Iftd .....'*.10 ........ pl)'d".." . . WuMor
MIl
........ r.a. r.rhr to ...... ....,.,..,.. ~ .................................. 0100 obIla'" _
..,..uy
...., • taandful tI CllImCUIa bI ............. _
..,_1tuM _
10
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n
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a
.
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"' ..... plJdl&llric . .pnabIeIMbuI _ .. "~.I
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."..,
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fJI_ .-1 ... _ , , _ _. _
·_ror_"".
n.._ _
.......lllOCIic:ioor......,.Oor,.....,_...tI.....,
__
,
"
1QIftCU
IU. TM til thu lUll hlby ......jorMy 01pnIWY'" ,.alley Iftd 1MlI _ _ IpOCUIo
1100_1· osori
S23
__
INNvtanl 1Ci
., • hMdt.l 01
,......, .. -
Ind
·
"'"
cloniooI_
pIo,...
;.cu. _1"heNION _ ""'"
"Simulalod_·
..
,..,_
_ 1 0 ...... 0_ · _ " ' - . _....... _""'-·" ... _n.._IoIod-podool_ ,........ .. opoafic .. tDpCl IUdI u fllYdUMric ...... ~ r..n'.,.....·rriculunl .. -.....
ror
).,....." c.... _~ ptOI,.. n6dauUy wM ... WlmonI toM:lHw IlIIftdHlL PInuy caR ........ puad.,... onaI'"CUmallhlm ~ br row addInanaI curnc.u.r · I - A ·a~ 0_' lUll""'" '" &oporvIood .. ......1: m. 4IKtpI1lW)' _ IV . A....,.., .., "'1"'" 01 _ .... 011 ~CIY.,.~IC IOM... lAcdor1*'cnl1dM0II '''II)'. 1)'11-.' i111er¥en1" .. pn1Ml)' calL 1M prwury caN cumadum "UlN. hi... .,. thi_ 'KUky-..I ......cn hil bf. . Ii~"....1.. (t) ... ...whMhh..,.e:uJa1lt. nu..traIIIl. . . . ., . . .._1000 _ _ idooI lar -...;aa _ _. .... (11
~
....
n.
"\II,,
r.....,
eM .me r r...,.·)'MI' 10 d. 1114 IndlttcIMI p.ychIlinc ICIM-pl)'Chl1I1J' ~ cb..c,.-.an lIeYoIed 10" .. .race 0I ...1t'1M MIl ptJduahy. NICIUCh and Uf*'MGI ...-.dI... 111M caI..,nc:a1 MedIcMa IIehavtonI ICMIIC* 0.-.... III IIU1 1'"'1.... thou... 'behlVMIfaI "*'*' wmcuI. . • ~ II'td
JII'CIIrwnL AI'"
CXlIItbIned ....1aM
wmeu_ wnh
............
ru
Ul,.. Ill""
~
pt}'dI"", ...w.ne, pI'DInnI
.pI'" ,.
2S to 30%of the patients seen in a general practitioner's office suffer from psychosomaticdisorden. In Swirzer1and there Is no slrUClured teaching of a psychosomatic approach to illness, neither in medical school nor during postgraduate training. In this presentation experiences with a two year training program in psychosomatic medicine for post-graduate clinicians arc reported. The training program has three parts: Part one consists of 12 training days over a two year period given in seminan with lecturesand case presentations using videotapes, one way mirror as well as role plays. Part two is case supervisionin small groups. In part dircc participantsarc taught and get experiences in a self relaxation technique. In our opinion the two year curriculum serves as a model and example for a certified training in ·Psychomatic Medicine·. The participanlS can benefitfrom their training in various ways: with regard to the organization and atmosphere of their practice, In respect of improvedcommunication skills when treating patients and advanced small group Interaction skills. We have just finished die second course and we received excellent feed-back from most of the participants.
S23
How to teach psychosocial skills to general practitioners? GETrING MEDICAL SPECIALISTS PSYCHOSOCIAL CARE: A ROLE INTERNISTS?
INVOLVED IN FOR GENERAL
P Cathebras Service de Medicine Interne. H6pltaux de SI Ellennt.
42055 St Etienne. France Intemalmedicine holdsa spccia1 positionin France. Confined 10 tertiary care settings, It is considered as a speciality among other medical specialities. In the rreantUre. intemislS favoura 'holistic'perspectivevery similar to the GP's approach.and opposed to most specialists' pointof view. Sinceconsultation-liaison psychiatry is poorly developed inmany hospitals. internists sometUres have to act as consultants for clinical problems situated outside the organ specialities domain, including 'psychosomatic' problems.This meansthat internistshave a specialrolc in educating their fellow specialists on emotional factors In physical disease, attentionto psychosocial context, patient-centred approach and emphasis on 'illness' vs. disease perspective In the management of symptoms. Our experience as internists as psychosocial specialists in the generalhospitalenvironment willbe brieflydiscussed.