Promoting a biopsychosocial orientation in family practice: effect of two teaching programs on the knowledge and attitudes of practising primary care physicians

Abstract

The bio-psychosocial (BPS) approach to patient care has gained acceptance in medical education. However, reported teaching programs rarely describe the efficacy of alternative approaches to continuing medical education aimed at promoting a BPS approach. The objective was to describe and evaluate the effect of two teaching programs on learners’ BPS knowledge, management intentions, patient-centered attitudes, professional self-esteem, burnout, work related strain and mental workload. The learners were Israeli general practitioners. The first (“didactic”) program consisted of problem-based reading assignments, lectures and discussions. The second (“interactive”) program consisted of reading assignments, lectures and discussions, in addition to role-playing exercises, Balint groups and one-to-one counseling by a facilitator. One month before and six months after the teaching interventions, we used structured questionnaires to test for knowledge, management intentions (responses to questions, such as “what would you tell a patient with …”) and attitudes. Both programs led to measurable improvement in knowledge, intentions, patient-centered attitudes and self-esteem. The interactive teaching approach improved significantly more the learners’ professional self-esteem and intentions than the didactic approach. Self-reported burnout significantly increased after the program. It is concluded that teaching intervention enhanced a BPS orientation and led to changes in knowledge, intentions, self-esteem and attitudes. An interactive method of instruction was more effective in achieving some of these objectives than a didactic one. The observed increase in burnout was unexpected and requires further study and confirmation.

Notes

Notes on contributors

ALON, P.A. MARGALIT is a board-certified family physician and Director of the Regional Health-Care Clinic of the Jordan-valley. He served as a Coordinator of Education, Family Health Care Department in Haifa and has coordinated and taught continuing education programs in Primary Care and Family Medicine at the University of Tel-Aviv, Ben-Gurion University and the Medical Corps of the Israeli army.

SHIMON M. GLICK is an internist, endocrinologist and professor emeritus at Ben Gurion University of the Negev, where he formerly served as Dean and as head of the Moshe Prywes Centre of Medical Education. He currently serves as ombudsman for Israel's National Health Service.

JOCHANAN BENBASSAT is an internist and a Research Associate at the Myers-JDC-Brookdale Institute. Formerly, he was a Professor of Medicine and the Israel Wechsler Professor of Medical Education at the Hebrew-University Hadassah Medical School, and and Head of the Department of Sociology of Health at the Ben Gurion University.

AYALA COHEN is a member on the Faculty of Industrial Engineering and Management at the Technion-Israel Institute of Technology. She is Professor and Head of the Statistics Laboratory that operates within the Technion Research and Development Foundation. Her main research areas are Biostatistics and Statistical methods in the Behavioural Sciences.

MICHAEL KATZ is a Senior Lecturer in the Departments of Psychology and Education at the University of Haifa and a Teaching Associate in the Department of Sociology and Anthropology at Bar Ilan University. He was Head of the Department of Education and is currently Chairman of the MA Committee of the Department of Psychology at the University of Haifa. He also conducted research and/or teaching at the Hebrew University of Jerusalem, Oxford University, London School of Economics, Queen's University at Kingston (Ontario), San Francisco State University and Stanford University.