Telesimulation and Behavioral Health

According to Mental Health America, 1 in 5 adults have a mental health condition. Mental health is associated with higher incidence of chronic diseases, lower use of medical care, and one of five most costly conditions in the US in 2006 according to the American Psychological Association. The Accreditation Council for Graduate Medical Education (ACGME) has called for residents to develop an understanding of social-behavioral sciences as a basis for patient care. ACGME advises that the curriculum is extended to physical aspects of patient care as well as the emotional, social and behavioral aspects. The Society of Teachers of Family Medicine (STFM) has also suggested the importance of the psychosocial realm. According to both the ACGME and STFM, being able to glean the necessary information is an integral part of being a family doctor.

The need for healthcare providers, medical students, and residents to possess basic interviewing, counseling and agenda setting skills to ascertain the pertinent contextual (e.g., familial, social, cultural, spiritual, etc.), health behavior, and health risk factors of patients' lives, is vital to close the gap on behavioral health and chronic diseases. In order to evaluate learners' interviewing skills, the Contextual Interview Observation Form (CIOF) an observation tool was developed using Robinson, Gould, and Strosahl's (2010) interview format. The CIOF can be used to teach a contextual interview "procedure" that is organized in a logical manner with a practical format. This "contextual interview" provides a no-cost format for the learner to capture the context of patients' behaviorally influenced health concerns and is applicable during the 4-year curriculum as well as during the clerkship years.

Many Americans lack access to health care, with an even greater shortage of access to mental health providers, especially in rural and underserved areas. Improving access to behavioral health providers and recognition of mental illness via telemedicine, could lead to improved patient outcomes and cost. However, in the pedagogical course of medical education, the investigators do not provide a robust platform for teaching telemedicine. Implementing the CIOF in a telesimulation format will allow for healthcare providers, behavior health providers, medical students, and residents to practice and experience providing basic interviewing and counseling via telemedicine. According to McCoy et al, telesimulation is "a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location. Off-site location refers to a distant site that would preclude the education, training, and/or assessment without the use of telecommunication resources."

Pacific Northwest University of Health Sciences educates and trains healthcare professionals emphasizing service among rural and medically underserved communities throughout the Northwest. Specifically, the investigators cover rural and underserved areas in Alaska, Washington, Oregon, Montana, and Idaho. PNWU's envisioned Institute for Interprofessional Practice \& Education (IIPE) focuses on cultivating healthcare teams from a variety of professional backgrounds to enhance person-centered health care. One goal of PNWU's strategic plan is to expand graduate level educational opportunities. In response to that goal, the Yakima Valley Interprofessional Practice and Education Collaborative (YVIPEC) was established in the fall of 2014 to promote the highest quality health care in the region through a culture of inclusive and collaborative interprofessional education, practice, and scholarship. Interprofessional education (IPE) fosters a team-based approach to health care which is the approach used in rural health clinics and is reported to be critical to success in working in medically underserved areas. These collaborations include:

• Pacific Northwest University of Health Sciences (PNWU), Doctor of Osteopathic Medicine;
• Heritage University (HU), Physician Assistant Program and Nursing Program;
• Washington State University (WSU), Nursing Program and Pharmacy Program;
• Central Washington University (CWU), Paramedicine Program and Dietetics Program;
• Washington State Allied Health Center of Excellence, located at Yakima Valley College

The current PNWU College of Osteopathic Medicine (COM) curriculum includes CLIN 618, which is a second year requirement and presents a multidimensional approach to the understanding of the most common clinical entities in psychiatry and behavioral medicine. Third and fourth year courses includes BEHCS 701 Behavioral Medicine rotation which is designed for students to learn and practice skills necessary for working with patients in a mental health setting. Incorporating the COIF via telesimulation would give students, residents, and faculty the experience for use beyond course requirements and prepare them for the future of healthcare.