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.

Inclusion Criteria:

- Any enrolled student at a participating program in the Yakima Valley Interprofessional
Collaborative

- Age 18-33 (focusing on the Millennial Generation)

Exclusion Criteria:

- Able to read, write, and speak English due to the pilot nature of the study

- Have no pending litigation with any education entity within the YVIPEC