The medical interview and psychosocial aspects of medicine: block curricula for residents.

PROFICIENCY in the psychosocial aspects of medical care is essential for physicians t-s and requires the development of appropriate interviewing, diagnostic, and therapeutic skills. 6"17 Professional organizations, including the American Board of Internal Medicine (ABIM), have defined training needs in psychosocial medicine and interviewing. 18-22 Physicians must demonstrate competence in these areas to receive ABIM certification. 2°-23 Primary care residency programs must provide training in these areas in order to receive federal funds. 24. 25 The average internal medicine residency devotes only five to nine hours of formal psychosocial teaching per year to each resident. 26, 27 A few hours are insufficient for residents to master the necessary bu t unfamiliar biological, psychological, and sociological knowledge base; to become aware of attitudes, feelings, and behaviors that interfere with their effectiveness in these areas; to adopt new attitudes; and to develop new skills. Like learning a new language, such learning is best done intensively. Providing blocks of t ime free from competing responsibilities can permit learners to focus, to read, to think, to process their feelings, to integrate new knowledge and skills, and to practice the skills to the point of fluency. We have developed block rotations in psychosocial medicine within our residency programs. By summarizing our exper ience and presenting consensus recommendations, we hope to help others developing curricula in this area.