Integration of the biopsychosocial model: perspectives of medical students and residents.
OBJECTIVE
To examine residents' and medical students' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and to identify barriers to the integration of evidence-based, mind-body methods.


METHODS
A random sample of third- and fourth-year medical students and residents was drawn from the Masterfiles of the American Medical Association. A total of 661 medical students and 550 residents completed a survey, assessing attitudes toward the role of psychosocial factors and the clinical application of behavioral/mind-body methods.


RESULTS
The response rate was 40%. Whereas a majority of students and residents seem to recognize the need to address psychosocial factors, 30%-40% believe that addressing such factors leads to minimal or no improvements in outcomes. The majority of students and residents reports that their training in these areas was ineffective, yet relatively few indicate interest in receiving further training. Females are more likely to believe in the need to address psychosocial factors. Additional factors associated with greater openness to addressing psychosocial factors include (1) the perception that training in these areas was helpful, and (2) personal use of behavioral/mind-body methods to care for one's own health.


CONCLUSIONS
There is a need for more comprehensive training during medical school and residency regarding both the role of psychosocial factors in health and the application of evidence-based, behavioral/mind-body methods. The current health care structure-particularly insufficient time and inadequate reimbursement for addressing psychosocial factors-may be undermining efforts to improve patient care through inconsistent or nonexistent application of the biopsychosocial model.
Astin
John A
JA
California Pacific Medical Center, San Francisco, California 94115, USA. john@integrativearts.com
Sierpina
Victor S
VS
Forys
Kelly
K
Clarridge
Brian
B
D000328:Adult; D001291:Attitude of Health Personnel; D004504:Education, Medical, Undergraduate; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D008297:Male; D015999:Multivariate Analysis; D011603:Psychophysiology / Q000193:education*; D012737:Sex Factors; D013337:Students, Medical