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Biopsychosocial Formulation: Recognizing Educational Shortcomings

Dr. McClain is from the Central Arkansas Veteran’s Healthcare System, Little Rock, Arkansas, and Assistant Professor of Psychiatry in the College of Medicine at the University of Arkansas for Medical Sciences, Little Rock Arkansas. Dr. O’Sullivan is from the Office of Educational Development at the University of Arkansas for Medical Sciences, Little Rock, Arkansas. Dr. Clardy is from the Department of Psychiatry in the College of Medicine at the University of Arkansas Medical Sciences, Little Rock, Arkansas. Address correspondence to Dr. McClain, 116/NLR, Mental Health Service, 2200 Fort Roots Dr., North Little Rock, AR 72114; Tina.McClain{at}med.va.gov (E-mail).

Objective: Since Engel introduced the biopsychosocial model, it has been extensively examined.The authors expect psychiatrists to formulate cases using the biopsychosocial model. However, resident psychiatrists’ ability to generate formulations using this model has received little attention. Methods: The authors evaluated resident biopsychosocial formulations using biopsychosocial scores from trained, blinded raters across four institutions. Second, the authors determined if an intervention could improve biopsychosocial formulation. Design: This study included nonexperimental and pre-post components using resident portfolio scores to measure biopsychosocial. Participants/Setting: Residents from four postgraduate years (PGY) in four different programs participated. In one institution, faculty made a concerted effort to improve biopsychosocial formulation. There were 33 entries in 2000–2001 and 46 entries in 2001–2002. Results: Using the combined data from all institutions, no PGY level averaged a rating of 3.0 (competent) in either year. In the institution implementing an intervention, a significant improvement was noted. Conclusion: This pilot study indicates that we can improve resident competency in this area.

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