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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
certification in internal medicine to complete 3 years of postgraduate training and an additional 2-year fellowship for subspecialization in medical oncology (ABIM, 2006b). ABIM incorporated the six ACGME competencies into its resident evaluation forms, and ACGME asked all residency review committees (RRCs) to make reference to them in their program requirements (Goroll et al., 2004). Program requirements for the medical oncology subspecialty further state that fellows “must have formal instruction, clinical experience, and must demonstrate competence in the prevention, evaluation and management of … rehabilitation and psychosocial aspects of clinical management of the cancer patient” (ACGME, 2005). However, very few questions on a typical certification examination in internal medicine or medical oncology directly address psychosocial health services. ABIM estimates that on average, five questions per examination may cover psychosocial or mental health content, but emphasizes that “drawing conclusions about examinee performance in these areas” would be impossible because “scores would be unreliable for such a small number of questions.”11
Family Medicine Residency Training Program The American Board of Family Medicine (ABFM) also requires candidates for certification in family medicine to complete 3 years of postgraduate training (ABFM, 2006b). Program requirements for family medicine state that residents must become trained in meeting the psychosocial health needs of patients. Specifically, residents must address the “total health care of the individual and family, taking into account social, behavioral, economic, cultural, and biologic dimensions” and become skilled in the “diagnosis and management of psychiatric disorders in children and adults, emotional aspects of non-psychiatric disorders, psychopharmacology … and counseling skills” (ACGME, 2006a:16,28).
Pediatric Residency Training Program and Pediatric Hematology-OncologyFellowship The American Board of Pediatrics (ABP) similarly requires candidates for certification in pediatrics to complete 3 years of postgraduate training; an additional 3-year fellowship is required for subspecialization in pediatric hematology-oncology (ABP, 2006a). Program requirements in general pediatrics state, in part, that (ACGME, 2006b)
Residents should “be able to interview patients/families … with specific attention to behavioral, psychosocial, environmental, and family unit correlates of disease” (p. 11).
Personal communication, P. Poniatowski, ABIM, October 12, 2006.