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Behavioral Science in Family Medicine Education

The Behavioral Science curriculum is based on the biopsychosocial-spiritual model (Engel, 1977; Wright, Watson, & Bell, 1996). Residency education in the Behavioral Sciences approach each patient as a complex but integrated system of many variables that can be organized under five domains: biological, behavioral, cognitive, sociocultural, and environmental. The curriculum is evidenced-based and designed so that every resident achieves the Accreditation Council for Graduate Medical Education (ACGME) milestones. Using the Curriculum Guidelines for Family Medicine Residents by the American Academy of Family Physicians (2011, p.2) to guide curriculum development, the interdisciplinary Behavioral Science faculty assist each resident to achieve the following competencies at the completion of their residency training:  


  • Understand normal and abnormal psychosocial growth and development across the life cycle and be able to appy this knowledge to the care of the individual patient. (Medical Knowledge, Patient Care)
  • Be able to recognize, initiate treatment for, and utilize appropriate referrals for mental health disorders to optimize patient care. (Systems-based Practice, Practice-based Learning and Improvement) 
  • Demonstrate the ability to effectively interview and evaluate patients for mental health disorders using appropriate techniques and skills to enhance the doctor-patient relationship. (Interpersonal and Communication Skills, Patient Care) 
  • Have sensitivity to and knowledge of the emotional aspects of organic illness. (Patient Care, Professionalism) 
  • Be able to intervene effectively and professionally in emergent psychiatric, domestic violence, child abuse, and disaster situations. (Professionalism, Systems-based Practice) 
  • Understand the impact of mental health disorders on the family unit.


During orientation, first year residents are videotaped and communication skills reviewed to prepare them for out-patient clinical care. Second year residents are also videotaped during their orientation and on-call communication skills are reviewed.

Behavioral Science Facilitators


Mark P. Knudson, MD, MSPH


Scott Harper, MD

Support group

Julie Kirk, PharmD


Gail Marion, PA-C, PhD

Communication Skills and Standardized Patients

First Year  Behavioral Science Rotation (two week block)


Didactic, interactive lectures on Behavioral Science topics include: 

  1. Anxiety/Depression
  2. Biopsychosocial-spiritual model
  3. Communication skills, e.g., Agenda Setting, Ask-Tell-Ask
  4. Difficult encounters
  5. Doctor/Patient relationship
  6. Insomnia, grief/loss, end of life issues
  7. Mindfulness and clinical relaxation strategies
  8. Primary care counseling skills, e.g., Motivational Interviewing.
  9. Psychopharmacology of depression
  10. Substance use

Direct Observation of Clinical Activity

  • Videotape
  • Live observation through closed-circuit video feed

Noon Conference Lecture

Residents prepare and present a one-hour lecture on a behavioral health specialty topic to faculty, residents, and medical students.

Second Year Behavioral Science Rotation (one week block)


Didactic, interactive lectures on Behavioral Science topics may overlap with the first year and include: 

  1. Communication skills, e.g., Agenda Setting, Ask-Tell-Ask
  2. Primary care counseling skills, e.g., Motivational Interviewing, BATHE
  3. Family systems/genogram, e.g., Five Family-Oriented Questions, genogram interview
  4. Difficult encounters
  5. Primary care psychopharmacology
  6. Insomnia, grief/loss, substance use, personality disorders

Direct Observation of Clinical Activity

  • Videotape
  • Live observation through closed-circuit video feed

Third Year Behavioral Science Rotation (two half days)*


Didactic, interactive lectures on Behavioral Science topics may overlap with the first and second year and include:

  1. Family-Oriented Care, e.g., Five Family-Oriented Questions, genogram interview, systems concepts and application, etc.

Direct Observation of Clinical Activity

  1. Home visits

Longitudinal Curriculum

Integrated Care

The Wake Forest Department of Family and Community Medicine was awarded a Primary Care Training and Enhancement by Health Resources and Services Administration (HRSA) for July 2015 – July 2020 to implement and sustain integrated care in the Wake Forest Family Medicine residency and the Federally Qualified Health Center (FQHC), Southside United Health Center. Together, both clinics have a care manager and three behavioral health providers working alongside faculty and resident physicians to provide comprehensive care to patients. In addition, integrated care teaching clinics provide an opportunity for physician and behavioral science faculty to observe resident and behavioral health clinical encounters, and provide feedback in an interdisciplinary setting.

Educational Lectures

Behavioral science topics are presented once a month at noon conferences and morning reports throughout the three years of the residency. Topics in Behavioral Science presented include family systems, adherence to medical advice, sleep disorders, psychophysiological disorders, personality disorders, chronic pain, caregiver fatigue, among many others. Topics may also be discussed on the inpatient medicine teaching service when the Director of Behavioral Science is present. 

Videotaping & Live Observation

Videotaping & shadowing (live observation of the clinical encounter through closed-circuit video feed) begins the first year of the Behavioral Health Rotation (BHR) and continues throughout residency training. 

Support Groups

1st Year

HO-Is attend a support group one to two times a week throughout the year to provide the skills and group support necessary to learn and to grow during the challenging internship year.

2nd Year

The HO-IIs meet once monthly to focus on the complexities of the Doctor-Patient relationship and explores all relationships as they contribute to the practice of medicine.

3rd Year

The HO-IIIs support group meets once a month and continues the format from the 2nd year. The group focuses on the residents' complex transition from residency to early career. 

Consultation & Referral

Behavioral Science faculty is available to review patients, facilitate treatment planning, and accessing community resources.

References within this article can be found at the following sources:

American Academy of Family Physicians (AAFP). Recommended Curriculum Guidelines for Family Medicine Residents: Human Behavior and Mental Health. AAFP Reprint No. 270 retrieved at        

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science196, 129-136. doi: 10.1126/science.847460

Wright, L. M., Watson, W. L., & Bell, J. M. (1996). Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.

 * Anticipated for rotation to be offered for graduating class of 2019.
Dr. Knudson

Mark P. Knudson, MD, MSPH
Behavioral Science Education

Last Updated: 09-20-2017
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