Teaching a biopsychosocial approach on medical attending rounds

The ascent of the biotechnical, disease-oriented model of medicine threatens to relegate the integrated, patient-oriented approach to a secondary position. In response to this, a program to teach medical housestaff a biopsychosocial approach was implemented in a setting of attending rounds by having a psychiatrist participate regularly as a member of the rounding team. The effectiveness of this program's teaching effort was significantly influenced by the psychological styles and level of training of the housestaff officers. Residents were the most teachable and potentially the most effective teachers with respect to the biopsychosocial model. Interns, appearing to respond to the stresses of internship with defensive behavior, e.g., turning passive into active and isolation of affect, were less receptive. The medical attending's attitude, however, was the most important factor affecting the teaching of this approach on rounds. Three medical-attending-teaching styles were characterized, one of which appeared incompatible with teaching a biopsychosocial approach on rounds. The psychiatrist had to learn to specifically adapt his teaching efforts to each of these three attending styles, as well as to the training level related needs and the defensive styles of the housestaff.