The difficult patient: creation of a curriculum by third-year family practice residents

Family practice residents tend to perceive psychosocial problems as less important than other factual aspects of their curriculum. To address this, we developed a problem-based learning (PBL) approach to the biopsychosocial model of medical care.

Third-year residents presented current problematic patients at a PBL advanced psychiatry conference. Data were collected on topics generated, resident attendance, and conference evaluation.

The residents generated a topic list that closely matched a prior faculty-generated list. Some topics were discussed on multiple occasions; others not on the faculty list were also generated. Topics omitted were mental health in the physician's home, crisis prevention/intervention, and troubled marriages. In 1992-1995, resident attendance ranged from 56%-79%. A minority (0-5 residents) consistently attended fewer than 50% of the conferences. Residents evaluated the conference from "good" to "very good."

By employing a PBL format and allowing residents to present current patients, conferences were better attended and covered almost all topics previously identified as important. PBL promoted efficient use of residents' time since residents were only required to research the literature about group knowledge deficits. This provided good training for the residents and excellent continuing medical education for faculty.