Table of Contents - Academy of Psychosomatic Medicine

Methods: The training is based upon methods developed in
our Communication Skills Training and Research Lab (Comskil
Lab). Training modules and materials were developed
using a process that included a systematic review of the
literature of CST. Our trainings consisted of three 5 hour sessions
focusing on a total of six training modules: Responding
to Patient Anger and Communicating with Patients via an
Interpreter (Session 1), Breaking Bad News and Conducting
a Family Meeting (Session 2), and Shared Decision Making
About DNR Orders and The Transition from Curative to
Palliative Care (Session 3). Each module was introduced by
a didactic presentation, which defined the communication
skills to be learned, and exemplary patient interview videos
to demonstrate the skills. Fellows were then divided into
small facilitator-led role plays using actors as standardized
patients. Prior to the training, all fellows were video recorded
doing an initial outpatient consultation. The recordings were
coded to indicate which specific communication skills the
fellows used and written feedback was sent to the fellows.
Post-training recordings were also done and coded to determine
uptake of skills.
Results: Previous results of Comskil trainings of medicaloncology
fellows have demonstrated increased usage of
skills particularly in the “establish the framework of the consultation”
and “empathic communication” categories. We will
present outcomes of CST among Psychosomatic Medicine
fellows.
Conclusion: CST is an effective and innovative method for
addressing one of the core competencies of Psychosomatic
Medicine fellowship training.
References:
1. Brown RF, Bylund CL: Communications skills training: Describing
a new conceptual model. Acad Med. 2008; 83:37-44
2. Bylund C, Brown RF: Oncologists participation in a comprehensive
communication curriculum: assessment of skills
uptake using the Comskil coding system. Psycho-oncology.
2008; 17(6 Suppl): S164
GROUP B
5. Predictors of Posttraumatic Stress
Disorder and Return to Usual Major Activity
in Traumatically Injured Intensive Care Unit
Survivors
Presenting Author: Dimitry Davydow, MD
Co-Authors: Douglas Zatzick, MD, Frederick Rivara, MD,
MPH, Gregory Jurkovich, MD, Jin Wang, PhD, Peter Roy-
Byrne, MD, Wayne Katon, MD, FAPM, Catherine Hough,
MD, Erin Kross, MD, Ming-Yu Fan, PhD, Jutta Joesch, PhD,
Ellen Mackenzie, PhD
Objective: This study aimed to assess intensive care unit
(ICU) and acute care service-delivery characteristics as well
as pre-ICU factors as predictors of posttraumatic stress disorder
(PTSD) and return to usual major activity after ICU admission
for traumatic injury.
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Method: Data from the National Study on the Costs and
Outcomes of Trauma was used to evaluate a prospective
cohort of 1,906 ICU survivors at 69 United States hospitals.
We assessed PTSD with the PTSD Checklist. Regression
analyses ascertained associations between ICU and
acute care service-delivery characteristics, pre-ICU factors,
early post-ICU distress, and 12-month PTSD and return to
usual activity, while controlling for clinical and demographic
characteristics.
Results: Approximately 25% of ICU survivors had symptoms
suggestive of PTSD. Higher levels of early post-ICU distress
predicted both PTSD and limitations in return to usual major
activity. Pulmonary artery catheter insertion (Risk Ratio (RR)
1.28, 95% Confidence Interval (95%CI) (1.05-1.57), p=0.01)
and pre-ICU depression (RR 1.23, 95%CI (1.02-1.49),
p=0.03) were associated with 12-month PTSD. Longer ICU
lengths of stay (RR 1.21, 95%CI (1.03-1.44), p=0.02) and
tracheostomy (RR 1.29, 95%CI (1.05-1.59), p=0.01) were
associated with diminished usual activity. Greater numbers
of pre-existing medical co-morbidities were associated with
both PTSD and limitations in return to usual activity.
Conclusions: Easily identifiable risk factors including ICU/
acute care service-delivery characteristics and early post-
ICU distress were associated with an increased risk of PTSD
and limitations in return to usual major activity. Future investigations
could develop early screening interventions in acute
care settings targeting these risk factors, facilitating appropriate
treatments.
6. Five-Factor Model Personality as Predictors
of Incident Coronary Heart Disease in the
Community: A 10.5 Year Prospective Cohort
Study
Presenting Author: Hochang Lee, MD
Co-Authors: Oscar Bienvenu, MD, PhD, Daniel Ford, MD,
MPH, Christine Ramsey, BS, William Eaton, PhD, Gerald
Nestadt, MBBS
Objective: Certain personality and behavioral traits (e.g.
Type A, and Type D) and depression have been reported
to be associated with cardiac morbidity and mortality in the
community. However, few have examined the putative relationship
based a comprehensive assessment of personality
along with a structured assessment of psychiatric disorders.
Based on the Baltimore ECA follow-up Study and the Hopkins
Epidemiology of Personality Study, We examined five
major domains of personality traits (neuroticism, extroversion,
openness, agreeableness, and conscientiousness) and
incident coronary heart disease (CHD) event (defined as
myocardial infarction, angioplasty, or coronary artery bypass
surgery).
Design and Setting: A 10.5 -year prospective, communitybased
cohort study.
Participants: 614 community residents (age: 45.4 +/- 10.9;
female: 64.7%).
Measurements: Between wave 3(1993-6) and wave 4
(2004), each participant responded to the 240 item NEO