Forgiveness: Moving on can be healthy.

Forgiveness as a procedure has been gaining prominence. The objective of this article is to provide the basics of forgiveness as an intervention so primary care clinicians can facilitate its use. These clinicians include but are not limited to physicians, nurses, medical assistants, pharmacy professionals, physical therapists, social workers, psychologists, case managers, and clergy. This narrative explains the rationale for understanding forgiveness as a procedure and ways to explain it. To assist clinicians and patients in making informed decisions, samples of forgiveness research are included that describe its positive relationship to specific physical health situations. The article also describes an evidence-based forgiveness therapy, circumstances in which it is harmful to forgive oneself or others, describes the limitations of this article, and suggests future directions.

Enter as an outsider: Teaching organizational humility.

The concept of cultural humility acknowledges the enormous task of becoming culturally competent by encouraging curiosity about the context within which others live. For physicians, this includes curiosity about the organizations in which they work as Outsiders in settings such as a new hospital or patients' homes. However, efforts to train healthcare professionals in cultural competence are often de-emphasized due to the pressure learners feel to acquire Medical Knowledge and clinical skills. Little time is devoted to address the significance of cultural humility for fully appreciating the experiences of others. Efforts to educate physicians-in-training about the cultural aspects of care require innovative approaches that help them recognize bias without provoking defensiveness. Enter as an Outsider is a highly focused activity which fosters a culturally humble approach to an often neglected problem, organizational bias. This article describes how cultural humility is explained to learners and small group activities are used to explore the thoughts and feelings of an organization's Insiders and Outsiders. This program relies on instructor self-disclosure to facilitate learning and on a video vignette from popular-culture media to illustrate being an Outsider in a healthcare setting. Participants in this training have improved their ability to recognize when they are Outsiders where they provide care. They have developed a better understanding that cultural humility in organizations is a gateway to providing quality care. They have begun the process of committing to respectfully learn from the organization's Insiders.

Building psychosocial programming in geriatrics fellowships: a consortium model.

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.

Helping depressed adolescents: a menu of cognitive-behavioral procedures for primary care.

Depression among adolescents has received recognition as a significant psychiatric problem that requires prompt intervention. This article will help primary care providers to understand the significance of adolescent depression, recognize its prevalence in primary care, cite the evidence supporting cognitive-behavioral therapy (CBT) as a treatment for depressed adolescents, recognize the challenges of using CBT in primary care, and use 7 different CBT approaches with their patients. Psychiatric diagnoses may be present in 38% of adolescents who see a primary care physician, and among that number, depression is the most common diagnosis. Cognitive-behavioral therapy provides a scientifically proven tool for those physicians who want to provide their young depressed patients an effective counseling approach. Cognitive-behavioral therapy enhances self-control, perceptions of personal efficacy, rational problem-solving skills, social skills, and participation in activities and physical exercise that bring the adolescent a sense of pleasure or mastery. CBT has been proven to be effective when delivered by physicians who have received significant instructions. Unfortunately, CBT techniques can at first seem overly abstract, overwhelming in number, and difficult to teach in the 15-minute visit. However, CBT techniques can be made clear and accessible for a busy physician. The case of a depressed 14-year-old male high school student who comes to his physician for a pre-participation sports physical is presented to illustrate the application of CBT in primary care.