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      A Review of 21st Century Utility of a Biopsychosocial Model in United States Medical School Education

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          Abstract

          Background

          Current medical practice is grounded in a biomedical model that fails to effectively address multifaceted lifestyle and morbidogenic environmental components that are the root causes of contemporary chronic diseases. Utilizing the biopsychosocial (BPS) model in medical school training may produce competent healthcare providers to meet the challenge of rising chronic illnesses that are a result of these factors. This study explored the current trend of research on the utility of the BPS model in medical education and examined medical school curricula that have explicitly adopted the BPS model.

          Methods

          A systematic review of peer-reviewed literature was conducted on the BPS model and medical education since the 1970s using multiple databases. Descriptive analysis was used to illustrate findings regarding the trends of the BPS model in medical education and its utility in specific medical schools in the United States.

          Results

          Major findings illustrated a growing trend in research on the BPS model in medical education since the 1970s with literature in this area most visible since 2000. The same trend was established for the incorporation of psychosocial or behavioral and social science components in medical education. From our peer-reviewed literature search, only 5 medical schools featured utility of the BPS model in their curricula utilizing variable educational processes.

          Conclusion

          Although literature regarding the BPS model in medical education is growing, the explicit utility of the BPS model in medical school is limited. Our findings can stimulate educational processes and research endeavors to advance medical education and medical practice to ensure that future doctors can meet the challenge of rising lifestyle and environmental associated illnesses.

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          Most cited references37

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          Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

          Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis. Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys. Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. When they do so, the resultant risk for cardiac events is often substantially elevated, equaling that associated with previously established risk factors for CAD, such as hypertension and hypercholesterolemia.
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            Projecting US primary care physician workforce needs: 2010-2025.

            We sought to project the number of primary care physicians required to meet US health care utilization needs through 2025 after passage of the Affordable Care Act. In this projection of workforce needs, we used the Medical Expenditure Panel Survey to calculate the use of office-based primary care in 2008. We used US Census Bureau projections to account for demographic changes and the American Medical Association's Masterfile to calculate the number of primary care physicians and determine the number of visits per physician. The main outcomes were the projected number of primary care visits through 2025 and the number of primary care physicians needed to conduct those visits. Driven by population growth and aging, the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. After incorporating insurance expansion, the United States will require nearly 52,000 additional primary care physicians by 2025. Population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, a 3% increase in the current workforce. Population growth will be the greatest driver of expected increases in primary care utilization. Aging and insurance expansion will also contribute to utilization, but to a smaller extent.
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              Links in the chain of adversity following job loss: how financial strain and loss of personal control lead to depression, impaired functioning, and poor health.

              The authors tested hypotheses concerning risk mechanisms that follow involuntary job loss resulting in depression and the link between depression and poor health and functioning. A 2-year longitudinal study of 756 people experiencing job loss indicates that the critical mediating mechanisms in the chain of adversity from job loss to poor health and functioning are financial strain (FS) and a reduction in personal control (PC). FS mediates the relationship of job loss with depression and PC, whereas reduced PC mediates the adverse impacts of FS and depression on poor functioning and self-reports of poor health. Results suggest that loss of PC is a pathway through which economic adversity is transformed into chronic problems of poor health and impaired role and emotional functioning.
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                Author and article information

                Journal
                J Lifestyle Med
                J Lifestyle Med
                Journal of Lifestyle Medicine
                Yonsei University Wonju College of Medicine
                2234-8549
                2288-1557
                September 2015
                30 September 2015
                : 5
                : 2
                : 49-59
                Affiliations
                [1 ]Medical Student, Department of Family Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, Texas 76107-2699, USA
                [2 ]Assistant Professor, Department of Family Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, Texas 76107-2699, USA
                Author notes
                [* ]Corresponding author: Jenny Seung-Hyun Lee, Department of Family Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, Texas 76107-2699, USA, Tel: 1-817-735-0521, Fax: 1-817-735-5089, E-mail: jenny.lee@ 123456unthsc.edu ; jleewelllife7@ 123456gmail.com
                Article
                jlm-15-049
                10.15280/jlm.2015.5.2.49
                4711959
                26770891
                9fdf2fee-7f49-4fda-a765-df57f09952f9
                © 2015 Journal of Lifestyle Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 May 2015
                : 31 July 2015
                Categories
                Original Article

                chronic disease,lifestyle factors,biopsychosocial model,medical education,curriculum

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