As mental health care increasingly shifts into primary care settings, the University of Utah’s Family Medicine Residency Program is evolving to ensure its residents are prepared to meet this growing demand. Currently, 40% of office visits for mental health concerns and 47% of prescriptions for mental illness are managed by primary care physicians, making mental and behavioral health training a critical component of residency education.
In late 2022, faculty and research staff from the Division of Family & Community Medicine launched a research initiative aimed at increasing the number of primary care providers trained in the prevention, identification, diagnosis, treatment, and referral of services for mental and behavioral health conditions. The project, funded by the Health Resources and Services Administration (HRSA), is led by principal investigator Susan Cochella, MD, MPH. The team also includes Katherine Fortenberry, PhD; Karly Pippitt, MD; Chin-Yin Shih; Elena Gardner, MPH; Robert Owens, PhD; Laura Moreno, MD; Erika Sullivan, MD; and Quang-Tuyen Nguyen, MD from the Division of General Pediatrics.
The initiative focuses on expanding clinical rotations in behavioral health settings, enhancing didactic training on mental and behavioral health topics, and building community partnerships to support integrated care.
The research team began the project by seeking to understand current gaps in resident knowledge, critical insight to inform additional training opportunities. With the leadership of Evaluation Specialist Elena Gardner, the team surveyed family medicine residency graduates and current residents to assess the types of mental health care provided in clinical practice, confidence levels in treating various conditions, sources of confidence, and areas where more training would be beneficial.
The data revealed that both residents and graduates feel confident treating anxiety and depression, as well as screening for and managing suicidal ideation. "This is the bread and butter of mental health care," said Fortenberry. "These are areas where we’ve really focused on strong didactic and clinical training." Respondents also indicated a desire for additional training in violence-related cases and psychiatric crises.
In response to the results of this survey, the Family Medicine Residency Program has implemented several key improvements including enhanced didactic training and expanded community partnerships. The residency program recently launched a new rotation experience in partnership with the Huntsman Mental Health Institute Crisis Care Center to enhance the behavioral health component of residents’ training by immersing them in real-time crisis care.
Additionally, the program has partnered with New Horizons Crisis Center to educate residents on the cycle of intimate partner violence, barriers to leaving unsafe relationships, and how primary care providers can support affected patients. To strengthen residents' skills in trauma-informed care, training includes time at the Children's Center of Utah and Thrive Utah, where residents learn approaches to supporting individuals who have experienced trauma. A collaboration with Utah Zero Suicide has also enhanced training in managing individuals in crisis, including instruction for residents and faculty development sessions to improve clinical support.
To share the impact of this work, Gardner and Fortenberry presented the team’s findings at the Society of Teachers of Family Medicine Conference on Practice & Quality Improvement in early September, highlighting how the data has helped strengthen the residency program’s approach to mental and behavioral health training. The program continues to seek new ways to improve and enhance training, ensuring residents are well-equipped to serve their patients and communities with competence and compassion.
