Current status of psychosomatic training in primary care residencies in the United States

Psychosomatic medicine is an important interface between psychiatry and primary care. However, what aspects of psychosomatic medicine is taught to medical students and primary care physicians depend on the nature of the program and also in what country it is being taught. In a survey of 1365 primary care training residency program directors in the United States, we found that a majority of internal medicine (IM), family practice (FP), obstetrics and gynecology (OB), and pediatrics programs (Peds) teach the psychosomatic areas of Somatoform Disorders, Psychological Factors Affecting Physical Condition, Physical Illness Affecting Emotions/Behavior, Eating Disorders, Grief/Bereavement, and the Dying Patient. However, a majority of IM, OB, and Peds programs considered their training in all the areas to be inadequate (p < 0.001). A majority of FP considered training to be adequate in all areas except for Eating Disorders, which only 50% considered adequate. For all areas, Peds programs considered their training to be least adequate and desired more compared with others. Most programs desired more training in Eating Disorders and the somato–psycho–somatic relationships such as Psychological Factors Affecting Physical Condition and Physical Factors Affecting Emotions/Behavior. Teaching more psychosomatic medicine was associated with training directors' satisfaction. Conclusion: While most primary care residencies cover areas of psychosomatic medicine, a majority of non-FP programs consider their training to be inadequate. There is a need to enhance psychosomatic medicine training for primary care physicians, particularly the somato–psycho–somatic relationships.