Knowledge, attitudes, and practices of clerkship supervisors regarding the biopsychosocial approach at the University of Botswana's Faculty of Medicine

doi:10.21203/rs.3.rs-4864340/v1

Background

The biopsychosocial and spiritual model (BPSM), commonly known as the body-mind-unity, does not contradict the biological model; it aims to expand health professionals understanding by integrating psychological and eco-social elements as influential factors in health and disease. We investigated the knowledge, attitude, and practice (KAP) of University of Botswana faculty of medicine (UB-FOM) clerkship supervisors on BPSM.

Methods

This was a quantitative cross-sectional survey. We distributed online (using Microsoft Forms) and self-administered paper-based questionnaires to clerkship departments. We gathered KAP information using a five-point Likert scale and an open-ended question section that asked respondents to elaborate on the factors they believed could limit their application of the BPSM.

Results

Forty-eight clerkship supervisors completed the questionnaire. Most participants (n = 38, 79.2%) reported that they received training on the BPSM throughout their undergraduate or postgraduate education. UB-FOM clerkship supervisors appreciated the importance of considering all four dimensions of health in any healthcare activity (mean score = 4.14 > weighted mean score of 4.04). They also noted the intricate nature of the interaction between psychological and physical health elements (mean score = 4.18 > weighted mean score of 4.04). However, they did not feel comfortable instructing medical students on the model during clinical rotation (mean score = 3.98 < weighted mean score = 4.04), and they expressed scepticism over the ability of psychosocial processes and treatments to alter medical illnesses. Additionally, they did not feel the importance of incorporating the spiritual evaluation into medical practice (mean score = 3.82 < weighted mean score of 4.04).
Obstacles to the implementation of a BPSM included time constraints during consultations and burden, a negative "attitude" towards the BPSM, a lack of updated training, and a defined guideline for the BSPM.

Conclusion

UB-FOM Clerkship supervisors appreciated the importance of considering all four dimensions of health in any healthcare activity. However, they did not feel comfortable instructing medical students on the model during clinical rotation, and they expressed scepticism over the ability of psychosocial processes and treatments to alter medical illnesses. We recommend implementation research that specifically targets the beliefs and attitudes of clerkship supervisors.

Knowledge-attitude and practice

clerkship supervisors

biopsychosocial model

In ancient Greece, the sense of health was based on the idea that it was a state of balance between an individual and their surroundings, the harmony between mind and body, and the belief that diseases had natural causes [1]. The World Health Organisation (WHO) defines health as "a state of optimal physical, mental, and social well-being, encompassing all aspects of an individual's life, rather than simply the absence of disease or infirmity." Recent times have recognized spiritual well-being as a fourth integral component of health [2].

The biopsychosocial and spiritual model (BPSM), often known as the body mind-unity, does not contradict the biological model; this new paradigm acknowledges the extensive and prosperous history of the biomedical model. Nevertheless, the BPSM aims to broaden health professionals understanding by integrating psychological and eco-social elements as influential factors in health and disease [3]. Medical practitioners who employ the BPSM prioritise their patients’ physical, psychosocial, and spiritual well-being. Including the psychosocial dimension in patient care has proven beneficial in preventing and treating physical and psychiatric illnesses [4]. This approach humanises patient care and leads to enhanced social functioning and patient satisfaction, as well as decreased healthcare disparities and reduced medical expenses on an annual basis [4, 5].

The BPSM is a component of the patient care curriculum at most medical training institutions. However, except for family medicine, implementing the BPSM in clerkship rotations faces obstacles [6]. Microlevel factors include knowledge and skills, personal factors, misunderstandings of clinical practice guidelines, and how people feel about patients and time. Mesolevel factors include the creation of clinical practice guidelines, clinical community factors, funding models, health service provision, resource issues, and workforce training issues. And macrolevel factors include health policy, organisational factors, and social factors. All of these can make it hard for clerkship supervisors to teach or practice BPSM [7].

While the research on the BPSM in medical education is growing, its practical application in medical school is still limited. This study's findings can serve as a catalyst for improving instructional methods and promoting further research in the field of medical education. Implementing BPSM may ensure that future doctors are adequately equipped to address the growing prevalence of lifestyle and environmental-related diseases.

While the research on the BPSM in medical education is growing, its practical application in medical school is still limited. This study's findings may serve as a catalyst for improving training methods and promoting further research in the field of medical education. Implementing BPSM may ensure that future health professionals are adequately equipped to address the growing prevalence of lifestyle and environmental-related diseases.

Furthermore, there is only a small amount of literature available that evaluates clerkship supervisors' knowledge, attitude, and practice of BPSM at newly established institutions in fields other than family medicine. In response to concerns over the continuous practice of the BPSM by final-year medical students, the curriculum committee of the UB-FOM appointed a team to address this issue. The team seized the opportunity to collaborate with a cohort of fourth-year medical students because it was mandatory for them to conduct a research project as a component of their School of Medicine 503 (SOM 503) course.

As we needed to identify specific microlevel factors that might impede the application of BPSM by the UB-FOM clerkship supervisors, we investigated the knowledge, attitude, and practice (KAP) of UB-FOM clerkship supervisors on BPSM.

Study design and period

This was a descriptive, quantitative cross-sectional survey. We collected data from December 1, 2023, to May 10, 2024.

Study setting

The UB-FOM, a recently established medical institution, provides clerkship training in Gaborone, the main training location, Lobatse (72 kilometres away from Gaborone), Mahalapye (200 kilometres away from Gaborone), and Maun (915 kilometres away from Gaborone) for family medicine (FM) rotations. A clerkship consists of three years: Students rotate through the third, fourth, and fifth years of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. In a small group of approximately 20, students spent eight weeks in each of the clinical domains. Medical officers and specialists from the Botswana Ministry of Health, UB-FOM postgraduate students, and UB-FOM academics who work in the relevant departments supervise medical students on clerkships.

Study population, and recruitment

The research population included medical officers and specialists from the Botswana Ministry of Health, UB-FOM postgraduate students, and UB-FOM academics who supervise medical students during clerkships. We invited every clerkship supervisor to participate in the study, as about 140 medical officers and specialists supervise UBFOM clerkship students.

Inclusion and exclusion criteria.

We included UBFOM clerkship supervisors from paediatrics, obstetrics and gynaecology, surgery, internal medicine, emergency medicine, anaesthesia, orthopaedics, and psychiatric departments. Individuals must have held a position at the university or health facility conducting the training for a minimum of one year, during which they fulfilled the role of clerkship supervisors, to be eligible. We excluded family medicine supervisors in our survey, as this category of UBFOM clerkship supervisors consistently implement, promote, and train students about the biopsychosocial model.

Data collection and procedure

We distributed self-administered questionnaires to UB-FOM clerkship supervisors across departments. An online questionnaire (Microsoft Forms) and a paper-based questionnaire were available for respondents to choose from. We used the questionnaire to gather sociodemographic data such as age, sex, marital status, level of education, clinical domain or department, and cadres. The instrument gathered data on the biopsychosocial model's prior training and the teaching of medical students at the UB-FOM. Additionally, the instrument facilitated the collection of data regarding the BPSM's KAP using a five-point Likert scale. The instrument featured an open-ended question section that asked participants, in a sentence or two, to elaborate on the factors they believed could limit their application of the biopsychosocial model.

We collected the data over a two-month period. We then attached the data to a spreadsheet file to allow for tabulation storage.

Data analysis

Where applicable, we summarised the data in the form of a table, frequency, mean (SD), and median (± IQR).

The 11 items that assessed knowledge and attitude had a reliability (Cronback Alpha) of 0.905, indicating that the item statements were understandable to the respondents. The reliability (Cronback Alpha) of the two items assessing practice was 0.845, suggesting that the respondents understood the item statements.

We computed the weighted mean (the sum of the mean divided by the number of items) and compared it to the item's mean to determine whether participants had a low or high perception of the KAP item statement. We used IBM SPSS 29.0.0.0 (241) for data analysis.

We manually created thematic indexes for the qualitative data. To analyse all the data, we methodically used the codes from the theme index. We used charting to perform data consolidation, grouping all data with identical codes. Subsequently, the researchers proceeded to analyse the consolidated data.

Validity and reliability:

Because they were excluded from the main study, the team conducted a pilot study with 16 clerkship supervisors from the Family Medicine department. This allowed for the questionnaire to be revised, improving its user-friendliness.

Of the potential 140 participants, 34.3% of clerkship supervisors responded. Table 1 presents the sociodemographic characteristics of the subjects. Forty-eight MBBS clerkship supervisors completed the questionnaire from seven departments, with psychiatry the most respondents (n = 15, 31.5%). Obstetrics and Gynaecology had the second highest response rate at 27.1%, followed by internal medicine at 18.8%. The sex ratio was about equal. Approximately two-thirds of MBBS' clerkship supervisors were between the ages of 30 and 39 (n = 29, 60.4%), married (n = 29, 60.4%), or served as medical officers (n = 31, 64.6%). Over half of Botswana Ministry of Health employees (medical officers or specialists) were clerkship supervisors (n = 28, 58.3%).

Table 1

Sociodemographic characteristics of University of Botswana, Faculty of Medicine clerkship supervisors.
Sociodemographic characteristics		n = 48	%
Age group	< 30	7	14.6
	30–39	29	60.4
	40–49	8	16.7
	50–59	3	6.3
	≥ 60	1	2.1
Sex	Male	22	45.8
Sex	Female	26	54.2
Marital status	Single	15	31.3
	Cohabiting	2	4.2
	Married	29	60.4
	Divorced	2	4.2
Department	Anaesthesiology	2	4.2
	Emergency medicine	1	2.1
	General Surgery	5	10.4
	Internal medicine	9	18.8
	Obstetrics and Gynaecology	13	27.1
	Paediatrics	3	6.3
	Psychiatry	15	31.3
Level of education	MBBS*	31	64.6
	MMED**	16	33.3
	PhD***	1	2.1
Cadres	Medical officer/ specialists from BoMoH#	28	58.3
	Resident	11	22.9
	Lecturer	3	6.3
	Senior lecturer	4	8.3
	Associate Professor	2	4.2

*, Bachelor of medicine and Bachelor of Surgery; **, Master of Medicine; ***, Doctor of Philosophy; #, Botswana Ministry of Health.

Table 2 presents the participants' responses about their previous training in the biopsychosocial model and supervision of UBFOM medical students. Most participants (n = 38, 79.2%) reported that they received training on the biopsychosocial model throughout their undergraduate or postgraduate education. In the ward or consultation room, one-third (n = 17, 35.4%) of participants supervised UBFOM medical students in small groups of 4–7 students, while 12 (25.0%) participants reported supervising UBFOM medical students in smaller groups of less than four students.

Table 2

Participants’ responses about past training in the biopsychosocial model and supervision of University of Botswana Faculty of Medicine medical students.
Questions:		n = 48	%
Did you receive any training in the biopsychosocial model during your undergraduate or post graduate studies?	No	10	20.8
	Yes	38	79.2
This week: How many UBFOM* students did you supervise in their clinical rotation (ward round or consultation room)?	0–3 per group	12	25.0
	4–7 per group	17	35.4
	8–11 per group	8	16.7
	Missing	11	22.9
This week: Do you also do classroom teaching?	No	40	83.3
This week: Do you also do classroom teaching?	Yes	8	16.7

*, University of Botswana Faculty of Medicine.

Table 3 shows that most respondents appeared to feel that all four health domains (biological, psychological, social, and spiritual) must be considered in every health care task (mean score = 4.14 > weighted mean score of 4.04). They perceived that the BPSM's goals were to provide compassionate, whole-person care, as quality of life was more important than only clinical goals (mean score = 4.25 > weighted mean score of 4.04). They believed that changes in one of these health domains could have a significant impact on the other(s) (mean score = 4.39 > weighted mean score of 4.04). They also acknowledged that the interaction between psychological and physical health factors can be extremely complex. Physiological factors can influence a patient's subjective experience, but they cannot solely influence it (mean score = 4.18 > weighted mean score of 4.04). A variety of factors, ranging from biological (tissues, structures, and molecules) to environmental (social, psychological, and spiritual), can cause suffering, disease, and illness (mean score = 4.57 > weighted mean score of 4.04). Therefore, respondents perceived that throughout the treatment process or course of a disease, biological, psychological, social, and/or spiritual factors influenced a patient's subjective experience, clinical outcomes, and effective treatment (mean score = 4.30 > weighted mean score of 4.04). They didn't seem to believe that biological factors alone influence some major medical conditions, such as diabetes's primary dysfunction, advanced cancers, or advanced cardiovascular disease. They also didn't believe that psychosocial processes and interventions could change these conditions, and in some cases, they didn't believe that biological interventions could change them (mean score = 2.66 < weighted mean score of 4.04).

They responded that psychological problems and/or multimorbidity require more time during consultation but should always be considered, regardless of time wasting (mean score = 4.14 > weighted mean score of 4.04), and psychosocial factors may be involved in the prognosis of some of the many medical conditions and surgical procedures (mean score = 4.16 > weighted mean score of 4.04). However, they didn't feel that mental habits could be the missing link between the biopsychosocial model and clinical reality (mean score = 3.91 < weighted mean score of 4.04) and that spiritual evaluation of a patient should be part of the medical practice (mean score = 3.82 < weighted mean score of 4.04).

Respondents indicated that the BPSM was relevant to their field of practice (mean score = 4.30 > weighted mean score of 4.04); however, they expressed that clinical and health education settings rarely use the BPSM, despite its frequent reference as the "overarching framework" for modern healthcare (mean score = 3.68 < weighted mean score of 4.04).

Table 3

Knowledge and attitude of biopsychosocial model among University of Botswana Faculty of Medicine clerkship supervisors
Statement Items	SD^a n (%)	D^b n (%)	N^c n (%)	A^e n (%)	SA^f n (%)	Mean	SD ^g	Decision
All four levels, biological, psychological, social, and spiritual must be considered in every health care task’	1 (2.3)	1 (2.3)	6 (13.6)	19 (43.2)	17 (38.6)	4.14	0.91	High perception
The biopsychosocial model's goals are to provide compassionate, whole-person care. Quality of life is more important than only clinical goals.	1 (2.3)	1 (2.3)	6 (13.6)	14 (31.8)	22 (50.0)	4.25	0.94	High perception
Changes in one of these factors (biological, psychological, social/environmental, or spiritual) have the potential to cause significant changes in the other(s).	1 (2.3)	0	1 (2.3)	21 (47.7)	21 (47.7)	4.39	0.75	High perception
The interaction between psychological and physical health factors can be extremely complex. The subjective experience of a patient can be influenced by physiological factors, but it cannot be reduced to them alone.	1 (2.3)	1 (2.3)	3 (6.8)	23 (52.3)	16 (36.4)	4.18	0.84	High perception
Suffering, disease, and illness are caused by a variety of factors, ranging from biological (tissues, structures, molecules) to environmental (social, psychological, and spiritual).	1 (2.3)	0	2 (4.5)	11 (25.0)	30 (68.2)	4.57	0.79	High perception
Throughout the treatment process or course of a disease, biological, psychological, social, and/ or spiritual factors influence a patient's subjective experience, clinical outcomes, and effective treatment.	2 (4.5)	0	3 (6.8)	17 (38.6)	22 (50.0)	4.30	0.95	High perception
Some major medical conditions, such as diabetes's primary dysfunction, advanced cancers, or advanced cardiovascular disease, appear to be influenced solely by biological factors, impenetrable to psychosocial processes and interventions, and, in some cases, unresponsive to biological intervention.	4 (9.1)	18 (40.9)	13 (29.5)	7 (15.9)	2 (4.5)	2.66	1.01	Low perception
Psychological problems and/or multimorbidity require more time during consultation but should always be considered, regardless of time wasting.	1 (2.3)	0	6 (13.6)	21 (47.7)	16 (36.4)	4.16	0.83	High perception
Psychosocial factors may be involved in the prognosis of some of the many medical conditions and surgical procedures.	1 (2.3)	3 (6.8)	5 (11.4)	15 (34.1)	20 (45.5)	4.14	1.03	High perception
Mental habits could be the missing link between biopsychosocial model and clinical reality.	1 (2.3)	1 (2.3)	11 (25.0)	19 (43.2)	12 (27.3)	3.91	0.91	Low perception
Spiritual evaluation of a patient should be part of the medical practice.	1 (2.3)	2 (4.5)	12 27.3)	18 (40.9)	11 (25.0)	3.82	0.95	Low perception
The biopsychosocial model is applicable in my field of practice.	1 (2.3)	0	7 (15.9)	13 (29.5)	23 (52.3)	4.30	0.90	High perception
The biopsychosocial model is widely used in clinical and health education settings, and it is often referred to as the "overarching framework" for modern healthcare.	2 (4.5)	3 (6.8)	11 (25.0)	19 (43.2)	9 (20.5)	3.68	1.03	Low perception
^a, strongly disagree; ^b, disagree; ^c, neutral; ^d, strongly disagree; ^e, agree; ^f, strongly agree; ^g, standard deviation. Decision-weighted average = 4.04

Participants appeared to feel comfortable with applying the biopsychosocial model when they attended to patients (mean score = 4.09 > weighted mean score of 4.04). However, they did not feel comfortable teaching a biopsychosocial model to medical students during their clinical rotation (mean score = 3.98 < weighted mean score of 4.04).

Table 4

Practice of the biopsychosocial model among University of Botswana Faculty of Medicine clerkship supervisors.
Statement Items	SD^a n (%)	D^b n (%)	N^c n (%)	A^e n (%)	SA^f n (%)	Mean	SD ^g	Decision
I am comfortable with applying biopsychosocial model when I attend to patients.	3 (6.8)	0	6 (13.6)	19 (43.2)	16 (36.4)	4.09	0.88	High perception
I am comfortable with teaching biopsychosocial model to medical student during their clinical rotation.	1 (2.3)	1 (2.3)	9 (20.5)	20 (45.5)	13 (29.5)	3.98	0.90	Low perception
^a, strongly disagree; ^b, disagree; ^c, neutral; ^d, strongly disagree; ^e, agree; ^f, strongly agree; ^g, standard deviation. Decision-weighted average = 4.04

When asked what they felt would restrict the practice of the BPS model, most participants stated that time constraints during consultations and workload were the most significant barriers:

“Time and patient load. Because it is not something we have been practising regularly it takes longer to incorporate it on our day-to-day practice” (Female, medical officer, internal medicine)

“Patient-doctor ratio plays a role as the volume of patients may require that time spend on a patient be limited not to ask about the psychosocial aspect of the approach” (Female, medical officer, psychiatry).

They indicated that the negative "attitude" towards the BPS model, as well as a lack of updated training and a defined guideline for the BSP model, were obstacles to implementing a BPS approach:

“I think we often focus on the biological and forgets other aspects of health. I mean a lot of times you find patients do not even know what they are being treated for in the hospital.” (Female, medical officer, internal medicine).

“I would need a refresher on the model” (Female, medical officer, anaesthesiology).

“...a structured guideline for the BSP model” (Female, lecturer, paediatrics).

They also expressed that privacy challenges during the ward round, lack of continuity of care and the shortage contributed to their inability to implement a BPS model in their routine practice:

“On the ward rounds that are often crowded with no less than five people around the patient who are also often new to her each time, as you probe into these questions if the setting doesn’t feel private and secure, they may not respond much.” (Female, senior lecturer, obstetrics and gynaecology).

“In the public sector a patient will be attended consistently by a specific doctor to build trust with them as they address all the aspects of their disease since all may not emerge at the initial consult or review but progressively.” (Female, senior lecturer, obstetrics and gynaecology).

“...personal may mean that other allied healthcare workers such as social workers, psychologist are not

easily accessible to patients.” (Female, medical officer, psychiatry).

This study identified specific microlevel factors (knowledge, attitude, and practice) that might impede the application of BPSM by the UB-FOM clerkship supervisors.

Most participants (79.2%) reported that they received training on the BPSM throughout their undergraduate or postgraduate education. Despite participants reporting that they received BPSM during their undergraduate or postgraduate medical training, many medical school institutes still primarily rely on the traditional and reductionist biomedical paradigm [6, 8].

Most respondents in this survey expressed the belief that any healthcare task should consider all four aspects of health (biological, psychological, social, and spiritual). Similarly, Astin et al. conducted a study among primary and non-primary health care experts in Boston and found that two thirds of the respondents believed that incorporating BPSM would result in "moderate" or "significant" enhancements in treatment outcomes [9].

In our study, respondents acknowledged that the relationship between psychological and physical health elements can be extremely complex. Respondents didn't seem to believe that biological factors alone influence some major medical conditions, such as diabetes's primary dysfunction, advanced cancers, or advanced cardiovascular disease. Recent research suggests a connection between psychological well-being, which includes positive emotions, optimism, a sense of meaning and purpose in life, overall life satisfaction, and physical health. Researchers specifically studied this connection in relation to mortality rates and the development and progression of chronic diseases [10]. DuBois et al. reported in their systematic review that positive psychological constructs were associated with 23% reduced rates of rehospitalization or mortality (p.<001). Additionally, positive psychological constructs appeared to be prospectively associated with health outcomes in most studies, but not all [11].

In this study, respondents didn't believe that psychosocial processes and interventions could change these conditions, and in some cases, they didn't believe that biological interventions could change them. In their study, Astin et al. conducted focus group interviews with physicians in Boston, USA, who recognised the importance of addressing psychosocial concerns and believed that doing so would lead to better outcomes [9]. Psychosocial factors have a direct influence on physical health outcomes. Chronic exposure to stressors is associated with hypertension, the onset of diabetes, and ischemic heart disease. Also, they exert a significant impact on health-related behaviours, including alcohol consumption, smoking, dietary choices, and physical exercise. The correlation between social, economic, and environmental factors and health is intricate and does not follow a straight line [12].

Respondents from the present study acknowledged that psychological problems and/or multimorbidity require more time during consultation but should always be considered, regardless of time wasting. However, they didn't feel that mental habits could be the missing link between the BPSM, and clinical reality and that the spiritual evaluation of a patient should be part of the medical practice. When one encounters dichotomies, is perplexed by problems, or confronts uncertainties, his most effective actions include invoking specific patterns of intellectual behavior that have become ingrained in mental habits [13]. These habits of mind include attentiveness, peripheral vision, curiosity, and informed flexibility. Proficiency in medicine extends beyond clinical skills, incorporating mental attitudes such as understanding the circumstances and establishing a connection with the patient [14]. Increasing evidence indicates the incorporation of spirituality into medical treatment. Religion generally has a beneficial effect on health, although doctors may differ in their willingness to address patients' religious and spiritual concerns [2, 15].

This study's respondents acknowledged the relevance of the BPSM to their field of practice, but they also expressed its infrequent use in clinical and health education settings. Negri et al. conducted a study that revealed approximately 66% of general practitioners acknowledged the potential benefits of psychological intervention for many patients. However, they consistently referred only a small percentage (9%) of these patients to a psychologist [16]. The challenges in reconciling the BSPM with clinical reality stem from the ambiguity surrounding its nature. There is uncertainty regarding whether the BPSM is a theory that can be empirically tested, a philosophy that is logically coherent, a descriptive model that broadens the scope of clinical investigation, a belief system that cannot be proven empirically, a practice guide with an implicit or explicit methodology, and/or a vision for a particular approach [14].

Additionally, respondents in this study expressed confidence in employing the BPSM when treating patients; however, they did not feel at ease teaching medical students on the model during their clinical rotation. Obstacles to the implementation of a BPSM included time constraints during consultations and burden, a negative "attitude" towards the BPSM, a lack of updated training, and a defined guideline for the BSPM. They also stated that the inability to incorporate a BPSM in their routine practice was a result of the shortage, the lack of continuity of care, and privacy challenges during the ward round. Since the initial descriptions of BPSM, practicing physicians have faced challenges aligning the biopsychosocial model with clinical reality [17]. Nevertheless, even after undergoing BPSM training, physicians often perceive the training as inadequate in terms of addressing the role of biopsychosocial elements. Consequently, they experience a sense of diminished self-confidence in dealing with and effectively treating biopsychosocial issues [18]. Several studies have revealed that the beliefs and attitudes of healthcare workers are the primary barriers preventing the implementation of BPSM [19, 20]. Additional factors influencing practice habits include an inherent desire to uphold a positive relationship between clinicians and patients, as well as the challenge of addressing patients' expectations and the limited expertise of healthcare professionals in managing psychosocial factors related to pain treatment [20]. A positive mindset and metal habits for BPSM can overcome the obstacles identified by the respondents in this study. Students can learn from clerkship supervisors and integrate BPSM into their own practice once it becomes ingrained in their routine.

The limited number of respondents (34.3%) and the nature of the study design (cross-sectional) may restrict the generalisability of this study's findings. We did not investigate the percentage of clerkship supervisors who practice and teach BPSM. Furthermore, we did not assess the potential impact of educational attainment on the knowledge, attitude, or practice of BPMS.

Future research should investigate how to integrate BPSM into clinical practice using digital health technology [21]. Implementing BPSM-standardised management protocols for specific disorders will streamline research efforts. The positive outcomes of this approach may motivate healthcare providers to adopt the model in their practice, leading to ultimate benefits for patients, carers, and healthcare professionals. We suggest implementation research that addresses the beliefs and attitudes of clerkship supervisors. We recommend that clinical guidelines be designed to incorporate the BPSM and promote mental habits that facilitate its practice and teaching.

Clerkship supervisors at UB-FOM appreciated the importance of considering all four dimensions of health in any healthcare activity. They also noted the intricate nature of the interaction between psychological and physical health elements. They expressed confidence in using the BPSM for patient treatment. However, they did not feel comfortable instructing medical students on the model during clinical rotation, and they expressed scepticism over the ability of psychosocial processes and treatments to alter medical illnesses. They did not feel that mental habits could potentially bridge the gap between the biopsychosocial model (BPSM) and clinical reality. Additionally, they did not feel the importance of incorporating spiritual evaluation into medical practice.

We did not examine the proportion of clerkship supervisors who engage in and instruct BPSM. Furthermore, we did not assess the potential impact of educational achievement on knowledge, attitude, or behaviour related to BPMS.

We recommend implementation research that specifically targets the beliefs and attitudes of clerkship supervisors. We advise incorporating the Biopsychosocial Model (BPSM) into the construction of clinical guidelines and encouraging mental habits that support the application and instruction of the BPSM.

Acknowledgements

We thank clerkship supervisors to have taken time to participate to the study.

Funding

This study was not funded.

Author contributions

Stephane Tshitenge has been involved in the design of the study and has been responsible for the development of the questionnaire. He has been accountable for the statistical analyses and the manuscript composition. While Katlego P. Molebatsi, Lesedi Moeng, Reneilwe S. Mothule, Bofelo Moeti, Ronald O.B. Manko, and Mompoloki M. Moses made contributions to study design, the conceptualisation of the questionnaire, data collection, and manuscript review.

Data availability

This article encompasses all data that was generated or analysed during this investigation.

This study was approved by the local Ethics Committee of the University of Botswana's Office of Research and Development (UBR/RES/UNDERGRAD/SOM/139/2023), and it adhered to the principles of the Helsinki Declaration. Every respondent agreed to participate in the study; we obtained informed consent from everyone (electronically or physically).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

The clinical trial number is not pertinent to this study, as it does not involve medicinal products or therapeutic interventions.

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No competing interests reported.

Knowledge, attitudes, and practices of clerkship supervisors regarding the biopsychosocial approach at the University of Botswana's Faculty of Medicine

Status:

Version 1

Abstract

Introduction

Methods

Study design and period

Study setting

Study population, and recruitment

Data collection and procedure

Data analysis

Validity and reliability:

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1