Implementing a behavioral medicine program in an internal medicine residency: A description of curriculum content,resources and barriers encountered

Abstract

Many internal medicine training programs are currently developing curricula designed to teach the psychosocial aspects of patient care and doctor-patient communication skills. However, faculty may lack expertise regarding how to accomplish new educational goals in these areas. This article is designed to assist programs by describing in detail how a comprehensive behavioral medicine program was integrated into a general internal medicine program at a university-affiliated community hospital. It describes the program goals, resources needed, content included, obstacles to implementation and potential solutions to the problems encountered.     

A Closer Look at Life Goals Across Adulthood: Applying a Developmental Perspective to Content,Dynamics, and Outcomes of Goal Importance and Goal Attainability

It is well established that goals energize and direct behaviour across the lifespan. To better understand how goals are embedded in people's lives across adulthood, the present research examined life goals' content (health, personal growth, prosocial engagement, social relations, status, work), dynamics (interplay between goal importance and goal attainability), and outcomes (subjective well‐being) from a developmental perspective. We argue that people rate those goals as important and attainable that enable them to master developmental tasks, that they adapt their goals to personal capacities, and that goals predict subjective well‐being after 2 and 4 years. The sample included 973 individuals (18–92 years old, M = 43.00 years) of whom 637 participated 2 years later and 573 participated 4 years later. Goal importance and well‐being were assessed at all occasions and goal attainability at the first two occasions. Results indicated that age was negatively associated with importance and attainability of personal‐growth, status, and work goals but positively associated with importance and attainability of prosocial‐engagement goals. The association between goal importance and attainability was largely bidirectional over time; and goal attainability, rather than goal importance, was positively linked to later well‐being. Implications of these findings are discussed in light of adult lifespan development. © 2019 European Association of Personality Psychology     

Principles for quality undergraduate education in psychology

The principles for undergraduate education in psychology presented here are designed for creating a world-class educational system that provides students with the workplace skills needed in this information age; a solid academic background that prepares them for advanced study in a wide range of fields; and the knowledge, skills, and abilities that will enhance their personal lives. A quality undergraduate education is designed to produce psychologically literate citizens who apply the principles of psychological science at work and at home. The American Psychological Association (APA) urges all stakeholders in undergraduate education in psychology to incorporate these principles in establishing goals and objectives that fit their specific institutional needs and missions.     

Exploring the future: a counseling/curriculum project

This article proposes the establishment of a curriculum that will engage students in a study of the future. The goals of this curriculum are: to help students examine their views, assumptions, and values regarding the future; to help them develop a sense of personal agency toward their futures; and to help them acquire the skills involved in planning and decision making. Described in the article are several activities—including brainstorming, futures windowing, and scenario writing—designed to help achieve these learning goals. The author indicates that leading this learning process of exploring the future should be an inherent function of counselors, in their role as persons who help students make plans and decisions for their futures.     

Interprofessional Education: Psychology Trainee Experiences and Perspectives on Team Skills

Interprofessional education (IPE) is defined as educational activities involving trainees from two or more professions learning about, from, and with each other with the goal of building team-based collaboration skills. The degree to which psychology trainees are involved in IPE is unknown. A national survey was distributed to gather information regarding the nature and prevalence of IPE experiences and psychology trainees’ perceived competence in collaboration skills. Participant responses (n?=?143) are presented overall and by training level. Some respondents reported no IPE activities in their training, especially trainees earlier in their training. Highest rated competencies were in acting with honesty and integrity and developing/maintaining mutual respect and trust of other professions. Lowest rated were in giving feedback to others and managing differences in opinion. More research related to the nature and impact of IPE on psychology trainees is critical.

     

Provider Perspectives on Outcome Goals for Children's Day Treatment

I describe service provider perspectives regarding outcome goals of children's day treatment and their ideas for how to make day treatment programs successful in achieving stated outcomes. Respondents were direct service staff from ten day treatment programs in one county in Washington state. Data were obtained through nominal group process methods. The primary outcome goals of day treatment reported were: community re-integration, improved adaptive functioning skills, psychological growth, and improved family functioning. Aspects of day treatment that may help achieve outcome targets included: team quality; comprehensive programming; a consistent, safe, accepting program environment; an individualized, developmental approach; linkages with other services; family involvement, and a low staff-to-client ratio. Outcome goals are discussed relative to those described within the research literature on children's mental health services. Implications for the use of outcome goals for quality improvement are described.     

Training Youth to Cope in Work Settings

This article deals with a study in which an experimental group of 71 economically disadvantaged youth was trained in generic coping skills as part of a CETA training program. The purpose of the program was to help these youth make the transition from school to unsubsidized work. The experimental group was compared to a control group that did not receive training, but did receive other commensurate training experiences. It was found that the experimental group rated their own gains resulting from training as larger than those of the controls, and that they indeed gained significantly more in knowledge and skills than the controls. In a pilot study of employer reactions, over 66% suggested that the coping skills were successfully applied in the work setting, and that it made a positive difference in how the employers evaluated the youths' performance. A six-mounth follow-up indicated that the coping skills training contributed to their employment and helped reduce dropping out of school. (Major portions of this article have previously appeared in the Michigan Personnel and Guidance Journal, whose editor has granted permission for reprint here.)     

Perceived consequences underlying approach goals and avoidance goals in relation to anxiety

Numerous studies have examined anxiety from a cognitive and affective perspective but relatively little research has studied anxiety from a motivational perspective. There are theoretical grounds (e.g., Gray, 1982) for expecting anxiety to be characterised by heightened avoidance motivation, but this motivational bias is not thought to be accompanied by diminished approach motivation. A cross-sectional, mixed model design was used to investigate individuals’ response-variations on personal approach and avoidance goal systems. A convenience sample comprising an anxious group (n = 41) and non-anxious group (n = 33) completed tasks that measured number of self-generated approach goals and avoidance goals, and number of associated positive and negative consequence steps for goals. As predicted, anxious individuals, relative to non-anxious individuals, generated more avoidance goals and more negative consequence steps in response to goal non-attainment (irrespective of goal type) but did not differ on number of approach goals or positive consequence steps in response to goal attainment (irrespective of goal type). The present findings highlight the importance of personal goal systems in understanding the nature of anxiety.     

Significant other primes and behavior: motivation to respond to social cues moderates pursuit of prime-induced goals

Significant others can automatically activate a variety of goals, including goals that significant others have for an individual and the individual's personal goals that are associated with the significant others. Across three studies, this article shows that the effects of significant other primes (i.e., mother, roommate) on behavior depend on individual differences in both personal goals and responsiveness to social cues (i.e., self-monitoring, need to belong). Specifically, individuals who are motivated to respond to social cues assimilate to a goal that their primed significant other has for them, regardless of whether they personally hold the goal. Individuals not so motivated, on the other hand, assimilate to the goal only when it is one that they also personally hold. Implications of these findings for research on the prime-to-behavior relationship and interpersonal goal pursuit are discussed.     

The influence of mastery‐avoidance goals on performance improvement

Two experiments focused on examining the influence of mastery‐avoidance goals on performance improvement, and more specifically, on mastery‐avoidance goals grounded in an intrapersonal standard. That is, herein, mastery‐avoidance goals entail striving to avoid doing worse than one has done before. Both experiments demonstrated that in a multiple‐trial context, mastery‐avoidance goals are deleterious for performance improvement relative to mastery‐approach, performance‐approach, and performance‐avoidance goals, and a no goal baseline. The findings were shown to be independent of participants' perceptions of goal difficulty, and were consistent not only across methodology but also across type of participant (undergraduates versus individuals in the workforce), and type and length of achievement task (a verbal skills task versus an ecologically valid managerial competencies exercise). Copyright © 2009 John Wiley & Sons, Ltd.     

Problems with Danforth's Early Diagnosis and Observational Bias in Behavior Management

ABSTRACT

Many children diagnosed with Attention-Deficit/Hyper-activity Disorder (ADHD) experience difficulties in social relations. While psychosocial approaches based on a combination of skills training and contingency management approaches do appear to improve social behavior, evidence that these benefits generalize and persist following training has been limited. We describe a social skills training program designed to help parents promote the display of appropriate social behavior and better athletic performance in sports settings. The program consists of standard psychological assessment, behavioral parent training, functional assessment, parent-mediated social and sports skills coaching, and generalization and maintenance programming. The goals of this intervention are to promote retention of the child in team sports and facilitate friendship acquisition. Training parents to coach their children effectively in sports-related social skills may prove useful in promoting the maintenance and generalization of skills as well as preventing some of the negative effects of social isolation that frequently accompany an ADHD diagnosis.     

Learning Contracts and the Use of Goal Attainment Scaling (GAS) for Occupational Therapy Students on Mental Health Fieldwork

SUMMARY

To counteract stereotyped views of the mentally ill and to empower occupational therapy students on their mental health clerkship, students developed individualized learning contracts. The contract required formulating their educational goals as a series of graded steps structured through the use of a sequential numerical scale, Goal Attainment Scaling (GAS) (Kiresuk & Sherman, 1968). Goals were related to the students' social-emotional concerns and anxieties encountered in this practice area through an affective GAS also known as a comfort scale. Task skills were addressed via a psychomotor/cognitive GAS. Students took an active role in monitoring their progress on their GAS while exploring emotional reactions. Through the use of an interactive log format, students received ongoing feedback and support from the academic instructor while honing their performance and clinical reasoning skills. Students often articulated a positive transformation of their views of the mentally ill and their sense of efficacy and comfort in working with this population fostered by success with their personal goal achievement on their GAS.     

The Relationship between Creativity and Interpersonal Problem-Solving Skills in Adults

The present study evaluated whether creativity training and interpersonal problem-solving training reflect equivalent or complementary skills in adults. A sample of 74 undergraduates received interpersonal problem-solving training, creativity training, neither, or both. Dependent variables included measures of problem-solving and creative performance, and problem-solving and creative style. The results suggested that creativity and interpersonal problem-solving represent complementary skills, in that each training program specifically affected performance only on related measures of performance. A combination of programs affected both abilities. Creativity training and interpersonal problem-solving training are popular psychoeducational interventions that developed in isolation from each other. Originally thought of as a mysterious process, the empirical analysis of the creative act can be traced to the work of Wallas (1926). Under the assumption that creativity is a desirable trait, a number of scales and training programs have been developed to measure and enhance creative skills. Creativity training has been used primarily in educational and industrial settings (e.g., Basadur, 1981). The principles of interpersonal problem-solving training have emerged more recently, in the work of Spivack and Shure (1974; Spivack, Platt, & Shure, 1976) and D'Zurilla (D'Zurilla & Goldfried, 1971; D'Zurilla & Nezu, 1982). These authors conceptualized interpersonal problem-solving training in the context of behavior therapy, and for this reason the literature on interpersonal problem-solving is more closely associated with therapeutic settings. Creativity and interpersonal problem-solving skills can be conceptually distinguished on the basis of their goals. Interpersonal problem-solving refers to one's skill in determining the means by which to achieve a specific end or overcome a specific problem. Creativity, on the other hand, need not be oriented towards achieving specific ends; it is associated with the capacity for thinking in new and different ways. Koestler (1964) has even argued that these two goals can be inimical, at least in adults, in that the ability to combine information in unique ways may be. hindered when the individual focuses his or her thinking on a specific problem. At the same time, there are clear similarities between the two domains of skills. Guilford (1977) noted that “creative thinking produces novel outcomes, and problem-solving involves producing a new response to a new situation, which is a novel outcome” (p. 161). Edwards and Sproull (1984) saw creativity training as a method for improving the quality of solutions to problems and increasing personal effectiveness. They considered problem-solving synonymous with creativity, since both training programs offer a variety of techniques to help identify useful solutions to problems. Similarly, Noller (1979) and others (e.g., Isaksen, Dorval, & Treffinger, 1994) have discussed the concept of creative problem solving, which attempts to integrate principles in the literature on creativity and on problem solving. Isaksen et al. conceptualized the process of creative problem solving as consisting of six steps which fall within three stages. The first stage involves understanding the problem, consisting of three steps: mess-finding, data-finding, and problem-finding. This is followed by the stage of generating ideas, involving the idea- finding step. Finally, there is planning for action, which involves solution-finding and acceptance-finding. The most important difference between the various creativity training models and the interpersonal problem-solving model lies in their emphasis. Creativity training models focus primarily on enhancing skill at generating solutions. The interpersonal problem-solving model places equal emphasis on the implementation and evaluation of potential solutions. Although many authors have suggested that participation in creativity training will have positive effects on social and interpersonal functioning (e.g., Parnes, 1987), only two studies have been conducted examining the relationship between the interpersonal problem-solving training model and creativity skills. Miller, Serafica, and Clark (1989) and Shondrick, Serafica, Clark, and Miller (1992) found that interpersonal problem-solving training for children also enhanced creativity skills, and that children's creative abilities appear to be predictive of their interpersonal problem-solving skills. The question of whether creativity and interpersonal problem-solving are equivalent, complementary, or even inimical has not been adequately addressed in the existing literature. For one thing, there are no studies examining the relationship between the two constructs in adults. This is an important question, given Koestler's (1964) conclusion that they are potentially inconsistent among adults. Second, there are no studies at all regarding the impact of creativity training on problem-solving skills in adults. The purpose of the present study was to evaluate whether creativity and interpersonal problem-solving skills can be distinguished in an adult sample.     

Teachers’ Experience, Attitudes, Feelings and Behavioural Intentions towards Children with Special Educational Needs

This project examined teachers’ attitudes to children with special educational needs. Understanding the implicit and explicit attitudes of teachers is an important precursor to improving teaching practices for children with special needs. Participants (N=77) were pre-service teachers and experienced teachers during in-service training courses. Results showed that behavioural intentions related to explicit rather than implicit attitudes, and that feelings of guilt and anxiety were associated with intentions for negative actions. Profiles of attitudes were substantially similar in terms of personal and teaching experiences. However, attitudes were less positive about children with low social skills and more positive about children with low cognitive skills. Findings have direct application to training teachers of children with special educational needs.     

Teaching simple addition to children with mental retardation using a microcomputer

Computer assisted instruction (CAI) was used for improving the efficiency of simple addition (single-digit without carrying) computation in three children with mental retardation. The training program, conducted on a portable personal computer, consisted of demonstrations and repetitive practices on simple addition presented in a vertical format. A number of behavioral instruction techniques such as direct feedback, corrective demonstration, verbal association, and token reinforcement were also included. To evaluate the effects of the CAI package, a multiple-baseline across subjects design with followup was employed. Results showed that performances of children improved with training and were maintained at 1-week, 4-week, and 12-week followups. Generalization of the learned skills was evident when children were assessed on a paper-and-pencil addition test in a vertical format. The skills were also transferable, with initial prompting, to a computerized addition test in a horizontal format. These findings reaffirmed the applicability of CAI and behavioral techniques for teaching math skills to children with mental retardation.     

Work-related goal appraisals and stress during the transition from education to work

People's personal goals interact with their life situations in many ways. This study examined the appraisals of personal goals during a transition from education to work and their interplay with stress in different domains of life. Finnish young adults (N = 265, 60% female) reported on their goals in the work domain, and related appraisals of importance, attainability, and progress, and the amount of stress they experienced with regard to economic situation, time, and work. The results showed that those individuals who appraised their work goals as important, attainable and progressing well, benefited from their goal striving as evidenced in less stress in all three domains. Moreover, individuals who initially experienced elevated stress levels due to their economic and work situation adapted their work-related goals, such that they later set goals which were more attainable and showed better progress. For these individuals, pursuing work goals remained highly important, whereas for others work goal importance declined.     

The efficacy of a pilot pediatric cognitive remediation summer program to prepare for transition of care

This study assessed the efficacy of a time-sensitive cognitive remediation summer program (CRSP) that provided patients and their families with tools to help mitigate neurocognitive deficits and promote independence to foster precursor transition of medical care skills. A total of 38 participants (aged 9–15) were included in one of the CRSPs offered yearly from 2013 to 2016. A longitudinal design was employed and at each evaluation time point, one week before start of the CRSP (pre-testing) and within three weeks after the end of the program (post-testing)), participants were administered measures of executive functioning in addition to parent ratings of behavior, executive functioning, and adaptive skills (Year 1–Year 4). In Year 4, additional measures were collected, including parenting style and parent engagement and involvement in the program. Results from Year 1 to Year 4 (n = 35) demonstrated that participants in the CRSP showed significant improvement on neuropsychological testing in sustained and selective attention, planning, and cognitive flexibility. Robust changes in parent ratings of adaptive functioning from pre- to post-treatment were also found. Specific to Year 4 (n = 13), results revealed that participants showed improvement in levels of independence with at least one of the individualized goals focused on during the program. This study provided a systematic method to gauge the levels of instruction necessary to reach goals, a crucial tool in skill-teaching. Overall, our study provides evidence for the efficacy of the CRSP and validates a feasible intervention that can be integrated into standard of care for pediatric medical populations.     

An examination of patience and well-being

Patience is the propensity to wait calmly in the face of frustration or adversity. The new 3-Factor Patience Scale (Study 1) measures three types of patience (interpersonal, life hardship, and daily hassles patience), which differentially relate to well-being and personality. In Study 2, goal pursuit and achievement mediated the relation between patience and well-being. Participants rated 10 personal goals on 15 dimensions of goal pursuit (e.g. patience enacted, difficulty, achievement satisfaction, effort). Patience facilitated goal pursuit and satisfaction especially in the face of obstacles. In Study 3, participants took part in a training program designed to increase trait patience. The program led to increased patience, decreased depression, and increased positive affect relative to a control condition, suggesting that patience may be modifiable.     

Impact of a personal goals management program on the subjective well-being of young retirees

A personal goal-based intervention was offered to retired people aged 50 to 65 years with the objective of increasing their subjective well-being. The program aimed to help the participants set, plan, and pursue their personal goals through a learning process based on literature on goal intervention. At the end of the program, the experimental group (N = 117) had improved significantly more than the control group (N = 177) on the majority of the goal and subjective well-being indicators, and this gain was maintained six months later. The enhanced well-being observed in the participants after the intervention stemmed from the mediating effect of the goals and was thus due to the greater focus on goals. Some ideas to make the program more effective are discussed.