A History of the Association of Medical School Psychologists

While psychologists have been active faculty members in medical schools for over 85 years, they lacked organization on the national level until 1981. This history traces the background of psychology's involvement in medical schools, landmark events that affected the discipline, and progress since formal organization has occurred. Office of the Senior Vice President and Provost     

Health Care Reform and Psychologists in Medical Schools: Stress, Challenge, and Change

Psychologists from 45 academic health science centers throughout the United States and Canada gathered at Georgetown University for a national conference November 2–5, 1995 organized by the Association of Medical School Psychologists. This paper introduces the proceedings of that conference described in the next four articles in this issue of the Journal of Clinical Psychology in Medical Settings[Volume 4, number 1]. Papers prepared by the working groups focus upon clinical services, education and training, research, and governance and administration within the academic medical setting.     

A Decade of Clinical Psychology in Medical Settings: The Short Longer View

The progress and accomplishments of psychology in medical settings over the past decade since the publication of the Handbook of Clinical Psychology in Medical Settings (J. J. Sweet, R. H. Rozensky, & S. M. Tovian, 1991) and the subsequent founding of the Journal of Clinical Psychology in Medical Settings (JCPMS) in 1994 are highlighted. Areas of progress and accomplishments reviewed include professional developments with our field, roles and services provided by psychologists, education, training and research issues, and program administration in medical settings. The current status of, and possible changes in, medical settings is identified. Future challenges and opportunities for the profession are discussed.     

Job Opportunities/Issues for Health Care Psychologists: The Coming of the Millennium

Job opportunities for psychology for the next decade are being influenced by ongoing shifts in our economic system and resultant general employment practices. As with many burgeoning fields, psychology is experiencing increasing diversification into subspecialities. Professionals in other fields are acquiring supplementary degrees in psychology to heighten their psychological knowledge and professional/organization skills. Thus, psychology is beginning to be viewed, like the MBA, as an important professional degree for many fields, not just mental health or teaching. Training programs are reflecting these diversification trends. Further, as professional applications at the doctoral level expand, there is increasing need for the master's-level technical competence to support the increasing specialities at the doctoral level. These changes represent the creative response of a young and vigorous profession to the challenges of changing market dynamics.     

The 2003 Survey of Academic Medical Center Psychologists: Implications and Outlook

This paper offers commentaries on Pate and Kohout’s (2005) report of data from the 1997 and 2003 surveys of psychologists in medical school settings. The commentaries reflect upon the significance of the survey findings and implications for psychology’s role in medical school and academic health science settings. Though the response rate to the survey was disappointing, the data indicate that psychologists are moving up in academic rank, and have made substantial gains in salary. The data also indicate that among psychologists who are medical staff members, who constitute half the 2003 sample, an increasing proportion are functioning autonomously as reflected in gains in the percentage having admitting privileges, staff voting privileges, and authority to write orders. Research continues to be a major focus for psychologists in academic medical centers. Overall, the findings indicate that psychologists can have productive, satisfying careers in medical school/academic health center settings—though there is one troubling sign, a sizeable drop in the number of positions being created for younger, more recently trained psychologists. Methodological enhancements are described that could improve the quality, scope, and usefulness of data from future studies, both for understanding long-term trends and for conducting salary negotiations. High quality data provide a solid foundation for advocating for psychologists’ full participation in the life of medical schools and academic health centers.     

Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

Report of the Working Group on Governance and Administration

Prepared by the Working Group on Governance and Administration from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper delineates the various trends in health care that may impact upon organizational structures for psychologists within academic medical centers. Ten variables that describe various functional issues within academic medical centers or health science centers are defined. Finally, seven organizational guidelines and recommendations pertaining to governance of psychological services are detailed.     

Report of the Working Group on Clinical Services

Prepared by the Working Group on Clinical Services from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper focuses upon issues related to the effects of health care reform and changes to the health care system on psychologists practicing within academic health care settings. Discussion of the changes in the health care economic system and the call for cost-effectiveness produced five specific suggestions for psychology to establish accountable, data-based models of behavioral health care.     

Report of the Working Group on Education and Training

Prepared by the Working Group on Education and Training from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper focuses upon the education and training of psychologists and education and training of other health care professionals about psychology in academic medical settings. Seven specific topic recommendations are offered that help psychologists define their educational and training missions into the next century.     

周围神经嵌压症诊治过程中的临床思维

运用自然辩证法培养良好的临床思维,指导周围神经嵌压症的诊治过程,有助于获得最佳诊治效果。诊断过程中需全面了解理论知识,学会科学观察,兼顾整体与局部的关系,通过合理分析与综合,可以做出确切诊断。治疗过程中需对有关医师的技术进行评价,采用控制论及系统论方法指导治疗,才能恢复周围神经的结构与功能。     

Medical crisis counseling: A new service delivery model

The diagnosis or exacerbation of a chronic illness, the aftermath of a serious accident, or worries about future in the context of illness or debilitating injury are all examples of medical crises that pose significant coping challenges. Too often, traditional approaches to psychotherapy have been unable to respond the most urgent needs of people confronting such crises. Medical crisis counseling is a specialized approach to addressing the needs of individuals and families confronted by the difficulties of coping with losses or changes, as well as the challenge of living with long-term illness. This paper describes the medical crisis counseling model in contrast with other more traditional intervention approaches.     

Medical Psychology in Australia

Medical psychology in Australia is heavily influenced by British and American thought. The dominant model for clinical training and practice is the scientist–practitioner model, yet a gulf exists between academic and practice settings. Membership of the professional society requires 6 years of university study in psychology. However, registration requires only 4 years training in psychology. Medical psychologists provide a broad range of services in hospital and community settings, often within multidisciplinary teams. Challenges for the future include bridging the divide between university and health settings, increasing qualifications required for registration, making psychology culturally relevant, and demonstrating to funding managers that psychological interventions are both clinically effective and cost effective.     

Medical Psychology in Brazil

In 1962, Psychology was officially accorded professional status in Brazil. Since then the profession has been undergoing continuous development, but the training of psychologists still suffers from flaws that are reflected in the public heath service, SUS (Sistema Único de Saúde). However, SUS itself is also open to criticism: the service is badly distributed, the number of posts for psychologists is limited, and working conditions are poor. Nevertheless, many positive changes are occurring. These include plans to alter academic training to better meet the needs of the Brazilian population, an expansion of the roles played by psychologists in the health service, and increasing research activity. These and many other changes suggest that the progressive evolution of the profession in Brazil will continue.     

The Future of Psychology in Medical Specialities: Introduction to the Special Issue

The continuing evolution of the health care delivery system in the United States presents threats and opportunities to psychologists in medical settings. This special issue explores the future of psychology in psychiatry, family medicine, rehabilitation, geriatric medicine, and pediatric medicine. The challenges facing neuropsychology and pain management are explored also. Finally, the professional issues of ethics in managed care, psychology in the public sector, and training future psychologists are addressed. Each paper summarizes concerns and provides recommendations for clinical practice, research, and training.     

Medical Psychology in New Zealand

This paper describes medical psychology and health psychology in New Zealand, particularly in relation to psychologists teaching in medical schools, psychologists working in general medical settings, and health psychologists. It identifies a reasonably slow but continuing consolidation of the discipline, particularly from a research perspective, but also with therapeutic initiatives in the public and private health sector. The potential for increased activity in health promotion and increased psychological analysis and influence in the health system is identified.     

When is enough enough? We are only beginning

Sheridan (1995) presents the problem of the psychologist consulting to a medical residency program as an example of the difficulty one experiences in attempting to challenge, even from a data-based perspective, the calcification inherent in health systems and medical education in particular. This paper responds to her challenging questions, “How much should we get involved in changing health care and medical education, and at what level (local, national) should psychology intervene (if at all)?” It is suggested that psychologists pick up the challenge to bring about change, whenever possible, with the admonition—we are only beginning.     

Psychology,behavioral sciences,and the challenge to medical education

It is generally agreed that the health care system is in crisis despite reform efforts over the past two decades. Evidence is presented which suggests that medical education has failed successfully to integrate medically relevant behavioral science research findings into medical school curricula or train physicians in the application of behaviorally based treatment technologies. Psychologists in medical education settings have the opportunity to impact medical education and foster psychology's role in health care. If psychology fails to respond to this opportunity, we cannot then complain of the inevitable consequences.An earlier version of this paper was presented at the annual meeting of the American Association of Medical Colleges, Washington, DC, November 1993.     

Teaching psychological knowledge and skills to family physicians

Psychological problems (e.g., anxiety, depression, substance abuse) are prevalent in primary care medical settings. Family physicians (FPs) treat more patients than any other primary care medical specialists. Thus, FPs can play an extremely important role in providing psychological services to their patients. In contrast to other specialists (e.g., internists, obstetricians), FPs are required to complete behavioral science training in their residencies. In this paper, we describe standard undergraduate, graduate, and postgraduate training of FPs. We present our unique program for teaching psychological principles and skills to family practice residents at the University of Kansas Medical Center. And finally, we introduce an instrument, the Interview Rating Scale (IRS), for evaluating the interviewing skills of physicians and residents.     

临床决策与卫生政策

从讨论趋利性临床决策与泛企业化卫生政策的共同作用是造成我国医改失败的根本原因入手,在对3个典型案例进行深入剖析的基础上,论证了临床决策和卫生政策相互依存、相互作用的基本关系;研究了临床决策与卫生政策的决策主体、影响因素、决策过程、信息反馈、关系调整的循环路径;认为完善决策机制是保证临床决策和卫生政策正确有效的必要条件,提出了进一步完善临床决策和卫生政策的决策机制的具体意见和建议。