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.     

Psychology’s Adaptation to Medical Schools,Teaching Hospitals,and Academic Medical Centers: The Role of Academic Medicine Organizations

Psychologists in medical schools, teaching hospitals, and academic medical centers are comparatively small in number, and are often undervalued and denied full practice privileges. As a profession, psychologists must therefore adapt to the realities of a physician-driven, physician-controlled environment. Psychologists’ adaptation to academic medical settings has been considered from several vantage points. An overlooked aspect of adaptation is psychologists’ knowledge of and participation in academic medicine organizations that regulate medical education and specialization. These organizations significantly influence teaching hospital and medical school environments and the psychologists and academic physicians who work in those environments. This paper focuses primarily on three academic medicine organizations, the Liaison Committee on Medical Education (LCME), the Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS), which together shape and regulate medical education across all levels and specialties. Knowledge of the evolution and workings of these organizations is useful information for psychologists, but beyond that, such information is a framework that provides benchmarks for understanding psychology’s evolving system of education and specialization.     

Psychology’s Adaptation to Academic Medical Settings

This introduction provides an overview of the papers that follow. Each paper contributes to the central theme of the issue, psychologists’ adaptation to the realities of academic medical settings. The specific approach of each paper to the shared theme of “adaptation” is described in some detail so the busy reader can go directly to the papers of greatest interest.     

Results from a National Survey of Psychologists in Medical School Settings—2003

Preliminary results are presented from a 2003 collaborative survey of psychologists employed in medical schools and academic health centers. The findings are reported along with comparable data from a similar survey conducted in 1997. There were several noteworthy changes in results from 1997 to 2003. Salaries increased substantially at all ranks, though women’s earnings remain lower than men’s. There were increases in the percentage of respondents who completed their doctorates 20 or more years ago, and in the percentages holding higher academic ranks and having tenure. However, there was a decrease in the absolute number and percentage of psychologists at lower ranks who received their doctorates recently. Overall, the findings indicate that psychologists have established a secure home in medical school settings. Future reports will present more detailed analyses of the 2003 dataset as well as additional comparisons with the 1997 survey data.     

Partnerships with Psychiatry and Other Clinical Disciplines: A Key to Psychology's Success in U.S. Medical Schools

This paper describes the growth of psychology in medical schools and the distribution of psychologists across medical school departments. The Association of American Medical Colleges (AAMC) and American Psychological Association (APA) use different data collection approaches that reflect their different missions. AAMC focuses solely on medical school faculty, whereas APA tries to reach all psychologists working in academic health centers (AHCs). The number of psychologists in medical school settings has increased, largely due to their research expertise; but psychologists also contribute through teaching and clinical service. Psychologists hold appointments in wide variety of medical school departments, which has been a key factor in their success. Through partnership and interdisciplinary collaboration with a wide range of academic physicians, psychologists have gained increased support, become valued members of the AHC and medical school communities, and can rise to leadership positions in medical schools.     

History of the Association of Medical School Psychologists (AMSP), 1982–2005

This paper presents a brief history of the Association of Medical School Psychologists (AMSP) from the Association’s beginning in 1982 to the present day. Prior to 1982, there had been several unsuccessful efforts to form an association that would represent psychologists in academic medical centers. Attempts by psychiatry to limit the growing number and influence of psychologists in medical schools created a sense of threat among psychologists that catalyzed the formation of the Association. Membership was initially restricted to one senior psychologist from each medical school, a restriction that limited AMSP’s development, but AMSP later opened its doors to all academic medical center psychologists. The Association was rebuffed in initial efforts to join the Association of American Medical Colleges, and at a later date, to become a Division of the American Psychological Association (APA). In time, however, AMSP did establish formal ties to both of those organizations, and it has collaborated with APA in important surveys of academic medical center psychologists. Following a period in the late 1990’s when AMSP seemed likely to lose its way, the Association rebounded. AMSP now has an Administrative Director, a stable home base, and revised bylaws that assure greater stability and continuity of leadership. These developments, in conjunction with a strong working relationship with the Journal of Clinical Psychology in Medical Settings, have positioned AMSP to grow and more effectively serve the community of psychologists who work in academic medical centers.     

Statistical significance testing, construct validity, and clinical versus actuarial judgment: an interesting (seeming) paradox

What practical implications does Meehl’s attack on significance testing have for clinical psychologists, and doesn’t Meehl contradict himself in placing so much emphasis on scientific theories in such works as “Theoretical Risks and Tabular Asterisks” and yet advocating for actuarial judgement, which is essentially an atheoretical approach to clinical predication? This seemingly paradoxical ideology, when considered within the broader context of Meehl’s work, can be readily aligned.     

Which factors best account for academic success: Those which college students can control or those they cannot?

This study integrates research linking academic performance with individual differences and class attendance. Whereas individual differences (ability, traits) are not controllable by students, students can control their attendance, study and work. Thus we sought to determine the extent to which “control” and “no control” variables predict academic performance. With N = 338, measures of verbal ability, the five-factor model, GPA, academic goals, and study behavior were used to predict exams, attendance, and independent projects completed. Uncontrollable factors accounted for 37% of the variance in exam scores; controllable factors accounted for an additional 6–10%. We also found an interaction such that, relative to low-ability peers, high-ability students’ attendance most enhanced their exam performance. Attendance was best accounted for by GPA, study and work. Projects were best predicted by low verbal ability and by personality traits.     

The Association of American Medical Colleges and the Association of Medical School Psychologists: Finding Psychology’s Place in Academic Medicine

This paper highlights the role of the Association of Medical School Psychologists (AMSP) as a bridge between academic medicine and psychology. AMSP’s affiliation with Division 12 of the American Psychological Association is discussed, but the primary focus is AMSP’s affiliation with the Association of American Medical Colleges (AAMC) and the AAMC’s Council of Academic Societies (CAS). The history, structure, activities, and goals of AAMC and CAS are examined. AMSP’s affiliation with AAMC is important for psychologists in medical schools and academic medical centers, and for psychology in general, because AAMC is the major voice of academic medicine in the US. AAMC activities affect medical education at all levels, as well as research and health services at academic medical centers, and health care policy at the national level. AMSP’s dual affiliation with AAMC’s CAS and APA’s Society of Clinical Psychology will increase psychology’s visibility and influence in academic medical centers and enhance the two-way flow of ideas and information between academic medicine and psychology.     

Faustlos: Evaluation of a curriculum to prevent violence in elementary schools

The “Faustlos”¹ curriculum, an adaptation of the American Second Step program, for the prevention of aggressive behaviors of elementary school children was evaluated in a 3-year control group study (30 classes served as an experimental group, 14 classes as a control group). The results show significant changes in the emotional competences and prosocial developments of children aged 6–9 years. Children who participated in the “Faustlos” lessons showed significantly reduced anxiety and internalizing behaviors compared with the control group. The parents’ ratings of their children's behavior (according to the Child Behavior Checklist) provided clear evidence of improved social behavior outside the school environment.     

Psychologists in medical schools in 1997. Research brief

The activities, income, and medical staff membership and limitations on that membership for psychologists working in U.S. medical school settings in 1997 were examined. A total of 1,938 psychologists responded to a survey conducted by the Research Office of the American Psychological Association, in conjunction with the Association of Medical School Psychologists. Some of the most salient findings were that (a) the largest number of psychologists was involved in research activities, (b) just over half of medical school psychologists were required to generate all or part of their own income through clinical work and research, and (c) the majority of these psychologists were members of a medical staff but were not extended full medical staff privileges. These and other results are discussed in the context of academic rank, tenure status, and other relevant factors.     

School Psychologist and Teacher Perceptions of Social Power in Consultation

Social power has been recognized as central to understanding aspects of school consultation. This study examined school psychologist and teacher perceptions of the effectiveness of 11 bases of social power that psychologists might use with initially resistant teachers. Results suggested that psychologists and teachers held similar views about power within consultation: Both groups rated expert and informational power as the most effective bases, ranked the 11 power bases in a similar way, and indicated that psychologists would be more effective using “soft” (i.e., subtle, positive, noncoercive) bases rather than “hard” bases. Findings also suggested that the groups held different views of social power: Psychologists rated impersonal and personal reward power as more effective than did teachers, and teachers rated psychologists' use of legitimate position, informational, and legitimate dependence power as more effective than did psychologists.     

The Meaning of Meaning-Fallibilism

Much discussion of meaning by philosophers over the last 300 years has been predicated on a Cartesian first-person authority (i.e. “infallibilism”) with respect to what one’s terms mean. However this has problems making sense of the way the meanings of scientific terms develop, an increase in scientific knowledge over and above scientists’ ability to quantify over new entities. Although a recent conspicuous embrace of rigid designation has broken up traditional meaning-infallibilism to some extent, this new dimension to the meaning of terms such as “water” is yet to receive a principled epistemological undergirding (beyond the deliverances of “intuition” with respect to certain somewhat unusual possible worlds). Charles Peirce’s distinctive, naturalistic philosophy of language is mined to provide a more thoroughly fallibilist, and thus more realist, approach to meaning, with the requisite epistemology. Both his pragmatism and his triadic account of representation, it is argued, produce an original approach to meaning, analysing it in processual rather than objectual terms, and opening a distinction between “meaning for us”, the meaning a term has at any given time for any given community and “meaning simpliciter”. the way use of a given term develops over time (often due to a posteriori input from the world which is unable to be anticipated in advance). This account provocatively undermines a certain distinction between “semantics” and “ontology” which is often taken for granted in discussions of realism.     

Conscientiousness and self-motivation as mutually compensatory predictors of university-level GPA

To help account for variability across studies in the predictive utility of conscientiousness, we proposed that conscientiousness and self-motivation mutually compensate for each other in predicting university-level academic performance. Consistent with this expectation, we found evidence of such mutual moderation in a sample of 377 college undergraduates. First, we found that conscientiousness and self-motivation compensated for each other in predicting university GPA: Students who were either high in conscientiousness or high in self-motivation had better academic performance (GPA) than those who were low in both conscientiousness and self-motivation. Second, these findings were still evident after we controlled for the students’ previous academic performance (high school rank) and academic ability (SAT/ACT). The study of mutually compensatory predictors not only offers the potential of developing better predictive models; it also helps to account for why some “main effect” predictors of university GPA are variable across studies in their degree of predictive utility.     

Schools as a source of stress to children: An analysis of causal and ameliorative influences

An analysis of factors leading schools to be a significant source of stress to children is presented. Debilitating school stress is seen as linked to forces, including some in prominent movements for school “reform,” that push schools to overemphasize academic acceleration, competition, evaluation, and test-based accountability. The paradoxical effects of these forces are to impede acquisition of academic skills and minimize opportunities for children to develop crucial competencies needed for citizenship, responsible adulthood, parenthood, and management of the complex world of work. Recommendations based on developmental and empirical considerations are presented to reduce the debilitating stress in our schools. The tenacious leadership and coordinated, sustained planning required to enact some of these recommendations is noted and encouraged.     

Accessibility as input: The use of construct accessibility as information to guide behavior

Priming typically increases behavioral enactments of primed constructs. The current work explored a novel mechanism for the behavioral effects of priming, termed the “accessibility as input” account. In two experiments, participants were nonconsciously primed and then completed anagrams until they judged themselves to have reached a particular state. Two different states, or stop rules, were specified, and were matched to the primed constructs such that the combination either implied that the state had been met (e.g., “slow” prime and “tired” stop rule) or had not been met (e.g., “fast” prime and “tired” stop rule). The priming and stop rule manipulations interacted to determine persistence on the anagram task. The results demonstrate that the heightened accessibility resulting from priming can be used as information about one’s current state in relation to situational requirements and, hence, can produce varying, contextually-dependent behavior.     

Feminism Across Borders: A Hungarian Adaptation of Western Feminism

A grounded theory model of feminist-activist identity development was constructed from semistructured interviews with volunteers of the first Women’s Rights Association (NANE) in Hungary. This article focuses on NANE volunteers’ feminist identity development, which emerged through interpersonal solidarity with Western women; the development of self-confidence and an assertive “voice” in their relationships; and an increased awareness of the violence and oppression against women. A grounded theory approach (Glaser & Strauss, 1967) was used to analyze the interviews. The core category, “Internalizing Western Feminist-Activism: Importing an External Culture to Revolutionize One’s Own,” describes volunteers’ conceptualization that their feminist-activist beliefs emerged from imported ideologies gained through exposure to Western ideas and the international women’s movement, which were then adapted to make changes in Hungary.     

Employment Characteristics and Salaries of Psychologists in United States Medical Schools: Past and Current Trends

In 1997 the Research Office of the American Psychological Association (APA) collaborated with the Association of Medical School Psychologists (AMSP) to conduct a comprehensive employment and salary survey of psychologists employed in medical schools and academic health centers. Questionnaires were mailed to 3894 psychologists; postcard reminders and a follow-up mailing to nonresponders resulted in a final 50% response rate. The questionnaire addressed appointment characteristics, department and school characteristics, employment activities, salary information, demographics, and changes in the medical school work environment that have occurred as a result of managed care. This survey, the 1997 Employment Characteristics and Salaries of Medical School Psychologists, is the most comprehensive analysis to date of the practice of psychology in U.S. schools of medicine and academic health centers. This article reports the most salient findings from this survey.     

Show-That-I-Can (Homework) in Cognitive-Behavioral Therapy for Anxious Youth: Individualizing Homework for Robert

Cognitive-behavioral therapy (CBT) has been reviewed and described as an empirically supported treatment for anxious youth. One component of CBT is the use of out-of-session “Show That I Can” tasks (STIC; i.e., homework tasks). STIC tasks vary in content and are to be completed between sessions. We discuss homework in CBT for Robert, a 13-year-old boy with social anxiety. Robert experienced distressing anxiety participating in and giving presentations at school and was fearful of open-ended questions. Robert had difficulty maintaining conversations with peers and reported being preoccupied with a concern that he would say something “weird” or “stupid.” Robert avoided numerous situations, and his social anxiety affected his grades, social interactions, family, and quality of life. Robert’s initial homework tasks entailed (a) journaling and self-monitoring anxious feelings and thoughts, and (b) practicing relaxation skills. During the second half of treatment, Robert’s STIC assignments were exposure tasks, including (a) opinion discussion assignments, (b) participating in class, and (c) initiating conversations with children at the bus stop. The present discussion focuses on how homework was individualized and presented so that it was palatable and sensitive. Issues regarding out-of-session exposure tasks that elicit sufficient anxiety, resistance to high-level exposure tasks, and parent involvement are explored.