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.     

Factors affecting the birth and death of mutual-help groups: The role of national affiliation,professional involvement,and member focal problem

Examined the predictive relationship of three variables to the birth and death of mutual-help groups for a statewide New Jersey sample of 3,152 groups over a 2-year period. The three variables studied were group affiliation with a national mutual-help organization, local professional involvement in group activities, and group members' type of focal problem. Log-linear logit analysis revealed that the best-fitting model included Affiliation Status x Professional Involvement, and Affiliation Status x Focal Problem interactions. Among unaffiliated groups, professional involvement was related to lower group mortality, while among affiliated groups it was related to higher group mortality. Unaffiliated behavior control groups had higher odds for mortality and for birth than either unaffiliated life stress groups or unaffiliated medical groups. Among main effect findings, unaffiliated groups had consistently higher odds for birth than affiliated groups. The implications for research and action are discussed.     

"I can tell when my blood pressure is up, can't I?"

Forty-four insurance company employees were measured on blood pressure, moods, symptoms, and predictions of their blood pressures, twice daily for 10 days. Twenty subjects had elevated blood pressure and 24 did not. The measures were correlated within-subjects to determine if blood pressure predictions were associated with moods, symptoms, or blood pressure readings, and if moods and symptoms were related to blood pressure. Predictions of pressure were expected to be correlated with symptoms and moods, but not with blood pressure. No strong relationship was expected when blood pressure was compared to symptoms or to moods. The data showed that self-predictions of blood pressure were most strongly associated with reported symptoms, next with reported moods, and least with actual blood pressure. A comparison of subjects who were accurate in predicting their blood pressure with those who were not showed no differences in blood pressure levels, systolic blood pressure variation, self-esteem, or private body-consciousness. Subjects' beliefs that they could monitor blood pressure were little influenced by contrary information. The results suggest it would be an error to encourage subjects to believe they can successfully treat blood pressure elevations by monitoring symptoms related to blood pressure change.     

Common-sense models of illness: the example of hypertension

Our premise was that actions taken to reduce health risks are guided by the actor's subjective or common-sense constructions of the health threat. We hypothesized that illness threats are represented by their labels and symptoms (their identity), their causes, consequences, and duration. These attributes are represented at two levels: as concrete, immediately perceptible events and as abstract ideas. Both levels guide coping behavior. We interviewed 230 patients about hypertension, presumably an asymptomatic condition. When asked if they could monitor blood pressure changes, 46% of 50 nonhypertensive, clinic control cases said yes, as did 71% of 65 patients new to treatment, 92% of 50 patients in continuing treatment, and 94% of 65 re-entry patients, who had previously quit and returned to treatment. Patients in the continuing treatment group, who believed the treatment had beneficial effects upon their symptoms, reported complying with medication and were more likely to have their blood pressure controlled. Patients new to treatment were likely to drop out of treatment if: they had reported symptoms to the practitioner at the first treatment session, or they construed the disease and treatment to be acute. The data suggest that patients develop implicit models or beliefs about disease threats, which guide their treatment behavior, and that the initially most common model of high blood pressure is based on prior acute, symptomatic conditions.     

Self-regulation,health, and behavior: A perceptual-cognitive approach

Abstract

Self-regulation systems are designed to adapt to threats via coping procedures that make efficient use of resources based upon valid representations of the environment. We discuss two components of the common-sense model of health threats: illness representations (e.g., content and organization) and coping procedures (e.g., classes of procedure and their attributes - outcome expectancies, time-lines, dose-efficacy beliefs, etc.). Characteristics of each of these domains, and the connection between the two, are critical to understanding human adaptation to problems of physical health. Rather than posing a barrier to factors outside the person that control behavior, an emphasis on subjective construal involves a view of the person as an active problem-solver embedded in a bidirectional system of sensitivity and responsiveness vis á vis the social, physical, and institutional environments in which health threats occur and through which intervention efforts may be directed.     

Masculinity-Femininity and Need for Social Approval

The relationship between the need for social approval and sex role identification was investigated. The Mariowe-Crowne social desirability scale, the Ed wards social desirability scale and the masculinity scale of the Guilford-Zimmerman Temperament Survey were given 184 college students. The results indicate independence between sex role identification and need for social approval, irrespective of biological sex. Thus, this research aids in defining the properties of the construct. The relationships found provide evidence for Crowne and Marlowe's argument that the Edwards scale is, in part, a measure of willingness to admit to weakness and pathology while the Marlowe-Crowne scale is independent of such willingness.     

I know distraction works even though it doesn't!

Resistance is high to findings negating commonsense beliefs. If McCaul, Monson, and Maki's (1992) four studies are taken seriously, we will address new questions about the components of analgesic interventions--specifically, whether distraction works only when combined with a competing affect, an analgesic cognition, or both. Addressing these questions should increase our understanding of the mechanisms involved in pain processing and may increase our ability to intervene and modify chronic as well as acute pain. Laboratory studies offer an efficient route to such understanding, although the question of generalization will always lurk in the background.     

Predicting Outcomes or Modeling Process? Commentary on the Health Action Process Approach

Schwarzer (2008 ) reviews the evidence for two major contributions of the Health Action Process Approach model (HAPA) to current theory and behavioral health research: (1) the differentiation of concepts by both content and process, and (2) clear recognition of the temporal aspect in the assembly of health behavior sequences. This commentary discusses four areas for HAPA to address for a more complete explanation of health behaviors and their determinants. Further, we suggest that incorporating into HAPA the hierarchical structure of the control systems that regulate health behaviors and the importance of concrete experience in initiating and maintaining behavior, elements emphasised in the Commonsense Model of Self‐regulation, will enrich HAPA's theoretical base and increase its utility for the development of interventions for behavioral change. Schwarzer (2008 ) examine les données confirmant deux contributions majeures du modèle de l’Approche du Processus de l’Action en faveur de la Santé (HAPA) à la théorie et aux recherches sur les comportements relatifs à la santé: 1) La différenciation des concepts à la fois par le contenu et le processus, 2) Un repérage précis de la dimension temporelle dans l’articulation des séquences comportementales relevant de la santé. Ce commentaire aborde quatre points qui permettraient à l’HAPA de fournir une explication plus complète des conduites liées à la santé et de leurs antécédents. Il semble en outre que l’introduction dans l’HAPA de la structure hiérarchique des systèmes de contrôle qui régulent les comportements de santé et de l’aspect important qu’est l’expérience concrète dans l’amorce et le maintien du comportement, éléments mis en valeur par le Modèle du Sens Commun de l’Autorégulation, enrichirait les fondements théoriques de l’HAPA et augmenterait son utilité pour l’élaboration d’interventions en faveur du changement comportemental.