New directions for the education of clinical psychologists: The primary care setting,the VA's PRIME program,and the in-depth generalist model

As part of this special issue on psychology in primary care settings, we describe the Department of Veterans Affairs' (VA's) new approach to education for practice in the primary care setting and we concurrently address some general issues related to the education of clinical psychologists for practice in this setting. In this article we argue that the primary care psychologist, in parallel with the generalist in medicine, must have a strong generic background in clinical psychology in order to gain the broad range of clinical skills necessary to function effectively as an in-depth generalist (IDG) who is capable of addressing the variety of psychological issues that emerge in the primary care setting. The IDG model of professional practice, which we believe is best suited for primary care/managed care settings, requires extensive training in generic clinical skills and increased time devoted to its implementation at both the predoctoral and the postdoctoral levels.     

Predictive testing and oncogenes

Case vignette: sharing unanticipated genetic information. The Questor family has experienced an unusual number of malignancies in the past two generations and has been advised by an oncologist that the p53 oncogene known as Li-Fraumeni Syndrome may be present in the family genome. The option of predictive genetic testing has been raised and several branches of the family have chosen to undergo screening to determine whether they are at risk for cancer because of the gene. Roger and Liz Questor have arranged for screening of themselves and their three children, ages 12, 10, and 7. The couple has, by all appearances, been happily married for 14 years. None of the family members are found to carry the oncogene; however, the geneticist conducting the analyses has made an interesting incidental discovery. The 10-year-old child is not the biological progeny of Roger Questor. Although the 12- and 7-year-olds are clearly the biological children of the couple, it is evident that the 10-year-old born to Liz Questor was fathered by a person other than Roger. What are the ethical obligations of the geneticist with respect to any sharing or disclosure of the information that has been discovered incidentally? What course of action, if any, do you recommend?     

Are microsaccades responsible for the gap effect?

Extinguishing a fixation point shortly before, or concurrently with, the onset of a peripheral visual target reduces the latency of saccades to that target. Saslow (1967) hypothesized that thisgap effect might occur because fixation point offsets reduce the incidence of corrective microsaccades with an associated saccadic refractory period. In the present study, a robust gap effect was obtained. However, using a Purkinje image eyetracker with 1 arcmin of resolution, we found that fixation point offsets had no effect on the occurrence of microsaccades and that the occurrence of microsaccades had no impact on the magnitude of the gap effect. Microsaccades therefore do not appear to play any part in the production of the gap effect.     

A pointing technique for rapidly collecting localization responses in auditory research

A technique is described for rapidly collecting responses in auditory-localization experiments. Subjects indicate the perceived direction of the sound by pointing at a 20-cm-diam spherical model. In Experiment 1, the subjects judged the direction of a broadband signal, which could originate from any of 239 directions ranging through 360° of azimuth and between ?45° and +90° of elevation. Using this technique, the subjects responded 2–8 times more rapidly than previous subjects who used either a verbal-reporting technique or a head-pointing technique. Localization judgments were as accurate as they had been with verbal reports, but were not as accurate as judgments collected using the head-pointing technique. In Experiment 2, the signal was turned off and the experimenter read the spherical coordinates of the signal location to the subjects. The subjects pointed to these coordinates more accurately than they had judged the direction of the sounds in Experiment 1, suggesting that the response technique had not been the limiting factor in that experiment. Circumstances relevant to the choice of response techniques for auditory-localization experiments are discussed.     

Memory impairment and source misattribution in postevent misinformation experiments with short retention intervals

The four experiments reported here provide evidence that (1) misleading postevent suggestions can impair memory for details in a witnessed event and (2) subjects sometimes remember sug-gested details as things seen in the event itself. All four experiments used recall tests in which subjects were warned of the possibility that the postevent information included misleading sug-gestions and were instructed to report both what they witnessed in the event and what was men-tioned in the postevent narrative. Recall of event details was poorer on misled items than on control items, and subjects sometimes misidentified the sources of their recollections. Our re-sults suggest that these findings are not due to guessing or response biases, but rather reflect genuine memory impairment and source monitoring confusions.