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.     

EFFECTS OF REINFORCER QUALITY ON BEHAVIORAL MOMENTUM: COORDINATED APPLIED AND BASIC RESEARCH

The high-probability (high-p) instructional sequence has been an effective treatment for noncompliance. However, treatment failures have also been reported. We hypothesized that the efficacy of the high-p treatment may be improved by using higher quality reinforcers for compliance to high-p instructions. The resistance of compliance to change was tested by varying reinforcer quality in two applied studies and a basic laboratory experiment. Experiment 1 tested the hypothesis that an increase in reinforcer quality for high-p compliance will increase the effectiveness of the high-p treatment when it fails to increase compliance. Experiment 2 assessed the effects of reinforcer quality on resistance of compliance to change by presenting successive low-p requests following the high-p treatment. A basic laboratory study (Experiment 3) was conducted to further isolate the relation between reinforcer quality and behavioral momentum. Two different liquid reinforcers (sucrose and citric acid solutions) were presented in a two-component multiple variable-interval variable-interval schedule followed by a single extinction test session. Results of all three experiments showed a generally consistent relationship between reinforcer quality and behavioral momentum.     

The role of individual differences,response profiles,and treatment consonance in anxiety disorders

The importance of individual differences, response profiles, and treatment consonance in anxiety-disorders clinical research is reviewed. Anxiety-disorders assessment, synchrony, and concordance phenomena are examined within the framework of the tripartite model. Issues regarding response stereotypy, response specificity, and etiological vs. current response typologies are discussed. Interactions of varying response profiles with different treatment modalities are addressed, in terms of both previous and prospective studies. A preliminary classification schema is offered, for illustrative purposes, with empirical support for the differential outcome of anxiety patients receiving consonant vs. nonconsonant response profile × treatment type pairings. Hypotheses are presented regarding predicted effects of consonant vs. nonconsonant subject-treatment interactions. Recommendations for programmatic research are offered to accelerate scientific inquiry into the role of individual differences and response profiles in anxiety-disorders assessment, treatment, and research.Preparation of this paper was supported in part by National Institute of Mental Health Grant MH 36299.     

A SUPERVISION PROGRAM FOR INCREASING FUNCTIONAL ACTIVITIES FOR SEVERELY HANDICAPPED STUDENTS IN A RESIDENTIAL SETTING

This study was designed to increase the amount of time severely handicapped students living in a residential facility engaged in age-appropriate and functional activities. After a brief in-service training, a program involving instructions to supervisors and staff feedback was implemented in a multiple-baseline design across settings. Results showed that after the supervision program was implemented, the students' participation in activities increased. Further, these increases maintained when feedback was reduced from an average of 3 days a week during treatment, to once a month for a 5-month period.     

Philosophy of medicine — From a medical perspective

In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but it so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.     

AIDS-related stigma,personal risks and career objectives among makerere medical students

The aims of this study were to investigate variables that influence AIDS-related stigma and to assess occupational risks, behavioural change, and career objectives of students in face of the AIDS epidemic. Data available on 150 randomly selected medical students were analysed statistically. Results indicated that sex and year of study significantly influenced AIDS-related stigma while age, religion and tribe did not. The majority of students recommended screening and health education for high-risk people and reported high levels of perceived risk. Various occupational hazards and behavioural changes were reported, but students still wanted to remain in the medical profession. Implications of these findings are discussed.     

CONTINGENT REINFORCEMENT FOR BENZODIAZEPINE-FREE URINES: EVALUATION OF A DRUG ABUSE TREATMENT INTERVENTION

This study evaluated contingent reinforcement for benzodiazepine-free urines as a therapeutic intervention for promoting reduced use of supplemental benzodiazepine drugs among methadone maintenance outpatients. Ten methadone maintenance patients were selected for participation on the basis of positive urinalysis results. During a 12-week intervention period these patients were offered clinic privileges, including monetary payments or methadone take-home doses, contingent on benzodiazepine negative urinalysis test results. Eight of ten participants responded to the intervention with at least 2.5 weeks of consecutive clean urines. An increase in benzodiazepine-negative tests during the contingent reinforcement period was significant for the group as a whole. The results suggest that more widespread application of contingent reinforcement procedures may be warranted in drug abuse treatment clinics.     

ON TOKEN REINFORCEMENT AND STUTTERING THERAPY: ANOTHER VIEW ON FINDINGS REPORTED BY HOWIE AND WOODS (1982)

Howie and Woods (1982) have provided data that, they claim, indicate that a token reinforcement system is redundant in instating and shaping fluent speech within a stuttering treatment program developed by Ingham and Andrews (1973a, b). However, there were substantial procedural differences between the treatment programs referred to in both studies, as well as methodological weaknesses in Howie and Woods' study. These factors provide ample sources of explanation for Howie and Woods' failure to demonstrate benefits from their token reinforcement system.     

Treatment of Young Children's Bedtime Refusal and Nighttime Wakings: A Comparison of “Standard” and Graduated Ignoring Procedures

Young children with sleep problems received either standard or graduated ignoring treatment. Both brief treatments were superior to a wait-list control condition and resulted in comparable improvements in bedtime and nighttime sleep problems. At bedtime, the treatments did not differ with respect to maternal compliance and stress. For nighttime wakings, mothers in the graduated ignoring group reported higher rates of compliance and less treatment-related stress. Maternal characteristics predicted treatment outcome in the standard ignoring condition. Following treatment, only positive side effects were observed. When compared to the wait-list group, mothers in the standard ignoring group reported less verbose discipline and decreased stress in parenting, while mothers in the graduated ignoring group reported improved parent–child relationships. Treatment gains were maintained over a 2-month follow-up period.