The utility of interdisciplinary training and service: Psychology training on a psychiatry consultation-liaison service.

Abstract

Increasing numbers of psychologists work in medical settings because of the growing acceptance of a biopsychosocial approach to illness. Do training programs prepare sufficient numbers of graduates to function effectively in medical settings? The authors describe the process of adding an inpatient medical-surgical consultation-liaison (C-L) service to a psychology internship's training rotations, the learning objectives used, and issues in the preparation of trainees for work in medical settings. Psychology trainees added significant capacity to the C-L service. These data may help facilitate the development of C-L training experiences for other programs.Opportunities for psychologists to work in health care settings have increased in recent years. Approximately one third of all employed recipients of new psychology doctorates in health service fields in 1997 worked in health care settings such as medical schools, hospitals, or specialized health care facilities such as nursing homes or rehabilitation centers (American Psychological Association [APA] Research Office, 1997). These statistics may be compared with indications from earlier times to demonstrate the growth in psychologists working in health care settings. For example, about 20 years ago, Gabinet and Schubert (1981) stated, "Traditionally, psychologists have not provided primary psychological services to medical and surgical inpatients" (p. 85).The contemporary need for training in medical settings in general, and consultation-liaison (C-L) settings in particular, has been recognized widely. A general proposal for training psychologists for hospital practice by Ludwigsen and Albright (1994) includes the need for consultation skills. More specifically, Resnick and Kruczek (1996) stated, "As part of their internship or postdoctoral experience, psychologists need specialized training in consultation-liaison . . . whereby they learn to consult with the medical community about the emotional and behavioral sequelae of physical illness" (p. 194). To prepare students for the growing opportunities in health care settings, psychology training must be responsive with regard to the knowledge base and experiential requirements for effective work in health care settings.In accordance with APA doctoral program accreditation requirements, most doctoral students will obtain some background in physiology, and students in clinical or counseling programs also should receive training in interviewing, diagnosis, and psychotherapy. These skills certainly are prerequisites for adequate functioning in a health care setting. However, few preinternship doctoral students work in hospital settings or, more specifically, in medical-surgical hospital settings. A survey conducted in October 1999 by Division 38 (Health Psychology) of all APA-accredited training programs in clinical psychology revealed 34 programs (out of 211; i.e., 16%) with a health psychology focus (APA Division 38 Education and Training Committee, 1999). Sampling these programs' brochures revealed that not all prog...

Consultation-liaison psychology: Training and research recommendations for this emerging interprofessional practice.

“…Table 2 summarizes the types of patients and services of the CL program over the last three fiscal years (FYs) of this period. The overall patterns of diagnoses and patient demographic characteristics largely mirrored those in prior CL psychology publications (e.g., Ritchie et al, 2017;Schmaling et al, 2002), apart from a higher percentage of men and posttraumatic stress disorder diagnoses predictable from a Veterans Affairs (VA) academic medical center setting.…”

“…Prior CL psychology training literature discussed programs designed for psychology interns rather than fellows. Schmaling and colleagues (Schmaling, Giardino, Korslund, Roberts, & Sweeny, 2002), for example, published the results of a CL program development effort for psychology interns at the University of Washington Medical Center over the period from 1999 to 2001. Their results indicated that CL psychology interns met with similar numbers of patients as psychiatry residents and enhanced their multidisciplinary and treatment skills while expanding the scale and scope of services provided by the CL team (e.g., offering more options for psychotherapy interventions and the use of psychological assessment instruments).…”

“…edge of medical and psychotropic agents, and reliance on brief assessments and interventions are more accurately considered as a distinct area of specialization not fully captured within any of the 54 divisions currently recognized by the APA (Schmaling et al, 2002 [see appendix of paper for an example of CL learning objectives]). A summary of the major areas of distinction necessary for CL psychology training follows.…”

“…These identified limitations offer valuable ideas for improving future CL psychology research. Table 4 summarizes a proposal for future CL psychology research divided into three areas of focus: (a) research investigating the training and experiences of CL psychologists and psychology trainees (e.g., Ritchie et al, 2017;Schmaling et al, 2002); (b) research addressing the interprofessional value of the CL psychologist, such as examining cost-effectiveness outcomes or methods of optimizing the CL psychology role within the treatment team (e.g., Wood, Williams, Billings, & Johnson, 2019); and (c) research focused on improving assessment, diagnosis, and treatment dimensions of CL psychology services (e.g., Paterson et al, 2018). Although examples from these three areas of CL research exist already, prior research is constrained by mostly descriptive and qualitative designs for Areas 1-2 and by a limited range of outcomes, methodological rigor, and demonstration of clinical significance in Area 3.…”

Patterns of Referral to Clinical Psychology Services in the Ministry of Health Malaysia

“…Despite the small percentage of referrals (17.8%) from these groups, this highlights the need for clinical psychology services in non-psychiatric departments, contrary to the traditional belief that clinical psychologists only work in psychiatric settings (4). Schmaling et al (13) pointed out that psychologists are increasingly involved with providing consultations to patients with medical illnesses, thus explaining the referrals from other specialists.…”