Training family physicians in behavioral aspects of primary care: The psychologist's role.

Abstract

In the past decade, many psychologists have joined family medicine departments to train residents in the psychological and interpersonal aspects of primary care. It is suggested that such training must not only teach psychology to residents but help them integrate behavioral science knowledge into all aspects of their work. A comprehensive system for physicians to use in reaching this goal, called the Psychosocial Systems Review (PSR), is described. This system provides guidelines for information gathering, goal-oriented assessment, and treatment planning. A program used to train residents in this system is described, and results-ofa study evaluating this training are briefly outlined. The results found that residents were only able to incorporate the diagnostic phase of the system-and then only after direct supervision by medical faculty. The implications of these results are discussed in relation to the psychologist faculty member's role in such training. These implications include the need to integrate training with everyday practice, the importance of working with medical faculty to create consistent models able to integrate psychosocial assessment with physical and biological assessment, and the need for development of collaborative treatment relationships with medical faculty to model such collaboration for residents.The emergence of family physicians as a major medical subspecialty has been one of the more intriguing developments in American medicine over the past decade. In the preceding 30 years, physicians had become more specialized, and the proportion of physicians in general practice had dropped, precipitously (Chisholm, 1978). This trend began to turn in the 1960s; criticisms of overspecialization, increased costs of medical care, and alleged "dehumanizing" aspects of treatment by specialty were among the arguments given for restoring the status of the general practitioner.As a response to these criticisms, the development of family medicine became a vehicle for bringing general practitioners back to the medical scene. Family physicians were seen as providing continuity of care while responding to the rrtedical needs of all family members,. The family physician was viewed as a professional skilled in treating common ailments at lower cost while having the knowledge to recognize and refer cases .requiring more specialized attention (Baker, 1974). A "holistic" approach to medicine was also emphasized: Family physicians were to treat "the whole person," being sensitive to interrelations between stress, emotions, and health.The most visible aspect of this movement has been the development of new training programs in family medicine, usually at the residency level. A major component of these programs has been an emphasis on integrating into treatment psychological, social, and biological variables. In developing the training programs for such a role, many departments turned to psychology. In what may be a unique role in the history of professional psychology, psychologists were hired as faculty members i...

Counseling psychology in behavioral medicine and health psychology.

“…Less anxious students preferred the role-playing exercises of the second program (Humans Relations Training). Second, role modeling has been identified as an important component of successful skills training for medical students (Howe, Tapp, & Jackson, 1982). However, how to build role modeling into training programs has not been addressed.…”