我国临床心理学专业训练工作的现状调查和分析

目的：试图在我国临床心理学专业训练现状调查和分析中，获得一些对改进今后本专业训练可资借鉴的信息。方法：用问卷和访问方法。结果：我国从１９７７～９５年夏，已有培养硕士研究生的基地１０个，导师２６名，已毕业的硕士研究生８７名，在读者４０名；并已有博士生培养基地两个，导师２名，已毕业者１０名，在读者８名。从１９７８～９６年，在一些城市举办了为期２周到３个月的分别为临床心理测验、心理治疗和咨询学习班，共约１００次，参加的学员达５千人次。这些学习班分普及班（学习基本知识和技能）和提高班（进一步提高本专业理论和技能）两类。参加前者的学员多，参加后者的少。结论：根据目前社会对本专业的需要来看，希望增加研究生培养基地和招生人数，在目前接受过系统专业训练的人员尚很少的情况下，仍很需要有短期学习班，并且需要有更多一些人继续参加提高学习班。     

How participatory action research changed our view of the challenges of shared decision-making training

Objective

This paper aims to demonstrate how the use of participatory action research (PAR) helped us identify ways to respond to communication challenges associated with shared decision-making (SDM) training.

Can we enhance the training of clinical supervisors? A national pilot study of an evidence‐based approach

Clinical supervision plays an essential part in maintaining professional standards and in achieving the National Health Service's objective of a modern workforce. Paradoxically, little is known about how supervisors themselves acquire competence, leading to lament that ‘something does not compute’. To contribute to a solution, a supervisor training manual that guided trainers in delivering continuing professional development to supervisors in an evidence‐based approach to clinical supervision was piloted nationally, in terms of the reactions of trainers (N = 25 tutors from clinical psychology courses) and their workshop delegates (N = 256 clinical psychology supervisors). Trainers were allocated randomly to either manual‐alone or to a manual‐plus consultancy group. The trainers all rated the manual favourably (mean rating of 78%), but there was no significant difference between the two groups. However, the supervisors within the consultancy group rated the sessions significantly more highly than their counterparts. It is concluded that brief training in an evidence‐based approach appears feasible and acceptable, making more rigorous evaluations appropriate. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Clinical supervision is now recognised as essential, yet supervisors tend to receive little or no training, which tends not to be evidence based.
• A training guide in evidence‐based clinical supervision has been disseminated and evaluated, in terms of the acceptability of the approach taken to supervision.
• The reactions of trainers and supervisors (all associated with clinical psychology training programmes) to this guide were positive, indicating that it merits further development and more rigorous evaluation.

     

A Delphi study to determine the European core curriculum for Master programmes in genetic counselling

Genetic counsellors have been working in some European countries for at least 30 years. Although there are great disparities between the numbers, education, practice and acceptance of these professionals across Europe, it is evident that genetic counsellors and genetic nurses in Europe are working autonomously within teams to deliver patient care. The aim of this study was to use the Delphi research method to develop a core curriculum to guide the educational preparation of these professionals in Europe. The Delphi method enables the researcher to utilise the views and opinions of a group of recognised experts in the field of study; this study consisted of four phases. Phases 1 and 4 consisted of expert workshops, whereas data were collected in phases 2 and 3 (n=35) via online surveys. All participants in the study were considered experts in the field of genetic counselling. The topics considered essential for genetic counsellor training have been organised under the following headings: (1) counselling; (2) psychological issues; (3) medical genetics; (4) human genetics; (5) ethics, law and sociology; (6) professional practice; and (7) education and research. Each topic includes the knowledge, skills and attitudes required to enable genetic counsellors to develop competence. In addition, it was considered by the experts that clinical practice should comprise 50% of the educational programme. The core Master programme curriculum will enable current courses to be assessed and inform the design of future educational programmes for European genetic counsellors.     

A national collaboration to disseminate skills for outpatient teaching in internal medicine: program description and preliminary evaluation.

The shift of clinical care and teaching to outpatient settings has challenged ambulatory and community-based teachers. To address this challenge, U.S. internal medicine organizations devised "Faculty Development for General Internal Medicine: Generalist Faculty Teaching in Ambulatory Settings," a national program to train leaders to create local faculty development projects. In 1999, teams from all 386 internal medicine training institutions were invited to apply. Participation required an acceptable plan for a local project and inclusion of an institutional leader, residency or clerkship director, and a community-based faculty member on the project team. Team members attended one of three national training conferences held in 1999 and 2000 that included plenary sessions, workshops, and team meetings. Participants were invited to a wrap-up conference to present their accomplishments. One hundred ten teams from 57 university and 53 non-university hospitals attended the training conferences; 412 (93%) participants returned conference evaluations. All sessions were rated highly. Participants preferred workshops and team meetings to plenary sessions. Two hundred thirty-five (57%) would have recommended the training conference to colleagues as an outstanding experience; 148 (36%) as a good experience; and 25 (6%) as a satisfactory experience. Forty-nine teams (122 participants) returned for the wrap up conference where 35 teams presented their local faculty development projects. Cost per team trained was US$11,818. This program demonstrated a national desire for training in teaching skills, reached a broad audience of ambulatory-based clinical teachers, provided highly rated faculty development conferences in teaching skills, and facilitated development of a variety of local projects at modest expense. Partnerships were forged between academic leaders and community-based teachers.     

The significance and importance of supervision in psychotherapy training

Though supervision has a central part in training there is little systematic study about how supervisees learn and how supervisors teach. After discussing the dynamics of interaction between trainees and supervisors and the necessity to differentiate between teaching and learning, the author summarizes the conclusions drawn from his own systematic study of the learning process in supervision.     

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision

OBJECTIVE: Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. METHODS: A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. RESULTS: Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. CONCLUSIONS: The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.     

RACE AND COMMUNITY PRACTICE: REFLECTIONS FROM THE SUPERVISION OF PROFESSIONAL TRAINING

Given South Africa's unique history of colonization and racial segregation, understanding and working with issues of race and racialization have been of paramount importance in South African critical community psychology. This article considers how race has emerged in the supervision of community work with master's students in a community psychology practicum. Using an autoethnographic approach, we document our reflections as two community psychology supervisors to discuss the dilemmas experienced in dealing with race in community psychology supervision. We engage with notions of Whiteness and Blackness, intersections of race and language, and race and crime, and document specific issues that emerge in the supervision for Black and White supervisors. In conclusion, we highlight the importance for supervisors to adopt a critical stance that utilizes reflexivity as a tool for the supervision of community work to help students to reflect on issues of race and racism as part of their community engagement.     

Clinical Supervision of Psychotherapy: Essential Ethics Issues for Supervisors and Supervisees

Clinical supervision is an essential aspect of every mental health professional's training. The importance of ensuring that supervision is provided competently, ethically, and legally is explained. The elements of the ethical practice of supervision are described and explained. Specific issues addressed include informed consent and the supervision contract, supervisor and supervisee competence, attention to issues of diversity and multicultural competence, boundaries and multiple relationships in the supervision relationship, documentation and record keeping by both supervisor and supervisee, evaluation and feedback, self‐care and the ongoing promotion of wellness, emergency coverage, and the ending of the supervision relationship. Additionally, the role of clinical supervisor as mentor, professional role model, and gatekeeper for the profession are discussed. Specific recommendations are provided for ethically and effectively conducting the supervision relationship and for addressing commonly arising dilemmas that supervisors and supervisees may confront.     

Medical residents reflect on their prejudices toward poverty: a photovoice training project

Background

Clinicians face challenges in delivering care to socioeconomically disadvantaged patients. While both the public and academic sectors recognize the importance of addressing social inequities in healthcare, there is room for improvement in the training of family physicians, who report being ill-equipped to provide care that is responsive to the living conditions of these patients. This study explored: (i) residents’ perceptions and experience in relation to providing care for socioeconomically disadvantaged patients, and (ii) how participating in a photovoice study helped them uncover and examine some of their prejudices and assumptions about poverty.

Methods

We conducted a participatory photovoice study. Participants were four family medicine residents, two medical supervisors, and two researchers. Residents attended six photovoice meetings at which they discussed photos they had taken. In collaboration with the researchers, the participants defined the research questions, took photos, and participated in data analysis and results dissemination. Meetings were recorded and transcribed for analysis, which consisted of coding, peer debriefing, thematic analysis, and interpretation.

Results

The medical residents uncovered and examined their own prejudices and misconceptions about poverty. They reported feeling unprepared to provide care to socioeconomically disadvantaged patients. Supported by medical supervisors and researchers, the residents underwent a three-phase reflexive process of: (1) engaging reflexively, (2) break(ing) through, and (3) taking action. The results indicated that medical residents subsequently felt encouraged to adopt a care approach that helped them overcome the social distance between themselves and their socioeconomically disadvantaged patients.

Conclusions

This study highlights the importance of providing medical training on issues related to poverty and increasing awareness about social inequalities in medical education to counteract prejudices toward socioeconomically disadvantaged patients. Future studies should examine which elective courses and training could provide suitable tools to clinicians to improve their competence in delivering care to socioeconomically disadvantaged patients.

     

Guidelines and evaluation: improving the quality of consultation-liaison psychiatry

Previous research has shown that residents in the consultation-liaison unit of Geneva University Hospital did not meet proposed guidelines on three counts: quickness of response to emergency situations, reporting cases to supervisors, and consulting with supervisors on major issues. The introduction of daily meetings between residents and supervisors improved the level of compliance with guidelines, from 69.2% to 82.6% for quickness of response, from 57.6% to 97.3% for reporting cases to supervisors, and from 25.0% to 98.0% for consulting with supervisors on major issues. Periodical evaluation would thus appear to enhance performance.     

PSYCHOTHERAPY SUPERVISION FACE-TO-FACE AND BY VIDEO CONFERENCING: A COMPARATIVE STUDY

ABSTRACT A shortage in qualified psychotherapy supervisors in rural Norway motivated a study evaluating the quality of the supervision process when supervisors and trainees communicated by interactive audiovisual videoconferencing (VC). Six trainee and supervisor pairs participated in five alternating VC based and face-to-face sessions. The pairs had previously established a good face-to-face relationship. Self-report data of the quality of communication, the alliance and disturbing elements in the supervision sessions were collected from specially designed questionnaires completed after each session. Independent ratings of the videotaped sessions and qualitative interviews conducted at the end of the study were also conducted. The only significant difference between the two conditions was that trainees scored higher on disturbing factors under VC conditions. Recommendations for use of VC are provided in light of the findings.     

Antimicrobial resistance in Staphylococcus aureus in Australian teaching hospitals, 1989-1999

An annual survey of antimicrobial resistance in clinical isolates of Staphylococcus aureus was conducted in 21 Australian teaching hospital microbiology laboratories in eight major cities from 1989 to 1999. A total of 19,000 isolates were tested for susceptibility to 18 antimicrobials, with 3795 being methicillin-resistant (MRSA). Resistance to ciprofloxacin in MRSA increased from 4.9% to 75.9%. The proportion of MRSA resistant to erythromycin decreased significantly (99.0%-88.9%), as did that to trimethoprim (98.4%-82.4%) and to tetracycline (96.5%-80.1%). The proportion of MRSA isolated increased in Sydney, Melbourne, Canberra, Adelaide, Perth, and Darwin, but not in Brisbane. The proportion in Hobart peaked in 1994. MRSA in Perth were predominantly non-multiresistant (nmMRSA) throughout the survey (i.e., resistant to less than three of eight indicator antibiotics) due mainly to local strains that originated in the community. The proportion of nmMRSA increased to modest levels in the other cities. In eastern cities, this was due to the appearance of strains closely related to nmMRSA seen in other countries of the southwestern Pacific.     

Country watch: Zimbabwe

The Bulawayo City Council Health Services Department launched a peer education program for sex workers in 1990. It consisted of formal meetings, informal outreach, condom distribution, and strengthening of sexually transmitted diseases services. Assessment was built in from the start in the form of monitoring, process ethnography, and outcome evaluation. 153 female prostitutes and 74 male sex clients were interviewed at baseline; follow-up interviews were held 1 year later with 48 prostitutes and 58 clients. These interviews revealed that 90% of women and 50% of men had attended program health education meetings; 96% of women and 69% of men had received condoms from the program; and condom use increased significantly among both men and women, although potential errors in the outcome data and their interpretation are acknowledged. The younger, better-educated women fluent in English initially recruited as peer educators were resented by older, less-educated women from rural areas. Attrition was also problematic among younger women as they left the business to enter other forms of employment and marriage. The most effective training proved to be practical, field-oriented, job-related, and frequently repeated and reinforced; regular field supervision was important. Further, the program found that interventions must discourage dependency among participants and instead promote cohesive, self-reliant groups. All people who are even remotely involved in such programs must be sensitized. This program is being replicated in other areas of Zimbabwe as well as in Siavonga, Zambia.     

Teaching and training in the psychiatric-psychosomatic consultation-liaison setting

BACKGROUND: The consultation-liaison (C-L) psychiatrist is in an opportune position to undertake the tasks of education, training and assessment of performance as regards future physicians, psychiatrists, specialists in other branches and nurses. This paper describes the education and training programme in the Psychiatric-Psychosomatic C-L Service of Modena University Hospital. DESCRIPTION OF THE PROGRAMME: This programme consists of the following main activities: (1) daily group-case supervision, performed by the full-time psychiatrist together with the psychiatry residents of the C-L staff; (2) a bimonthly quality management meeting, which is part of a European project of measurement and improvement of quality of service; (3) weekly lectures on selected topics; (4) monthly tutorials in research techniques; (5) bimonthly presentations of literature reviews; (6) weekly clinical case conferences, which are the nucleus of the curriculum and which focus on the following main topics: 'the patients', 'the intervention' and 'the group', and (7) liaison meetings requested by non-psychiatric departments. CONCLUSIONS: A common denominator seen throughout the teaching and training activities of such a programme is the attitude of openness and effort toward integration which should be the C-L psychiatrist's distinguishing mark, in the context of the general hospital.     

Towards responsible system development in health services: A discourse analysis study of design conflict resolution tactics

We set out to examine design conflict resolution tactics used in development of large information systems for health services and to outline the design consequences for these tactics. Discourse analysis methods were applied to data collected from meetings conducted during the development of a web-based system in a public health context. We found that low risk tactics were characterized by design issues being managed within the formal mandate and competences of the design group. In comparison, high risk tactics were associated with irresponsible compromises, i.e. decisions being passed on to others or to later phases of the design process. The consequence of this collective disregard of issues such as responsibility and legitimacy is that the system design will be impossible to implement in factual health service contexts. The results imply that downstream responsibility issues have to be continuously dealt with in system development in health services.     

Stimulating preventive procedures in primary care. Effect of PIUPOZ program on the delivery of preventive procedures

Introduction

Educational meetings are one of the most frequently used strategies to change doctors’ professional behavior; however, their effectiveness as a single intervention is limited. This study evaluated the effect of a multifactorial intervention, based on interactive workshops, on the GPs’ knowledge and the delivery rates of preventive procedures in primary care.

Material and methods

The study population comprised 106 GPs working in the Wielkopolska region recruited to the PIUPOZ program (Improving Quality in Primary Care). The intervention in the program consisted of lectures, interactive workshops and an audit, before and three months after the training. Trained medical students directly observed GPs to register which of 12 studied preventive procedures were performed during the consultation in patients aged 40+.

Results

A total of 1060 consultations were recorded, during which 4899 preventive procedures were delivered: 2115 before and 2784 after workshops. The mean number of preventive procedures per patient before and after workshops was 3.84 and 5.25 respectively (p < 0.0001). The most commonly performed preventive procedures were blood pressure, blood glucose and lipid profile measurement. Mean number of correct answers for 16 questions in the initial knowledge test was 8.7 and 12.7 in the final test (p < 0.0001).

Conclusions

The observed number of delivered preventive procedures was below the recommended range. Preventive procedures based on laboratory tests were performed more often than lifestyle counseling.     

Learning to have less pain — is it possible?: A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain

A randomised controlled study with the objective to explore the effects of a group learning programme based on a phenomenological epistemology and personal construct theory. Main outcome measures were: experienced pain, pain coping strategies, absenteeism, disability pension and health care consumption. One hundred and twenty-one patients with chronic musculoskeletal pain and high absenteeism were included in this study. The intervention group (n=77) consisted of nine smaller groups with 6-10 persons in each and were counselled by health personnel with special training. The control group consisted of 44 persons. The learning programme emphasised awareness, possible relations between bodily symptoms, emotions, mind and life situation, and change of focus from pain and disability to resources and potentials. One year after the end of the learning programme (T3), patients in the intervention group reported significant pain reduction, increased pain-coping abilities and a higher reduction of health care consumption than the control group (P<0.05). Absenteeism was not significantly reduced compared to the control group, but there were fewer persons receiving disability pension in the intervention group at T3 (38 versus 59%) (P<0.05). This group-learning programme should be considered an important adjunct to the therapy of patients with chronic muscular pain.     

Reflections on the preparation of psychotherapy supervisors.

The preparation of psychotherapy supervisors to provide supervision services is examined briefly in this paper. The persistent paradox of psychotherapy supervision training--that the supervisor role is considered highly important in graduate and internship programs, but graduate and post-graduate training in how to be a supervisor is very limited--is discussed. The need to resolve this paradox in psychology training is considered.