The scientifically-minded psychologist: science as a core competency

At the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, the Scientific Foundations and Research Competencies Work Group focused on identifying how psychologists practice scientifically. This article presents the subcomponents associated with the core competency of scientific practice. The subcomponents include: 1). access and apply current scientific knowledge habitually and appropriately; 2). contribute to knowledge; 3). critically evaluate interventions and their outcomes; 4). practice vigilance about how sociocultural variables influence scientific practice; and 5). routinely subject work to the scrutiny of colleagues, stakeholders, and the public. In addition, the article briefly discusses how the depth of training for and assessment of each subcomponent will vary by training model. Implications and future directions for individual psychologists, training programs, and the profession are discussed. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Competencies conference: future directions in education and credentialing in professional psychology

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was organized around eight competency-focused work groups, as well as work groups on specialties and the assessment of competence. A diverse group of psychologists participated in this multisponsored conference. After describing the background and structure of the conference, this article reviews the common themes that surfaced across work groups, with attention paid to the identification, training, and assessment of competencies and competence. Recommendations to advance competency-based education, training, and credentialing in professional psychology are discussed. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Achieving competency in psychological assessment: directions for education and training

This article provides an overview of issues related to the development and evaluation of competency in psychological assessment. Specifically, we delineate the goals, ideas, and directions identified by the psychological assessment work group in the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist. The psychological assessment group was charged with the tasks of: (a). identifying the core components of psychological assessment competency; (b). determining the central educational and training experiences that will aid competency development; (c). explicating strategies for evaluating competence; and (d). establishing future directions for furthering the identification, training, and evaluation of competence in psychological assessment. We present a set of eight core competencies that we deemed important for achieving psychological assessment competency and discuss four guidelines for training in the domain of psychological assessment. A variety of methods for evaluating competencies in this domain are suggested, with emphasis on using a collaborative model of evaluation. Recommendations for future directions include strengthening the academic prerequisites for graduate school training; increasing training in culturally sensitive measures; incorporating innovative assessment-related technologies into training; and addressing discontinuities between academic training, internship, and practice environments.     

Individual and cultural-diversity competency: focus on the therapist

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was held in Arizona in November 2002. One of the workshops, Individual and Cultural Differences (ICD), focused on racism, homophobia, and ageism. The consensus was that self-awareness and knowledge about the three "isms" are critical components in the education and training of psychologists. This article, authored by four of the workshop attendees, is a review of the current research and theoretical literature. Implications that address both content and context in graduate programs and training sites are presented. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Consultation and interprofessional collaboration: modeling for the future

Consultation and interprofessional collaboration by psychologists occur with individuals, groups, programs, and organizations. The practice of consultation and interprofessional collaboration involves interdisciplinary relationships, preparation, and advanced skill development within specialty areas of psychology (e.g., clinical, counseling, industrial-organizational, and school). The Workgroup on Consultation and Interdisciplinary Relationships engaged in a planning process at the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology to address fundamental issues regarding consultation and interprofessional collaboration in professional psychology. The Workgroup articulated working definitions, consensus points about psychologists as consultants and interprofessional collaborators, a consulting and interprofessional competency blueprint for preparation and assessment strategies, and future directions. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

The Hierarchical Clustering of Clinical Psychology Practicum Competencies: A Multisite Study of Supervisor Ratings

Competency evaluation rating forms are widely used to assess a range of global and specific psychology practitioner competencies during and at the end of clinical placements. Surprisingly, there is little research examining the dimensional structure or the hierarchical clustering of items on these ratings. The current, multisite study examined supervisor ratings of clinical psychology trainees (N = 204) on the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS). Based on the proximity criterion chosen, hierarchical clustering yielded either nine clusters or four super clusters: Good Practitioner Attributes and Conduct, Scientist Practitioner and Professional Management, Assessment and Intervention, and Psychological Testing. The study also tracked the developmental trajectory of competency attainment. CΨPRS ratings differentiated groups between early but not between later stages of training. Measurement issues and implications for training and practice are discussed.     

A model and method for "making" a Combined-Integrated psychologist: equilintegration (EI) theory and the beliefs, events, and values inventory (BEVI)

Although the Consensus Conference on Combined and Integrated Doctoral Training in Psychology (e.g., Bailey, 2003) generated much content of relevance to the structure and commitments of Combined-Integrated (C-I) programs, faculty, and students-and Competencies 2002: Future Directions in Education and Credentialing in Professional Psychology (www.appic.org) developed language and guidelines regarding the knowledge areas, skills, and values that students in professional psychology programs should acquire and demonstrate-specific models and methods are necessary to translate these professional guidelines and aspirations into reality. This article offers one such model, Equilintegration (EI) Theory, and method, the Beliefs, Events, and Values Inventory (BEVI), that can be used by faculty, training staff, supervisors, and students in C-I programs to operationalize, assess, and cultivate basic values of education and training from a C-I perspective (e.g., self-awareness, self-assessment, and self-reflection). In addition to this model and method, relevant background information, theory, and research are presented along with attendant implications, hypotheses, and principles.     

Residents' end-of-life decision making with adult hospitalized patients: a review of the literature.

PURPOSE: The authors performed a structured literature review to understand residents' experiences with end-of-life (EOL) decision making with adult hospitalized patients, specifically regarding decisions to withhold or withdraw advanced life-support measures. METHOD: An Ovid-based strategy was used to search Medline, ERIC, PsychINFO, and CINHAL databases for articles published between 1966 and February 2005, combining the domains of "resuscitation orders," "decision making," and "internship and residency." All quantitative and qualitative studies examining residents' EOL decision making with adult hospitalized patients were included. The authors developed and applied a scoring system for relevance and quality, performed data abstraction and quality assessment independently and in duplicate, then met to collate findings and identify factors in residents' EOL decision making. RESULTS: The searches yielded 884 articles, of which 26 were included. Variable methodologies precluded meta-analysis. In these studies, residents felt unprepared to handle patient EOL decision making, although exposure to EOL discussions helped them gain confidence. Residents' attitudes, skills, and knowledge were key determinants of whether EOL decisions were addressed. Many misinterpreted the terms "DNR" and "futility." Residents' understanding of the patient EOL decision-making process could be extremely variable, and their do-not-resuscitate discussions suboptimal. Residents' lived practice experience of the patient EOL decision-making process was often at odds with what they were taught in formal curricula. CONCLUSIONS: Educational strategies aimed at changing residents' knowledge, skills and attitude should address the hidden curriculum for the patient EOL decision-making process that is part of the experienced culture of every day practice. Future studies of this experienced culture would inform specific educational interventions.     

A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from a literature review.

PURPOSE: To create a framework for teaching the knowledge and skills of practice-based learning and improvement to medical students and residents based on proven, effective strategies. METHOD: The authors conducted a Medline search of English-language articles published between 1996 and May 2001, using the term "quality improvement" (QI), and cross-matched it with "medical education" and "health professions education." A thematic-synthesis method of review was used to compile the information from the articles. Based on the literature review, an expert panel recommended educational objectives for practice-based learning and improvement. RESULTS: Twenty-seven articles met the inclusion criteria. The majority of studies were conducted in academic medical centers and medical schools and 40% addressed experiential learning of QI. More than 75% were qualitative case reports capturing educational outcomes, and 7% included an experimental study design. The expert panel integrated data from the literature review with the Dreyfus model of professional skill acquisition, the Institute for Healthcare Improvement's (IHI) knowledge domains for improving health care, and the ACGME competencies and generated a framework of core educational objectives about teaching practice-based learning and improvement to medical students and residents. CONCLUSION: Teaching the knowledge and skills of practice-based learning and improvement to medical students and residents is a necessary and important foundation for improving patient care. The authors present a framework of learning objectives-informed by the literature and synthesized by the expert panel-to assist educational leaders when integrating these objectives into a curriculum. This framework serves as a blueprint to bridge the gap between current knowledge and future practice needs.     

Evidence-based practice in psychology

Evidence-based practice is a growing topic of interest in the field of psychology. In 2006, the American Psychological Association (APA) developed a formal policy statement on evidence-based practice in psychology (EBPP). It is now important for the profession to come to a better understanding about what EBPP is (and is not), and to develop a skill set associated with EBPP. The next seven articles explore the history of EBPP, elaborate the definition and present uses of the term, and provide information relevant to the skill set regarding a practice consistent with the evidence-based approach. Many of the articles were derived from the 2007 midwinter meeting of the Council of University Directors of Clinical Psychology, where the program topic was "Evidence-based Practice: What it is, Why It's Important, and What you Need to Know."     

Pathology graduate medical education (overview from 1926 to 2005)

Postgraduate training of pathologists in the United States dates from 1926. From 1926 to 1936, certification was developed as a measure of competence for the public. In 2000, competence was redefined by the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project for all physicians-in-training as mastering "the six competencies." These consist of (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. The Outcome Project emerged in parallel with the American Board of Medical Specialties' Maintenance of Certification Project for all physicians. Outcome measures and benchmarks are the methods by which competence in medical practice will be measured for the public. Trends in pathology graduate medical education previously reported in 2001 (Hum Path 2001;32[7]:671-676) are updated through 2005 and reviewed. Demographic data regarding number and size of programs, curricula initiatives for pathology, changes in assessment, and outcomes information on certificates issued are discussed. Factors shaping pathology residency training are reviewed, as well as future trends that will impact training curricula.     

Preparing graduates for the first year of residency: are medical schools meeting the need?

PURPOSE: Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training. METHOD: A questionnaire about 100 skills and competencies expected of new first-year residents was sent to 50 U.S. residency directors from surgery, internal medicine, family medicine, pediatrics, and obstetrics-gynecology programs. Each director was asked to state expectations of a first-year resident's competence in each skill at entry to residency and after three months of training. Skills deemed most appropriately acquired in residency were also identified. Competencies included diagnosis, management, triage, interpretation of data, informatics and technology, record keeping, interpersonal communications, and manual skills. RESULTS: A total of 39 residency directors responded, including seven surgery, nine medicine, seven family medicine, eight pediatrics, and eight obstetrics-gynecology. In addition to physical examination skills, 13 competencies achieved more than 70% agreement as being entry-level skills. There was wide variability as to the relative importance of the remaining skills, with residency directors expecting to devote significant resources and time in early training to ensure competence. CONCLUSIONS: Medical schools should consider the expectations of their students' future residency directors when developing new curricula. Assuring students' competencies through focused curricular change should save both time and resources during residency.     

期望效应理论在实习护生临床带教中的应用研究

目的探讨期望效应理论在带教护理专业实习生实践中的应用,为实际护生带教工作提供依据。方法将76名实习护生随机分为两组,采用问卷法调查,所得资料使用SPSS软件进行统计分析。结果实验组出科考核（包括理论和操作）成绩明显优于对照组（P〈0．01,P〈0．05）,病人对护理质量满意度实验组显著高于对照组（P〈0．01）。结论期望效应在实习护生临床带教中的应用效果良好,提高了实习护生职业适应力与护理效果。     

The Development and Validation of a Low Back Pain Knowledge Questionnaire �C LKQ

OBJECTIVE:

The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled “The Low Back Pain Knowledge Questionnaire”.

INTRODUCTION:

There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients.

METHODS:

The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention.

RESULTS:

The focus groups generated a questionnaire with 16 items. The Spearman’s correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p< 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p< 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p< 0.001).

CONCLUSION:

The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.     

Back to our future? The Consensus Conference and Combined-Integrated model of doctoral training in professional psychology

Is it possible and advisable for the profession of psychology to articulate and endorse a common, generalist, and integrative framework for the education and training of its students? At the Consensus Conference on Combined and Integrated Doctoral Training in Psychology, held at James Madison University in Harrisonburg, VA (USA), May 2 to 4, 2003, participants from across the spectrum of education and training in professional psychology ultimately answered "yes." This article, the first in this special series on the Consensus Conference and Combined-Integrated (C-I) model of doctoral training in professional psychology, essentially provides an overview of the conference rationale, participants, goals, proceedings, and results. Because the other 12 articles in this series all reference the Consensus Conference and C-I model, this overview provides a good starting point for understanding what occurred at the conference, what it means to educate and train from a C-I perspective, and what the potential implications of such a model might be for the profession of psychology.     

An Evaluation of an Educational Intervention in Psychology of Injury for Athletic Training Students

Context:

”Psychosocial Intervention and Referral„ is 1 of the 12 content areas in athletic training education programs, but knowledge gained and skill usage after an educational intervention in this area have never been evaluated.

Objective:

To evaluate the effectiveness of an educational intervention in increasing psychology-of-injury knowledge and skill usage in athletic training students (ATSs).

Design:

Observational study.

Setting:

An accredited athletic training education program at a large Midwestern university.

Patients or Other Participants:

Participants included 26 ATSs divided into 2 groups: intervention group (4 men, 7 women; age  =  21.4 ± 0.67 years, grade point average  =  3.37) and control group (7 men, 8 women; age  =  21.5 ± 3.8 years, grade point average  =  3.27).

Data Collection and Analysis:

All participants completed the Applied Sport Psychology for Athletic Trainers educational intervention. Psychology-of-injury knowledge tests and skill usage surveys were administered to all participants at the following intervals: baseline, intervention week 3, and intervention week 6. Retention tests were administered to intervention-group participants at 7 and 14 weeks after intervention. Analysis techniques included mixed-model analysis of variance (ANOVA) and repeated-measures ANOVA.

Results:

The Applied Sport Psychology for Athletic Trainers educational intervention effectively increased psychology-of-injury knowledge (29-point increase from baseline to intervention week 6; F_2,23  =  29.358, P < .001, η_p²  =  0.719) and skill usage (50-point increase from baseline to intervention week 6; F_2,23  =  5.999, P  =  .008, η_p²  =  0.343) in undergraduate ATSs. These increases were maintained at the 7-week and 14-week retention testing (P < .001 for both).

Conclusions:

This first attempt at evaluating an educational intervention designed to improve ATSs'' knowledge and skill usage revealed that the intervention was effective. Although both knowledge and skill usage scores decreased by the end of the retention period, the scores were still higher than baseline scores, indicating that the intervention was effective.     

Overcoming our resistances to "doing" evidence-based group practice: a commentary

This commentary focuses on how the articles in the group therapy issue of the Journal of Clinical Psychology: In Session can address the resistances that many group practitioners exhibit to "doing" evidence-based practice (EBP). The articles attempt to overcome the resistances to practicing evidence-based group therapy through a process of education and skills training. A major issue cutting across the articles is the narrow focus of incorporating empirical findings only from studies specifically examining psychotherapy groups. The author argues that incorporating research from the whole field of group dynamics research can increase the empirical basis for evidence-based practice.     

Unified professional psychology: implications for the Combined-Integrated model of doctoral training

The authors outline a new identity for the professional psychologist termed Unified Professional Psychology (UPP). UPP combines recent movements toward a unified psychological science, an independent professional psychology, and Combined-Integrated (C-I) doctoral training programs in psychology. The value in the synthesis of these ideas is that they (a) provide a comprehensive system of thought that defines the science and practice of psychology in a commensurable manner, (b) offer a clear identity for the professional psychologist, and (c) set the stage for a training model that develops competencies that will prepare graduates to serve as leaders and advocates in a wide array of health settings. Issues pertaining to why a new view is needed and how UPP specifies the science-practice relationship are addressed in detail.