The Consensus Conference and Combined-Integrated model of doctoral training in professional psychology--overview of part 1: nature and scope of the Combined-Integrated model

This special series of articles on the Consensus Conference and Combined-Integrated (C-I) model of doctoral training in professional psychology consists of 13 articles in two successive volumes of the Journal of Clinical Psychology. Six articles are presented in Part 1 (Vol. 60, Issue 9), which collectively describe the "nature and scope" of the C-I model (e.g., historic and definitional issues; the potential advantages of this model; implications for the profession). In Part 2 of this special series (Vol. 60, Issue 10), articles 7 through 12 address the broader implications and potential applications of the C-I model within a range of professional and societal contexts (e.g., for interprofessional collaboration; the health care field; development of a global curriculum; the unified psychology movement; issues of assessment and professional identity; and higher education); article 13 provides a summary of the series as well as a discussion of future directions. As an overview, this paper provides the abstract for each of the articles in Part 1, and describes the various topics of the articles in Part 2. Taken together, the articles in this special series are designed to provide a coherent account of how and why the C-I model is timely and relevant, and therefore warrants serious consideration by the larger education and training community in professional psychology.     

From the horse's mouth: a case for Combined-Integrated doctoral training in professional psychology

Although new to many members of the psychological community, the notion of a "combined" model of training has been in existence for nearly 30 years (Beutler & Fisher, 1994). The present article is intended to outline the benefits and advantages of the Combined-Integrated (C-I) model. Following a brief discussion of the terms "combined" and "integrated," the advantages of C-I training are discussed across five key themes: (a) the high overlap across traditional practice area training, (b) the advantages of the breadth of training offered, (c) the advantages of C-I training for the professional of psychology, (d) the pragmatic advantages of C-I training to faculty and students, and (e) the benefits of C-I training for salient constituency groups.     

Development of a global curriculum for professional psychology: implications of the Combined-Integrated model of doctoral training

This article considers the development of a global training curriculum and qualification in professional psychology, with particular emphasis on the Combined-Integrated (C-I) model. The C-I model exposes professional psychology trainees to two or more of the practice areas (i.e., clinical, counseling, school/educational). The authors argue that the C-I approach is one that is well suited to the development of a global training curriculum due to its emphasis on broadly training psychologists as well as its respect for diversity and integration of various theoretical and professional orientations. A survey of training programs in 16 countries/regions on six continents found significant variation in training, minimal qualifications, and roles of the professional psychologist. The authors recommend that an international group of psychologists develop a regionally flexible, but common, training curriculum and qualification that would include a five- to six-year competency-based qualification. Ways in which the C-I training model may serve to integrate and globalize professional psychology are discussed.     

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace.     

What do students want? Perspectives from the front line of doctoral training in professional and Combined-Integrated psychology

Doctoral students in professional psychology face broad challenges, such as changing market demands and increased competition for careers in traditional practice settings. To prepare for these demands, students must decide how much and when to specialize, if at all, predoctorally. Complicating matters, students in single practice area programs (clinical, counseling, or school) may risk becoming insulated within the culture of their practice area, which can limit exposure and understanding of the larger practice field. Despite conditions that may drive potential students away from psychology, little research exists on efforts to address student needs, or on student perspectives of doctoral training in general. One training model that is sensitive to these student needs and concerns is the Combined-Integrated (C-I) model. An exploratory study of C-I student and graduate opinions, experiences, and aspirations revealed that C-I students value breadth of training, diversity of experience, and professional flexibility, and that they experience diverse training opportunities and socialization experiences. Implications of these results vis-à-vis the larger framework of student concerns are examined.     

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.     

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.     

Internship Programs Offering Clinical Experience With Children,Youth, and Families

A listing of internship programs offering clinical experience with children, youth, and families was compiled by obtaining information from all programs that listed such experiences in the current directory published by the Association of Psychology Internship Centers (APIC; 1985) and in the Directory of Internship Programs in Clinical Child and Pediatric Psychology (DIPCCPP; Tuma, 1986). This list provides a convenient source of information about available training experiences to interested students and faculty and is a first step in implementing the recommendations of the Hilton Head Conference on Training Clinical Child Psychologists as it pertains to internship training.     

Preparing neuropsychologists for the future: The need for additional training guidelines.

New guidelines for training in neuropsychology are needed for several reasons: increased diagnostic accuracy of neuroradiologic techniques: an increasing need for functional neuropsychological evaluations; emergence of other psychological specialties; and managed care/economic factors. Current INS-Division 40 guidelines emphasize neurological and diagnostic areas with minimal suggestions for training in rehabilitation and functional issues. The recent publication of training guidelines for Rehabilitation Psychology (APA Division 22) illustrates weaknesses in Division 40 training. It is proposed that neuropsychological training guidelines (formal guidelines and informal training experiences) incorporate another content area for training and demonstration of competency, defined as Functional Outcomes. Specific training is suggested in: (a) issues in disability; (b) ecological validity of tests; (c) vocational evaluation/training; (d) academic programs for students with disabilities; (e) independent living resources; (f) specific cognitive-behavioral interventions; (g) resources for individuals with disabilities; and (h) government assistance programs for individuals with disabilities.     

Interprofessional collaboration: implications for Combined-Integrated doctoral training in professional psychology

Interprofessional collaboration (IPC) is becoming "best practice" in the field of professional psychology and other health care professions. It was named as a core competency at Competencies 2002 and the Consensus Conference and has been endorsed by the American Psychological Association on several occasions. The authors provide a definition of IPC, present conceptual, scholarly, and pragmatic support for IPC, and offer guidance on how Combined-Integrated (C-I) doctoral programs in professional psychology can include IPC to ensure students are well equipped to respond to a client's complex needs. Furthermore, although C-I programs might be particularly well prepared to incorporate IPC into their training, it is argued that programs in the single practice areas of clinical, counseling, and school psychology also may benefit from the inclusion of IPC.     

A history of Combined-Integrated doctoral training in psychology

The history of doctoral training in psychology is reviewed, with special emphasis on the development of training models for applied psychology. Among applied psychology doctoral programs, most label themselves as being one of the three currently recognized practice areas: clinical, counseling, and school psychology; however, since the 1970s, APA also has accredited "combined" programs. The history of the development of the combined model is traced, including information from the programs themselves about the manner in which each evolved. Recently, new interest in the combined category -or Combined-Integrated (C-I) as these programs wish to become known-has emerged, and an organization representing these programs has formed. The C-I model is described, and the potential that the model may serve as a template for the future of professional training in psychology is discussed.     

Evaluating the Impact of Clinical Psychology Training Programs: Process and Outcome Issues

These comments identify key issues that need to be resolved to evaluate the impact or achievement of graduate training programs in clinical psychology. Three questions ought to be addressed to evaluate impact empirically: (1) What is a given training program trying to accomplish; that is, what are the goals? (2) What features of the program are designed to contribute to these goals; that is, what are the means? and (3) How can the goals and the means be assessed to elaborate their connections? Evaluating training programs is not fundamentally different from other research and begins with a careful analysis of the constructs of interest (e.g., program goals), identification of measures of the goals and the means, and considering, ruling out, or making implausible the influence of other factors (e.g., student selection, faculty selection, curriculum) that, if not conceived of as part of training, could serve as confounds.     

Predictors of doctoral student success in professional psychology: characteristics of students, programs, and universities

In the face of the rising number of doctoral recipients in professional psychology, many have voiced concerns about the quality of nontraditional training programs. Past research suggests that, on a variety of outcomes, graduates from clinical PhD programs outperform graduates from clinical PsyD and, to a lesser extent, counseling PhD programs. We examine an aggregate archival dataset to determine whether student or university characteristics account for the differences in outcomes among programs. The data show meaningful differences in the outcomes of clinical PhD, PsyD, and counseling PhD programs. Furthermore, graduates from research-intensive universities perform better on the psychology licensure exam and are more likely to become American Board of Professional Psychology diplomates. The available data support the notion that the ability to conduct research is an essential component of graduate education. In this light, PsyD programs represent a unique opportunity to train students in the types of evaluation and outcomes assessments used by practicing psychologists. We discuss implications for graduate-level training in professional psychology.     

IMPROVing communication about diversity,equity, and inclusion in health professions education

There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called “Humanity in Medicine.” Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.     

Dyadic,triadic, and group models of peer supervision/consultation: What are their components,and is there evidence of their effectiveness?

Models that meet the Psychology Board of Australia's definition of peer consultation include dyadic, triadic, and group formats. Components of these models (e.g., goals, theoretical basis, role of leader, members' roles, structure, and steps in procedure, stages in group development) are presented, and evidence of their effectiveness is reviewed. Psychologists are encouraged to identify the model components and goals that match their own learning goals for continuing professional development.     

A strategy for the detection and evaluation of unprofessional behavior in medical students. University of California, San Francisco School of Medicine Clinical Clerkships Operation Committee.

The authors describe the first four years (1995-1998) in which the University of California, San Francisco School of Medicine operated an evaluation system to monitor students' professional behaviors longitudinally through their clinical rotations. The goals of this system are to help "turn around" students found to have behaved unprofessionally, to demonstrate the priority placed by the school on the attainment of professional behavior, and to give the school "muscle" to deal with issues of professionalism. A student whose professional skills are rated less than solid at the end of the clerkship receives a "physicianship report" of unprofessional behavior. If the student receives such a report from two or more clerkships, he or she is placed on academic probation that can lead to dismissal even if passing grades are attained in all rotations. Counseling services and mentoring by faculty are provided to such students to improve their professional behaviors. From 1995 to 1998, 29 reports of unprofessional behavior on the part of 24 students were submitted to the dean's office; five students received two reports. The clerkship that submitted the most reports was obstetrics-gynecology. The most common complaint for the five students who received two reports was a poor relationship with the health care team. Four of these students had their difficulties cited in their dean's letters and went on to residency; the fifth voluntarily withdrew from medical school. The authors describe the students' and faculty members' responses to the system, discus lessons learned, difficulties, and continuing issues, review future plans (e.g., the system will be expanded to the first two years of medical school), and reflect on dealing with issues of professionalism in medical school and the importance of a longitudinal (i.e., not course-by-course) approach to monitoring students' behaviors. The authors plan to compare the long-range performances of students identified by the evaluation system with those of their classmates.     

Ensuring the success of women faculty at AMCs: lessons learned from the National Centers of Excellence in Women's Health.

Since the early 1970s, the numbers of women entering medical school and, subsequently, academic medicine have increased substantially. However, women faculty have not advanced at the expected rate to senior academic ranks or positions of leadership. In 1996, to counter this trend, the U.S. Department of Health and Human Services (DHHS) Office on Women's Health included women's leadership as a required component of the nationally funded Centers of Excellence in Women's Health to identify effective strategies and initiate model programs to advance women faculty in academic medicine. The authors describe the experience of Centers at seven U.S. medical schools in initiating and sustaining leadership programs for women. The processes used for program formation, the current programmatic content, and program evaluation approaches are explained. Areas of success (e.g., obtaining support from the institution's leaders) and difficulties faced in maintaining an established program (such as institutional fiscal constraints and the diminishing time available to women to participate in mentoring and leadership activities) are reviewed. Strategies to overcome these and other difficulties (e.g., prioritize and tightly focus the program with the help of an advisory group) are proposed. The authors conclude by reviewing issues that programs for women in academic medicine will increasingly need to focus on (e.g., development of new kinds of skills; issues of recruitment and retention of faculty; and increasing faculty diversity).     

Clinical/community internships: Needed now

The discrepancies between APA guidelines for internship accreditation and internship training practices as reported in brochures and The Association of Psychology Internship Centers are analyzed. Those discrepancies reflect a predominant training emphasis on traditional clinical psychology priorities and an overwhelming neglect of sociocultural diversity concerns as spelled out in the APA guidelines. On the basis of these discrepancies, and the developing history of psychology's professional training practices, it is argued that training conceptions and practices which teach and model individual and cultural diversity at each step of our graduate educational process are needed. Increasing the socio-cultural diversity in student groups, role models, teaching perspectives, professional activities, and client populations is necessary just to comply with existing accreditation guidelines. Taking those minimally necessary steps will require taking major steps toward generating needed and long overdue conceptions about training. Those new training conceptions in turn are essential to accomplish the objectives stated in APA's accreditation guidelines.