The Register Report, Fall 2006: Competencies Hospital Practice Competencies for Psychologists by: John C. Linton, Ph.D. Return to Table of Contents

Psychologists became active in hospitals after World War II, and their involvement was largely in psychiatric facilities, either through departments of psychiatry at medical schools or other large teaching institutions and in Veterans Administration hospitals or state hospitals, where they functioned in a supportive, typically assessment role with staff psychiatrists. During the sixties there was a rather dramatic increase in the number of psychologists working in medical schools, where in addition to clinical work they participated in research, and were active in the training of both undergraduate medical students as well as residents.

With time psychologists expanded their practices beyond departments of psychiatry, with departments of neurology depending on their neuropsychology staff for extensive evaluations of brain-behavior functioning. Neuropsychologists and rehabilitation specialists entered departments of physical medicine and hospital medical rehabilitation units to treat the head and spinal cord injured, amputees, and assist with the wide variety of other challenges rehabilitation patients face. Psychologists met the needs of chronic pain patients in Inpatient pain programs, and psychologists addressed infertility, perinatal loss, and special symptoms such as hyperemesis gravidarum in departments of obstetrics and gynecology. Psychologists became involved in primary care specialties such as internal medicine, pediatrics and family medicine, where they taught social and communication skills to residents, and treated a wide gamut of patient problems such as poor adherence to treatment, and coping with painful medical procedures. They assessed and treated nephrology patients needing dialysis or transplant and worked with surgeons doing bariatric surgery for extensive weight loss to clear patients for surgery and call attention to behavioral problems that might be exacerbated post surgically.

From rather modest beginnings, clinical health psychology has flourished over the past 25 years, as psychologists have visibly demonstrated their worth in general hospital settings. Whereas the psychiatric hospital offered a relatively stable environment, with demands more consistent with the traditional training and experience of professional psychologists, the general hospital and the complexity of modern healthcare offers a wide range of opportunities and paths to follow, with new prospects for utilizing psychological proficiency steadily emerging (Brown et al, 2002). With these growing opportunities comes the need to attend to the competencies required for skilled and ethical practice in hospitals.

One must consider the sequence of competency development during the training continuum. Until about 25 years ago, it was common for psychologists in general hospitals to be licensed and fairly seasoned. Then postdoctoral training programs developed in medical centers, often with a research focus, but also centered on specialized skills training in fairly narrow areas, such as neuropsychology, gerontology or pediatric psychology. Around that time predoctoral internships also became more common in general medical settings, often with a large medical center as the fulcrum of the training program. At first predoctoral interns arrived at these training sites with little experience in clinical health psychology from their graduate training programs, whereas in the past 20 years courses in health psychology and behavioral medicine have become some of the most cited in clinical programs (Sayette & Mayne, 1990). But even with the increase in didactics, there were limited field experiences or practica in hospitals available to graduate students before internship, whereas now students frequently come to internship having completed a number of practica assignments in hospitals near their graduate departments. It is also common for graduate students to study and anticipate the special challenges that they might face in hospital settings before actually working there (Guiffre, 2006).

So any discussion of competencies must consider the knowledge and skill level of the psychologists in question, whether considering their entry into practicum (beginner), entry to internship (advanced beginner), entry to practice (competent), new career (proficient), or advanced specialty practice (expert). Each will have specific expectations relative to their stage of development, from graduate training readiness for practicum, to lifelong learning in advanced practice. And psychologists all along this continuum are now found in general hospitals.

Competencies

As suggested elsewhere in this issue of The Register Report, the examination of competencies in professional psychology has been ongoing for a number of decades, but really came into the spotlight at the Competencies Conference held in 2002 (Kaslow, 2004). As an outgrowth of this conference, the APA Board of Educational Affairs assembled a task force, the Competency Benchmarks Workgroup, to examine the assessment of competence along the sequence of professional training, with a preliminary report on their benchmarking recommendations due in November, and with at least one aim to integrate these benchmarks into accreditation standards.

Kaslow (2004) notes that foundational competencies include individual and cultural diversity and ethical practice. Core competencies include scientifically minded practice, intervention skills, consultation and interpersonal collaboration, supervision, and professional development. Those competencies unique to particular specialties build upon the foundational and core competencies. These specialized competencies are acquired last in the training sequence, require pertinent advanced knowledge, skills and attitudes, and entail more refined credentialing such as board certification. Medicine has also outlined six general competencies required of graduates from accredited medical residency programs. Two involve interpersonal and communication skills and professionalism, which are topics psychologists are well qualified to teach to residents, thereby adding to what psychologists can bring to hospital based training programs (Linton, 2005). continued

 

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