The Register Report, Fall 2008 Health Psychology in Primary Care: Postdoctoral Fellowship Training at the University of Mississippi Medical Center by: Patrick O. Smith, Ph.D. and Kathy L. Crockett, Ph.D.  Return to Table of Contents

The Health Psychology Postdoctoral Fellowship Program in the Department of Family Medicine is organizationally located in the School of Medicine at the University of Mississippi Medical Center (UMMC). UMMC is the only academic health science center in the state, serving a population of approximately three million residents and employing approximately 7,800 people. UMMC has four tertiary care hospitals representing 722 beds, a complementary outpatient network, and an annual budget of close to 1 billion dollars. UMMC is dedicated to improving health and ensuring patient satisfaction by offering the latest state-of-the art treatment modalities while providing high-quality education. UMMC recently received accolades at the state and national levels for excellence in patient care and teaching. Consumer Reports ranked UMMC as the Mississippi Hospital of the Year (large hospital) for providing the most conservative treatment in Mississippi, and UMMC was recently listed as one of the top hospitals in the country (Thomson Top 100 Hospitals). In addition to being a leading center for patient care and quality education and training, UMMC also supports a large research program dedicated to promoting health, preventing disease, and managing chronic illness.

The development of the Health Psychology Postdoctoral Fellowship Program at UMMC was facilitated by recognition of the importance of the integration of primary health and behavioral healthcare in the provision of quality services. The discipline of Family Medicine historically has endorsed a biopsychosocial model of health and illness, and the UMMC Department of Family Medicine has implemented this model philosophically and practically in guiding clinical practice and training. The need for comprehensive, collaborative care, noted by healthcare quality organizations, such as the Institute of Medicine, has increasingly led the field of psychology to examine its potential role outside specialty mental health care practice settings and to better integrate psychologists’ knowledge and skills with those of other healthcare providers to improve overall health outcomes for patients. The UMMC Department of Family Medicine established the Health Psychology Fellowship Program in 1998, and since that time, the Department’s leadership has provided financial support for two fellowship positions, based on a medical cost offset model with complimentary goals of training fellows to participate in clinical care delivery, contribute to graduate medical education, and further their academic scholarship. Operationally, two postdoctoral fellows and the psychologist program director are embedded into a School of Medicine, Department of Family Medicine clinical service department, which also administers a family medicine residency program.

Our training setting offers a wide range of stimulating experiences in clinical health psychology. Although incoming fellows might have little or no experience in filling the diverse roles and functions of a health psychologist in an academic primary care setting, the training program enables them to understand the relationship between behavior and health and learn the capacity of psychologists to be the behavioral science experts and important change agents within healthcare settings. The fellowship’s training program focuses on a scientist-practitioner model, empirically supported treatments, and a cognitive-behavioral orientation, which is consistent with the Department’s emphasis on evidence-based practice and the Accreditation Council for Graduate Medical Education’s core competency requirements for physician resident training. By taking a comprehensive approach to training fellows as behavioral health providers in the clinical, teaching, and research activity domains, the program is designed to optimally prepare psychologists for careers in academic health care settings as effective members of transdisciplinary primary care teams. At the time of this writing, 10 fellows have graduated from the program, which includes two fellows working in a staggered vertical team program design. This design allows for the recruitment of one new fellow per year, who functions as a Junior Fellow during their first year and upon matriculation to the second year, becomes a Senior Fellow. The Senior Fellow’s provision of orientation and peer mentorship to the Junior Fellow adds another dimension to the training experience of fellows who complete the program.

The two-year training sequence has yearly and quarterly goals that encompass the domains of clinical work, research, teaching and professional development, while allowing for individualized training elements. For example, some fellows who wished to extend their training in teaching taught undergraduate or graduate courses at local colleges or universities while other fellows who wanted to expand their scientific knowledge base took courses offered on the UMMC campus, such as advanced pathophysiology. Other fellows have conducted research projects, such as one that included the cooperation of three local hospitals and led to a publication in a top ranked American Psychological Association (APA) journal.

The delivery of quality behavioral health services serves as the foundation for UMMC’s Health Psychology Postdoctoral Fellowship Program. Fellows provide clinical services in two outpatient primary care Family Medicine residency training clinics and occasionally respond to consultations in a large tertiary care community hospital. Fellows function as behavioral health consultants within the outpatient clinic treatment teams, which are comprised of Family Medicine faculty physicians, social workers, nursing staff, family medicine physician residents, pharmacy residents, and medical students. As part of training, fellows also provide behavioral health consultationliaison services to two un-referred call inpatient teams in a 500-bed community hospital; these teams typically include two family medicine faculty and six to eight residents. Inpatient consultation usually involves the provision of bedside assessments and recommendations, although some cases might require inpatient treatment.

Fellows see patients with a range of clinical conditions that span the continuum of behavioral disorders and health related behaviors.

Table 1 summarizes the common clinical conditions encountered by fellows in this healthcare setting.

Table 1. Common Clinical Conditions Substance use (prescribed and non-prescribed) Alcohol use Tobacco use Adherence problems (medical regimen and pharmacotherapy) Eating disorders Obesity Gastrointestinal disorders Sexual disorders Sleep disorders Stress related illness Pain management Grief and bereavement Chronic illness Mood disorders Anxiety disorders Somatoform disorders Personality disorders

Behavioral health services are delivered, using an “integrative paradigm” and “ecological model” to foster collaboration across disciplines in the outpatient setting (Seaburn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Fellows meet with patients in exam rooms and are fully embedded into the primary care culture while providing direct consultative services. Fellows conduct behavioral assessments and strive to provide brief problem-focused empirically supported interventions which include health promotion activities, specific psychological treatments, and delivery of behavioral interventions. These activities often lead to treatment recommendations made to the primary care team to insure provision of comprehensive services or referral to external services. In addition, they also provide informal or indirect consultation in which they do not see the patient but guide a clinician during the assessment and treatment process. Finally, fellows also provide collaborative consultation in which the fellow is present and integrated in the patient meeting with a clinician from another specialty.

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