by Patrick O. Smith, Ph.D. and Kathy L. Crockett, Ph.D.
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
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.
As part of our efforts to provide excellent training and meet appropriate licensure required thresholds, each fellow receives a minimum of three hours of individual “face-to-face” weekly supervision by a licensed psychologist. In addition, fellows also receive three to four hours of group supervision weekly. Supervision is provided using videotape, direct observation of patient rooms (using state-of-the art monitoring equipment housed in clinic supervision areas), as well as review of case notes, case presentations, and other supporting materials. Fellows receive ongoing summative feedback from the fellowship director, along with three formative feedback episodes per year. Additionally, the Junior Fellow receives peer supervision from the Senior Fellow and both fellows provide feedback to the program director. Overall, there is a strong emphasis on ongoing, transparent 360-degree feedback within the program.
Across the two-year training period, licensure preparation, licensure attainment and national credentialing are encouraged and supported. The Department purchases a preparatory study program for taking the Examination for Professional Practice in Psychology (EPPP) administered by the Association of State and Provincial Psychology Boards (ASPPB). Fellows usually begin their EPPP preparation in the latter half of their Junior year with the goal of passing the examination and being able to sit for their oral examination (Mississippi requirement) as they begin their Senior year. The fellowship director aids fellows in the licensure application process, development of EPPP preparation goals, and the provision of study time.
Fellows are strongly encouraged to initiate the programmatic means of credential banking for future credentialing, credential verification, and licensure mobility. We promote this process through ASPPB and the National Register of Health Service Providers in Psychology (NR). We also recommend our fellows apply for a “Credentialing Scholarship” through NR, and we are very pleased to announce that our present Senior fellow (Co-author Dr. Crockett) has been recently selected to receive a 2008 National Psychologist Trainee Register (NPTR) Credentialing Scholarship. The NPTR Credentialing Scholarship is given in conjunction with the American Psychological Association of Graduate Students (APAGS). It allows the fellow to complete the NPTR and become credentialed upon initial licensure without paying any application and registration fees. By guiding and promoting licensure and credentialing simultaneously, our program is also encouraging future application for specialty certification through the American Board of Professional Psychology.
In addition to strengthening their clinical foundation and in preparation for jobs in academic health centers, fellows also receive training and experience in teaching and research. Using Bloom’s taxonomy of adult learning fellows learn direct, indirect, and interactive instructional methods and apply these with a wide variety of trainees. Examples of trainee groups taught by fellows include medicine and pharmacy residents, medical students, nurses, psychology graduate students, dental students, and emergency medical technician students. Within the family medicine residency program, fellows are directly involved in behavioral science curriculum design and implementation across the 36-month residency training sequence. These activities include facilitating resident support groups, making a variety of didactic presentations, teaching patient-physician communication and interpersonal skills training, and providing clinical co-supervision with physician faculty in the training clinics. External to the Department of Family Medicine the Senior fellow administratively coordinates a campus-wide physician impairment and wellness presentation series with 27 residency programs. In addition to these primary training responsibilities, fellows have been involved in the development and implementation of a tobacco treatment specialist workshop and the Behavioral Science course in the School of Dentistry.
Many of the teaching and training activities of the Fellowship have been directly tied to research activities. For example, fellows have published their work following studies evaluating the difference in graduate and undergraduate education of physician impairment and wellness. The same is true for tobacco treatment training. For the past seven-year period, fellows have been actively involved in conducting tobacco research. Two areas of research development underway focus on the application of the behavioral sciences to organ transplant and promotion of scholarship among family medicine residents and faculty. The program director participates on the UMMC Transplant Service Line Task Force and is a Champion of the Family Physician Inquiry Network (FPIN). We are presently in the developmental stage of transplant research, but have a long term history of fellows co-authoring publications through FPIN. A new initiative within the department focuses on increasing faculty and resident publications, which provides another opportunity for fellows, who will serve as mentors to other healthcare professionals to promote this scholarly thrust within the department.
Additionally, to support a focus on research training, fellows are routinely encouraged to apply to the Pittsburgh Mind-Body Center, which offers an annual summer institute to “provide basic training to junior faculty and postdoctoral fellows in mind-body science and health.” We have had four successful applications in this very competitive program. In addition, fellows are strongly encouraged and supported in their application for the National Institutes of Health loan repayment program; three fellow graduates have received repayment awards. To support fellows’ research and scholarly work, UMMC and the Department of Family Medicine have financially supported presentation of fellows’ work at local, state, and national conferences. Fellows routinely publish several articles and make several presentations across the training sequence.
The professional development domain of training is designed to bring the clinical, teaching, and research program elements in sync. Much of the group supervision focuses on topics related to ethics, campus citizenship, collegial communication, guild participation, curriculum vitae development, job searching, career mentorship, job negotiation, and financial planning.
The program’s future goals include consideration of developing a campus-wide fellowship consortium with subsequent seeking of APA postdoctoral residency accreditation. Also, we are presently in the midst of moving toward a predominately integrative primary care model where the primary clinical focus will be very brief 15-minute interactions, rather than traditional delivery of psychological treatment.
To apply to UMMC’s Health Psychology Postdoctoral Fellowship Program, applicants must have completed an APA clinical or counseling psychology doctoral program including an APA approved internship prior to beginning the postdoctoral fellowship program. In addition, applicants are required to submit a completed application packet. We are fortunate enough to offer fellows a very competitive stipend and a generous benefits package. For additional information on becoming a postdoctoral health psychology fellow in the Department of Family Medicine at UMMC, visit our web site at http://familymed.umc.edu/. Additional information can also be obtained by calling 601.984.5425 or by email (firstname.lastname@example.org).
The Program Director, Patrick O. Smith, PhD, is a Professor of Family Medicine at the University of Mississippi Medical Center and holds adjunct appointments in the Department of Surgery and in the Department of Psychiatry and Human Behavior. He presently is the Executive Secretary of the Mississippi Board of Psychology and is the Treasurer of the Association of Psychologists in Academic Health Centers.
Kathy Lynn Crockett received her PhD in Clinical Psychology from Jackson State University, Jackson, Mississippi. She received a pre-doctoral fellowship grant from the National Institute on Drug Abuse through collaboration with Brown University Medical School/Miriam Hospital in Providence Rhode Island and Jackson State University (T32) to conduct HIV/AIDS and substance abuse research. Kathy completed an internship at Brown University Medical School. Presently, she is participating in a 2-year postdoctoral health psychology fellowship in primary care at University of Mississippi Medical Center, Department of Family Medicine, Jackson, Mississippi.
Seaburn, D. B., Lorenz, A. D., Gunn, W. B., Gawinski, B. A., & Mauksch, L. B. (1996). Models of collaboration. New York: Basic Books.