Speaking of Education

To achieve national goals of safety, effectiveness, patient-centeredness, timeliness, efficiency and equity, health-care reform must go beyond covering the uninsured; it must also change health care delivery. Given the role of behavior in health, psychology as a discipline and profession is integral to these efforts. That's why APA's 2009 Education Leadership Conference (ELC) will examine psychology's progress in preparing tomorrow's health work force, and identify areas needing further attention.

Preparing other professions

ELC 2007 examined the teaching of psychology in the preparation of physicians, dentists, pharmacists and public health personnel, among others. Indeed, psychological knowledge has been codified in the accreditation process of a number of health professions. What needs more systematic review is how we teach psychology to other members of the health work force, including but not limited to nurses, emergency medical technicians, hospital administrators, dental hygienists, and respiratory, physical and occupational therapists. What from our discipline is most essential to their curricula? Our faculty at two- and four-year colleges play a significant role in these endeavors.

Preparing psychological scientists

We must continue to educate and train psychological scientists to create knowledge relevant to such diverse topics as assessment, treatment and prevention of physical and mental disorders, safety in health care, clinical decision-making, implementation of practice guidelines, health disparities, adherence to treatment regimens and health promotion. Researchers need skills for working with other disciplines in complex health-care environments—a silo approach to research training will not meet future needs. Graduate programs housed in or affiliated with academic health settings are perhaps best poised for these endeavors. Although psychology has many notable examples of such training, how can we ensure that psychology will have the human capital required to address these issues?

Preparing psychological practitioners

Clinical health psychology has taken the lead in articulating the importance of integrating biological, social, cognitive and affective bases of behavior with biological, social, cognitive, affective and behavioral bases of health and disease in the training of future practitioners. This specialty has also articulated the importance of interdisciplinary training, knowledge of health policy and competence in working in health-care settings. On reflection, it seems these features are important to the preparation of all health service providers in psychology. Will we see the figure-ground reversal in psychology education and training about which a number of us speculated many years ago? If so, we will see the background as broad and general preparation in the domain of health, with mental health just one subset in that domain. Such change could be accelerated by the increased emphasis on primary care in health-reform efforts. Indeed, the World Health Report 2008 has unequivocally called for a return to a primary health-care approach in order to improve world health.

For U.S. psychology, primary care is where our specialties of clinical, counseling, school, clinical health and family psychology meet to address the population's behavioral health needs. Although we have exemplars for such training at every level, we do not have cross-cutting models specific to primary care, and have only a very general definition of education and training of health service psychologists.

Given the breadth and diversity of psychology, we must have a clear identity for the health service subset of psychology so that we can communicate effectively with the public, health policymakers and other professions. Our education and training cannot take place in disciplinary isolation or working only with other mental health professions. Moreover, as interprofessional education becomes prevalent in the preparation of other health professions, psychology cannot expect to be added to the health-care team when team members did not train with our students and faculty.

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