Speaking of Education

At the May Association of Psychologists in Academic Health Centers (APAHC) conference, topics ranged from genomics, to competencies in practice, to research funding and the examination of critical issues facing academic health centers (AHCs). As a section of APA Div. 12 (Society of Clinical Psychology), APAHC represents the interests of psychologists in AHCs regardless of area of research, practice or administrative activity. Since I had worked in such settings for most of my career, it felt like "going home." But then I started thinking about broader issues for psychology.

Translational enterprises

An AHC consists of an allopathic or osteopathic medical school, one or more other health profession programs, and one or more organized health-care systems. Medical schools became the cornerstone when tied to the academy by the legendary Flexner Report. More than 100 AHCs in this country receive substantial public funds to educate the nation's future health-care researchers and providers. Their professional organization advocates for a national, multidisciplinary approach to health work force planning.

AHCs unique contributions lie in their integration of roles in education, research and patient care-so thatresearch develops the evidence; patient care applies, refines and feeds back into research; and education teaches evidence-based and interdisciplinary teamapproaches that prepare future scientists and practitioners. AHCs are truly translational enterprises. They have provided fertile ground for psychology's growth in neuroscience, as well as in clinical, pediatric, health and neuropsychology. They offer excellent opportunities for scientist-practitioner psychologists to integrate teaching, research and practice, and for that same model of graduate education.

AHCs are also major economic engines at the forefront of patient care and research. Their choices reverberate throughout the health-care system. How they train health professionals influences subsequent practice patterns and their decisions to pursue types of research influence the advancement of science. AHC leaders and Institute of Medicine reports consistently urge all health professions to remove barriers to interprofessional education in AHCs, and to increase behavioral science education throughout their curricula. Psychology has a very important place at this table.

Education and training

If the purpose of AHCs is to educate and train the nation's future health-care scientists and practitioners, and if a sizable proportion of psychology graduate education is preparation for careers in health research and practice, why isn't psychology education and training more prevalent in AHCs? In addition, if our science is so important to the AHC mission, who will prepare psychologists for careers in AHCs? Haven't most systems learned that if they want a work force to supply it, they had better train the work force within it?

We do know that about 10 percent (n=49) of accredited psychology internship programs are in medical schools, training about 10 to 11 percent of all psychology interns each year. Yet I hear faculty's concerns about insufficient preparation in biological sciences and health-care systems for those seeking these positions.

Perhaps education and training at the internship level is too late for either psychology's mission or AHCs. There are doctoral degree programs in neuroscience in AHCs, but only about 10 of the more than 375 accredited doctoral programs in professional psychology are in AHCs. Graduate education in psychology is obviously not a core component of this enterprise. However, unknown numbers of students throughout psychology obtain relevant research and clinical experiences based on individual arrangements with AHC faculty. We must learn more about and continue to expand research and clinical training in AHCs-not only to prepare psychology's own work force, but to prepare researchers and practitioners from other disciplines to work with psychologists and to incorporate knowledge from our science in their work. If we are not in the mix early on, we risk being left out.

Barriers to more organized education and training efforts are many, including the fact that psychologists are housed throughout different administrative units. For example, of the nearly 4,000 psychologists identified as working in medical schools, about half are in departments of psychiatry and little more than half are involved in training psychologists. There areunknown numbers of psychologists working in colleges of nursing, pharmacy, dentistry, public health and other units within AHCs. In the past, visionaries such as Ed Sheridan provided opportunities for psychology to consolidate its efforts in the academy-but we remain splintered. Couldn't we at least get together within AHCs to foster the mission of health research and patient care, even if we dare not do so campus-wide?

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