Speaking of Education
Of the more than 4,000 psychology doctorates earned annually, more than half are awarded by programs that prepare students for professional practice. Of these, the vast majority are preparing health-service psychologists. I have already noted (see the March Monitor) that the 21st century health-care system requires that these graduates have competencies in informatics, interdisciplinary collaboration, quality improvement methods, and evidence-based practice (EBP). The focus on EBP has intensified over the past decade due to societal demands for accountability in health care and the development of methodologies to analyze the expanded scientific knowledge base of clinical practice.
Although training in EBP represents a paradigm shift for many health professions, it has long been integral to education and training models in psychology. APA accreditation policy states that "all programs should enable their students to understand the value of science for the practice of psychology and the value of practice for the science of psychology, recognizing that the value of science...requires attention to the empirical basis for all methods involved in psychological practice." We require a curriculum that includes the scientific foundations for practice and supervised clinical training in empirically supported procedures. Our disciplinary journals and the development of educational resources, such as texts, videos, treatment manuals and Web sites, as well as the growth of theory and research on clinical supervision, have all supported these endeavors.
However, the pedagogy of EBP in psychology does have some aspects that warrant increased attention. For example, we need to know more about how best to use treatment manuals so as not to neglect the ideographic study of the individual patient. In addition, our teaching methods are less advanced for "life-long learning...and professional problem-solving as psychologists in the context of an evolving body of scientific and professional knowledge" (APA's Guidelines and Principles for Accreditation of Programs in Professional Psychology).
To train our students for EBP we need more than education in the scientific foundations of practice and training in empirically supported procedures. We need to provide systematic training in the acquisition of skills in self-assessment that are fundamental to self-directed study. Research on teaching self-assessment is currently being done in other health professions such as medicine, surgery, nursing, dentistry and occupational therapy. We need more evidence-based teaching of evidence-based practice in psychology.
The following observations stem from preparing to co-lead a workshop on the teaching of EBP with Frank Collins at the meeting of the Society of Behavioral Medicine in March.
We need to promote knowledge of, and appreciation for, secondary sources in the literature. I recall when the use of secondary sources was seen as suspect in reviewing literature. Yet, given the expansion in knowledge, trainees need early awareness of resources such as the Cochrane Library, journals such as Evidence-Based Mental Health, and the major efforts under way to develop information infrastructures in health care.
We need an increased focus on the synthesis of knowledge. Of the domains of scholarship articulated by Ernest Boyer, graduate education in psychology has historically emphasized the generation and the application of knowledge. However, systematic training in the synthesis of knowledge has more often been in the area of one's dissertation rather than in the broader clinical science literature. Nor has this area of scholarship enjoyed the same kinds of career rewards for faculty as has the generation of new knowledge. Given the expansion of knowledge, the development of new methodologies in knowledge synthesis, and the certainty that evidence will change over the course of one's career, learning activities that promote competencies in the synthesis of knowledge in the context of ongoing patient care are critical. We also need to nurture the development of career paths for scholars in our field who will be the "complex data miners" required to create our evidence databases.
Our clinical supervisors need to model evidence-based practice. Trainees often make decisions based on the authority/expertise of the supervisor, or the theoretical/psychopathological model being utilized. In fact, clinical supervisors are often chosen in order to learn a particular approach to patient care. Yet we also need clinical supervision in which trainees are required to use an evidence-based approach to applying formal rules of evidence while evaluating clinical literature.
These issues of professional education and training in EBP will be among the topics addressed at our 2003 Education Leadership Conference this September. I invite your comments toward that end at e-mail.
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