Preparing the Next Generation for Integrated Care in Medical Settings: Training in Primary Care as a Foundation

Abstract

Shifting the focus of a psychology training program to an increased emphasis on knowledge and skills to work in a variety of medical settings requires willingness to try new training paradigms. New training sites must be identified. Supervisors with experience working in medical settings must be located. Then, making it happen necessitates strong, ongoing working relationships among key players (i.e., training directors, psychologists, medical providers) and respect and commitment to interdisciplinary training among the various disciplines involved. Financial support must be obtained for trainee stipends and benefits as well as for resources needed (e.g., assessment measures, psychoeducation materials, and treatment resources) and space. The final ingredient is a patient population that is open to new models of clinical service delivery. Thus, the current chapter focuses on the opportunities and challenges of training psychologists to work in medical settings. Most notably, examples are used of educational and training models within integrated care settings (subsequently referencing team-based treatment affording a patient at a minimum access to medical and psychological care concurrently) designed to prepare psychologists to operate within the patient-centered medical home (PCMH). The primary care setting is focused upon because changes in the health care system suggest that frequently psychologists may find themselves working in primary care. Additionally, training psychologists to work effectively in this setting not only prepares them for primary care but also specialty medical settings, as training in primary care serves as a solid foundation to build on for work in the health care system in general secondary to the complexity and diversity of patient-related issues seen. Similar to the primary care physician who must be prepared for all patient presentations (knowing their limitations and when to refer for specialized care), the psychologist integrated into primary care must be prepared for all presentations (knowing their limitations and when to refer for specialized care). Additionally, the psychologist in primary care must be a provider to the providers and able to impact the primary care system in which they are employed. Thus, training models must equip trainees to be self-reflective and critical thinkers, aware of the ethical dilemmas that present in primary care, prepared to interact with a culturally and individually diverse group of patients and providers, able to engage in program development, invested in advocacy, and display interprofessional professionalism in addition to clinical skills.