Psychology and medical education: A historical perspective from the United States.

Abstract

Byline: Wade. Pickren Psychology became an integral and popular part of the undergraduate curriculum in the United States by the 1920s. It continued to grow in popularity throughout the century and now, in the 21[sup] st century, remains one of the top undergraduate degree programs in terms of the number of students who take it as their major. Psychology is also a popular and important program of undergraduate study for students who then pursue advanced education and training in a wide range of fields, including Medicine. Undergraduate Psychology courses that are popular with premedical students include Biological (Physiological) Psychology and Abnormal Psychology. Even with the growth and popularity of Psychology and its increasing relevance for health care, there has been resistance to incorporating it in the training of physicians. For most of the 20[sup] th century, Psychology was not considered a necessary part of medical education and psychologists were considered adjunctive in the practice of Medicine. However, by the last third of the 20[sup] th century, the situation had begun to change. In this article, I describe efforts from early in the 20[sup] th century to make Psychology a more formal part of medical education and suggest some reasons for why they failed to gain a purchase in the medical curriculum. I then briefly describe some factors that led to a greater acceptance of Psychology in medical training and settings and suggest some reasons for this acceptance. At the beginning of the 21[sup] st century, lessons can be drawn from these examples to help articulate a viable role for psychologists in an integrated health-care system, both in India and in the United States. Psychology in the Context of the Reform of Medical Education In the first half of the 20[sup] th century, there were many opportunities for interaction between psychologists and the medical profession in the United States.[sup] [1] In a few instances, there were genuine collaborations, such as in child guidance and neuroscience. In other arenas, such as mental testing and psychotherapy, physicians strongly resisted what they viewed as presumptuous incursions by psychologists into the domain of medicine.[sup] [2] Psychologists won the battle over mental testing in the United States, but physicians retained hegemony over psychotherapy until well after the end of World War II.[sup] [3] The question of whether instruction in Psychology should be part of the reformed medical curriculum was another area of debate. The years around the turn of the 20[sup] th century were a period of social change in American history. The social, political and professional order was transformed; new scientific disciplines were formed and professions were reformed. For scientific psychologists at the beginning of the 20[sup] th century, one point of potential application for their discipline was through an alliance with the medical profession. The practice of medicine was placed on a more scientific basis in the last quarter of the 19[sup] th century. This resulted in greater success in the treatment of some diseases and a higher status for medicine in American society. The medical sciences became increasingly centered on the laboratory as the locus of their work.[sup] [4],[5] Medical education began to focus on the several sciences considered basic to Medicine: anatomy, bacteriology, biochemistry, histology, pharmacology, physiology and pathology. This was the result of a gradual and halting reform of the medical school curriculum that began around 1840.[sup] [6] The reorganization of Harvard Medical School (1871) and the establishment of the Johns Hopkins University Medical School (1893) along lines emphasizing both clinical instruction and medical research were landmarks of the reform and signposts to the future of medical education. All the leading medical schools eventually raised standards of admission, and the length of training was expanded from two years to three years and then to four years. …