Training Medical Students in Behavioural and Cognitive Strategies

Introduction to the Special Issue on Training Psychologists and Nonpsychologists in Cognitive and Behavioural Procedures

This article introduces a special collection of papers that discuss issues in training nonpsychologists and psychologists in behavioural and cognitive procedures. It is argued that while this has been a neglected issue, it is an important strategy in achieving the overall goal of the large-scale dissemination of cognitive-behaviour therapy (CBT), a stated aim of the Australian Behaviour Modification Association and like organisations. It is proposed that to successfully train nonpsychologists in CBT a number of conceptual issues need to be clarified. The first concerns the nature of CBT; it is argued that CBT is not an entity in itself, but the process of applying the science of psychology to human problems. Second, CBT knowledge is a continuum, with various levels of complexity. Therefore attempts to train nonpsychologists need to consider the trainees' level of psychological knowledge in determining the goals of training. Needs for (a) a comprehensive conceptual framework to guide the training of nonpsychologists, (b) research to identify the best ways of accomplishing training, and (c) “top-down” strategies, such as changing service-system philosophies, to complement the “bottom-up” strategy of training individuals, are highlighted.

The general practitioner's role in AOD issues: overcoming individual, professional and systemic barriers

General practitioners (GPs) and increasingly other medical practitioners are well placed to address alcohol and other drug (AOD) problems. Their involvement in this area of care, however, is assessed to be less than optimal. There is, however, a growing body of evidence for the potential efficacy of medical practitioner intervention at the primary care, emergency department and in-patient level. There is also considerably expanded scope to operate from an evidence-based perspective. However, key questions arise regarding what constitutes best practice in the translation of the growing AOD knowledge base into clinical practice behaviours. This paper explores possible contributory factors to the low level of engagement with AOD issues by GPs and examines a wide range of individual, structural and systemic issues that may be amenable to change. Strategies for the dissemination of research findings, changing professional practice behaviour and introducing sustainable structural reforms are also addressed.

Interactional skills of students from traditional and non-traditional medical schools before and after alcohol education

OBJECTIVE

To compare alcohol-related intervention and general interactional skills performance of medical students from a traditional (Sydney) and a non-traditional (Newcastle) medical school, before and after participation in an alcohol education programme about brief intervention.

DESIGN

In two controlled trials, students received either a didactic alcohol education programme or didactic input plus skills-based training. Prior to and after training, all students completed videotaped interviews with simulated patients.

SETTING

The Faculties of Medicine at the University of Newcastle and the University of Sydney, Australia.

SUBJECTS

Fifth-year medical students (n=154).

RESULTS

Both alcohol-related intervention and general interactional skills scores of the Newcastle students were significantly higher than those of the Sydney students at pre-test but not after training. Although alcohol-related interactional skills scores improved after training at both universities, they did not reach a satisfactory level. The educational approach used had no effect on post-test scores at either university.

CONCLUSIONS

Significant baseline differences in interactional skills scores favouring non-traditional over traditional students were no longer evident after both groups had been involved in an alcohol education programme. Further research is required to develop more effective alcohol intervention training methods.

Teaching medical students alcohol intervention skills: results of a controlled trial

OBJECTIVE

To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills.

DESIGN

In a controlled trial, two student blocks received a manual, lecture and demonstration about the principles and practice of brief alcohol intervention. In addition, experimental students made a 20-min videotape and participated in a 1.5-h small group feedback session. Prior to and after training, all students completed questionnaires and videotaped interviews with simulated patients.

SETTING

Faculty of Medicine and Health Sciences of the University of Newcastle, Australia.

SUBJECTS

Final-year medical students.

RESULTS

Levels of alcohol-related knowledge, attitudes and interactional skills as well as general interactional skills were significantly improved after teaching. Alcohol-related interactional skills that were unsatisfactory at pretest reached satisfactory standards at post-test. An intergroup comparison of the improvement between pre- and post-teaching scores indicated that there was no significant difference in the effectiveness of the two methods.

CONCLUSIONS

Training can improve medical student performance in alcohol intervention. Further research is required to examine the relative effectiveness of different teaching methods.

The role of the clinical psychologist in gynecological cancer

Gynecological cancers, which account for a substantial proportion of cancer cases in women, can precipitate a wide range of psychological difficulties including affective disturbances, sexual problems, certain somatic symptoms, and family issues. The clinical psychologist has a unique contribution to make in the assessment and treatment of the psychological needs of gynecological cancer patients, while also conducting research and providing training for health professionals regarding the psychological issues associated with gynecological cancer. Although the gynecological cancer setting affords the clinical psychologist multiple personal benefits, strategies must usually be implemented to minimize any negative impact arising from working in an area of considerable psychological stress.

Teaching psychiatry in an integrated medical curriculum

OBJECTIVE

Efforts to improve the psychiatric competence of the general medical workforce must include an appraisal of how psychiatry is taught in medical schools. As a contribution to this appraisal a description is given of psychiatric education in the innovative undergraduate medical curriculum at the University of Newcastle.

METHOD

An outline of the features which characterise medical education at Newcastle is provided and the way in which the teaching of psychiatry is organised within this framework is presented.

RESULTS

The characteristics of the Newcastle undergraduate program in psychiatry include its integration with teaching in other clinical and basic science disciplines, continuity throughout the entire five years of the course, and the emphasis on skills acquisition and their assessment.

CONCLUSIONS

The relative merits and disadvantages of the Newcastle approach to undergraduate psychiatry education are presented and the problem of assessing the effectiveness of this approach by outcomes measurement, particularly of integrated competencies and their application in general medical settings, is discussed.