Journal of Clinical Psychology in Medical Settings最新文献

Career management models are valuable tools for faculty pursuing a career in academic medicine. These models help faculty transition through various stages of their careers, including commonly pursued academic advancements from assistant professor to full professor, as well as less common transitions like moving from full-time to part-time status, taking sabbaticals, going on medical leave, or assuming executive leadership roles. The success of faculty members across these stages is influenced by both environmental factors and individual-level characteristics. Recognizing career stages and transitions, as well as the impact of personal and environmental factors on career growth, is crucial. The proposed Faculty Career Self-Management Model (FCSM) provides a visual and descriptive framework to guide individual faculty and the professionals who support them in understanding, preparing for, and navigating career stages and professional transitions to build and sustain meaningful careers in academic medicine. The FCSM serves as a framework to explore, develop, and share best practices in supporting faculty vitality across the career lifespan.

Current literature lacks data related to the role of psychologists on consultation-liaison (CL) services; previous data indicates only 4% of CL services are run by psychologists, while 32% of liaison mental health services include a psychologist. As CL psychologists' roles within hospitals grow, it is critical to identify clinical strategies and organizational structures of CL services across hospital systems. The current study seeks to provide a deeper understanding of CL psychologists' scope of work. Participants (N = 77) (15% response rate) completed a measure developed for this study, exploring psychologist roles, clinical practice, and departmental structures. Thirty-two percent of respondents were in Psychiatry Departments, 58% were in academic medical centers, almost half had training programs and the most frequently utilized billing code was: Given the limited data available, this study provided a contemporary and foundational understanding of the CL psychologist roles as well as future avenues of empirical inquiry such as discrete organization and structural characteristics.

Psychologists in faculty affairs/faculty development (FAFD) roles can contribute to faculty vitality in academic health centers (AHCs) and mitigate barriers to advancement and retention. We describe a novel psychologist-led consultation service within an Office for Faculty Success (OFS) to support faculty across their career trajectories. We used 5 years of consultation data including faculty demographics, presenting concerns, and post-consultation evaluation data on consultation satisfaction and perceived benefits to examine trends and demographic group differences in consultation frequency, presenting concerns, and perceived benefits. From 2018 to 2023, 434 individuals presented for 683 consultations. Promotion in rank was the most frequent presenting concern. Women and racially/ethically minoritized faculty were found to present more frequently for repeat consultations, for concerns related to careers negotiation and advancement, and for intersectionality issues specific to gender and/or racial minority identities. From years one to five, there was a 93% increase in number of annual consultations performed and users were highly satisfied with the service (3.86/4). The consultation service is a unique, highly acceptable addition to interventions focused on career satisfaction and retention for AHC faculty, especially for women, early career, and minoritized faculty, and can serve as a model for other institutions.

Caregiving is a complex occupation, with a significant impact for informal caregivers (IC). Stress-process models propose a framework that considers that this impact depends on primary and secondary stressors, but also on the IC situation appraisal. This work aimed to verify: whether being, or not, an IC of an individual with dementia influenced the relationship between family functioning and burnout; the association between neuropsychiatric symptoms of the individual with dementia and IC burnout and whether the IC burden and perceived family functioning had a mediating role in such relationship. This cross-sectional study investigated differences in family functioning and its association with burnout between IC and non-IC. For IC specifically, the study examined a mediation model to explore the possibility of neuropsychiatric symptoms indirectly affecting IC burnout through the impact on family functioning and burden. Measures included the Copenhagen Burnout Inventory, the McMaster Family Assessment Device, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Results showed an association between poorer family function and high burnout, specifically in IC. They also showed that burden mediated the relationship between neuropsychiatric symptoms and burnout. The findings offer a significant contribution to the growing knowledge about the relationship between stressors associated with informal caregiving in dementia context, such as neuropsychiatric symptoms and its outcomes, like burnout.

Virtual reality (VR) and hypnosis (H) are useful pain management tools, but the potential benefit of their combination (VRH) has yet to be studied. This study examines the user experience of VRH, compared to H and VR alone, using interviews following an experimental study examining the effect of the three interventions on pain perception. Following a within-subjects repeated measures experimental design, 16 participants received the three interventions during which they received painful electrical stimuli. Following each intervention, explanatory interviews were conducted to allow participants to elaborate on their user experience. A thematic analysis was conducted on the data collected. Three themes emerged from the interviews: (1) satisfaction: participants mostly had positive feelings toward the three modalities, with the most beneficial effects on relaxation expressed for H. (2) Body perception and attention focus: immersion in the VR and VRH conditions was appreciated. Participants described their perceptions of pain perception during the 3 conditions. (3) Device acceptability: H was the most liked, followed by VRH, and then VR alone. Intention of use was reported following the same order. The data collected highlighted participants' opinions of these different interventions and suggested adjustments for future development of the VRH intervention in pain management.

There is growing recognition of the profound mental health challenges faced by the 53 million U.S. family caregivers, and the need for increased access to psychosocial care for this vulnerable population. Family caregivers are increasingly seeking support from hospital-based counseling centers. This trend-combined with a public policy landscape that promotes the delivery of caregiver-specific supports and services-highlights challenges faced by mental health professionals to provide and bill for psychosocial care to family caregivers. In this paper, we discuss three interrelated challenges that mental health professionals face in providing care to family caregivers and which our field needs to confront as healthcare transfers more responsibilities onto the shoulders of family caregivers: (1) caregiver burden is not recognized as a formal diagnosis; (2) current documentation for caregivers is typically linked to patient encounters; and (3) support for family caregivers occurs within larger systematic barriers to mental health integration. By accurately describing and documenting caregiver burden and advocating for increased parity in mental health coverage, we hope that the field can bridge the gap between emerging research, momentum in policy, and available psychosocial services for this vulnerable population.

Loneliness and low social support are associated with negative health outcomes among adults with asthma or COPD. Although social support is correlated with loneliness, low social support is neither necessary nor sufficient for the experience of loneliness. This study compares the relative association of loneliness and social support on symptom exacerbation (i.e., acute deteriorations in respiratory health) and acute health service utilization (i.e., hospitalizations, emergency department visits) among 206 adults with asthma and 308 adults with COPD. Separate logistic regression models were used to simultaneously examine the association of loneliness and social support with each outcome. Among adults with asthma, loneliness was associated with greater odds of hospitalization (AOR = 2.81, 95%CI [1.13, 7.02]), while low social support was not (AOR = 1.44, 95%CI [0.78, 2.65]). However, neither loneliness nor social support were associated with any other acute health service use or symptom exacerbation among adults with asthma. Among adults with COPD, loneliness, and greater social support were associated with increased odds of symptom exacerbation (AOR = 1.67, 95%CI [1.03, 2.69]; AOR = 1.36, 95%CI 1.02, 1.83]) and hospitalization (AOR = 3.46, 95%CI [1.65, 7.24]; AOR = 1.92, 95%CI [1.15, 3.22]), but only social support was significantly associated with ED visits (AOR = 1.72, 95%CI 1.12, 2.66]). These findings support prior research demonstrating that loneliness and social support are related but separate determinants of patients' physical symptoms and service utilization.

Childhood experiences, both positive and negative, play a crucial role in shaping individual development. Extensive research has demonstrated that adverse childhood experiences (ACEs) have long-lasting negative effects on physical, mental, and social health. Over the last two decades, many studies have found a strong link between ACEs and poor health outcomes in adults. However, there is less understanding of how positive childhood experiences (BCEs) might lead to better health in adulthood, particularly in overcoming adversity. This study aims to explore how BCEs impact adult physical and mental health and how they might mitigate the harmful effects of ACEs. Resilience theory served as the theoretical framework for this research. A total of 177 participants aged 19 to 41 years completed an online survey evaluating their physical, social, cognitive, and mental health, including their ACEs and BCEs. Regression analyses were used to investigate the connections between BCEs, ACEs, and adult health. The results show that BCEs act as protective factors that enhance overall well-being and significantly reduce depressive symptoms and physical discomfort. Additionally, when ACE levels are moderate, positive childhood experiences can largely counteract the negative health effects of ACEs.

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

Little is known about the impact of the COVID-19 pandemic on medical students. We examined medical students' burnout, career regret, and medical school experiences from before to during the pandemic, and differences between students from marginalized and nonmarginalized groups. We analyzed data from 2019 to 2022 Association of American Medical Colleges Year Two Questionnaires (N = 52,152) and Graduation Questionnaires (N = 66,795). Given large samples, we focused on effect sizes versus statistical significance. All effects of study year were less than small (η² < .01) indicating minimal differences in medical students' burnout, career regret, and school experiences from before (2019) to during (2020-2022) the pandemic. Interactions between study year and demographic characteristics (gender, race-ethnicity, sexual orientation) were less than small; thus, students from marginalized groups were not affected more by the pandemic than others. Across study years, women reported more exhaustion and discrimination than men. Black students reported more discrimination than students from other racial-ethnic groups; bisexual students reported more discrimination than heterosexual students (all ds > 0.20). Differences between students from marginalized and nonmarginalized groups were bigger than the effects of the pandemic, suggesting a need for system-level interventions to foster inclusion in medical education.