DEPARTMENT OF FAMILY MEDICINE AND COMMUNITY HEALTH
POST DOCTORAL FELLOWSHIP IN
CLINICAL HEALTH PSYCHOLOGY IN PRIMARY CARE
The Department of Family Medicine and Community Health of
the University of Massachusetts Medical School hosts a
Post-doctoral Fellowship in Clinical Health Psychology in Primary Care. The
fellowship is affiliated with the Family Medicine Residency Programs of the
Department.
The two-year, full-time fellowship adheres to a
practitioner- scholar model and is designed to prepare clinical and counseling
psychologists to achieve the following goals:
§
Become leaders and advocates for integrated,
collaborative healthcare
§
Practice evidence-based psychology in a primary
care environment
§
Be capable of advanced practice competency in
independent practice as Clinical Health Psychologists with sufficient
preparation to be credentialed and ultimately Board Certified by ABPP in
clinical health psychology
§
Make meaningful scholarly contributions,
particularly by learning how to conduct applied research projects leading to
practice-based evidence for integrated care
§
Develop programs and service lines using
inter-professional teams within health care settings
§
Assume roles in medical education, working as
behavioral science experts within Family Medicine residency training programs,
Family Medicine Departments or other medical departments including but not
limited to Oncology, Obstetrics, Pediatrics, and Internal Medicine
§
Train other psychologists and behavioral health
providers in integrated, collaborative healthcare
§
Help change the face of healthcare to include
behavioral health as an indispensable component of primary healthcare and the
patient centered medical home
The training philosophy and model is based on a supervised
experiential approach in which first year post-doctoral fellows are training in
evidence-based clinical health psychology through intensive didactics, clinical
observations, clinical supervision, and by training side-by-side with family
medicine residents. In the second year of the program, the fellows continue
their clinical training and supervision, but also begin a more focused
experience of learning how to teach and train family medicine residents to
recognize behavioral needs and use psychosocial knowledge and behavioral health
skills. Fellows also learn to build
integrated service programs in a primary care setting.
Fellows are evaluated in a variety of ways, including live
observation, and are expected to gain competencies in:
§
clinical health psychology assessment techniques
§
clinical health psychology and family therapy
intervention strategies
§
conducting effective consultations with
physicians
§
professionalism, communication, effective
documentation, and acculturation to the medical environment
§
healthcare management and administration,
including leadership skills
§
research skills,
particularly in the area of conducting clinical quality improvement
initiatives.
Candidates are sought annually, beginning in the Fall. The application deadline is February 15th
or until the position is filled, whichever is earlier. Thus, interested applicants are strongly encouraged to complete their
application early. Additional details about the application process and
requirements can be found below.
The Setting:
The first residency in Family Medicine at the University of Massachusetts Medical Center (UMass) was established in
1971. The Department of Family Medicine
and Community Health presently supports two residencies in Family Medicine: the
Barre Family Health Center is located in rural north-central
Family Health Center of Worcester (FHCW) is a Federally Qualified
Community Health Center that has been serving the underserved populations of
Community Health Connections Family Health Center in
There are presently post-doctoral
fellows based at
Purpose:
The purposes of the Department for instituting and
supporting a post-doctoral training program for psychologists are:
·
to provide significantly more teaching in
behavioral science to family medicine residents
·
to teach family medicine residents to work
collaboratively with behavioral health providers in providing primary care
services
·
to increase the capability of the department to
conduct research on primary care questions
·
to develop a group of providers for the primary
care practices that are part of the U.Mass/Memorial
system
·
to increase the
visibility and status of the department nationally as a center for innovation
in primary care service and training.
The reasons fellows choose to come to our program for
post-doctoral training are:
·
to practice evidence-based psychology in a
primary care environment
·
to make meaningful scholarly contributions,
particularly by learning how to conduct applied research projects leading to
practice-based evidence for integrated care
·
to have a teaching role and develop teaching
skills while still in training and receiving supervision that can help shape
and improve their teaching styles
·
to prepare for a position as a health provider
in primary care and/or as a faculty member in a medical or medical education
and training setting
·
to obtain advanced and
specialized training in clinical health psychology which enables them to seek
board certification (ABPP) in clinical health psychology.
Every effort is made identify fellows as part of a family
medicine resident class. Having
behavioral health providers as peers in their training helps residents develop
the personal relationships on which collaboration is based. Having family medicine residents as peers in
their training helps the fellows develop familiarity with the primary care
setting in an environment of support where help with the vagaries of “medical
culture” is easily available.
Core Faculty:
Nicholas Apostoleris, PhD, is the
Director of Behavioral Science in the
Alexander Blount, EdD, is
the Director and a primary clinical supervisor of the Fellowship. Dr. Blount is the Director of Behavioral
Science for the Department of Family Medicine and Community Health. He was previously
Director of the
Kathleen Braden, MD, is a Developmental Behavioral
Pediatrician with extensive experience in child behavior problems, autism
spectrum disorders and child psychopharmacology. She is one of the faculty in the Program for School Aged Children clinic in
which fellows learn brief child and family assessment and therapy.
William Ferrarone, PhD, is
a member of the faculty at the
Daniel Mullin, PsyD, is the
onsite supervisor at the
Tina Runyan, PhD, recently joined
our faculty at Associate Director of Behavioral Science. She has extensive experience in health psychology
in primary care. She has been a leader
in developing integrated primary care in the Air Force and has experience in
teaching and academic leadership in health psychology graduate training.
Craig Wiener, EdD, is the on-site
clinical supervisor at Family Health Center of Worcester. He has
extensive experience in residency training and a special interest in child
behavioral issues.
There are approximately thirty-five
physician faculty members who are active in training residents and fellows at
the different health centers.
The Program:
Fellows receive focused training in clinical health
psychology as it is practiced in primary care.
They provide behavioral health treatment in the health centers and in
other Family Medicine practices in the U.Mass/Memorial
system. They provide behavioral science
precepting (one on one observation and teaching) for residents in Family
Medicine and join them in collaborative patient care. They teach selected behavioral science
subjects in the health centers. Finally,
they participate in research on the processes of primary care, either by
proposing their own research studies or by working on ongoing faculty research
projects. Instead of doing their own research, some fellows opt to
attend the LEND program, (described below) to work on health policy and
research as it relates to populations with disabilities.
Fellows receive one hour per week of clinical supervision
from the Director of the program and one from the site supervisor in their
health center in both years of their program. In addition, they average
one to two additional hours of supervision per week in live supervision and
case discussions. During all their work,
there is a medical faculty preceptor available on site for back up with
decisions, adding a second layer of guidance and support.
YEAR ONE
The first year is spent refining skills that are necessary
for the practice of clinical health psychology in primary care, becoming
familiar with the routines, language, and issues of assessment and intervention
in primary care. They learn how to
develop a role as a caregiver in primary care medical practice. The weekly
training time is roughly broken down into 10 half-days, with supervision and
other learning opportunities such as grand rounds, chart rounds, pain rounds,
and other relevant training and learning opportunities occurring over the lunch
hour. A sample schedule for a first year fellow is below followed by additional
descriptors of the various experiences. As some activates occur monthly or only
for a portion of the half-day, more than one experience is represented in this
schedule per half-day.
|
|
Morning |
Afternoon |
|
Monday |
Clinic, Dual Interviews, Team Precepting, |
Clinic, Dual Interviews, Chart Rounds |
|
Tuesday |
Clinic, Dual Interviews, Supervision |
Balint Group, Tuesday workshops |
|
Wednesday |
Clinic for School Aged Children, Supervision |
Clinic, Dual Interviews, Chart Rounds |
|
Thursday |
FMIS, Supervision |
Open Clinic, Informal Supervision, Chart Rounds |
|
Friday |
Clinic, Dual Interviews, Certificate Program |
Clinic, Admin, Certificate Program, Chart Rounds |
Clinical practice
and consultation in primary care - Six half-days per week
The fellow spends the majority of
his or her time as a member of primary care treatment team in one of the family
practice residency clinics. This
involves observing resident physicians in their practice, seeing patients
jointly with physicians, and carrying a caseload referred by physicians in the
practice. In the beginning of the year,
the fellow’s time is fairly unstructured.
They learn what the residents are doing by observing them as they see
their patients. This leads quickly to
dual interviews in which residents and fellows work together to treat patients.
All family medicine residents have to complete a minimum number of dual
interviews with the behavioral science faculty throughout their three year
training and the post-doctoral fellow conducts the majority of these with the
residents thereby having both the resident and the fellow experience true,
collaborative, team-based patient care.
In their clinical work in this setting, fellows are most
likely to see patients who are anxious, depressed, coping with illness, child
behavior problems, having relationship or family problems, or are abusing
substances. They also consult to physicians concerning patients with
serious mental illnesses or in acute risk situations. As our clinics implement
chronic care disease processed and protocols, the post-doctoral fellow is also
likely to be called into cases to assist with lifestyle changes, adherence to a
treatment plan, chronic pain management, smoking cessation, sleep disorders and
other physical health conditions.
Program for School Aged Children – One half-day
This is a family therapy oriented brief assessment and treatment
clinic co-directed by Dr. Blount and Dr. Braden. It serves children aged 5-12 and their
families. In addition to the
post-doctoral fellow, it is also a training clinic for residents in Family
Medicine and Pediatrics. Fellows
practice clinically in front of the one-way mirror under the supervision or
provide teaching for residents during this rotation.
Behavioral Medicine Practice – One half-day
On this half-day per week, fellows practice alongside Dr.
Blount and Dr. Runyan at
Family Medicine Inpatient Service (FMIS) Hospital
Rounding – One half-day
Fellows spend one half-day per week rounding in the hospital
with teams of residents and Dr. Mullin. The fellow is an integral part of
the team, helping to highlight psychosocial issues and offering a
psychologist’s perspective on the patients.
Team Precepting –
One half-day
Team Precepting involves a medical
preceptor and a behavioral science preceptor working with one resident for one
half-day patient session. The precepting
team is behind a one-way mirror while the resident sees their usual schedule of
patients in front of the screen. The
purpose of team precepting is to provide medical and behavioral science
precepting together so that residents do not have to dichotomize patients’
problems into “physical” and “psychosocial” domains in order to determine whether
a particular problem should be presented to a medical or a behavioral science
preceptor. Being with the team allows
the fellows to observe primary care services and hear the feedback of faculty
about what they are seeing. Fellows can
observe or participate in the process as they gain confidence and experience.
IN
ADDITION …
Seminar in Primary
Care Behavioral Health
Fellows take and often help teach the Certificate Program in
Primary Care Behavioral Health. The program consists of six all day workshops
given one Friday a month for six months which are designed to provide the
skills and tools needed by mental health professionals who want to work
successfully as a behavioral health clinicians in primary care. The
course is given twice a year. Initially it provides the core didactic component
to the fellowship; however, over time, the fellow also develops expertise in
the various areas and is eventually called upon to teach some portion of the
certificate program.
Tuesdays are set aside and protected to provide special educational
activities for fellows and residents. Family Medicine and Community Health
Grand Rounds are held weekly on Tuesdays at noon at the Memorial Campus on a
wide array of Family Medicine topics. Fellows participate alongside the family
medicine residents in the Tuesday workshop curriculum, which is focused on a
wide array of topics including communication skills,, core family medicine
outpatient knowledge and skill development, counseling skills, practice management,
or current important medical and ethical topics like palliative care, abortion
and options counseling, and chronic pain and addiction.
Chart Rounds and Noon Conferences
All of the health centers thrive in an atmosphere of perpetual learning.
Conferences are an important part of the daily routine on rotations and in the
health centers. Chart rounds, which occur daily, are case-based,
learner-centered conferences focusing on the science and art of medicine and
fellows are in attendance at these to offer a behavioral science perspective
and input to case discussions. Fellows also give occasional lectures on mental
health topics of interest to residents at.
They usually give one Grand Rounds presentation to the Department of
Family Medicine and Community Health.
The fellows also help deliver structured behavioral and educational
programs for identified groups of patients.
Balint Group
First
year fellows join the second year family medicine residents in their weekly Balint group. Balint group (http://americanbalintsociety.org/)
is a group of clinicians who meet regularly in a leader-facilitated group to
present and discuss clinical cases in order to better understand and utilize
the clinician-patient relationship in a therapeutic, professional way. Balint Groups provide an opportunity for doctors to reflect
on their work as well as an outlet for anxieties and frustrations generated by
their work. It can arouse a doctors’ interest in patients whom they have
previously found upsetting, annoying or “difficult” and open minds to other
possibilities, both of diagnosis and day to day management. This same group
remains together the Balint the following year,
allowing the fellow two years of Balint group experience
with the same family medicine residents. The fellow is not the leader of the
group; he/she is a participant and is expected to remain in that role and allow
the Balint facilitator(s) to lead the group so that
the fellow can take maximum advantage of this training and professional growth
opportunity.
YEAR TWO
The second year is spent refining primary care psychology
skills as well as creating opportunities for more advanced study in one or more
area of interest. Additionally, second year fellows spend a fair amount of time
in formal precepting with residents and in the development of a research
project that is expected to be conducted throughout the second year of
training. Whereas in the first year, the fellows are functioning more as peers
and collaborators with residents, in the second year they take on more
faculty-like responsibilities. Again, the training time is accounted for and
described based on a 10 half-days per week. A sample schedule which depicts the
various activities for a second year fellow is below followed by descriptors of
any experiences not described above, or as they may differ for second year
fellows. As some activates occur monthly or only for a portion of the half-day,
more than one experience is represented in this schedule per half-day.
|
|
Morning |
Afternoon |
|
Monday |
Clinic, Dual Interviews, Supervision |
Clinic, Dual Interviews, Team Precepting, Chart Rounds |
|
Tuesday |
FMIS, Research |
Balint Group, Tuesday workshops |
|
Wednesday |
Clinic, Dual Interviews |
Clinic, Supervision, Chart Rounds |
|
Thursday |
Clinic (new practice), Diabetes Group visits |
Clinic (new practice), Chart Rounds |
|
Friday |
Clinic, Research |
Clinic, Admin, Certificate Program, Chart Rounds |
Clinical practice
and consultation in primary care – Five or six half-days per week
As in the first year, the fellow spends the majority of his
or her time as a member of primary care treatment team in a family practice
residency clinic. However, there is special emphasis on consultation to help
residents care for patients that they would have referred before. There is also an experience of developing
population-based clinical care. The
fellow identifies a particular group of patients who need a behavioral aspect
to their care and researches, develops, proposes and helps implement one
“critical pathway” of care to be offered to every patient in the practice with
the identified illness.
Family Medicine Inpatient Service (FMIS) Hospital
Rounding – One half-day
Second year fellows also spend one half-day per week
rounding in the hospital with teams of residents but do so independently except
for one week per month when Dr. Mullin is also present for a biopsychosocial case conference with the attending
physician and family medicine residents who are rotating on that service for
the month. The goal on this rotation in the second year is for fellows to
develop teaching skills in the inpatient medical setting. The conference will case-based learning and
focus on the review of a challenging case encountered by the heath center teams
on the FMIS. The focus will be on
reviewing the case in terms of relevant biopsychosocial
issues and collaboratively developing “lessons learned” to inform improvements
in teamwork and future patient care.
Teaching and consultation at a different Family Medicine
practice – One day
During this day the fellow is flexibly available for patient
care and consultation at a practice that is new to him or her. We are offering the experience of joining a
practice and meeting the needs there when the practice is not used to having a
fellow. It teaches organizational
transformation skills in addition to allowing the fellow to use their clinical
and consultation skills in a new venue.
Fellow’s research or LEND Program – One half-day
Fellows pursue their own research project. The Department of Family Medicine and
Community Health has developing and ongoing research in primary care in areas
such as pain, homelessness, depression and substance abuse. The fellow is also invited to develop their
own project.
Alternatively, fellows can opt to take one half-day from
their health center practice and their research time to spend a day per week at
the LEND program. LEND is a post graduate training experience that has been
designed to enhance the knowledge and skills of future leaders and clinicians
in interdisciplinary, family-centered and culturally competent care of children
with neurodevelopmental disabilities and their
families, or other populations with similar disabilities. Funding from the
Maternal Child Health Bureau (MCHB) is used to develop a comprehensive program
that ensures that attention is paid to identifying leadership potential in
individuals, to creating learning opportunities that will enhance this
potential, and to monitoring the progress of selected individuals in acquiring
the skills and competencies they will need to be effective in the worlds of
policy and advocacy. http://www.umassmed.edu/shriver/education/lend/index.aspx
IN
ADDITION …
The second year fellow still attends chart rounds, noon
conference, weekly Balint group, and the Tuesday
lecture series with the third year family medicine residents. The second year fellow is also called upon to
teach in the Primary Care Certificate Program.
Evaluation:
Fellows participate in a “360 degree” evaluation twice
yearly. Feedback relevant to each
group’s experience with the fellow is solicited from psychological and medical
faculty, nursing and office staff members and residents. The fellows and immediate supervisors
complete a rating of the fellows on the competencies identified by the program.
A summary document, signed by the Fellow, Director, site supervisor and
Residency Director is placed in the record.
The Fellow is permitted to add a comment on the document if they
choose. Feedback on Fellows' work is
ongoing. Because Fellows view their
supervisor's clinical work and are observed in their work, the process of
exchange for mutual growth is ongoing, making formal evaluations usually
enjoyable, and sometimes redundant in feel.
A Due Process plan has been adopted for trainees. It is available on request. In areas that are relevant to fellows not
covered by the Due Process plan, the Residency Policy Manual of residency of
the fellow’s main placement is observed.
Qualifications:
Admission requirements include completion of all
professional doctoral degree requirements in clinical or counseling psychology
from an APA/CPA-accredited program and pre-doctoral internship meeting APPIC
standards. We will give preference to candidates with demonstrated training and
experience in family therapy and/or behavioral medicine. Successful candidates commonly have previous
experience in primary care settings.
Bilingual (English/Spanish) candidates are especially sought after. Candidates who show enthusiasm for working in
a diverse workforce with a very diverse patient population are sought. Minority and candidates with disabilities are
urged to apply.
Information for
Applicants:
The salary is $40,000 ($42,000 the second year).
Fellows are employees of the University of
Massachusetts Medical School and receive the same benefits package as medical
residents. This includes four weeks vacation, low cost individual or
family health plan, disability and life insurance. Applications will be accepted until the position is filled or February
15, whichever comes first. Early submission improves a candidate’s
chances. Start date is July 1, 2010, though this can be delayed if
the candidate we select is not available until September. The fellow will
be invited to an orientation program developed for the incoming medical
residents and first year post-doctoral fellow to orient them to
To Apply:
A letter stating interest, a CV and three letters of
recommendation constitute an application. We prefer to receive these by
e-mail to Alexander Blount, Ed.D. The email address
is Amy.Green@umassmed.edu .
Applications can be mailed to Any Green, Department
of Family Medicine and Community Health,