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This paper presents a first-person account of using qualitative research methods to address medical residency education. The results of this project have been published. However, the study's process and its educational impact on the participants have not been well-described. The purpose of this article is to describe the background and conduct of the study itself. A family medicine residency program, the setting for this project, had recently begun accepting international medical graduates (IMGs) who had lived and received medical school education outside of the United States. The author, a faculty member in the residency and a clinical psychologist, and the physician faculty observed residents as they saw patients in the family medicine residency clinic. Concern was expressed about some of the IMG resident physicians’ knowledge base and their ability to develop rapport with patients. In providing instruction in behavioral science, the author and a psychologist colleague noted that some of the IMG residents were confused by aspects of U.S. family life and the educational system. The relationship with clinical instructors and expectations of faculty also differed from the pedagogical norms in U.S. medical education. As a result, a qualitative interview project was undertaken to understand better how these IMG residents were experiencing and interpreting faculty-learner and resident physician-patient interactions. The results were beneficial in multiple ways. First, recognizing that faculty members were interested in their experiences helped develop rapport and trust between the faculty and residents. Providing the project results to the residents helped open discussion about cultural differences in medical education and patient care. For educators who may have difficulty understanding the perspective that learners bring to their education, the process described could be of potential benefit.

Abstract. This conceptual paper provides an overview of the impact of COVID-19 on healthcare disparities and particularly its impact on marginalized communities. This critical analysis addresses the United Nations Sustainable Development Goals (SDGs) 3, 10, and 16, which include health and well-being, reduction of inequality between and within countries, and the need for peaceful and inclusive societies. COVID-19 has infected over 189 million individuals in 220 countries and territories. The pandemic exposed long-standing healthcare inequities between and within countries. Prior to the pandemic, there were limited health and mental health services available to marginalized communities, individuals of lower socioeconomic status, and those in low- and middle-income countries; COVID-19 overburdened healthcare and mental health systems, which resulted in grave mental and physical health consequences. SDG 10 focuses on reducing inequality within and between countries and the need for advocacy for vulnerable groups. International psychology is in a unique position to address the ethical issues associated with healthcare disparities and rationing of care. SDG 3 addresses the need for good health and well-being for all. Achieving this goal is a challenge because of unequal access to healthcare and barriers to services continue, particularly in countries without universal healthcare. Goal 16 focuses on creating and promoting peaceful, just, and inclusive societies and institutions. However, access to healthcare does not erase long-standing histories of injustice, colonialism, and discrimination. Additionally, appreciation of the suspicion with which many minority communities view the healthcare system can be the first step in addressing vaccine reluctance.

First-generation (F.G.) university students whose parents did not attend college comprise 30-50% of those pursuing higher education in the United States. Research suggests that compared with those whose parents attended college, F.G. students are less likely to graduate. American universities reflect upper middle class values, implying that academic success requires students' independence from family. Previous research suggests that F.G., compared with non-F.G. students, place a greater value on interdependence relative to independence. The current study was a multi-method investigation involving quantitative and qualitative assessment approaches. Specifically, on standardized measures, F.G. students scored significantly higher on the Communal Orientation Scale, reflecting norms of social reciprocity and attentiveness to others. Results of qualitative interviews indicated that F.G. students are often self-conscious about their family status more likely to experience university culture as ambiguous and frequently overwhelming and lack a knowledgeable support system.

Introductory psychology is typically presented to undergraduates as a set of loosely related topics reflecting the organization of most textbooks. The empirically based evidence presented in the topical format is likely to be limited by progressive knowledge obsolesce and replicability challenges impacting contemporary science. We suggest that psychology instructors consider an alternative course format organized by theories or perspectives. A perspective-centered introductory psychology provides a consistent and pluralistic view of the field and embeds research findings and methodology within psychology’s major explanatory theories. Current trends in undergraduate higher education emphasize career readiness. Development of critical thinking and applying psychological principles to real-world situations, including students’ own lives, may be better achieved through a perspective-based approach. Given that the typical introductory psychology student is a non-major taking the course to fulfil liberal arts requirements, a perspective approach offers several advantages. A focus on understanding human behavior from multiple vantage points is a skill valued by prospective employers of new bachelor’s degree recipients. With its emphasis on divergent and dialectical reasoning, a perspectivecenteredintroductory psychology course can become the centerpiece of the general education curriculum. In addition to promoting post-formal reasoning, a perspective-centered introductory psychology illustrates the diverse epistemologies that have shaped our field.

Current demographic and migration trends in many developing countries are increasing the demand for foreign language interpreters in mental health settings. Most mental health professionals have not been formally trained in providing psychotherapy through an interpreter. The addition of this third party to the therapist–patient dyad raises a number of ethical issues. While psychotherapists assume that interpreters are fluent in at least two languages, this fluency may not extend to the unique demands of mental health settings. While ethical guidelines indicate that the therapist bears responsibility for the interpreter’s competence, most interpreters will not have received formal training in facilitating psychotherapy. Since many patients with limited English proficiency (LEP) have sustained psychological trauma related to migration and war in their home counties, interpreters are at-risk for secondary traumatization during psychotherapy. Ethically, psychotherapists must consider the relative risks and benefits of interpreter-mediated psychotherapy and work towards reducing barriers to optimal treatment.

With an increasing population of persons with limited English proficiency (LEP), psychologists are likely to need to conduct assessments through a foreign language interpreter at times. The goal of the interpreter-mediated patient encounter should be to approximate a language-congruent clinical encounter. Issues such as the spatial configuration of all participants during the session, guidelines for the interpreter’s verbalizations, and some modification of the psychologist’s interview style will maintain patient rapport while obtaining necessary patient information.

Telling patients the truth about a life-threatening condition is less common outside of the United States.

While medical ethics can be dated back to the Ancient Greeks, cotemporary bioethics’ origin is typically dated to the early 1970s.

The differences in views of advance directives, hospice care and do not resuscitate orders that characterize different ethnic and cultural groups may appear illogical to healthcare professionals of White European background.

This admonition from members of the Navajo community arose in response to the discussions of terminal illness and a patient’s desire for life-support—both of which are implicit topics in discussions of advance directives.

While patients’ and family preferences for nondisclosure of life-threatening illness found among contemporary Native Americans and Asian Americans may seem to be a cultural anomaly, a brief review of physician practices and legal rulings in the 20th century suggests that disclosure of this information to patients is a relatively recent practice.

As is evident in the case of Mrs. Kim from Chap. 1, when confronted with serious illness, family relationships are a key element of patient decision-making. While clinicians, including the author, have encountered situations where the family and the patient are at odds with one another about optimal treatment, it is important that healthcare providers not necessarily assume that active family involvement is a type of corrupting influence on individual patient autonomy.

Advance care planning can take a number of forms including discussions with family members that are not formally documented, similar discussions with one’s physician, and directives for level of care during hospitalization such as do not resuscitate (DNR) orders.

Searight and Meredith review the ethical, clinical, legal, and cultural aspects of deliberate non-disclosure of medical “bad news.” The chapter explains how US norms for physicians’ communication of life-threatening illness to patients have changed over the past 60 years. The authors also discuss how cultural dimensions play a significant role in the disclosure of serious medical conditions. Further, the chapter examines historical examples of physicians writing for the general public and defending non-disclosure, thereby misleading patients that such practices are compassionate and a medical virtue. Searight and Meredith trace the gradual evolution of the norm of patient informed consent from the 1930s to the present and argue that withholding medical “bad news” continues to be a value in some collectivist cultures.

Family physicians spend substantial time counseling patients with psychiatric conditions, unhealthy behaviors, and medical adherence issues. Maintaining efficiency while providing counseling is a major challenge. There are several effective, structured counseling strategies developed for use in primary care settings. The transtheoretical (stages of change) model assesses patients' motivation for change so that the physician can select the optimal counseling approach. Structured sequential strategies such as the five A's (ask, advise, assess, assist, arrange) and FRAMES (feedback, responsibility of patient, advice to change, menu of options, empathy, self-efficacy enhancement) are effective for patients who are responsive to education about health risk behavior. For patients ambivalent about change, motivational interviewing is more likely to be successful. Capitalizing on a teachable moment may enhance the effectiveness of health behavior change counseling. The BATHE (background, affect, troubles, handling, and empathy) strategy is useful for patients with psychiatric conditions and psychosocial issues. Patients should be referred for subspecialty mental health or substance abuse treatment if they do not respond to these brief interventions.

According to the dominant models of medical ethics in the United States and many Western countries, physician disclosure of information such as diagnosis, treatment options, and prognosis is considered an essential precondition for patient informed consent. While being consistent with the principle of patient autonomy stressed in many Western healthcare systems, full disclosure—particularly of life-threatening diagnoses and poor prognoses—is inconsistent with the cultural values of many ethnic communities within the United States. A systematic review of research examining cultural preferences for disclosure of medical “bad news” was conducted. Results suggested that cultural preferences are more heterogeneous than has often been portrayed. Particularly when communicating with patients and families from culturally and ethnically diverse backgrounds, health care professionals should ask about preferences for receiving medical information and making treatment decisions.

Expanding the Boundaries of Major Depressive Disorder in DSM-5: The Removal of the Bereavement Exclusion

Attention deficit hyperactivity disorder (AD/HD), characterized by impulsivity, distractibility, and inattention, has an estimated pediatric population prevalence of 6–8%. Family physicians and pediatricians evaluate and treat the majority of children with this condition. The evidence-based treatment of choice for ADHD, stimulant medication, continues to be a source of public controversy. Surveys suggest that among parents of children with ADHD, there is considerable interest in complementary and alternative medicine (CAM). These therapies include herbal preparations, mineral supplements, sugar restriction, and polyunsaturated fatty acids. Other AD/HD therapies include neuro-feedback, cognitive training, mindfulness meditation, and exposure to “green space.” In order to assist physicians and mental health professionals in responding to patient and parent queries, this paper briefly describes these CAM therapies and current research regarding their effectiveness. While investigations in this area are hampered by research design issues such as sample size and the absence of double-blind placebo-controlled trials, there is some evidence that omega three fatty acids, zinc supplements, and neuro-feedback may have some efficacy.

University students frequently send and receive cellular phone text messages during classroom instruction. Cognitive psychology research indicates that multi-tasking is frequently associated with performance cost. However, university students often have considerable experience with electronic multi-tasking and may believe that they can devote necessary attention to a classroom lecture while sending and receiving text messages. In the current study, university students who used text messaging were randomly assigned to one of two conditions: 1. a group that sent and received text messages during a lecture or, 2. a group that did not engage in text messaging during the lecture. Participants who engaged in text messaging demonstrated significantly poorer performance on a test covering lecture content compared with the group that did not send and receive text messages. Participants exhibiting higher levels of text messaging skill had significantly lower test scores than participants who were less proficient at text messaging. It is hypothesized that in terms of retention of lecture material, more frequent task shifting by those with greater text messaging proficiency contributed to poorer performance. Overall, the findings do not support the view, held by many university students, that this form of multitasking has little effect on the acquisition of lecture content. Results provide empirical support for teachers and professors who ban text messaging in the classroom.

Previous research has suggested that exposure to outdoor surroundings is associated with improved attention and concentration among children with attention deficit hyperactivity disorder (AD/HD). This effect has been attributed to the impact of exposure to “green space” in restoring fatigued attention. Because of concerns about side effects and misuse of stimulant medication, there has been considerable interest in green space exposure as a possible alternative or complementary therapy for ADHD. In the current study, adults completed a 20 minute walk in three types of outdoor settings: a wooded trail, a residential neighborhood, and a parking lot. Participants completed subtests from the Wechsler Memory Scale assessing attention, concentration, and short-term memory as well as the Profile of Mood States, a self-report measure for assessing current emotional status. Based upon previous green space research, it was anticipated that participants in the wooded trail condition would perform better on the cognitive tasks. However, there was no difference between the three conditions in participants’ pre- and post-walk cognitive functioning. When data from the three groups were pooled, there was a significant benefit associated with the 20 minute walk for short-term memory as well in reducing tension, depression, anxiety, fatigue, and confusion. The results do suggest that relatively brief outdoor physical activity may be a useful complementary intervention for persons with conditions adversely affecting short-term memory

Many undergraduate programs require students to complete an independent research project in their major field prior to graduation. These projects are typically described as opportunities for integration of coursework and a direct application of the methods of inquiry specific to a particular discipline. Evaluations of curricular projects have usually found that they positively impact students’ knowledge and skills in that discipline. However, little attention has been devoted to the impact that these projects have on broader aspects of psychosocial development. The current study describes the results of a focus group conducted with students who had recently completed their senior research project in psychology. Results of the focus group interview were transcribed and coded according to grounded theory principles. Five developmentally-specific categories emerged from the analysis. These included a greater sense of competence attributed to completing a large-scale project, an experience of being in a professional role relative to research participants as well as to the audience presented with their study results, and a sense of ownership and pride in completing their project. Universities that either require or are contemplating requiring senior projects should consider these broader benefits to young adult development.

Given the growing linguistic diversity in the United States, many practicing psychologists will work with foreign language interpreters. However, few clinicians receive formal training in providing interpreteraided psychological services. By federal law (88th Congress, 1964; PL-88-352), psychologists or their agencies are responsible for providing interpreter services. To maintain a patient-centered, rather than interpreter-centered dialogue, psychologists should initiate pre- and postsessions to orient the interpreter to the pending encounter, clarify expectations, and discuss cultural issues. Psychological testing, diagnostic interviewing, crisis intervention, family, child, and individual adult therapy present distinct challenges when an interpreter is involved. Mental health is a specialized area requiring advanced interpreter knowledge and skills. According to the American Psychological Association’s (2002) “Ethical Principles,” psychologists are responsible for ensuring that interpreters demonstrate competence and professionalism. Because there are relatively few interpreters trained specifically for mental health practice, psychologists and health care institutions may need to assist in providing specialized interpreter education.

Problem-based learning (PBL) is a small-group pedagogical technique widely used in fields such as business, medicine, engineering, and architecture. In PBL, pre-written cases are used to teach core course content. PBL advocates state that course material is more likely to be retained and applied when presented as cases reflecting "real life" applications of class material. However, rather than traditional lecture-discussion, PBL encourages student autonomy in analyzing cases, with the instructor serving initially as a structuring facilitator before gradually becoming less active as students take more responsibility for their learning. As students proceed through each case, they address four dimensions: What they know, what they want to know, possible causal hypotheses, and questions that can be answered through library research. The PBL cases referred to herein were developed and employed for an undergraduate psychology course, "Psychology of the Exceptional Child." Students completing this course included psychology, special education, and human service majors and have positively evaluated this technique as a teaching tool.

Up to 60% of ambulatory primary care patients have psychosocial factors contributing to their symptom presentation. Counseling, although helpful, is seen as requiring specialized training that most primary care physicians lack, as well as being complex and time-consuming. Several counseling methods have been developed that are brief, relatively easy for the physician to learn and implement, and patient-centered. These include the BATHE technique, the FRAMES strategy, the Stages of Change (Transtheoretical Model) approach, and Motivational Interviewing. Although limited, available research suggests that carefully targeted brief counseling in medical settings does produce meaningful change.

In 1952, The British psychologist, H. J. Eysenck published a landmark study essentially concluding that psychotherapy was ineffective. Coincidently, at the time that Eysenck announced his findings, the number of psychologists providing psychotherapy was increasing dramatically (Norcross et al. 2011). Eysenck’s (1952) study was an obvious threat to a rapidly growing profession. The next 25 years were characterized by multiple studies refuting Eysenck’s claim culminating in one of the earliest published meta-analyses which concluded that the average person receiving psychotherapy was better off than 75 % of untreated individuals (Smith and Glass 1977) To date, The Rise and Fall of the Biopsychosocial Model has not incited a scholarly response comparable to that provoked by Eysenck. However, in the 5 years since the book appeared, Ghamei’s (2010) work has been widely cited by both advocates and critics of the biopsychosocial (BPS) model. As the book’s title suggests, Ghaemi devotes over 200 pages to challenging and systematically dismantling a theory that has become a mainstay of North American medical school curricula and postgraduate psychiatric education. Yet, it appears that the BPS may still be alive and well with recently published applications to orthopedics (Ayers et al. 2013), cardiology (Kirian et al. 2012), obstetrics and gynecology (Edozien 2015), as well as pediatrics and internal medicine (Crosby et al. 2015). While the psychiatrist, Roy Grinker used the term ‘‘biopsychosocial’’ in 1952, Engel (1977) is typically credited with describing the current version of the BPS in a 1977 Science article, ‘The need for a new medical model: A challenge to biomedicine.’ Engel argued that the prevailing biomedical worldview was outdated

During the 1990s, approximately 300,000 Bosnian immigrants came to the United States as a result of the Balkan wars. In contrast to immigrants from less developed countries, Bosnian refugees were typically older, had experienced significant war related trauma, and were accustomed to universal health insurance coverage. There is little information about Bosnian immigrants' transition to the U.S. health care system. As part of a related project, 12 Bosnian immigrants were interviewed about their perceptions of the U.S. health care system and their experiences as patients. Participants were universally critical of the U.S. system and described several core issues: confusion about insurance coverage, personalized quality of care, access to primary and specialty care; and a perception of U.S. health care as bureaucratic. Participants compared their experience with prewar Bosnian health care along these dimensions. Implications of the findings and suggestions for improving care to the Bosnian immigrant population are provided.

Despite the developmental significance of emerging adulthood as a time for critical self reflection and clarification of values, college and university education rarely includes self-assessment in curricula. Stephen Covey’s book “The Seven Habits of Highly Effective People is a description of the importance of formulating a personal mission and critically reflecting on personal priorities. As part of a course in organizational psychology, students read about mission statements, their importance, and completed an accompanying workbook/journal. A key component of this exercise was for students to develop a personal mission statement. Students reported that they found this activity to be very helpful-- particularly regarding values clarification and how they were actually using their time. Students commented that because of the fast pace of their lives, they rarely had time to engage in this type of reflection and were appreciative of the structure provided by the reading, journal, and opportunity to discuss their goals and values.

Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.

Summary Children who are recent victims of sexual abuse may initially present to their primary care health provider. Often, the outward manifestations of sexual abuse are somatic complaints or nonspecific behavioral changes. Retrospective reports of adults suggest that about 20-30% of women were sexually abused as children, with figures for men ranging from 10-15%. Interview guidelines for children and adolescents emphasize the need for sensitivity to cognitive development and emotional issues while simultaneously being focused on eliciting specific behavioral data. The use of anatomically detailed dolls, in the context of a comprehensive assessment, is discussed. Health care providers are mandated reporters and must disclose suspected child sexual abuse to the state's child protective service department. Guidelines for reporting as well as addressing this issue with parents are discussed.