1. Resolving Ethical Issues 1.01 Misuse of Psychologists’ Work 1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority 1.03 Conflicts Between Ethics and Organizational Demands 1.04 Informal Resolution of Ethical Violations 1.05 Reporting Ethical Violations 1.06 Cooperating With Ethics Committees 1.07 Improper Complaints 1.08 Unfair Discrimination Against Complainants and Respondents

Ethical Principles of Psychologists and Code of Conduct

Objectives The educational alliance is argued to be at the heart of supervision in medical education. This review aims to map the research field and develop a conceptualisation of the nature of such educational alliances within postgraduate supervision for general practitioners. Methods An integrative review of the international literature on supervision from 2011 to 2018 was undertaken, and papers assessed for relevance and quality. Data analysis incorporated framework analysis techniques. Bordin's working alliance-based model of supervision was used as a springboard for synthesis, as well as allowing for the emergence of new ideas, theories and concepts from the literature. Results A total of 49 full texts were included for analysis. There was evidence of the importance of trust, agreement and bond in accordance with Bordin's model. The results also highlighted the importance of greater clarity on supervisory goals, and the tasks to support these goals, to effectively address competing priorities and roles within supervision. Non-hierarchical relationships were advocated, although supervisors must remain impartial in their assessment and monitoring roles. The influence of the wider practice community and situated learning through legitimate peripheral participation are documented. A model of General practice (GP) supervision is proposed that integrates the findings. Conclusions GP supervision requires a greater emphasis than is suggested by the working alliance model, both on the clarity of expectations and the appreciation of the multiple roles and competing priorities of both trainee and supervisor. Furthermore, as GP supervision develops within the rising workload of contemporary general practice, the role of the wider community of practice may become more prominent. We have adapted the working alliance model for postgraduate General practice (GP) supervision, emphasising the explicit sharing of expectations relating to goals, tasks and roles to facilitate negotiation and agreement.

/pdf/a-systematic-review-of-supervisory-relationships-in-general-1jvmjy5tu7.pdf

A systematic review of supervisory relationships in general practitioner training.

In recent years in the United States (US), there has been a shift in primary care service delivery through patient-centered medical home (PCMH) implementation, a focus on the Triple Aim, and the passage of the Patient Protection and Affordable Care Act (Baird et al., 2014; National Committee for Quality Assurance [NCQA], 2014; Nielsen, Gibson, Buelt, Grundy, & Grumbach, 2015). These efforts have set the stage for payers, primary care service professionals, and patients to expect integrated behavioral health services as an essential component of primary care. Three prominent models of integrating behavioral health services in primary care include the Screening, Brief Intervention and Referral to Treatment (SBIRT) model, the Collaborative Care model (CoCM), and the Primary Care Behavioral Health (PCBH) model. The SBIRT model focuses on patients with risky, but not yet problematic substance use, and has received ample review on model components and effectiveness (e.g., Moyer, 2013). The CoCM largely focuses on patients with depression and anxiety and has been widely described and evaluated with a review of 79 randomized controlled trials summarizing model impact (Archer et al., 2012). The PCBH model has also been described in a number of publications (e.g., Gatchel & Oordt, 2003; Hunter, Goodie, Oordt, & Dobmeyer, 2017; Robinson & Reiter, 2016; Serrano, 2015; Strosahl, 1998, 2005). It has been implemented across the US in large healthcare systems (e.g., Hunter, Goodie, Dobmeyer, & Dorrance, 2014; Kearney, Post, Pomerantz, & Zeiss, 2014), community health organizations (e.g., Freeman, 2011; Kanapaux, 2004), family medicine residency programs (Hill, 2015), university health centers (e.g., Funderburk, Fielder, DeMartini, & Flynn, 2012; Sadock, Auerbach, Rybarczyk, & Aggarwal, 2014), and homeless clinics (Ogbeide, Buck & Reiter, 2014). There is also a growing number of PCBH model studies examining patient and implementation outcomes (Hunter et al., 2017). Despite these efforts, there remains confusion in the literature and professional community regarding the core goals, tenants, and strategies of the PCBH model. In an attempt to remedy this situation, this special issue is designed to serve as a one-stop information foundation for the PCBH model overview and definition; current state of the science; ethical considerations; diverse intervention strategies, training, and workforce development; and payment, legislative, and policy developments. We hope that this collection of articles will achieve a number of goals. One major aim is to provide the field with a concise definition of the PCBH model to aid in understanding key model features using consistent terminology. Such a definition could serve as a benchmark for clinicians, administrators, and researchers in determining what the PCBH model “is” and “is not” across diverse settings and organizations, and more clearly distinguish it from other models of integrated care and from co-located care. This is a prerequisite for the continued progression and dissemination of the model. A second major goal of the special issue is to provide comprehensive summaries of the major challenges currently facing proponents of the PCBH model. These include lack of clear ethical guidance specific to integrated service delivery models, difficulties with reimbursement and funding due to unsupportive policies and regulations, lack of a sufficiently trained behavioral health and primary care * Christopher L. Hunter christopher.l.hunter16.mil@mail.mil

/pdf/integrating-behavioral-health-services-into-primary-care-3hejevwy1u.pdf

Integrating Behavioral Health Services into Primary Care: Spotlight on the Primary Care Behavioral Health (PCBH) Model of Service Delivery.

Background: General practice supervisors are increasingly being expected to assess their registrars Objective: In this article we explore the issues this raises for supervisors, and discuss the literature, which suggests that global assessments are the most accurate and feasible Discussion: We suggest the following guidelines for supervisors: inform registrars at the beginning of the term about how and when they will be assessed; be clear that the aim is to decide if the registrars' practice is safe for patients and appropriate for their stage of training; observe registrars at work; make an initial judgement of registrars' performance; test the initial judgement on performance applying qualitative research methods to improve trustworthiness and reduce potential biases; use the working diagnosis of registrar performance to guide the level of support and clinical oversight needed and flag registrars who require further assessment by educational organisations for remediation decisions

GP supervisors assessing GP registrars – theory and practice.

Supportive and effective clinical supervision is imperative to the training and development of assessment skills in clinical psychology. This article presents the development of the Multilevel Assessment Supervision and Training approach, a clinic-based method to supervision of assessment. This approach utilizes advanced predoctoral students to serve as peer supervisors for beginning predoctoral trainees conducting psychoeducational assessments. It offers several advantages, providing a peer mentoring supervisory experience during graduate education, improving the training experience and oversight for beginning trainees, and improving service delivery. Satisfaction ratings were collected from graduate trainees and their peer supervisors who support the utility of this approach.

Supervision of clinical assessment: The Multilevel Assessment Supervision and Training (MAST) approach

Healthcare training environments, particularly in multidisciplinary training settings, present unique ethical dilemmas as a result of the multiple relationships faculty must balance while working with trainees. The historical and current perspectives on multiple roles in training environments will first be summarized. Evidence of a gap between the extant discipline specific guidelines and the realities of situations that occur in healthcare training will then be revealed, as illustrated in a case example. Primary care medicine training environments are highly nuanced, potentially leading to an infinite number of ambiguous situations that require a generalizable model for managing multiple roles. Rather than recommend specific modifications to existing ethical guidelines, a new model emphasizing role awareness and decision making when challenges in healthcare training settings arise is proposed. Recommendations for the case example using the model are offered. All professionals are prone to boundary transgressions; explicit training about and the maintenance of appropriate role balance will help to ensure high-functioning relationships and maximize the quality of patient care, resident education, faculty and resident satisfaction, and modeling of professional behavior to improve competencies as clinicians and educators.

Multiple role relationships in healthcare education.

The interprofessional nature of the Primary Care Behavioral Health (PCBH) model invites potential conflicts between different ethical guidelines and principles developed by separate professional disciplines. When the foundational model of care and training on which ethical principles were developed shifts, the assumptions underlying the guidance also shifts, revealing gaps and mismatches. This article reviews the extant literature in this realm, and proposes a more unifying set of ethical guidance for interprofessional, integrated primary care practice. We discuss common ethical dilemmas unique to the PCBH model through case examples, and then apply the newly proposed ethical guideline model to these cases to illustrate how the newly proposed model can be efficient and effective navigating these dilemmas.

Stephanie Carter-Henry

Papers

Multiple role relationships in healthcare education.

Ethical Challenges Unique to the Primary Care Behavioral Health (PCBH) Model.