Psychology in a Community-Based Medical School
A community based medical school uses private hospitals for its clinical work and teaching, while a normal medical school would have a university-owned facility. As a result, community schools are more practice-oriented and less research-driven. I would like to address the unique challenges encountered in this type of academic setting, and the impact of a “non-traditional” academic environment on my research endeavors.
My setting is atypical, in that I have only a small number of interns and post-docs, no psychology graduate students, and no research laboratory. The medical school is not based in the same geographic location as the main university campus, and because Southern Illinois University is a small medical school, the number of faculty in any division is limited.
Similar to other medical schools, there is increased reliance on clinical revenues, which translates into burgeoning clinical loads being placed on faculty – psychology included – coupled with other service and teaching demands. The community-based scenario often places young investigators in a “Catch-22” situation: Because there is no “team” to compete for research dollars, one often cannot obtain such funding, and if one does not have research support, then there is no way to build a team. Therefore, to maintain research productivity in this type of environment, I have had to use clinical populations and have participated in multidisciplinary collaborative projects, both inside and outside of the medical school.
The upside is that the clinics and their populations have afforded a source of data that would be difficult to obtain in a more traditional psychology setting. My areas of research interest could only be maintained in this environment, or one where the psychology department has an on-campus medical school, or at least an affiliation with a medical facility.
Having worked in a medical setting for more than 25 years, I have witnessed many changes affecting psychologists. Initially there was the “triple threat” mindset – excellence in teaching, research, and service – which over the years has evolved into the “best two out of three.” Psychologists were routinely based in psychiatry, but now also are found in pediatrics, family practice, neurology, and other departments. Similarly, tenure track appointments appear to be decreasing in many schools, mine included, with promotion and tenure often being separate procedures. The PhD degree was traditionally associated with basic science research, so it becomes confusing to physicians when one is a PhD in a clinical department, a psychologist, and a clinician to boot. There is a tendency to pigeonhole the psychologist into the role of a technician of some sort, or a research consultant. To better define their role, psychologists should aspire to the “triple threat” goal, and address research, clinical service, and teaching. This is the most effective way to establish credibility.
My primary area of research is in early developmental neuropsychology. More specifically, I am involved in early neurodevelopmental assessment, longitudinal prediction of cognitive and motor functioning, and developmental screening and prescreening. As a result, I work with infants and young children, although I also collect data on older children referred for evaluation because of learning or attention problems. This wide range of interest is not as disparate as it might initially appear, because many children who are at early biologic risk later have high prevalence, low severity dysfunctions such as learning disabilities, ADHD, or other neuropsychological problems. In fact, I would like to better define the relationships between the two, and identify early indicators of these school-age problems. My research could not be effectively implemented without a medical school, and would be impossible had I not received early training and experience in such an environment.
As I had indicated in Infant and Early Childhood Neuropsychology (Aylward, 1997), developmental neuropsychology requires specific training that is not routinely available in traditional clinical or developmental psychology programs. The logical extension is that both training experiences and subsequent research involve specialized populations that are not accessible outside of a medical facility. My long-term goal is to someday develop a specialized training program in this area, and to do so will require bridging psychology and medicine with both psychologists and physicians as faculty. This goal can best be accomplished in an academic environment that is “non-traditional” with respect to psychology.
The Osteopathic Path
Psychology outside the traditional academic psychology pathways can be either a very rewarding or very stressful experience. Being doubly outside such a pathway is more arduous, but perhaps even more rewarding. Making the experience rewarding takes the willingness to enthusiastically embrace the situation, and to bring to it tools unique to psychology.
My training was in the traditions of the “dustbowl of empiricism,” methods of Isidore Gormezano and Richard F. Thompson, my doctoral and postdoctoral mentors respectively. My expectations were to go to an academic psychology department and to explore the interfaces between learning and brain function. However, my plans took a turn when I was offered a position at small and isolated Kirksville College of Osteopathic Medicine in Kirksville, MO. They offered a light teaching load, labs for behavioral and brain research, and a position in the department of physiology. Thus, my first position, and each one since, has been doubly outside the normal academic psychology path, in a medical school focusing on the minority profession of osteopathic medicine.
What is osteopathic medicine, and how did it find me? Osteopathic physicians are trained as fully licensed physicians, but are taught to view the human bodily, psychological, and spiritual functions as the determinants of health and disease, and to use manipulative medicine as one of their treatment modalities. They are equipped to deal with patients from a more inclusive perspective. KCOM was looking for new scientific talent for the school, and I was already somewhat familiar with the osteopathic school of medicine.
For a beginner, the environment was good. I received my first NIH grant and published several papers. After six years, I accepted an invitation to move to the Ohio University College of Osteopathic Medicine as director of research affairs, where I continued my research, but also had access to graduate students from the psychology department. That was the closest I would ever come to a psychology department. In 16 years there, I trained seven PhD students and several master’s students. In subsequent moves to the Kansas City, MO and now Ft. Lauderdale, FL osteopathic schools, my research interests have turned more to the basis of osteopathic manipulative medicine.
Why would a psychologist go so far outside the traditional psychology pathway to find a career? What can the non-traditional pathway offer, and what does it take to be successful on the road less traveled?
To go to an institution that is not well known and to be with colleagues who have little understanding of experimental psychology can be daunting. To do so takes a certain self-assurance, and some sense of adventure. In my case, it meant learning what the osteopathic profession was and what it needed. I was even willing to take courses to learn how to best teach osteopathic students and serve the profession’s research needs. In return, I was given a vast new opportunity for service in a profession that needed research expertise. I was provided with another source of grant funding that, in fact, sustained my research during lean years. I was given a new area in which to apply my fundamental research design and analysis skills, and I was soon opened up to an entire profession that has rewarded my contributions with significant recognition. I did, however, continue to interact with psychology colleagues at conventions and in other venues – an important aspect of maintaining one’s identity.
Of course, I gave up the day-to-day contact with colleagues trained as I was. At Ohio University, I had graduate students from the psychology department, but still, most collegial interactions were with biological scientists or physicians. At times I had to put up with attitudes that placed psychological science at a somewhat inferior position along the scientific spectrum. I could hardly hope to move to the administrative levels of my physician counterparts.
But without question, it has been worth the sacrifices. To go to a non-traditional setting necessitates learning a different discipline or risking always being viewed as an outsider. It necessitates being adaptable to unfamiliar settings and insensitive or biased colleagues. The rewards include opportunities to expand one’s horizons, to meet and influence colleagues who would be outside one’s usual sphere, and to apply the fundamentals of psychological research skills to new areas.
To take advantage of these rewards, one must have the self-confidence to reach out to those in that setting, remembering that they were there first, and that coming together usually means that you make the first move. If one has these qualities, I can highly recommend considering such a career path.
An Education in Action Research
Finding and accepting my current position as director of assessment and testing at California State University, Hayward was a deliberate attempt to get re-centered on the action agenda and related basic and applied research questions that defined my career mission thirty-five years ago – not originally as a psychologist, but as an undergraduate philosophy major.
As a philosophy student, my burning questions were about the intersection of epistemology and axiology, the interdependence of knowledge and values. I found the discourse on these questions most compelling in the philosophical and historical literature, as well as the contemporary public policy arena, concerning liberal and general education. My action agenda became, and remains, democratizing liberal education. Democratizing liberal education requires us to operationalize the aims of liberal education in the context of universal higher education; that means bringing learning sciences and technologies to bear on both education policy and teaching.
This is actually my second time appearing in the Observer to talk about my “non-traditional” career path. The first was an interview entitled, “A Conversation with Michael Strait,” (March 1990). At the time of the interview, I was “riding high” in my new position as project officer for research and evaluation for the Annenberg/CPB Project in Washington, D.C. The original mission of the project was to make it possible for more people to pursue a high quality baccalaureate-level education through innovative applications of television, radio and interactive technologies. From a curricular perspective, the focus was on the general education portion, or first two years, of the baccalaureate degree. The idea was to provide subject matter and learning objectives that could be most widely adapted and adopted by all types of institutions, from community colleges to major research universities. My concluding statement in that interview about my new position was, “This job is me, in a way I always hoped I would be able to say. It’s the perfect meeting point of my interests in education, psychology, and technology, and I couldn’t be happier.” Yet two months before that interview went to press, my dream job of less than one year’s duration had already started to disappear, as our project’s namesake and his advisors began to refocus their philanthropy on K-12 math and science education reform.
Between then and now, I spent five very productive years with the Annenberg/CPB Projects, and then two years with WETA TV/FM, helping public broadcasting program producers understand and embrace “cyberspace,” for community and educational outreach purposes. But in the process, I found myself getting more distant from my action and research interests in higher learning.
I actually began to find my way back to academe and my original career plan by venturing into the “private enterprise” side of research and education as a senior research scientist with a small company called Intelligent Automation, Inc. There I worked on several R&D projects, which helped me get up to speed on both the research base and the interesting technological advancements in the learning sciences that I needed to reignite my earlier ambitions. I also got to experience one of the hard realities of private enterprise – the pink slip.
And then there was Hayward. My third “dream job.” Cal State, Hayward is part of the 23-campus, 370,000 student California State University System that, together with the 10-campus, 188,000 student, University of California System and the 108-campus, 2.9 million student California Community College System, is bringing higher education to California today. Its size, diversity, and comprehensiveness make this the place to be to figure out the meaning, method, and measure of democratizing liberal education in our twenty-first century global society.
What do I do? The phrase du jour is “assessment of student learning outcomes,” for all majors as well as for general education. I get to work with faculty, staff, and students from every discipline, to help them figure out what every student is supposed to gain through their general education, and as a result of earning a bachelor’s (or master’s) degree in a particular discipline or major program area. Articulating the desired learning outcomes in measurable terms is no picnic, but it is, relatively speaking, easier than the next steps of creating and implementing a plan of assessment, evaluation, and program improvement that is going to continually challenge us to get clearer about our goals, and closer to achieving them. As a strong believer in action research, I couldn’t be happier. Uh-oh.