I. Specific Objectives

The goal of the Health Psychology track is to advance the development of the resident as a competent clinical psychologist through enhancement of core skills and abilities, as well as application of skills and abilities to the inpatient and outpatient medical setting. The specific objectives are to: 1) improve knowledge and skill in diagnostic evaluation, intervention and consultation; 2) increase facility in use of current science to inform clinical practice and clinical practice to inform scientific endeavors; and 3) increase knowledge of psychological issues and interventions in health and illness.

II. Structure

The Health Psychology Track interweaves several experiences: Core Residency Experiences (required of all residents), Required Clinical Rotations, Elective Rotations and Health Core Meeting. Each resident completes the four required clinical rotations: 1) Cancer Integrative Medicine/Psychosocial Oncology; 2) Geriatric and Rehabilitation Psychology; 3) Outpatient Psychotherapy; and 4) Sleep Disorders.

Within the Health Track, there is also an option to focus on traumatic stress. This focus would include work with the Rush Traumatic Stress Center as well as work in such areas as Psychosocial Oncology where residents gain experience working with the trauma of cancer.

Each rotation lasts six months and is approximately 15 hours per week. Residents spend the first six months of the year on two rotations, then change to the second pair of rotations for the second six-month period.

Daily activities of the resident are designed to integrate all experiences necessary to achieve goals for residency. On all rotations, the resident functions as a full member of that clinical service, thus assuming the same range of responsibilities as supervisors, at the appropriate level of autonomy for each resident. The resident participates in all aspects of evaluation and treatment of the patient, receiving new patients as well as carrying an ongoing caseload. Activities include interviewing and testing; writing reports, consultations and treatment summaries; written and verbal communication with referral sources and other professionals; "curbside" consultation; participation in unit and/or clinic patient staffings and family meetings; facilitation of support groups and presentation at rounds and clinical conferences. Time is allocated to the two simultaneous rotations as necessary on a daily basis. The resident and supervisor monitor the workload to meet resident training goals and abilities.

III. Program Description

A. Required Clinical Rotations

1. Cancer Integrative Medicine Program/Psychosocial Oncology. This program plays a major role within the Rush Department of Hematology and Oncology which organizes cancer treatment, research and education at the medical center. This service combines a breadth of treatment modalities and focuses on evaluation and treatment of the most common disorders found in cancer patients, providing both inpatient consultation and outpatient services. A hybrid model, which includes both cognitive/behavioral orientation (with some existential and insight-oriented treatment where appropriate) and a disease-specific assessment of quality of life, is utilized. Residents apply assessment and treatment skills to illness, treatment and survivorship related problems including pain, nausea, swallowing difficulty, and noncompliance as well as more generalized adjustment disorders, depression, anxiety, disease-specific quality of life concerns and emotional issues associated with end of life.

2. Geriatric and Rehabilitation Psychology. This inpatient rotation applies core skills to training in (a) psychological and cognitive evaluation and treatment of adults, most of them over age 65; and (b) the role of the psychologist in rehabilitation settings for adults. All patient consultations include assessment of cognitive and psychological status. Based upon the evaluation, tailored psychological interventions are recommended and implemented. Primary medical diagnoses include stroke and other neurological disorders, amputation, recent cardiac or orthopedic surgery, and cancer. Patients present with psychological problems such as depression, anxiety, grief, and ineffective pain management skills, among a host of other premorbid psychiatric conditions. Residents work primarily on two 20-bed inpatient rehabilitation units and function as an integral part of the multidisciplinary team, consulting with rehabilitation staff, and participating in patient care conferences and family meetings.

3. Outpatient Psychotherapy. The Outpatient Psychotherapy rotation focuses on the evaluation and treatment of a wide variety of psychological and health-related issues. Typical presenting problems include depression, anxiety, adjustment to medical condition (e.g., diabetes, chronic pain), women's health issues, smoking cessation, weight management, stress management, and anger management. Treatment approaches are empirically validated and include cognitive behavioral, interpersonal, psychodynamic and client-centered treatment modalities. Pre-surgical psychological evaluations are conducted for gastric bypass, laparoscopic gastric banding, and heart transplant patients. Specialty services for gastric bypass and laparoscopic gastric band patients include pre-surgical cognitive-behavioral preparation as well as therapy for post-surgical adjustment.

-Trauma Focus: Residents choosing a traumatic stress focus will work within the context of the Rush Traumatic Stress Center and will be trained in exposure therapy and other cognitive behavioral treatment of trauma. Trauma in women's lives is a particular focus of the Center. A traumatic stress focus may also include exciting research opportunities, and the potential for post-doctoral fellowships.

4. Sleep Disorders. The Sleep Disorders Service and Research Center (accredited by the American Academy of Sleep Medicine) is a diagnostic and treatment facility for persons with sleep disturbances. Within the Sleep Center, the Behavioral Sleep Medicine (BSM) service provides residents with an opportunity to gain experience in the diagnosis of major sleep disorders, to learn behavioral applications to sleep disorders, and to understand the role that behavioral specialists can play within an interdisciplinary sleep center. The service is primarily outpatient and includes assessment and treatment for patients of all ages. The evaluation includes a clinical interview and a battery of psychological tests. Following the initial evaluation, patients may have further diagnostic workup in the Sleep Laboratory. Treatments include cognitive-behavioral therapy for insomnia, adherence to Positive Airway Pressure treatment, and coping with chronic sleep disorders. The Sleep Center team includes psychologists, neurologists, and pulmonologists and all team members participate in new patient staffings and Sleep Grand Rounds. The BSM program is accredited by the American Academy of Sleep Medicine to provide training in preparation for Certification in BSM (CBSM).

B. Elective Rotations

Elective rotations provide the flexibility for each resident to develop a training program that best meets his/her professional goals. The elective is a four to five hour per week experience that lasts four to five months. Up to two electives per year are offered to residents who have completed and defended their dissertations. Residents are able to begin electives after they have successfully negotiated the first quarter of the training year. Eligible residents select or propose electives in consultation with the Training Director and the faculty member overseeing the elective. Electives may have a clinical or a research emphasis.

IV. Seminars and Supervision

Each of the four Health Track rotations have scheduled weekly meetings in which concepts, research and skills training pertinent to the functioning of a psychologist in the specialty area are covered. These required clinical case conferences, journal clubs, walk rounds and didactic sessions enrich the resident's face-to-face clinical experiences in the rotation. The seminars provide opportunities for advanced-level skill building in the areas of assessment, intervention and consultation, and increase the resident's body of knowledge regarding medical conditions and psychological issues germane to the particular patient population seen.

Supervision is the critical component of the residency training experience. Across the year, the resident will work with the majority of the Health Track supervisors in order to be exposed to multiple orientations and areas of expertise. The resident has an assigned individual supervisor for each rotation. Supervisor and resident meet weekly for individual supervision or as frequently as necessary. Supervisor orientation is primarily cognitive-behavioral with considerable use of interpersonal and dynamic approaches as well.