THE CLINICAL PSYCHOLOGIST AS PROGRAM CONSULTANT - WHEN IS ENOUGH ENOUGH

One of the most influential roles clinical psychologists play in healt h care settings is as consultant to medical colleagues. The psychologi st consultant typically approaches either clinical or programmatic que stions intending to tap both empirical research and clinical judgment perspectives in trying to answer them. This paper describes a specific ''program consultation case,'' a not atypical consultation situation in which graduate medical education directors asked for advice about t heir residency training program. The purpose is to use this example to generate ideas and provoke discussion about such consultation process es and their usefulness in the health care training and service delive ry world. The psychologist may be faced with questions that have meani ngful implications beyond the specific consultation. What if the conce rns being posed by this particular program are concerns which have bee n raised before, have been researched before, and have generated reaso nable suggestions, conclusions, and strategies for improvement? And wh at if no one has paid attention so that the questions are being raised again? When empirical and clinical data consistently combine to ident ify problems within health-related training or service delivery system s, and when suggestions or alternatives for their solutions have been presented and, also presumably, ignored, what does the clinical psycho logist consultant do next?