Almost all of clinical science, including applied behavior analysis, encourages practitioners to apply effective treatments with sensitivity to client preferences. Interestingly, applied behavior analysis has focused largely on measuring preferences to treatment content (i.e., the procedures we use) and little on treatment process (e.g., the way those procedures are delivered). However, clinical evidence suggests that the process by which treatment is delivered can matter to clients and to referral sources in primary care. The purpose of this study was to evaluate the value assigned to the therapeutic process by parents and caregivers seeking treatment for their children in both traditional and in integrated primary care settings. Using a modified delay-discounting methodology, parents were asked to make choices that reflected how much they would prefer treatment effectiveness content over various therapist process characteristics. Results showed that parents were willing to tolerate a treatment with significantly less empirical support in favor of numerous preferred therapist characteristics. Implications for a field that prides itself on effectiveness but values dissemination and integration in primary care are discussed.

Background By all indications, well-being among physicians is poor, which manifests in various outcomes, including burnout, depression/anxiety, low life satisfaction, alcohol/substance misuse, suicide ideation, and suicide. Despite the vast literature on physician burnout, there is relatively little research on how pre-clinical experiences in medical school may be an antecedent to subsequent poor health among physicians. Here we focus on two neglected areas within the literature by focusing on the pre-clinical stage of medical school and the positive, as opposed to exclusively the negative, aspects of the medical school experience as it affects well-being. Methods This study utilizes the metaphor of the Coping Reservoir Model as a theoretical and analytical framework for understanding medical student well-being by identify the ‘depleting’ and ‘replenishing’ inputs that are deposited into students’ coping reservoirs. We analyze 105 medical students’ reflective writings using a data analytic process consistent with an interpretive description approach, engaging in a hierarchical 3-step coding process to identify the main replenishing inputs deposited into students’ coping reservoirs. Results The main depleting inputs that we identify are consistent with those identified by The Coping Reservoir Model. In addressing our main research question regarding the replenishing inputs, results show the main positive factors are psycho-social resources, intellectual stimulation, and social support/relationships. Most importantly, relationships with patients shape all three of these positive factors and provide the main source of hope that the stress of medical school will get better. Conclusions What allows students to frame their experiences with hope and optimism are the connections they form with each other and with patients. The prolonged stress of medical school is made “worth it” in hopes that it will “get better” with more meaningful patient interaction in the future. These results that emphasize the positive aspects of medical school are discussed in context of their theoretical contributions to The Coping Reservoir Model and the practical implications for medical education to improve medical student well-being by facilitating human connection.

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