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How long does it take you to write reports?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by clinpsych, 03.22.12.

  1. clinpsych

    clinpsych New Member

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    For those of you who do some but not a lot of psychological assessment (e.g., not neuropsych folks), how long do you think it would take you to write up a 15-page report consisting of the following?

    *background information (gathered from an electronic medical record and client report)
    *diagnostic assessment (e.g., a SCID, ADIS or MINI)
    *personality instrument (e.g., a MMPI or PAI)
    *measure of symptom exaggeration
    *assorted (brief) symptom inventories and miscellaneous measures
    *integrative conceptualization/diagnoses
    *recommendations

    I'm drowning in reports lately, and I'm trying to get a sense of whether I'm too slow or whether I'm taking on more than is reasonable.

    (It might be helpful to note your level of training/experience in your answer.)

    Thanks!
  2. eudaimonPsyD

    eudaimonPsyD Clinical PsyD Student

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    I am an advanced graduate student and I have been working in an assessment-based private practice for about 7 months now, and my report time has really cut down with experience over time. Initially I would be taking reports home and working on them, sometimes spending upwards of 10 hours. I have streamlined as much as I possibly can. I have templates (male/female, adult/child) that contain any tables I may need and personal reminders for myself of the critical information that needs to be in each section. Also I have a template of standard recommendations that may be more widely applicable and a back record of recommendations more specific to certain diagnoses. Now I would say I can knock out a fairly decent size report (11-15 pages, usually a battery of 8-12 protocols) in 4-5 hours. Really the most time consuming part for me is the diagnostic section.

    That is not to say there isn't that report here or there that takes much longer than that. Sometimes we get unique cases that require more investigation and reference to clinical research. But the nature of my workplace lends itself to a fairly common pool of diagnoses (PDD, ADHD, Anxiety, Depression).

    What is your caseload right now? What is your expected turn-around time? On average, how long do you spend?
  3. Pragma

    Pragma

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    Who is going to read 15 pages?

    I am just curious because after leaving my initial training site, where we wrote crazy long reports, new settings and other professionals who were consumers of the reports appreciate shorter versions.
  4. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    Agreed, although it seems the OP is still in grad school, and possibly fairly early on in training. As you've said, most professionals aren't going to want to wade through a 15-page report (if they get one, they'll likely skip straight to the summary/conclusions and recs), but I do feel that writing a few such very thorough reports is a useful training exercise, and grad school is about the only place one might have an opportunity to do so.

    The only places I've frequently seen reports of that length outside of university clinics are either for forensic cases/IMEs or standardized testing accommodations. Then again, I've run into quite a few reports from practitioners out in the community that run 10-15 pages and summarize two days' worth of testing. Quite a disparity from the 2-5 page reports and ~4 hours worth of testing I do with AMCs and the VA.
  5. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    Nobody will read a 15 page report, unless its an Atkins death penalty case. Why are you not being taught how to write reports that are actually integrated and that will be read by other professionals?

    There is no reason the above cant be conveyed in 5 pages. And the history should by far be the longest part of that 5 pages.
    Last edited: 03.23.12
  6. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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  7. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    I can say that at least in my case, writing lengthier (although admittedly by "lengthier," I mean 7 pages as opposed to 15) does force you to pay a great deal of attention to essentially every bit of information you've gathered. And especially for individuals who haven't yet had many/any opportunities to synthesize that amount of data, getting it all spelled out in written form first a few (dozen) times helps you to begin picking out what's important, and what is foregone/can be left out.

    Even if the reports aren't ever actually given to anyone (i.e., they're only used as a trianing exercise, and the "real" reports are significantly shorter), I feel it to be a useful undertaking. But that's just me.

    Beyond that, I don't necessarily think it behooves the trainee to immediately jump into having an efficiency-oriented mindset from the get go. Again, at least in my opinion and experience, having the opportunity (or even being forced) to spend a substantial amount of time on reports early on, and thereby have a chance to fully conceptualize a case, can help you practice those skills to the point that they happen much more quickly by the time you get to internship.

    You of course don't want to be telling students that 15-page reports are going to be poured over by people in the real world. But allowing them to spend a good amount of time on a case early in their training, while providing the caveat that eventually they're going to need to essentially cut their reports in half, seems to work well for many of the students I've trained with.
  8. Pragma

    Pragma

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    Yes I agree when it is actually considering a lot of details in the case. But this should really only be maybe during the time people are learning their assessment sequence. After that, why practice something that is not useful? There are other ways to consider data (e.g., lay all of the scores out on a normal curve and discuss them) and how they fit together than writing a summary. I think Erg's point is that you can get into bad habits (writing way too much and not learning to be succinct) that you have to be trained out of when you get to the "real world."

    To the OPs question, I would give yourself several hours to do this for each report. You will get better at it with more experience and will become more efficient.
  9. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    AA, reports are for OTHER people. You did the asessment. You know it already. You should pay attention to every piece of data, sure. But not EVERY piece of data is important frankly, and there is no reason to write about EVERY piece of data. And I would never want my trainees to waste time doing that and/or get the habit of doing that. It's actually intellectually lazy in my opinion. If its non-germane, then it should recognized and treated as such...and my time shouldn't be wasted.

    Do we train radiologists to overintepret and over write findings initially? No. They are trained how to seperate relevant findings from non-relevant findings from the very get- go, and then to write those finigs in an efficent manner. Seems to work well for them.
    Last edited: 03.23.12
  10. NotTheHoff

    NotTheHoff On Internship

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    As others have said, 15 pages is likely unnecessary, but I'm assuming this page estimate is protocol for your current practicum site. Assuming you have consulted with your supervisor(s) and have a clear idea of your case conceptualization and recommendations, I'd venture to estimate I'd typically spend roughly 6-8 hours spread over 2-3 days on the report.
  11. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    Agreed, although ultimately I think this might just be something we may never fully see eye-to-eye on. Reports should always be written with the intended audience in mind, definitely, and should only include the relevant information. But IMO, you're only going to learn to figure out what relevant information is by having spent enough time (and worked on enough cases) wading through all of the data.

    I suppose in my mind, the process of writing it out at first ensures that the trainee is actively attending to all of the data. The supervisor then has the opportunity to see and review how the trainee is actually conceptualizing everything. This could of course be practiced and reviewed in other ways, but something about the process of writing it down a few times seems to help people clarify those thoughts and processes initially so that they can then not need to write it all out in the future.

    Again, though, I'm not proposing that it's at all helpful to be handing clients or referral sources 15-page behemoths. There has to be a happy medium reached, and even early on the trainee shouldn't just be rotely summarizing EVERYTHING from the testing session. However, I feel that the "happy medium" tends to err on the side of slightly-lengthier (i.e., 7-page) reports early on vs. the more palatable 2 to 4 page reports that come later.

    >7-8 pages would seem like overkill even to me, though. We typically ran 6-8 hour batteries, and even then, unless it was an accommodations report that explicitly required W, X, Y, and Z all be individually addressed, I don't know that I could've willfully forced my reports to be any longer. And this was while including a healthy number of tables and graphs in each report.
    Last edited: 03.23.12
  12. cara susanna

    cara susanna Predoctoral Intern

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    In my Assessment classes our reports were usually 10-15 pages by the end. It definitely scared me off from testing because I thought all reports would be like that. They are not at all like that in the "real world"--usually my reports are 5 pages at the longest.
  13. clinpsych

    clinpsych New Member

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    OP here. Thanks to everyone for their feedback so far.

    While I am aware that most treatment providers won't be reading more than my summary, conceptualization and treatment recommendations (and am writing my reports with that in mind), I am expected to include detailed background and assessment results.
  14. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    And I think the argument is to shorten your reports if you wana cut down your time.

    Even a detailed history can be done in 3 full pages (although a "relevant history" is all that should really be written in a standard clinical, non-forensic, report) and a detailed analysis of the assessment you are using could be done in 3 pages (i.e., there is no reason to have a page long MMPI profile description except in very complicated cases). Summary and recommendations would be 1-2 pages. Voila, you've cut your report in half and presumably your time as well.
  15. eudaimonPsyD

    eudaimonPsyD Clinical PsyD Student

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    I think that most posters make a good point on here. There are plenty of situations where a lengthy report likely won't be useful, efficient, or cost-effective. You will likely end up with much shorter reports in the future, if you were to include assessment as part of your career.

    And as someone pointed out, when you're just a prac student, you do what your supervisor tells you. Thus, I write 10-12 page reports that follow a very specific structure.

    Those with more experience may be able to answer this: have you noticed that the report length that come out of private practices are notably longer than hospital/VA settings? My supervisor conceptualized it as that since these clients are private pay/insurance paid, they expect/deserve to be fully attended to and be presented with all relevant information. Has anyone else followed/heard of this approach before?
  16. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    Not really. If anything PP people may cut corners more, write shorter reports to save time and increase billable hour availability, and/or be more reliant on templated reports. My experience is that report writing that I was taught in a grad school class was useless and bears no resemeblance to real world practice, save the university training clinic.
  17. Pragma

    Pragma

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    Well the interesting part about this, IMO, is that at first I think it takes people longer to write more concisely. It is tough to immediately recognize what are the important things to include and what can be left out. As with undergrads writing papers, me writing my master's initially, and many other academic situations I can think of, it is easier to just write more because it requires less thought. Learning to give the same amount (or more) of information in half the space is a tall order when you are just starting out.

    I think this is was AA was arguing a bit, and I see the point. You run the risk of shoddy training if you teach students all of the heuristics up front. They are supposed to know their s*** first, then take the shortcuts. It's a process and the speeding up of writing comes with practice and easier recognition of important patterns and information.
  18. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    I actually have noticed that the only lengthy reports I see (e.g., 10+ pages) come from private practice. I wouldn't at all doubt that this may be done in some respects to appease the client and make them feel as though they've gotten their "money's worth."

    Just in my own experience, AMC reports tend to be the shortest, followed by VA, then PP, and then university counseling clinics. Others have likely had experiences more similar to what erg mentioned regarding PP reports, though.
  19. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    That was exactly my point, yes.

    And I think most everyone here would agree with you--writing less is much, much more difficult, particularly early on. But the pay-off in clarity is definitely worthwhile.
  20. Ollie123

    Ollie123

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    I've trained in settings that emphasized both (2-3 page reports and 15 page reports). I see advantages to both models, frankly. I view it akin to working on the master's or dissertation. At least traditionally (though many universities are moving away from this), both of these documents will be much, much longer than any journal article you would ever write save perhaps for a Psych Bulletin review. My understanding is that the rationale is that this is one of the few times in your "career" you WOULD actually have someone reviewing details. Certainly peer-review is not necessarily detail-oriented for many manuscripts and there are often a whole lot of assumptions and trust in the process. Similar with report-writing...short reports SHOULD be the goal, but reading a short report typically entails some degree of "trust" that the person knows what they are doing and included/excluded information appropriately. We also have a wide range of approaches for theses/dissertations here. We go for manuscript-length here. My thesis was very short (20 pages of text). My dissertation proposal is ~12 pages double-spaced (submitted an F31 so basically just used the research strategy section), though the defense document will be longer since my results will be necessarily crazy-long due to the methods I'm using (I'll be splitting it into multiple papers). The length is certainly advantageous for me, but I also feel like there would have been benefits to producing a longer document.

    Personally, if I am one day in a position where I am doing this it may be dictated by the particular student/setting/etc. If it is a trustworthy student, there is enough time allotted for supervision to be done properly, and we have had time to review the details PRIOR to the student writing...no need to waste time, keeps things brief from the outset. Obviously this also depends on how much experience the student has too. In contrast, if its a questionable student or for whatever reason, supervision is somewhat less intensive...I will want ALL remotely relevant information in the report. If my license was the one on the line, I wouldn't want someone who had never written a real report before leaving out things that they deem "irrelevant" that I may or may not find out about. There is a big difference if I am in the room for the interview, watching videos of testing, etc. versus primarily relying on things the student brings up when they discuss their 5 active cases during our 1 hour supervision meeting.
  21. FadedC

    FadedC

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    This is actually a helpfull discussion for me to see as well. I'm doing a practicum in a private psychoeducational assessment center where the reports are actually quite a bit longer then 15 pages, and getting one done in only 10 hours would be a dream. I've been struggling with the writing, and it's been putting me off on assessment quite a bit. It's good to know that it's normally quite a bit more sane.
  22. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    Wow; quite honestly, that sounds horrible to me, and I'm an assessment-slanted individual. I don't think I've ever spent 10 hours writing a single report, and likely would not consider doing so unless it were either an extremely complicated case, or involved a fairly staggering amount of records review (i.e., forensic eval).

    So yes, it does get better.
  23. clinpsych

    clinpsych New Member

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    That, my friend, is a bold statement, given that you know nothing about my training, the purpose of the assessments that I am conducting, and the application of the reports that I am writing.

    If posters want to debate the ideal length of reports on this thread, be my guest. However, I am guessing that my supervisor (whose credentials in this area are unassailable) will be unswayed by the opinions of strangers on the internet.
  24. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    No ones trying to convince your supervisor of anything here, so relax.

    But, I will stand by my statement that unless you are conducting forensic evals or complex psychoeducational testing, what is 15 pages can easily be 5,6, 7, or 8 pages. I think its a shame that our profession continues to have the "because that they way its done" mentality when some of the the most consistent feedback other professionals give us about out reports is that they are too long and filled with superfluous information that, while might be neat to the Edith Kaplans of the world, they could careless about. Its a good way to isolate your profession from the rest of the medical community. And I thought that's something that we def DON'T want to continue to do, lest we actually like the drastic cuts in reimbursement and being shut out of ACO organizations?
    Last edited: 03.24.12
  25. IT514

    IT514

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    I did a practicum doing psychoed evals where the culture was 15-20 page reports (their stupid template was 30 pages!). I turned in an 8 page report just to see how my supervisor would take it. She loved it, and wondered why her students felt the need to turn in such long reports.

    As I gained more experience with reports, I found that what I thought was oversimplified was read by others as clear and concise. At this point I save almost all of my energy for the summary and recommendations sections.
  26. ClinPsychEnthus

    ClinPsychEnthus Psy.D. candidate, VA intern

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    I'm interested in this discussion, as I am on a practicum now in neuropsych where our administered batteries (done in a 9-5 day) include the a clinical interview with mood assessments such as the Beck scales, then the WAIS-IV, WMS-III, WIAT-III, MMPI-2, the full Halsted-Reitan Neuropsych battery, the Bender-Gestalt, and occasionally some adjunctive tests such as Grooved Pegboard etc... and I'm finding that the comprehensive reports for these batteries thus far have been in the 25 pg range. Granted, I'm new at writing reports this comprehensive, but am I being too detailed? The site I am at has such a great rep in the area that we are consistently busy and referral sources love the agency's work... So is 25 pages too long in others experiences given what the battery is comprised of?

    I appreciate hearing peoples' perspectives on this.
  27. IT514

    IT514

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    25 pages is a lot. I've done around 60 neuropsych reports (VA and academic medical ctr), and the longest was 10 pages (with the help of supervision of course). No matter how long your battery is, you should be able to distill things down to no more than 8-10. One recommendation I would make for shorter reports is to keep your results section separate from your conclusions. By this I mean very, very concise...no conjecture, no explaining why they scored this or that - save that for the conclusions and even then keep it simple. Another recommendation that helped me in my first neuropsych practicum was that we do not have to defend ourselves in the report, but that everything we write must be defense-able. Do you see physicians defending their statements with data, citations, or in any fashion whatsoever? Nope. I'm not sure what the culture is in your practicum, but typically our referral sources trust that we're competent without having to justify every statement with the same rigor of an academic paper. Part of it has to do with confidence and part of it is simply experience and practice.
  28. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    I agree with the post above mine--I've done over a hundred batteries very similar to yours (e.g., using the PAI instead of MMPI, but with the Halsted-Reitan [including grip, pegs, and tapping], WAIS, WMS, etc.), and the reports never topped 7-8 pages (and this includes civil forensic cases). Break it down to sections/domains; definitely don't attempt to explain the results test-by-test. Unless it's a forensic case with boxes' worth of records to review, IMO, 25 pages is likely going to be too much.
    Last edited: 03.24.12
  29. Doctor Eliza

    Doctor Eliza

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    I think this is a really good topic to discuss. It is yet another example of how grad school does not prepare you for the real world.

    I am in a position where I am in private practice and do about 2 assessments a month (mostly adult and child ADHD and some bipolar). I have recently be questioning this decision from a financial perspective, as I spend so long writing the report, that I'm sure I am earning less than minimum wage per hour!

    As a point of reference, our local children's hospital does a lot of child assessment. Last time I saw a "report" from them I was horrified....it consisted solely of check boxes. For example things like "History of mania? Yes No" I find this to be a somewhat appalling extreme.

    Honestly, I think one of the reason I write thorough reports (7pgs) is to make myself feel important and like my education wasn't a waste. The sad thing is though, that you can write what you want, but at the end of the day, often all that matters is what some physician makes of your report. It is the MDs who rx the meds. I recently killed myself on a report ruling out bipolar. My dx was that many of her odd sx were better explained by PTSD. I sent her to a psychiatrist that I really like and respect to treat her severe sx of anxiety and depression. He called and said, yeah, it looks like PTSD, but also she's a little bipolarish, so I rx'd a mood stabilizer. I felt like the work I had done was just a useless waste of time. We could have just cut to the chase and tried some meds and saved everyone a lot of time and money.

    I don't know, we are always told that assessment is our superpower as psychologists. I suppose that could be true with the deep in-depth neuropsych assessments, but a lot of it seems like it isn't as important as we think it is.

    Dr. E
  30. ClinPsychEnthus

    ClinPsychEnthus Psy.D. candidate, VA intern

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    Your perspectives on this are really interesting and practical- thanks!

    I don't think I'm too detailed or flowery in report writing, but I definitely break down tests. Though in my perspective that is interesting or helpful, I'm realizing from this discussion that my interest in describing the patient with the goal of better understanding and treatment may not be translating into reality. I'm definitely seeing why a well done 7-10 pages would in some ways be more helpful.
  31. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    While I'm in my "...and ya know what else pisses me off" mode, I might as well mention that one way to cut down length of reports very easily it stop describing/explaining the tests before we intepret them.

    I know we have to do this somewhat when interpreting a result, but don't give me two sentences on what block design is, how its done/administered, and what it measures before giving me the score and interpretation. I mean, WTF! I never see physicians do anything like this when they write reports that are seen by other professionals. When was the last time a read a H&P with detailed explanation of how hemoglobin A1c was collected and what it means? You dont. There is no reason a PCP would need to know what block design is beyond how its relevant for for this patient. Is there? And if its another psychologist reading it..guess what? They already know!:laugh:
    Last edited: 03.25.12
  32. ClinPsychEnthus

    ClinPsychEnthus Psy.D. candidate, VA intern

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    I think my personal issue is brevity in comparing and contrasting various constructs (working memory in WAIS, in contrast to some working memory and exec functioning through Halsted subtests, in contrast to WMS weaknesses...)

    Trying to be detailed and yet practical hasn't been lending itself to brevity for me. But I am re-evaluating what is truly helpful for a person or treatment provider if my write up is too detailed.
  33. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    This is why I'll sometimes omit most test names entirely, and just focus on the domains evaluated. If I mention a test specifically, it'll be to very briefly explain its purpose if I feel it to be relevant (e.g., "Patient's performance on XXXX, a measure of YYYY, was in the ZZZZ range and indicated ____"). We, as a field (particularly neuropsych), are fairly horrible for the sheer number of acronyms we wantonly toss around. Including them all in the body of the report can very quickly confuse just about any reader.

    In general, though, especially in shorter reports, I tend to omit specific test names unless it's something I know the referral source will be particularly interested in reviewing. Some neurologists, for example, may be familiar with the CVLT and would like to know the results on that measure specifically.
  34. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    I agree, that's where some of the more interesting results can be found. But we generally don't need to include all the hypothesizing we do in our heads in the actual report. Instead, we can give just the final take (e.g., "Patient's variable performance across measures of working memory indicate _____").
  35. ClinPsychEnthus

    ClinPsychEnthus Psy.D. candidate, VA intern

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    Great point, AA, as I'm thinking about how the referral question would impact what details are emphasized and how that can help me write more succinctly.
  36. IT514

    IT514

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    True. I love writing reports for a physician audience. I hate writing for schools and teachers because they love charts and graphs, and I despise the time it takes for me to visually present data.
  37. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    I have a few graph-in-report templates that a former grad student colleague made up just for this purpose. I feel they can be helpful for clients if you're throwing a lot of data at them, but given how much space they take up, they definitely aren't as often useful in a medical setting.
  38. Pragma

    Pragma

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    I have to admit, while "short is sweet" has been a theme at most places I have worked, there is a lot of variability by supervisor. During my practicum and internship, we really streamlined things and usually had the referral source in mind when we wrote up results.

    On fellowship, my supervisor is much more process-oriented, and I find myself having to write a lot of details within the results section that I find pointless to include in the report. But, some people either a) value that information, b) want you to write out all of your thoughts/rationale as a training exercise to prepare you for the boarding process (neuro), or c) are very detail-oriented and given their limited interaction with patients, like to have all of the details in front of them before they sign off on the report.

    I can't say I have been exactly happy about putting things in the report I don't think are as useful (to WRITE), but the qualitative information is important to consider. When I am on my own I will probably leave some of those things out. However, we still keep our reports under 10 pages, probably 6-7 pages on average.
    Last edited: 03.28.12
  39. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    Oh god, don't even get me started on the process report folks. This does not mean some process aspects aren't important, it means they are generally speaking, important to us, and really no one else. Neuropsychology is oddly narcissistic in that way.

    Now, process aspects of item/task failure is important of course, and I think she always be explained in a report.

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