Internship Experiences

[psyman]

Your "workload expectation" during internship should be what's needed for training. We just had this discussion as we are planning our internship program. If they need workhorses then they shouldn't have even developed an internship. Working over 40 hours is fine, but I would prefer that's because I am using that time to further my career/training/vita, not because the admins view me as a clinical cash cow.

Stress about your productivity numbers and keeping admin happy should not be one of the stresses of an training experience, and I would argue that stress from those variables is counterproductive to the training process.

I agree. I was a lowly intern. What could I do?

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[erg923]

I agree. I was a lowly intern. What could I do?

Provide the feedback to the TD. We met with out TD once a month for the "airing of grievances" so to speak. This was the interns idea.

 

[psyman]

Provide the feedback to the TD. We met with out TD once a month for the "airing of grievances" so to speak. This was the interns idea.

You don't think interns may be hesitant to do that? Complaining about the workload could easily result in a lesser LOR than if you hadn't complained. Particularly compared to someone who just gets their work done and doesn't complain.

...and btw, people complained.

 

[erg923]

Then don't "complain." Provide "alternative ideas" that would provide higher quality training experience that would benefit interns AND the site. If they don't care about that, then you attended a ****ty internship. Period.

 

[AcronymAllergy]

All sites are likely different in this regard, but I can say that mine paid a lot of attention to feedback from current and outgoing interns. Almost too much, at times. However, if the site is already viewing interns as clinical workhorses, they might not be quite as receptive or reactive to input.

 

[psyman]

Then don't "complain." Provide "alternative ideas" that would provide higher quality training experience that would benefit interns AND the site. If they don't care about that, then you attended a ****ty internship. Period.

Package it however you want, some supervisors call it complaining. [see AA's comment below] No need to get pissy with me about how my supervisors may have been. Sorry that I didn't have all of your Mr. Rogers training experience. You really never had bosses who were unreasonable? Lucky you.

Given the match rates, we felt lucky to have internship.

However, if the site is already viewing interns as clinical workhorses, they might not be quite as receptive or reactive to input.

Yeah, that's how I felt.

 

[Therapist4Chnge]

No need to drag Mr. Rogers into this!

 

[erg923]

You have a role in shaping your training experience. In fact, I would argue this is indeed partly your responsibility.

And of course I have had unreasonable supervisors...and I used the resources and processes available to students to diplomatically tell them so. My program encouraged this aspects of our professional development. And because of this, there actually was a minimum of unreasonable supervisors/sites. The two are related, see what I'm saying? If you don't want to be viewed and treated as a wet dishrag, then you cannot act like one. Behavior that is continually reinforced will continue, right?

@psyman we work in systems that all too often either don't value what we can bring to them or patients or whose priorities are not alligned with mental health. "Diplomatic Assertiveness" as the OD researchers coin it, is a necessary component to work in this field and produce actual change (both at the system levels and individual levels). The sooner you start practicing the better. Until you become "the boss", you will always have one, so don' fool yourself into believing that once your license comes through you are gonna start suddenly asserting your opinions to the powers that be.

 

[psyman]

You have a role in shaping your training experience. In fact, I would argue this is indeed partly your responsibility.

And of course I have had unreasonable supervisors...and I used the resources and processes available to students to diplomatically tell them so. My program encouraged this aspects of our professional development. And because of this, there actually was a minimum of unreasonable supervisors/sites. The two are related, see what I'm saying? If you don't want to be viewed and treated as a wet dishrag, then you cannot act like one. Behavior that is continually reinforced will continue, right?

@psyman we work in systems that all too often either don't value what we can bring to them or patients or whose priorities are not alligned with mental health. "Diplomatic Assertiveness" as the OD researchers coin it, is a necessary component to work in this field and produce actual change (both at the system levels and individual levels). The sooner you start practicing the better. Until you become "the boss", you will always have one, so don' fool yourself into believing that once your license comes through you are gonna start suddenly asserting your opinions to the powers that be.

I appreciate what you're saying. I really do. However, I think you are discounting how many of us ARE treated given the current state of things in the field. I would make definite changes to my internship program, but organizational and personality factors by the higher ups make those changes unlikely. There is a tone of "just do the work" that we knew to abide by. You know, "it's the same for interns every year so why can't YOU do the job like them?" Surely you can understand how that happens.

 

[WisNeuro]

The thing is, I don't know how much of this is the state of the field, vs. a minority experience in the field. In the dozens of people I've known going through internships in VA/AMC/PP settings, this was not the case.

 

[psyman]

The thing is, I don't know how much of this is the state of the field, vs. a minority experience in the field. In the dozens of people I've known going through internships in VA/AMC/PP settings, this was not the case.

When 1,000 people CAN'T get an internship each year because there aren't enough positions (that includes APPIC, non-APA...a lot more than that if we only talk about APA), I'd say it's pretty easy for interns just to be glad they got a spot and to just want to make it through the year.

 

[erg923]

@psyman I understand the power differentials. And I understand that what I am talking about can sometimes be "hard" or "scary." But that's what a doctorate is. Hard. And we are suppose to be training to confront, treat, and problem solve scary things, right? I have never found pessimism about the outcome to be an adequate excuse for failure to act when you're in the right and advocating for your and your peers just treatment. How would justice ever get done if no one ever had the balls to stick their neck out a bit? I often have to "talk" with various physicians in my clinic who hold "a higher place" than me, about the sharing agreement they have with primary care mental health, and like it or not, it is what it is, and they can not turf ever single insomnia case to me and my staff. Many get annoyed (even though personally they like me). Do I care? Not really. That's my job.

When, exactly, do you propose that you will feel confident enough to assert yourself in a situation involving a power differential? This is a skill that will just magically appear in your professional repertoire?

 

[erg923]

When 1,000 people CAN'T get an internship each year because there aren't enough positions (that includes APPIC, non-APA...a lot more than that if we only talk about APA), I'd say it's pretty easy for interns just to be glad they got a spot and to just want to make it through the year.

You are viewing these issues (self-advocacy and being a good trainee and doing good work) as mutually exclusive. If that your attitude, then I get it. I think its unfortunate that you have been trained (bullied?) into that mentality. It is not how many programs and supervisors train their students to think. Its certainly not how I was taught to teach and supervise. We are training critical thinkers here. I saddens me that you were trained to shut-off that part of the scientific thought process for the sake of "just doing the work." Everyone loses in that scenario.

 

[psyman]

You are viewing these issues (self-advocacy and being a good trainee and doing good work) as mutually exclusive. If that your attitude, then I get it. I think its unfortunate that you have been trained (bullied?) into that mentality. It is not how many programs and supervisors train their students to think. Its certainly not how I was taught to teach and supervise. We are training critical thinkers here. I saddens me that you were trained to shut-off that part of the scientific thought process for the sake of "just doing the work." Everyone loses in that scenario.

I really do hear you and generally agree. I think you are really discounting a power differential AND that some are just not receptive to an intern's feedback on SOME issues. AA said it well earlier, so I refer back to her comment. If you knew me you'd know I am quite assertive. On this issue, I made the decision to keep my head low for my reasons. If you had been at my site you would have created no change either (with regard to workload). The site was receptive to our feedback on other issues, but workload was not negotiable for them.

I think we've come full circle here.

 

[erg923]

I guess you're right. I did not feel a significant power differential by supervisors on internship. so this timidness is difficult for me to relate to.

The invisible power differential is likely the best indicator of an appropriate and effective command structure, both in training and in the general workforce. Ultimately, it's there. But it's not worn on the sleeve.

 

[mrvsevolodovich]

from a user anonymously

-consortium
-I moved; far.
-moving sucked: long distance with my partner, miss my friends / old city, had to get roommates to make it affordable. That being said, many in my cohort are in similar situations, so we all support each other and are very close.
-training is great, learning a lot and like the faculty
-impact TBD, as I am applying to post doc now
-stress level varies.. I work 45ish hours per week, but have to work extra at home on research projects, my diss, and post doc apps. Being away from my spouse and the uncertainty of postdoc adds to stress, but that would have been true anywhere.

 

[smalltownpsych]

I really do hear you and generally agree. I think you are really discounting a power differential AND that some are just not receptive to an intern's feedback on SOME issues. AA said it well earlier, so I refer back to her comment. If you knew me you'd know I am quite assertive. On this issue, I made the decision to keep my head low for my reasons. If you had been at my site you would have created no change either (with regard to workload). The site was receptive to our feedback on other issues, but workload was not negotiable for them.

I think we've come full circle here.

Sometimes the wise choice is to keep your head low and get through it. For me the one year internship was mainly that time. Nevertheless, I also went head to head with a psychiatrist and got him to change his decision to discharge my patient. Learning which battles to fight is also an important skill along with how to effectively confront. I continue to get opportunities to work on these skills every day.