Need help with internship experience

[nailah16]

Hi all,

I'm about two months into my Pre-Doctoral internship (Clinical Psychology PhD student here) and I have nothing to do. I'm talking having 4-7.5 hours per day (out of an 8 hour workday) where I have literally nothing to do associated with my internship. I spend only 10-15% of my time doing clinical work when the program was advertised as providing clinical services 45-50% of the time. When this has been brought up to supervisors, they either brush it off and say it will get better or they assign us administrative tasks like chart audits or alphabetizing the chart room. There are new patients coming in, however they are being assigned to the staff therapists as their job depends on their productivity and mine does not as I am contracted and can't get fired for lack of productivity. I'm disappointed to say the least as this is not how I imagined spending my last year of clinical training before the end of my program. I'm struggling with what to do here and want to see if this is a common experience? I'm also wondering if my expectations for this year are too high given the pandemic and other societal issues. Thanks in advance!

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[erg923]

or alphabetizing the chart room.

WTF?!

 

[nailah16]

WTF?!

yeah, I was under the impression that that was a bizarre request... It's almost like gaslighting; they're trying to convince us that this is a normal response to not giving us patients.

 

[ExecutiveDysfunction]

I was going to say something about COVID making it a weird time and probably making it harder to get started, but the referrals to staff and mundane administrative tasks seem unfair.

How much actual patient contact are you getting per week? Are you receiving didactics?

If this is a mutual concern from your cohort, I might consider banding together to discuss your concerns to your supervisors. If that fails, maybe consider the TD (although that’s more of the nuclear option, so make sure you’ve tried everything first).

 

[nailah16]

I was going to say something about COVID making it a weird time and probably making it harder to get started, but the staff piece seems unfair.

How much actual patient contact are you getting per week? Are you receiving didactics?

If this is a mutual concern from your cohort, I might consider banding together to discuss your concerns to your supervisors. If that fails, maybe consider the TD (although that’s more of the nuclear option, so make sure you’ve tried everything first).

As it stands, we each have about 4-5 individual patients and one group, so we do about 5.5-6.5 hours of clinical work per week (out of a total of 44.5 hours that we are on-site). We are receiving didactics for 1.5 hours once per week (total # of hours for seminars/supervision is about 7 hours per week). This equates to us having almost nothing to do for about 31 hours per week. We also have all gone to the supervisors with this and continue to express our frustration and disappointment at this. Unfortunately, one of my individual supervisors is the training director for the site (but works in a different program so is less aware of the daily goings on in our program) and I have tried to bring this up but she changes the topic. I might either reach out to her via email or be more insistent next time we speak.

 

[beantownpsych]

Yikes! Honestly as uncomfortable as it is, I think it makes sense to band together as a group and discuss the concerns with the TD. At this rate you won't have enough face to face hours to complete internship or get licensed. 6 hours of clinical work is unacceptable.

I'm a TD and it's our responsibility (even with all the problems assoc w/ covid19) to provide trainees appropriate training experiences. Alphabetizing charts is not what I would consider appropriate. To echo others WTF!

 

[summerbabe]

I'm also wondering if my expectations for this year are too high given the pandemic and other societal issues.

Absolutely not. I'm not involved with training at my VA but a lot of effort is being put into trying to get interns as much direct contact hours as during a pre-COVID year, even though it's still falling short (AFAIK). But it feels like the effort isn't even being made at your site and you'll be the ones who suffer in the future if things don't change.

6 hours of clinical work is unacceptable.

This x100000.

I think it makes sense to band together as a group and discuss the concerns with the TD.

It sounds like this has been brought up verbally without change. One option could be an email to the TD with a letter signed by the intern cohort detailing the concerns. Especially since it'll require a formal response and hopefully starts a dialogue while also leaving a papertrail.

Also, check your program handbook to see if it has a section detailing grievances or similar matters.

 

[PsychPhDone]

As it stands, we each have about 4-5 individual patients and one group, so we do about 5.5-6.5 hours of clinical work per week (out of a total of 44.5 hours that we are on-site). We are receiving didactics for 1.5 hours once per week (total # of hours for seminars/supervision is about 7 hours per week). This equates to us having almost nothing to do for about 31 hours per week. We also have all gone to the supervisors with this and continue to express our frustration and disappointment at this. Unfortunately, one of my individual supervisors is the training director for the site (but works in a different program so is less aware of the daily goings on in our program) and I have tried to bring this up but she changes the topic. I might either reach out to her via email or be more insistent next time we speak.

When did you start?

 

[nailah16]

When did you start?

End of July, so almost 2 months ago.

 

[Terri Dactyl]

Agreed about checking your internship training manual for any type of guidance on bringing up grievances. And also strength in numbers.

If you can start it now, begin documenting any efforts that have been made to bring this up to your supervisors. Day, time, persons involved, and issue(s) discussed and their response or lack thereof etc; in addition to the hours you are tracking for time that is being spent.

If as a group your concerns about meeting minimum training requirements, especially contact hours, goes further ignored without any act to remediate the situation, you may need to involve your training department so that they can advocate for you and ensure that you receive the training that was agreed upon and that is necessary for you to complete internship.

 

[PsyDr]

Got you, fam. Hated internship, skilled at getting work done, and then doing my own thing. Some ideas:

1) Subscribe to a ton of listservs, read their archives. These are an invaluable source of information, where you can literally see informal communications from world class thought leaders. Essentially, these are free classes from huge names. Don't comment. Just read. Learn some information. Learn who the players are, how they talk, who likes who, who hates who, controversial topics, etc. Ballers will look for trends in communication from potential employers in regions you're looking at. Superballers will notice the lifestyles of these people, cause some big names are poooor. Plus, reading your email at work is generally accepted.

2) Learn how awesome stairwells are. No one looks there, and no one questions a person walking out of a stairwell. Nice place to read a book, if that is unacceptable in your place.

3) Learn about the business of psychology. CPT codes and all that.

4) Do a deep dive into whatever subject matter you're into. And I mean deeeeeeeeeep.

5) Review stats, and explore deeper maths. No one questions a person with a ton of weird formulas on the screen. Coincidentally, did you know that both the binomial theorem and monte carlo simulations apply to Las Vegas?

6) some browser extensions make it look like you're using Word or excel.

7) Review trends of stuff you're into a few hours of week. Maybe you call the trust to learn about what malpractice insurnace costs. Maybe you're looking at buying a house in a specific area. Can't hurt to have a general idea of how home prices are trending there over the last year. Maybe you're looking at the stock market. Same. Maybe you're looking at starting salaries, or income taxes in a state, or a car, or whatever.

8) Make some games to screw with supervisors. Maybe they have turns of phrases that you can count, or pretend like you have to take a drink each time they say it (don't drink anywhere near clinical situations). Maybe you can distract them by bringing up a subject that makes them go on a rant; like how they promised paper clothes in the 60s.

9) Daydream about what you want your life to look like when you're licensed. Having a target makes life a lot easier. Once you have a target, you can make plans to meet those targets. Get very specific about this. Down to the clothes.

10) Define the key components of your work (e.g., the components of a clinical interview). Get better at this. A novice just asks the questions. A master can work the questions into casual conversation in such a way that the patient never knows it happened. Maybe this is trying to take a pulse via handshake (seen it done, never been able to do it). Maybe this is orientation questions, or gait assessment, or aphasia screening, or cranial nerves. Maybe it is determining the key componeents of a report, how many sentences are in each section, and then practicing how quickly you can write this.

11) Read stuff from other professions. Good to know how referral sources think. Ebay used to sell old professional books in batches/lots for super cheap. You have to put those books in the freezer for a week to kill potential bedbugs, but it is helpful.

12) Generally look busy using the Costanza methods, and by always carrying a clipboard.

 

[summerbabe]

And if you haven't yet been working on dissertation during the downtime, get going! I was encouraged to do so during my VA internship and it was super helpful.

Hopefully you'll get a significant bump in direct contact hours soon but even if you hit the originally promised 50% mark and you're thoroughly prepping and documenting, there likely would still have been some free time.

 

[AbnormalPsych]

Also, if you work for VA - figure out a way to move your mouse every 2-5 minutes so it looks like you are "active" on Skype (or whatever you people are using these days) at your workstation while you read or do whatever. Protip - place a watch underneath the mouse, the movement of the second hand should do the trick. There are battery operated movement devices, but you know... noise, and that may look weird if someone walks in.

 

[conky124]

Hi all,

I'm about two months into my Pre-Doctoral internship (Clinical Psychology PhD student here) and I have nothing to do. I'm talking having 4-7.5 hours per day (out of an 8 hour workday) where I have literally nothing to do associated with my internship. I spend only 10-15% of my time doing clinical work when the program was advertised as providing clinical services 45-50% of the time. When this has been brought up to supervisors, they either brush it off and say it will get better or they assign us administrative tasks like chart audits or alphabetizing the chart room. There are new patients coming in, however they are being assigned to the staff therapists as their job depends on their productivity and mine does not as I am contracted and can't get fired for lack of productivity. I'm disappointed to say the least as this is not how I imagined spending my last year of clinical training before the end of my program. I'm struggling with what to do here and want to see if this is a common experience? I'm also wondering if my expectations for this year are too high given the pandemic and other societal issues. Thanks in advance!

I am running into a similar problem at my VA internship. I am in the SUD clinic and then do an administrative like rotation on the side so I have been getting few clinical hours. I was bored to tears only until very recently due to getting a couple more clients. I just keep bringing up the issue gently in clinic meetings and supervision. My supervisors had brushed it off too then realized there may be a problem within the clinic with other providers (mainly SWs) who are referring all the clients to themselves to keep their productivity up. I do think that it could be a problem in some clinics that is made a lot worse with COVID.

During COVID shut down I felt envious of the essential and front line workers although I appreciated them and the very hard work they did. There is no shame in wanting to stay home during all of this to keep yourself and others safe, I just hate the feeling of sitting on the sidelines with nothing to do and feeling held back from helping. In regard to the SUD clinic I am concerned that treatment isn't getting to clients who likely desperately need it at this time.

 

[conky124]

Got you, fam. Hated internship, skilled at getting work done, and then doing my own thing. Some ideas:

1) Subscribe to a ton of listservs, read their archives. These are an invaluable source of information, where you can literally see informal communications from world class thought leaders. Essentially, these are free classes from huge names. Don't comment. Just read. Learn some information. Learn who the players are, how they talk, who likes who, who hates who, controversial topics, etc. Ballers will look for trends in communication from potential employers in regions you're looking at. Superballers will notice the lifestyles of these people, cause some big names are poooor. Plus, reading your email at work is generally accepted.

2) Learn how awesome stairwells are. No one looks there, and no one questions a person walking out of a stairwell. Nice place to read a book, if that is unacceptable in your place.

3) Learn about the business of psychology. CPT codes and all that.

4) Do a deep dive into whatever subject matter you're into. And I mean deeeeeeeeeep.

5) Review stats, and explore deeper maths. No one questions a person with a ton of weird formulas on the screen. Coincidentally, did you know that both the binomial theorem and monte carlo simulations apply to Las Vegas?

6) some browser extensions make it look like you're using Word or excel.

7) Review trends of stuff you're into a few hours of week. Maybe you call the trust to learn about what malpractice insurnace costs. Maybe you're looking at buying a house in a specific area. Can't hurt to have a general idea of how home prices are trending there over the last year. Maybe you're looking at the stock market. Same. Maybe you're looking at starting salaries, or income taxes in a state, or a car, or whatever.

8) Make some games to screw with supervisors. Maybe they have turns of phrases that you can count, or pretend like you have to take a drink each time they say it (don't drink anywhere near clinical situations). Maybe you can distract them by bringing up a subject that makes them go on a rant; like how they promised paper clothes in the 60s.

9) Daydream about what you want your life to look like when you're licensed. Having a target makes life a lot easier. Once you have a target, you can make plans to meet those targets. Get very specific about this. Down to the clothes.

10) Define the key components of your work (e.g., the components of a clinical interview). Get better at this. A novice just asks the questions. A master can work the questions into casual conversation in such a way that the patient never knows it happened. Maybe this is trying to take a pulse via handshake (seen it done, never been able to do it). Maybe this is orientation questions, or gait assessment, or aphasia screening, or cranial nerves. Maybe it is determining the key componeents of a report, how many sentences are in each section, and then practicing how quickly you can write this.

11) Read stuff from other professions. Good to know how referral sources think. Ebay used to sell old professional books in batches/lots for super cheap. You have to put those books in the freezer for a week to kill potential bedbugs, but it is helpful.

12) Generally look busy using the Costanza methods, and by always carrying a clipboard.

This is gold

My favorite Costanza method is to maintain a slightly furrowed brow as it looks like you are working hard. Also, take advantage of swing space you sign out during no-shows. Great place for a power nap to get over that brown bottle flu

 

[cara susanna]

Also, if you work for VA - figure out a way to move your mouse every 2-5 minutes so it looks like you are "active" on Skype (or whatever you people are using these days) at your workstation while you read or do whatever. Protip - place a watch underneath the mouse, the movement of the second hand should do the trick. There are battery operated movement devices, but you know... noise, and that may look weird if someone walks in.

You could just always show yourself as away. That's what a lot of people do here. Unless your site gets mad about that, but even some admin do it here.

 

[summerbabe]

I just keep bringing up the issue gently in clinic meetings and supervision. My supervisors had brushed it off too then realized there may be a problem within the clinic with other providers (mainly SWs) who are referring all the clients to themselves to keep their productivity up.

Have you talked to your TD? They may need to gently remind the supervisor(s) of their training obligations.

Your direct supervisor is getting productivity credit since they are the primary provider in CRPS and it would benefit them to be more proactive/aggressive in securing you cases as new consults come.

Are your supervisors new to training? New to the VA system/this SUD clinic? Are there tensions in clinic? Has your VA offered productivity guidelines that people are struggling to meeet (e.g., x% VVC apts to remain on ad hoc telework)?

 

[conky124]

Have you talked to your TD? They may need to gently remind the supervisor(s) of their training obligations.

Your direct supervisor is getting productivity credit since they are the primary provider in CRPS and it would benefit them to be more proactive/aggressive in securing you cases as new consults come.

Are your supervisors new to training? New to the VA system/this SUD clinic? Are there tensions in clinic? Has your VA offered productivity guidelines that people are struggling to meeet (e.g., x% VVC apts to remain on ad hoc telework)?

My supervisors aren't new and actually are pretty great. They just work up with the MHS chief. One is the chief of operations and used to run the SUD clinic and the other is an assoc MHS chief and may still be the TD but transitioning out. They are aware of it and they have been doing their best to make changes once they realized the problem wasn't just a slow start. I was just told the SUD clinic just received a lot of referrals so they assured me it is changing. They have also been addressing the other clinic issues, but the last chief of the clinic was very hands off and apparently providers just started doing their own thing which lead to bad habits. I also don't think some clinicians were happy that they had to come back into work because of the interns and fellows starting. They are also transitioning SWs out of the intake evals and making only psychologists do them (including their psychology supervisees, this may be VA wide). So I guess there is some tension. I also think maybe a couple of folks in the SUD clinic just don't like my face. That isn't new to me, I've been told that my face makes me look like a d-bag to some people, lol.

 

[erg923]

yeah, I was under the impression that that was a bizarre request... It's almost like gaslighting; they're trying to convince us that this is a normal response to not giving us patients.

It should be embarrassing to them that they even thought this was appropriate use of time for a doctoral-level training position. I probably would have given some lip about this back to them. I'm sure APA would be thrilled to learn about this....

 

[WisNeuro]

It should be embarrassing to them that they even thought this was appropriate use of time for a doctoral-level training position. I probably would have given some lip about this back to them. I'm sure APA would be thrilled to learn about this....

What better way to learn what assessment instruments are available and where they are, than by reorganizing the assessment closet? Honestly, if its minimal, a little admin work here and there isn't a big deal.

 

[erg923]

What better way to learn what assessment instruments are available and where they are, than by reorganizing the assessment closet? Honestly, if its minimal, a little admin work here and there isn't a big deal.

Time would be better spent problem solving why the are seeing fewer patients/clinical hours than a practica students would? And even then, why not assign research and clinical reading literature/articles, more didactics, supervision training, design a mini clinical research project, give dissertation time etc??? In other words, use their heads a little, right? Sounds lazy.

Its not clear what the COVID role is here, but if they don't have a telehealth plan set-up for interns 7 months into this, that's also a sign of problems with the training program, IMHO.

 

[WisNeuro]

Time would be better spent problem solving why the are seeing fewer patients/clinical hours than a practica students would? And even then, why not assign research and clinical reading literature/articles, more didactics, supervision training, design a mini clinical research project, give dissertation time etc??? In other words, use their heads a little, right? Sounds lazy.

Its not clear what the COVID role is here, but if they don't have a telehealth plan set-up for interns 7 months into this, that's also a sign of problems with the training program, IMHO.

Indeed, which is why I qualified my statement with "minimal." They should be getting all of those things, but an hour or two of admin work here and there isn't going to kill anyone, and it's not a violation of any kind. In the OPs case, there's a lot more wrong than just some organizing of files.

 

[AbnormalPsych]

You could just always show yourself as away. That's what a lot of people do here. Unless your site gets mad about that, but even some admin do it here.

This was frowned upon at the VAs I was at. On internship some trainees actually got called out on it. It was wild.

My current place is much more chill about all that.