New paper on the internship crisis

[MCParent]

Not to toot my own horn, but....

http://www.ncbi.nlm.nih.gov/pubmed/26991243

J Clin Psychol. 2016 Mar 18. doi: 10.1002/jclp.22290. [Epub ahead of print]
"The Worst Experience of My Life": The Internship Crisis and Its Impact on Students.
Parent MC1, Bradstreet TC1, Wood M2, Ameen E2, Callahan JL3.
Author information

Abstract
OBJECTIVE:
The objective of the present study was to understand how internship applicants perceive themselves as being affected by the ongoing imbalance between the number of internship spots available and the number of applicants to internship.

METHOD:
The present study undertook a qualitative, and supplemental quantitative, analysis of 1,076 internship applicant responses to an item included in the 2011 postmatch survey asking participants how the internship crisis has affected them.

RESULTS:
Results indicated that the internship application process in general was viewed overwhelmingly negatively. Respondents described personal stress and system issues in their responses. Respondents described reciprocal stresses; applications spur on stresses, which are compounded by fears of not matching. Such fears cast negative light on training. Participants also described resiliencies that buffered against stresses and perceptions of discrimination or bias that add to stress.

CONCLUSIONS:
The implications of these findings for supporting students, working to resolve the internship crisis, and adapting policy are discussed.

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[AcronymAllergy]

Results indicated that the internship application process in general was viewed overwhelmingly negatively.

Unfortunate, but not surprising.

I'd be interested to see if things change after the current cycle, with the more even match between spots and applicants (although of course still with an imbalance with respect to accredited sites/spots).

 

[WisNeuro]

I'd be interested to see how students' perceptions of their training, readiness, and confidence in matching affects this view.

 

[MCParent]

I'd be interested to see how students' perceptions of their training, readiness, and confidence in matching affects this view.

We checked for differences among those who matched and did not, among those who gave a clear indication of either in their responses. There were not major differences.

 

[WisNeuro]

We checked for differences among those who matched and did not, among those who gave a clear indication of either in their responses. There were not major differences.

Ah, interesting.

 

[bmedclinic]

what about differences based on where they matched in their ranking list?

 

[MCParent]

what about differences based on where they matched in their ranking list?

Those data were not linked to the qual responses.

 

[bmedclinic]

Those data were not linked to the qual responses.

ah, i've forgotten since its been a few years since I matched. I'd be interested in this, if ever available. TBH though, it really doesnt matter too much since across the board seems like everyone hates the process pretty equally.

 

[smalltownpsych]

ah, i've forgotten since its been a few years since I matched. I'd be interested in this, if ever available. TBH though, it really doesnt matter too much since across the board seems like everyone hates the process pretty equally.

That's how I interpreted the results. I think even if they resolved the crisis, we would still hate the process. In other words, if you really enjoy the whole application process, I'm thinking you might have bigger problems that could preclude you from matching anywhere. Although, I did like travelling to the interview sites cause it gave me a chance to do a little sightseeing though. Too bad I was so poor at the time.

 

[WisNeuro]

That's how I interpreted the results. I think even if they resolved the crisis, we would still hate the process. In other words, if you really enjoy the whole application process, I'm thinking you might have bigger problems that could preclude you from matching anywhere. Although, I did like travelling to the interview sites cause it gave me a chance to do a little sightseeing though. Too bad I was so poor at the time.

I actually enjoyed the process. I kind of like traveling and a hectic schedule though. It really only started to wear on me at the very end. I had also budgeted for it for the year prior, so I didn't feel like I was scraping by.

 

[deleted343839]

I can't say I enjoyed applying for internship, though it doesn't come close to the few events competing for top billing as "worst experience of my life."

 

[Ardor]

what about differences based on where they matched in their ranking list?

You would have to think that would significantly impact applicants' reflections on the entire process...

 

[WisNeuro]

I can't say I enjoyed applying for internship, though it doesn't come close to the few events competing for top billing as "worst experience of my life."

Yeah, if that is someone's worst ever life experience, I'd have to say that their life has been extremely fortunate up to that point.

 

[erg923]

"Worst experience of my life" seems quite melodramatic and largely dependent on ones tendency towards catastrophication, coping skills, distress tolerance, overall confidence level, presence of anxiety disorders, etc.

That said, no, I did not really enjoy it. It was statically hyper-competitive(which will spike non pathological levels of anxiety in anyone), airplanes and travel in dead middle of winter suck, and it all felt very impersonal and devaluing. Especially not even being offered a freakin breakfast in the morning. What the ****!

 

[bmedclinic]

You would have to think that would significantly impact applicants' reflections on the entire process...

it does for me, I clearly did a terrible job at matched at my #7 slot. Ugh. I still feel like I wasted a year.

 

[AcronymAllergy]

You would have to think that would significantly impact applicants' reflections on the entire process...

Possibly, although perhaps in a variety of ways. We might think folks who matched higher on their list would be happier with the process, for example, but then there might be a bimodal satisfaction/happiness distribution, where those who matched toward the end of their list were equally happy to have matched somewhere (rather than needing to go through the process again).

I randomly also wonder if there's any satisfaction difference between folks matching in Phase I vs. Phase II.

 

[Justanothergrad]

Unfortunate, but not surprising.

I'd be interested to see if things change after the current cycle, with the more even match between spots and applicants (although of course still with an imbalance with respect to accredited sites/spots).

I think the big issues impacting frustration with the system is the combination of cost (seriously, which single grad student has the cash for this) and lack of feedback/perceived randomness for sites you get selected for interview, and difficulty with life planning (how do you move forward with planning relationships, kids, etc. with so much uncertainty). Mix in when sites are nothing like what they describe themselves or entirely crummy and a waste of your time and its a recipe for a frustrating experience. For the programs I'm involved with folks from, no one should have been concerned about matching (or matching accredited) given history/reputation, but we still worried about these factors a lot. However, As long as a large number of folks don't get accredited sites, there will continue to be heighten anxiety about that as well.

 

[smalltownpsych]

I was reading some of the med students talking about the psychiatry match process and noticing some catastrophizing tendencies there, as well. The higher the stakes, the greater the anxiety and even lower probability events become more threatening. I'll gamble 50/50 odds for a few bucks easily, but a game of Russian roulette where it is one out of six - I don't think so. The match process is not quite life or death, but we do have a lot riding on it.

 

[WisNeuro]

I was reading some of the med students talking about the psychiatry match process and noticing some catastrophizing tendencies there, as well. The higher the stakes, the greater the anxiety and even lower probability events become more threatening. I'll gamble 50/50 odds for a few bucks easily, but a game of Russian roulette where it is one out of six - I don't think so. The match process is not quite life or death, but we do have a lot riding on it.

For reputable grad programs, your odds are exceedingly good. The stakes are high, but when your program is riding a 95%+ accredited match rate, the anxiety may outpace the actual risk.

 

[Justanothergrad]

For reputable grad programs, your odds are exceedingly good. The stakes are high, but when your program is riding a 95%+ accredited match rate, the anxiety may outpace the actual risk.

Too bad decision making about worry (and anything else really) has so little to do with logical thought processes

 

[WisNeuro]

True, but that's a personal issue rather than a programmatic one.

 

[smalltownpsych]

For reputable grad programs, your odds are exceedingly good. The stakes are high, but when your program is riding a 95%+ accredited match rate, the anxiety may outpace the actual risk.

I would still have been worried that I would be that 1 out 2o or even 100 who didn't make it. Our program had a nearly 100% match rate for those who didn't limit themselves geographically. I applied broadly and still had a few sleepless nights. I matched at my top choice and then I thought, "that wasn't so bad, what was I so worried about."
To be honest I had more stress about applying for doctoral programs than I did with the match. During the match, I had the support and camaraderie of my cohort, during grad school apps I had my non-college educated family members saying "I don't see what the big deal is about it."

 

[MCParent]

"Worst experience of my life" seems quite melodramatic and largely dependent on ones tendency towards catastrophication, coping skills, distress tolerance, overall confidence level, presence of anxiety disorders, etc.

I assumed that was hyperbole on the part of the participant. Still, made a good title.

 

[Justanothergrad]

True, but that's a personal issue rather than a programmatic one.

How so?

Seems to reason that if the natural psychological process would be to worry based on the way the stressor (internship application) is structured, then perhaps expecting individuals to overcome that natural process would be a bit hard, to say the least. Why not put it on the system as a thing that is more easily changed and adapted rather than expecting biological factors to adapt?

 

[WisNeuro]

How so?

I simply don't believe that any and all anxiety provoking life experiences should be eliminated. Sometimes adversity is good. I'd rather try and help my students and patients learn to adapt to stressful life situations than have them avoid them at all costs.

 

[erg923]

How so?

Seems to reason that if the natural psychological process would be to worry based on the way the stressor (internship application) is structured, then perhaps expecting individuals to overcome that natural process would be a bit hard, to say the least. Why not put it on the system as a thing that is more easily changed and adapted rather than expecting biological factors to adapt?

???

For goodness, sakes, this is what half of counseling is. Helping individuals cope (functionally adapt) with less than perfect life/life circumstances. Life is hard sometimes, yes.

 

[Justanothergrad]

I simply don't believe that any and all anxiety provoking life experiences should be eliminated. Sometimes adversity is good. I'd rather try and help my students and patients learn to adapt to stressful life situations than have them avoid them at all costs.

Sure, I don't either. I'm about as far from touchy feely as it gets. I just don't see any 'value added' to having internship applications be extremely stressful. Is there some part I'm missing that helps us/the field?

???

For goodness, sakes, this is what half of counseling is. Helping individuals cope (functionally adapt) with less than perfect life/life circumstances. Life is hard sometimes, yes.

Sure, but the other half is advocacy for change. That seems a much more efficient approach here since we control the stressor's design. It just seems odd to stay the course of an obviously stressful (and inefficiently so) system given the easier option of changing it.

 

[WisNeuro]

Sure, I don't either. I'm about as far from touchy feely as it gets. I just don't see any 'value added' to having internship applications be extremely stressful. Is there some part I'm missing that helps us/the field?

Well, I imagine that students would also include things like competency exams, the EPPP, final exams, and going to the dentist as extremely stressful. I don't think we should be getting rid of those things either.

 

[Justanothergrad]

Well, I imagine that students would also include things like competency exams, the EPPP, final exams, and going to the dentist as extremely stressful. I don't think we should be getting rid of those things either.

True. Those things are very valuable (as is internship). But thats a bit of a logical fallacy. I never suggested we should get rid of internship as you suggest we should with comprehensive exams, etc. The issue I am suggesting has no effective purpose is the large degree of stress, not the experience (internship is useful, is the stress during the application process). So unless there is an incremental value to the rather large stress of the internship application process (a process which is largely ineffective and all consuming), why not re-evaluate it? Not just from a 'stress' perspective but from the financial burden perspective which (to be honest) I think is hugely problematic.

 

[WisNeuro]

True. Those things are very valuable (as is internship). But thats a bit of a logical fallacy. I never suggested we should get rid of internship as you suggest we should with comprehensive exams, etc. The issue I am suggesting has no effective purpose is the large degree of stress, not the experience (internship is useful, is the stress during the application process). So unless there is an incremental value to the rather large stress of the internship application process (a process which is largely ineffective and all consuming), why not re-evaluate it? Not just from a 'stress' perspective but from the financial burden perspective which (to be honest) I think is hugely problematic.

I'm with you on the financial burden aspect. I would not agree about the "largely ineffective and all-consuming" statements. Additionally, whenever we discuss the "internship crisis" we never discuss problems at the front end. Bad programs and/or students who are really not prepared for doctoral level work or career in the field, but are passed up the line anyway.

 

[Justanothergrad]

I'm with you on the financial burden aspect. I would not agree about the "largely ineffective and all-consuming" statements. Additionally, whenever we discuss the "internship crisis" we never discuss problems at the front end. Bad programs and/or students who are really not prepared for doctoral level work or career in the field, but are passed up the line anyway.

I think we're over looking the impact of the inefficiency. If you ask applicants how many times they flew/zig-zagged back and forth across the country and try to reschedule interviews (sometimes ineffectively) to avoid it or stayed a few extra days in hotels somewhere else from home to avoid that. The inefficiency is part of the financial burden. Its probably why neuropsych doesn't do this for their post-docs anymore and relies on the conference approach. It seems reasonable that it could be done in a similar way utilizing regions for internship. For the better part of a month and a half you simply aren't home and thats your life. In my mind, thats both inefficient and all consuming in my life.

I agree with have really bad gatekeeping. Thats just another layer to an already complex cake.

 

[AcronymAllergy]

I'd imaging physicians-in-training might be interested in potential solutions/changes as well, given that as far as I'm aware, their residency interview process also involves quite a bit of zigging and zagging. No clue to how many places the average medical student applies, but I believe it's even more than us (e.g., http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply says, per survey data, that it ranges from 21.7 to 58.2).

I think getting rid of the imbalance would be a huge step in the right direction toward reducing the anxiety induced by the process, and agree that much of this should be done via front-end methods rather than simply creating more spots.

No clue how to actually reduce the travel expenses/general hecticness, though. Regional conferences developed specifically for internship interviews to which sites and applicants can go (ala INS in neuropsych)?

 

[Justanothergrad]

No clue how to actually reduce the travel expenses/general hecticness, though. Regional conferences developed specifically for internship interviews to which sites and applicants can go (ala INS in neuropsych)?

I remember hearing my TD talk about this being a point that was up for discussion last year at APA for representatives until they had to spend the whole time talking about the hoffman report. Not sure what the solution will be, but I believe this was indeed one of the things up for consideration.

 

[DynamicDidactic]

congrats on the pub. Can't wait to read the full text when I get some free time.