Am I being difficult?

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tennispsycguy747

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So I recently started a new rotation on internship and am in the midst of trying to learn a new clinical settings I am not familiar with. Last supervision, my supervisor said that they would be expecting me to write 10-12 page reports in 2 hour time frames. I was shocked, as I have never heard of any student, outside of maybe really experienced neuropsych students, being able to accomplish such fast writing. I consider myself a somewhat slower writer, and definitely do not have an extensive neuropsychology or assessment background. Also, should note that these reports include no tables and are heavy on chart review and history.

Am I being unreasonable for thinking that I won't be able to meet this high expectation?
 
Step 1: obtain an old report for EACH type of diagnosis.
a. Use the normal appeasing BS with your supervisor to get it (e.g., “Dr. X, I’d like to learn more from you. Can I look at some old reports to see how you do it? Is there a patient who is ideal for (insert most common Dx?”). Start with the most common dx, obtain that, get supervisor comfortable with the process, then repeat for the next most common, etc.
b. If that process fails, bring donuts, or a $5 gift card to starbucks, for the administrative assistants, and then ask them for the same.
c. If that process fails, ask other interns and/or former students. This isn't the first time this has happened: Someone has an email saved with some reports or forms.

Step 2: de -identify said report(s).

Step 3: copy and paste that BS to word create a "bank" of report components *
a. If they use a format where they go by test: copy and paste that BS
b. If they go by domain, determine where each test/sub test goes in the paragraph structure. Identify how they describe each test (e.g., "on a test of conceptual fluency...").
c. Start a document to "bank" recommendations.
d. Also start a document to "bank" professional terms with weird spelling (e.g., encephalomalacia). Save that document, add each word to your Word's dictionary. You'll need this document when you switch computers in the future.

Step 4: Go back to #2, and create a form FOR EACH DIAGNOSIS. Use a low frequency text to replace common terms (e.g., use Zzz for male/female; WWW for standard scores; UUUU for t scores; etc). Now you can just search for those low frequency texts, and replace with whatever. It’s the dumb man’s macro. Just remember to proof it before it goes back to a supervisor.

Step 5: read Lezak in an efficient way. Look at the Table of Contents. There’s really like 2 general categories of neuropsychological patterns of performance. Just memorize cortical and subcortical patterns. Now go back to the Table of Contents, and identify the 3 general pathologies associated with a cortical pattern (but you should probably add vascular to that sorta), and 5 general pathologies of subcortical patterns. Yes, there are a bunch of other diagnoses in there. Don't worry about that right now.

Step 6: Look at WHERE you are practicing. Are you in a generic clinic? A "memory" clinic? A movement disorder clinic? Now look at WHO is referring the patient to you. Is it a neurologist? Is it a psychiatrist? Great. Now you know what 70% of your diagnoses are going to be. Go back to Lezak, read page 347. You would feel pretty good if you were taking a multiple choice test, and you knew that "B" would be correct 70% of the time.

*if you are an iPhone user, google how to use the camera to convert pictures to text.
** page 607 of the DSM5 gives you the psychometric definitions of neurocognitive disorders
 
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At the prac level, I'd say it's unreasonable, at the intern level, reasonable. Get a de-identified report from your supervisor(s), make a template, write the report in under two hours. Large portions of history sections are fairly plug and play info.
Even if I have a condition that impacts concentration?
 
Even if I have a condition that impacts concentration?
You are about to experience a pretty strong culture change, as you move from being a student to being a professional. When in school, the environment accommodates your difficulties. When you are a healthcare professional, the environment neither cares nor accommodates your difficulties. I'm sorry it's hard for you, but I would urge you to think about what happens to healthcare providers who are impaired. Hint: it starts with a licensing board.

Would you excuse lapses in care from your physician, because he/she is going through a divorce? Or is that just medical malpractice? Would you tell your criminal defense lawyer, "It's okay that I'm going to prison for 6 months because you forgot to file that thing when you were having a hard time?". Or would you sue for legal malpractice? Does the IRS accept excuses, or do they just start fining you?
 
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I write long reports at my neuro prac site that typically take me 4 hours to complete give or take depending on the complexity of the case, how long the battery is (usually 6 hours), and how familiar I am with the presenting condition. This includes chart review. My advice is to familiarize yourself with your supervisors writing style and reports asap before you try writing your first one. You want to automate this process as best as you can.

Your first one is always going to take significantly longer, but you’ll eventually become more efficient. Two hours seems rather quick to me if you haven’t had much assessment experience during your practicum.

The two hour pomodoro videos on YouTube have worked wonders for me and some people in my cohort. I believe the technique was developed for students struggling with focus and time management.
 
It may not seem like it now but your supervisor is doing you a huge favor. You might surprise yourself at how efficient you can get.
So. True.

I can write up the results section in my sleep now bc it’s mostly templated. The synthesis of the data boiled down to 1-2 paragraphs are what referrers care about, but you can’t just do that part well off of the bat. Writing those obnoxiously long reports can feel like torture, but you’ll get so much better about distilling down all of the details as you learn to cut and refine your craft.

When I first got out I joked that I was a “professional homework do’er”, but it’s true. If trained correctly, a neuropsychologist will become an excellent writer, which dovetails nicely w legal work. Being methodical and detailed oriented are both vital skills, but they lead to well written reports, which can lead to a very comfortable career. Those long reports suck, & I’ll still occasionally will dream about one, but they are an important part of training. You need to enjoy the process, but once you get a few years out, you can work half as much as other psych colleagues and make twice as much.
 
I think it's unreasonable to expect 2 hour writing turn around times. Sounds like a sweatshop of testing, just pumping em out. I wouldn't , in your position as an intern, say it that way of course. Talk to your school and see what their thoughts on this are.

I trained and worked in a number of neuropsych practices and the standard turn around time from clinical interview to feedback session was roughly 2 weeks or so. They'd generally allot 8 hours for testing and maybe 6 hours for scoring/writing/reviewing. But this was in rotation with other cases. Most of the older neuropsychologists I know tend to chunk their workweek like "Mon/Wed - testing, Tue/Thur - scoring/writing/reviewing".)

End of the day though others here are correct, get some templates of reports, learn to copy/paste and edit as needed, and just get through the internship as best you can. Their advice is by and large a strategy to just getting through this internship. A silver lining is that you'll become more efficient in your report writing; and it's likely not a battle worth getting into for an internship. Once you're licensed you can be more selective about the work you take on or what you're willing to compromise on for your work if you are employed by someone else as there will be another opportunity.

You are about to experience a pretty strong culture change, as you move from being a student to being a professional. When in school, the environment accommodates your difficulties. When you are a healthcare professional, the environment neither cares nor accommodates your difficulties. I'm sorry it's hard for you, but I would urge you to think about what happens to healthcare providers who are impaired. Hint: it starts with a licensing board.

Would you excuse lapses in care from your physician, because he/she is going through a divorce? Or is that just medical malpractice? Would you tell your criminal defense lawyer, "It's okay that I'm going to prison for 6 months because you forgot to file that thing when you were having a hard time?". Or would you sue for legal malpractice? Does the IRS accept excuses, or do they just start fining you?
How exactly does a setup pushing interns to pump out reports in 2 hours factor into this? If anything rushing to finish the work might lead to more problems than taking adequate time to complete the work. In OP's case the burden of liability lies with the supervisor and the site if they rush their interns.

As for things like ADHD, the ADA absolutely does offer protections and requests for reasonable accommodations. If OP is concerned that their concentration/focus would lead to difficulties with their work, in this setting, wouldn't the school have recourse to tell the internship site that student needs additional time to complete written reports? And when OP is out working in the field, if they're in a practice or employment situation where this arises again, do they not have the right to file an ADA reasonable accommodation request? Being aware of and proactive in recognizing and in managing one's difficulties is far better than just scare tactics or telling people to essentially suck it up. After all, aren't we generally in the business of helping people manage and adapt based on their strengths and their weaknesses?

There's still stigma towards mental health difficulties among healthcare professionals (i.e. medical doctors who may be depressed but couldn't seek treatment due to fear of licensing board or professional scrutiny) but let's be a voice for reducing stigmas, not increasing them: Out of the shadows: Physicians share their mental health struggles

OP, you'll eventually find your rhythm and flow in report writing that works for you. There will be opportunities and strategies to help you balance concentration difficulties with doing the work. The goal presently is to try and bridge the gap between what you can do and what this internship expects you to do.
 
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So. True.

I can write up the results section in my sleep now bc it’s mostly templated. The synthesis of the data boiled down to 1-2 paragraphs are what referrers care about, but you can’t just do that part well off of the bat. Writing those obnoxiously long reports can feel like torture, but you’ll get so much better about distilling down all of the details as you learn to cut and refine your craft.

When I first got out I joked that I was a “professional homework do’er”, but it’s true. If trained correctly, a neuropsychologist will become an excellent writer, which dovetails nicely w legal work. Being methodical and detailed oriented are both vital skills, but they lead to well written reports, which can lead to a very comfortable career. Those long reports suck, & I’ll still occasionally will dream about one, but they are an important part of training. You need to enjoy the process, but once you get a few years out, you can work half as much as other psych colleagues and make twice as much.
So if people like OP make critical errors and mistakes in the name of making twice as much as their colleagues; how will this fare if they get caught up in a malpractice case, lawsuit, or just a headache of having to redo their work if they realize their errors before they finish the report and make it official?

I can template and write out stuff really fast, I can laser focus in 1 hour chunks and really get stuff done. But not everyone can and I'd urge leaning towards caution of knowing thyself and strengths/weaknesses to ensure the quality is more important than the quantity. I'm doubtful that 99% of testing and evaluation cases are so critical they need a turn around time this quick and there are likely strategies to manage one's professional time better. Some people will just take longer to, as you say, be methodical and detailed oriented with excellent writing.
 
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This seems ableist. What if OP has a documented disability and is worried that said disability would impair their functioning?

Efficiency in writing is a key competency. Once you are in private practice, feel free to take as long as you want, with the knowledge that at certain point, you will not be compensated for that work. ADHD is not a valid reason to take an inordinate amount of time to get work done.
 
How exactly does a setup pushing interns to pump out reports in 2 hours factor into this? If anything rushing to finish the work might lead to more problems than taking adequate time to complete the work. In OP's case the burden of liability lies with the supervisor and the site if they rush their interns.

As for things like ADHD, the ADA absolutely does offer protections and requests for reasonable accommodations. If OP is concerned that their concentration/focus would lead to difficulties with their work, in this setting, wouldn't the school have recourse to tell the internship site that student needs additional time to complete written reports? And when OP is out working in the field, if they're in a practice or employment situation where this arises again, do they not have the right to file an ADA reasonable accommodation request? Being aware of and proactive in recognizing and in managing one's difficulties is far better than just scare tactics or telling people to essentially suck it up. After all, aren't we generally in the business of helping people manage and adapt based on their strengths and their weaknesses?
1) I wasn't defending the supervisor.
a. I gave OP a very good way to get through this, in very actionable steps. I don't see anyone else doing that.
b. So where did anyone ever suggest that they "suck it up"?
2) As I said, in an educational setting the environment can adjust to someone's difficulties.
3) As I said, employment settings do not have to accommodate anything. An employer can request any accommodations they want from an employer. But accommodations must be "reasonable" for that specific employer. Guess who gets to determine if an accommodation is "reasonable"? The employer. They can just write the job description as "must get reports done in X hours". If it's the fundamental component of the job, accommodations don't apply. And most healthcare institutions are required to report impaired providers. Right or wrong, would you really want to tell a hospital that your cognition is impaired? I wouldn't want to dance on that wire.
4) I must have missed the literature where they recommend "avoid doing things that you can't focus on" in the ADHD and cog rehab literature.
5) Explain to me how you ask a patient for ADA accommodations.


OP is an overwhelmed student, asking for ways to deal with a hard situation. I am simply suggesting that he/she use a way to adapt and get through it (ie., a template). I'm also suggesting that patients have zero obligation to accommodate the provider. Next, I'm suggesting that an intern supervisor with this type of expectations is probably not going to accommodate much, and might retaliate. Finally, I'm again suggesting that OP use a template as a way to get around this situation.
 
Efficiency in writing is a key competency. Once you are in private practice, feel free to take as long as you want, with the knowledge that at certain point, you will not be compensated for that work. ADHD is not a valid reason to take an inordinate amount of time to get work done.
This is simply incorrect. Efficiency is important but not a key competency. Surely you’ve read reports from efficient money making practices that aren’t that good. And read reports from slow moving practices that are proverbial works of art lol.

Also ADHD is indeed a valid difficulty and if someone needs more time to effectively get the task done then they have the right to do so.

Telling someone do it in 2 hours because you have to is assuming just because you can they should to. Result is the same just different approaches.
 
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1) I wasn't defending the supervisor.
a. I gave OP a very good way to get through this, in very actionable steps. I don't see anyone else doing that.
b. So where did anyone ever suggest that they "suck it up"?
2) As I said, in an educational setting the environment can adjust to someone's difficulties.
3) As I said, employment settings do not have to accommodate anything. An employer can request any accommodations they want from an employer. But accommodations must be "reasonable" for that specific employer. Guess who gets to determine if an accommodation is "reasonable"? The employer. They can just write the job description as "must get reports done in X hours". If it's the fundamental component of the job, accommodations don't apply. And most healthcare institutions are required to report impaired providers. Right or wrong, would you really want to tell a hospital that your cognition is impaired? I wouldn't want to dance on that wire.
4) I must have missed the literature where they recommend "avoid doing things that you can't focus on" in the ADHD and cog rehab literature.
5) Explain to me how you ask a patient for ADA accommodations.


OP is an overwhelmed student, asking for ways to deal with a hard situation. I am simply suggesting that he/she use a way to adapt and get through it (ie., a template). I'm also suggesting that patients have zero obligation to accommodate the provider. Next, I'm suggesting that an intern supervisor with this type of expectations is probably not going to accommodate much, and might retaliate. Finally, I'm again suggesting that OP use a template as a way to get around this situation.
But it’s not a fundamental component of the job, it’s a preference not a requirement. I’ve had reasonable accommodations in the past due to health issues that can impact among other things my fatigue levels. And I’ve successfully obtained them in clinical settings because to all the points you mention : I wanted to get ahead of the difficulty and make sure I could do my job correctly not just quickly. And in some cases it didn’t even need to be a formal request. This isn’t an uncommon experience.

I’m not saying in OP’s internship this is necessary but let’s stop parroting this outdated narrative that just because one provider writes reports in 2 hours that this is the way it has to be. Efficiency is fine but it’s a preference not a mandate; we’re writing reports here not doing open heart surgery. Getting it done in a timely manner and triaging your more urgent reports is fine, but again this may vary.

Your advice to OP is fine, it’ll get them through the internship unless the supervisor then claims taking templates is copying and not learning (I’ve seen that happen to a fellow student where they got accused of plagiarism by a bad supervisor which was absolutely absurd and the supervisor ended up leaving that organization). So sure OP shouldn’t rock the boat but OP’s likely best course of action is to seek insight from their school before proceeding.
No one mentioned patients accommodating providers ; talking about practices and employers accommodating providers. You can avoid a lot of these subjective impairment issues by being proactive and setting mechanisms in place to alleviate the problem before it becomes a problem.

Let’s be real if it takes 2 hours or 8 hours to write these reports , the reason this place wants 2 hours is $$$.
 
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But it’s not a fundamental component of the job, it’s a preference not a requirement. I’ve had reasonable accommodations in the past due to health issues that can impact among other things my fatigue levels. And I’ve successfully obtained them in clinical settings because to all the points you mention : I wanted to get ahead of the difficulty and make sure I could do my job correctly not just quickly. And in some cases it didn’t even need to be a formal request. This isn’t an uncommon experience.

No one mentioned patients accommodating providers ; talking about practices and employers accommodating providers. You can avoid a lot of these subjective impairment issues by being proactive and setting mechanisms in place to alleviate the problem before it becomes a problem.

Let’s be real if it takes 2 hours or 8 hours to write these reports , the reason this place wants 2 hours is $$$.
Let’s be real, you’re not giving OP any actionable suggestions. You’re just taking about your personal experience, in a setting that is different than OP. You don’t get to decide if something is a fundamental part of a job. Again, the employer gives that in the job description, and the employer decides if an accommodation is reasonable for that specific job description. The job description and if an accommodation is “reasonable” varies from employer to employer.

Do you REALLY think that this particular supervisor is going to give accommodations? I don’t. I also don’t think anyone, besides Brainstormer, is giving actionable options. All this “oh, this supervisor is so wrong” or “it gets better” is completely useless.
 
If the site supervisor is asking for the task to be completed in 2 hours, I presume this is possible and feasible. A terrible report with wrong names, wrong pronouns for the client bc it’s a recycled report, and wrong numbers all over the place is going to take longer to fix than it would take to give additional time to the intern in the first place. I also presume that this is not a brand new practice and the supervisor has had other interns complete the task in the requested time.

There are other possibilities, but I’d say they’re low likelihood. Maybe the supervisor is a weirdo who gets off on correcting interns for terrible reports and loves wasting their own time. I’d say low probability. On the other hand, OP being withholding of some details on exactly what they’re being asked to do, and it being more feasible than they are presenting? Yeah frankly that’s a higher probability of being the case than an insane, self-sabotaging supervisor running a shoddy sweatshop.
 
Let’s be real, you’re not giving OP any actionable suggestions. You’re just taking about your personal experience, in a setting that is different than OP. You don’t get to decide if something is a fundamental part of a job. Again, the employer gives that in the job description, and the employer decides if an accommodation is reasonable for that specific job description. The job description and if an accommodation is “reasonable” varies from employer to employer.

Do you REALLY think that this particular supervisor is going to give accommodations? I don’t. I also don’t think anyone, besides Brainstormer, is giving actionable options. All this “oh, this supervisor is so wrong” or “it gets better” is completely useless.
Your actionable suggestions might help OP but they do little to highlight these ongoing problems in academia and in clinical training when it comes to bad supervisors and unbalanced power differentials.

I agree the supervisor doesn’t sound like they’re the type to have flexibility in this. Which is crappy for OP and I imagine is a scenario we’ve all seen or even experienced at some point during our training and education. A range of time expected for report writing is more reasonable than saying 2 hrs, but you’re right this supervisor probably would not agree and probably would say “that’s just the way I do it.”

What’s wrong with calling out the obvious? OP wants both a solution , and it seems , an answer to if they’re being unreasonable in their thinking…they’re not. It’s an unrealistic expectation that sounds like it’s coming from an inflexible old school supervisor.

As for jobs, how often do employers give specifics like that in job hiring details? Or change them on the fly after someone is hired?
 
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Your actionable suggestions might help OP but they do little to highlight these ongoing problems in academia and in clinical training when it comes to bad supervisors and unbalanced power differentials.

I agree the supervisor doesn’t sound like they’re the type to have flexibility in this. Which is crappy for OP and I imagine is a scenario we’ve all seen or even experienced at some point during our training and education. A range of time expected for report writing is more reasonable than saying 2 hrs, but you’re right this supervisor probably would not agree and probably would say “that’s just the way I do it.”

What’s wrong with calling out the obvious? OP wants both a solution , and it seems , an answer to if they’re being unreasonable in their thinking…they’re not. It’s an unrealistic expectation that sounds like it’s coming from an inflexible old school supervisor.

As for jobs, how often do employers give specifics like that in job hiring details? Or change them on the fly after someone is hired?

Here is the thing, the program is not going to get involved because they have no say about what happens at the internship. Beyond that, their main concern is to maintain the relationship with the internship for future students, not go to bat for a single student. Fair or unfair, this is not going to change because the internship has all the power. Complain too much and supervisors stop supervising and then there is no internship. At the end of the day, get through it and get your license. Then you have more freedom and power.
 
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Your actionable suggestions might help OP but they do little to highlight these ongoing problems in academia and in clinical training when it comes to bad supervisors and unbalanced power differentials.

I agree the supervisor doesn’t sound like they’re the type to have flexibility in this. Which is crappy for OP and I imagine is a scenario we’ve all seen or even experienced at some point during our training and education. A range of time expected for report writing is more reasonable than saying 2 hrs, but you’re right this supervisor probably would not agree and probably would say “that’s just the way I do it.”

What’s wrong with calling out the obvious? OP wants both a solution , and it seems , an answer to if they’re being unreasonable in their thinking…they’re not. It’s an unrealistic expectation that sounds like it’s coming from an inflexible old school supervisor.

As for jobs, how often do employers give specifics like that in job hiring details? Or change them on the fly after someone is hired?
So, when someone is confronted with an unfair situation, your approach is to tell them it’s unfair? And then, nothing?

I have answered your questions. I can’t say you have done the same.
 
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So if people like OP make critical errors and mistakes in the name of making twice as much as their colleagues; how will this fare if they get caught up in a malpractice case, lawsuit, or just a headache of having to redo their work if they realize their errors before they finish the report and make it official?
Sadly, the vast majority of trash reports just lose, but some still win. There are plenty of hacks out there who get referrals bc they are willing to say anything is a brain injury. I’m not encouraging that, quite the opposite.

My point was more about the importance of training and mentorship throughout, even if at times it can be abrasive and a lot of work. I try and talk about the good and bad of things. Many people are not cut out for neuropsych work bc it can be a grind, but most are in private practice, so they can make their own schedules.

In a classic PP (not out-pt practice connected to an AMC) allows for the most freedom. I do intakes Mon/Tues (clinical and IME interviews), Wed are mostly my F/U & Feedback days. Thur/Fri/Sat/Sun are only for report writing; afternoons on clinical days are soft times to report write…depending how I feel that day.

I see less patients each year as I do more record review. I also only schedule half day of face-to-face bc it wears me out, but I can do record review for 8-10hrs/day if needed. Flexibility comes w the experience and having a solid foundation. You have to really love writing, reading research, and analyzing data bc those are key components of the actual work. There is a lot of range within assessment, it just depends how you want to spend your time.
 
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Telling someone do it in 2 hours because you have to is assuming just because you can they should to. Result is the same just different approaches.
As someone who can be quite variable with efficiency, I always hate being told that. As a trainee I just had to grind through what my mentors wanted at each part of training. I wrote mainly at night and had to adjust to my mentor/supervisors. It sucked at times, but I preferred to write solid reports, but they took more time. It was a struggle throughout training (my ADHD was helpful & hurtful), but I tried to make the best of it.
 
As someone who has done a lot of work around trainee disability/accommodations, the question that needs to be answered here, legally, in regards to accommodation is if writing the reports in 2 hours is actually an essential function of the position, or if the essential function is something like "have reports completed by the end of the day of the evaluation," "have reports completely finalized and ready for feedback sessions within a week," "have documentation complete in X days to be able to bill insurance," etc. What is the essential function that the supervisor is trying to get at here? (This is different if you're in setting with standardized timelines like the VA, though if and how those can be accommodated is still kind of a gray area).
 
As someone who has done a lot of work around trainee disability/accommodations, the question that needs to be answered here, legally, in regards to accommodation is if writing the reports in 2 hours is actually an essential function of the position, or if the essential function is something like "have reports completed by the end of the day of the evaluation," "have reports completely finalized and ready for feedback sessions within a week," "have documentation complete in X days to be able to bill insurance," etc. What is the essential function that the supervisor is trying to get at here? (This is different if you're in setting with standardized timelines like the VA, though if and how those can be accommodated is still kind of a gray area).
Well said. I imagine there’s also way for OP or another student to inquire respectfully during supervision about the 2 hr requirement , phrasing it as a curiosity to learn more rather than a challenge to the 2 hr requirement. If OP doesn’t want to reveal their concern about focus and speed in writing they can phrase it as a clinical practice type question.

As someone who can be quite variable with efficiency, I always hate being told that. As a trainee I just had to grind through what my mentors wanted at each part of training. I wrote mainly at night and had to adjust to my mentor/supervisors. It sucked at times, but I preferred to write solid reports, but they took more time. It was a struggle throughout training (my ADHD was helpful & hurtful), but I tried to make the best of it.
Efficiency can be quite subjective. This is quite accurate and well said. Knew quite a few who had a similar experience to you.

So, when someone is confronted with an unfair situation, your approach is to tell them it’s unfair? And then, nothing?

I have answered your questions. I can’t say you have done the same.
I did. And to OP I recommended they talk with their school/program as well. So I provided a reason it’s unfair, experience with the issues at hand, and one possible path to determining next steps for OP.
 
Here is the thing, the program is not going to get involved because they have no say about what happens at the internship. Beyond that, their main concern is to maintain the relationship with the internship for future students, not go to bat for a single student. Fair or unfair, this is not going to change because the internship has all the power. Complain too much and supervisors stop supervising and then there is no internship. At the end of the day?. Get through it and get your license. Then you have more freedom and power.
Nah schools can and do get involved , but it might just be them consulting with the student to help the student figure out how to proceed. Might be guidance on how to navigate supervision and broaching the topic, might be strategies for managing it, or might be a question to the site.

Thats not the students’ problem or responsibility, it’s the program’s responsibility. Many programs go to bat for their students or at least try to help resolve the problem or least find where there can be some flexibility. You’ve never seen programs pull students and cut ties with sites? Happens. And no party involved really wants that outcome. Let’s not forget many internship sites probably rely on cheap internship labor and don’t want to lose that.

I agree sometimes it’s best to just buckle down and get through the BS and get on to the next step in the licensure process but we also shouldn’t keep helping perpetuate that it has to be this way.
 
Nah schools can and do get involved , but it might just be them consulting with the student to help the student figure out how to proceed. Might be guidance on how to navigate supervision and broaching the topic, might be strategies for managing it, or might be a question to the site.

Thats not the students’ problem or responsibility, it’s the program’s responsibility. Many programs go to bat for their students or at least try to help resolve the problem or least find where there can be some flexibility. You’ve never seen programs pull students and cut ties with sites? Happens. And no party involved really wants that outcome. Let’s not forget many internship sites probably rely on cheap internship labor and don’t want to lose that.

I agree sometimes it’s best to just buckle down and get through the BS and get on to the next step in the licensure process but we also shouldn’t keep helping perpetuate that it has to be this way.
Are programs able to pull students and cut ties with internship sites (through the APPIC match) or just practicum sites? For the latter, I imagine that it would be straightforward given that my program has a specific contract with each site, but I wonder how it would work given the additional loopholes of APPIC.
 
Are programs able to pull students and cut ties with internship sites (through the APPIC match) or just practicum sites? For the latter, I imagine that it would be straightforward given that my program has a specific contract with each site, but I wonder how it would work given the additional loopholes of APPIC.
A supervisor told me to do something that I think is hard -> my program should end my internship and sever all ties with the internship.

That’s definitely not how that works.
 
Are programs able to pull students and cut ties with internship sites (through the APPIC match) or just practicum sites? For the latter, I imagine that it would be straightforward given that my program has a specific contract with each site, but I wonder how it would work given the additional loopholes of APPIC.
I mean, a student is certainly free to leave an internship at any point and a school is free to discourage future students from applying to specific sites they believe to be problematic (or I guess prohibit by refusing to provide a DCT letter just because they are SO against a student going somewhere....but that would take a pretty whack-a-doodle program).

Pulling out of internship would likely mean:
- The student doesn't graduate that year, at least not with a clinical degree.
- Unless something has changed, the student will be prohibited from participating in match again. They may be able to pursue non-APPIC internships (if the program allows it). Or switch to a non-clinical track if the program allows it.

That said, this thread devolved at a reddit-caliber rate and I'm not sure whether to be impressed or disappointed with y'all. Stop hate-reading /r/therapists because I worry some of it is rubbing off. Notably, I don't think any of this is on the OP, who has really only said:
Last supervision, my supervisor said that they would be expecting me to write 10-12 page reports in 2 hour time frames.
Then followed it up with:
Even if I have a condition that impacts concentration?

We don't have any context here. Note that nowhere was it mentioned "We start beating you with chains at the 2 hour 5 minute mark to motivate you. Failure of internship occurs at 2 hours and 15 minutes."

Unless this supervisor is a known sociopath that everyone hates, chances are this isn't a big deal. Heck, its not even entirely clear OP views this as a serious problem with the supervisor - I initially read it more as them asking for a reality check on report writing in real-world settings. Start by clarifying whether that is an immediate expectation or just a misunderstanding. Based on the information we have, I think its entirely possible the supervisor responds with some form of "That's the goal and we're looking to get you there by the end of the rotation. But some reports will always take longer or shorter. I know you didn't come in with as much report writing experience as some, so we'll work on it - let me know how I can help."

I think PsyDr's initial post was some good advice for helping improve efficiency. In what I consider an extremely unlikely event based on current information this reaches a point where ADA is even a concern, I trust Futureapp's word on that.

Based on the information at hand we're a very, very, very, very, extremely, comically long way from a situation that warrants ADA complaints, dropping out of internship, banning this program from APPIC, criminal charges against the supervisor for "toxicity" or whatever reddit stuff might come up next 🤣

Edit: Oooo, I forgot about a referral to EMDR for processing the trauma of a supervisor stating this!
 
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Current pre-doc intern here. I would say for neuropsych reports I take around 4 hours and no one has raised any concerns about this time. For health related assessments (like bariatric evals etc) that include heavy chart review and history, I usually get those cranked out in about 2 hours ( they are usually only 5-6 pages though). One thing I see some folks struggle with is taking A LOT of time on chart review. Go in with a plan for what sort of notes and info you are looking for and stick to the plan. It is easy to get lost in the chart and little details and lose a lot of time. If you aren't already, make sure you know how to filter through notes if you are using an EHR system to search certain terms/note types so you aren't wading through a bunch of unnecessary notes. As someone who also struggles with attention and detail, start building your toolbox of skills that will help you to stay on track. I generally have to utilize some form of time chunking in order to get work completed. Whether it is right or not, if you end up working for anywhere other than pp, they are going to look a lot at productivity as the basis for performance evaluations, so it is a skill that will come in handy. Also, templates are so helpful and I would be really shocked if your supervisor cannot provide you some to help you out! Also, if you have a system to work with that has dot phrases as a capability, those can be lifesavers in cutting down on time for templated parts of reports. Hope any of this is helpful. We all out here just trying to make it 🙂
 
I agree that there's a lot of context missing. If 2 hours/report is the end goal of the rotation, that seems fine, and ideally the supervisor will be checking in as things go along. If it's an immediate expectation with potential repercussions if not met (which seems...excessive), then some concern and further action may be necessary, as discussed above.

When I supervised interns, it was routinely the case that by the end of my rotation, they'd about cut their report writing time in half. If they began having trouble keeping up with reports and evaluations, and/or they expressed concerns about the amount of time it was taking them to write, I would start providing more structure and support.

I know of training rotations that have run the gamut with expectations--some that allowed up to a month to complete reports, and some that required the eval and report be entered into the chart on the same day (from day 1). So it's very important to clarify what's a requirement vs. a guideline vs. a goal vs. an ideal outcome.

To the OP: I'd recommend that you start tracking your time spent on each major report writing component now (e.g., scoring, reviewing the chart, writing and editing the report). That way, you'll have some information to bring to your supervisor if you notice it's taking you longer than expected to finish.
 
So I recently started a new rotation on internship and am in the midst of trying to learn a new clinical settings I am not familiar with. Last supervision, my supervisor said that they would be expecting me to write 10-12 page reports in 2 hour time frames. I was shocked, as I have never heard of any student, outside of maybe really experienced neuropsych students, being able to accomplish such fast writing. I consider myself a somewhat slower writer, and definitely do not have an extensive neuropsychology or assessment background. Also, should note that these reports include no tables and are heavy on chart review and history.

Am I being unreasonable for thinking that I won't be able to meet this high expectation?
why so long? seems unnecessary. Summarize better.
 
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Even if I have a condition that impacts concentration?
As a psychiatrist, impaired concentration is one of the easiest symptoms to treat pharmacologically. Even if it isn't because of ADHD, oftentimes those sorts of medications can be reasonable. One can always stop taking the medication when in an environment that doesn't tax attention as much or once having figured out a way to get the tasks done without meds.
 
Too little info is provided to say much of value beyond what @PsyDr suggested.

Some people seem to be interpreting “2 hours” as “the patient is sitting in the waiting room and you better be done in 2 hours when they have their feedback session.” Seems more likely to me that the supervisor is saying “allocate 2 hours of your schedule each week to report writing for each report.” Bc the intern still needs direct contact hours time, that seems reasonable.

Likewise, what’s “write the report”? Is the history scrawled on cocktail napkins and it’s the OP’s job to interpret it? Or is the report in bullet points and OP just has to change it to normal paragraphs? Big differences in whether the time allowed is reasonable, no details provided to know which it is closer to.
 
why so long? seems unnecessary. Summarize better.
This may be outside the OP's control, which has typically been the case in my experience. My read is that the 10-12 page guideline is from the supervisor.

Although it's hard to know for certain without clarification.
 
Too little info is provided to say much of value beyond what @PsyDr suggested.

Some people seem to be interpreting “2 hours” as “the patient is sitting in the waiting room and you better be done in 2 hours when they have their feedback session.” Seems more likely to me that the supervisor is saying “allocate 2 hours of your schedule each week to report writing for each report.” Bc the intern still needs direct contact hours time, that seems reasonable.

Likewise, what’s “write the report”? Is the history scrawled on cocktail napkins and it’s the OP’s job to interpret it? Or is the report in bullet points and OP just has to change it to normal paragraphs? Big differences in whether the time allowed is reasonable, no details provided to know which it is closer to.
Yes, I agree with PsyDr.

Telling a trainee to write a 10-12 page report in 2 hours says a lot about the value the site puts on the quality of the report. OP, lower your standards, get it done, and keep your head down, especially if you want to stay on as a postdoc. Make it to the end of the rotation. You won't be at the bottom of a hierarchy much longer.
 
Except that research has shown that giving extra time for ADHD is actually not a great accommodation.

While this is true, issue at hand has nothing to do with ADHD (or really the OP) other than the fact that it was brought up as a defense or excuse. The two arguments here boil down to:

1. How can a trainee accommodate the system they are in vs the system being something that should accommodate the trainee.

2. Whether two hours is a reasonable expectation for the work to be completed (adhd or any other reason not withstanding).

As no one but the supervisor or the OP have a detailed handle on #2, the arguments have been about #1. It may be an unreasonable supervisor or a reasonable request that the trainee is struggling with at the moment. I have seen both things be true in the past. That said, the system usually has little interest in accommodating trainees because teaching and training are generally things that are either poor compensated or altogether uncompensated.
 
1. How can a trainee accommodate the system they are in vs the system being something that should accommodate the trainee.
Exactly.
It isn’t specified how many reports are done a week. Let’s say three. 6 hours of report writing per week in the schedule leaves lots of time for direct contact hours. If the intern claims they need 4 hours, that’s then 12 hours of report writing, which is a big chunk of time not seeing patients. It’s going to be the internship’s main priority that the intern gets enough contact hours. A licensing board isn’t going to accept “I have adhd” in lieu of missing 100 of the required internship hours.
 
Wasn't this just for tests?
Studies have looked at writing tasks (though probably not psychological reports).

Really extended time doesn't address poor time management or distractibility , which are often symptoms of ADHD.
 
This is simply incorrect. Efficiency is important but not a key competency. Surely you’ve read reports from efficient money making practices that aren’t that good. And read reports from slow moving practices that are proverbial works of art lol.

Also ADHD is indeed a valid difficulty and if someone needs more time to effectively get the task done then they have the right to do so.

Telling someone do it in 2 hours because you have to is assuming just because you can they should to. Result is the same just different approaches.
This is still such a wild thing to post.
 
So I recently started a new rotation on internship and am in the midst of trying to learn a new clinical settings I am not familiar with. Last supervision, my supervisor said that they would be expecting me to write 10-12 page reports in 2 hour time frames. I was shocked, as I have never heard of any student, outside of maybe really experienced neuropsych students, being able to accomplish such fast writing. I consider myself a somewhat slower writer, and definitely do not have an extensive neuropsychology or assessment background. Also, should note that these reports include no tables and are heavy on chart review and history.

Am I being unreasonable for thinking that I won't be able to meet this high expectation?
Is this for the final report after the full assessment? If so, most of the information will probably be plugged in (other than the results of the testing) and if there are any de-identified templates as said above ^ you should be able to manage it. I would suggest getting familiar with the language used in old reports and what sections need certain key pieces of information to serve as a guide for yourself.

My first practicum required nearly 30 pages for the reports (neuropsych rotation). It was a lot, and we got heavy criticism/feedback, but it certainly is possible to get done.

The problem you may run in to is the slow writer part. Are you a slow typer, or slow to come up with what you want to say?
 
Is this for the final report after the full assessment? If so, most of the information will probably be plugged in (other than the results of the testing) and if there are any de-identified templates as said above ^ you should be able to manage it. I would suggest getting familiar with the language used in old reports and what sections need certain key pieces of information to serve as a guide for yourself.

My first practicum required nearly 30 pages for the reports (neuropsych rotation). It was a lot, and we got heavy criticism/feedback, but it certainly is possible to get done.

The problem you may run in to is the slow writer part. Are you a slow typer, or slow to come up with what you want to say?
30 pages for a non-forensic eval is excessive.
 
Hell, most of my forensic reports are <30pg bc there are commonly utilized citations and structures within a report that tend to be pretty concise if written correctly. As long as the record review isn’t mountainous, super lengthy reports are not necessary in most settings, unless you get into the weeds in an addendum/rebuttal report.

Clinical reports w the kitchen sink are fine for learning and part of the process, but not ‘’typical” outside of pre-internship training.
 
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