Internship Questions - Competitiveness, Hours, etc.

[RxPsych]

Hi everyone,

I'd like some input from TDs (preferably VA neuro, but I'd love if others could jump in) regarding minimum hours to be considered for internship and some follow-up advice. I plan on applying to VAs and AMCs for their neuro tracks.

1) Which hours requirements should I be considering as the absolute minimum? For example, on the APPIC website a program lists the minimum required hours to apply as 250 intervention and 50 assessment. However, on their brochure, they list a "minimum of 500 hours of total practicum experience" as the requirement, with no mention of the specific breakdown between intervention and assessment. For clarity, this particular site is a VA so I'd imagine there is some standardized practice here.

2) In the above example, let's say I was applying with less than 250 intervention, say 200-230, but have over 300 hours of neuropsych assessment hours. Would the site overlook the lack of intervention hours in favor of the heavy assessment hours? Or would my application be thrown out based on not meeting the minimum intervention hours?

3) Adding to Question 2, would it be worth it to pass up a neuro-focused practicum site in favor of an intervention-focused site to bump up those hours? Would it look weird to a training program that an applicant was neuro-focused then decided to do external practicum at a non-neuro site for more intervention hours? I'm considering taking on a non-neuro practicum site to boost my intervention hours before applying this year, even though I would love to do another neuro practicum.

4) Finally, before I began my PhD program, I received a terminal master's degree that provided a lot of neuro didactics and practicum experience. Over the course of my terminal master's degree, all practicum experience was supervised and signed off by licensed clinical psychologists and/or a neuropsychologist. I accrued over 300 direct (including 120 therapy/group therapy and 130 neuropsych assessment) hours. Does this matter at all when applying to internship programs? I know it'll be on the application, but do TDs care about these hours at all? Especially given the context provided above... will these hours help my application?

It's difficult to get a lot of the above info from my DCT since they are fairly new to their position and are still learning the ropes. Thanks in advance! I appreciate any and all input.

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[jdawg2017]

Not a TD but I am a few years on the other side of neuropsych apps, so I figured I can offer some perspective.

1) I think usually the brochure is more accurate than APPIC, but APPIC should be updated. If in doubt, reach out to the TDs to ask.

2) My understanding is minimums are firm at many sites, but there could be some variability. However, in your specific example I would not consider 300 neuropsych assessment hours to be "high." I feel like most folks are coming in around 400-500, and many PsyD students I know are well into the low thousand because they do multiple pracs at once.

3) In short, no (IMO). If anything, see if your in-house training clinic can maybe give you 2-5 therapy patients a week that you can see in house with their supervision, assuming that this is how your training program works (it's how mine worked). I did this to boost my hours a bit because my biggest prac experience hours wise was the year COVID began and everything shut down for a solid few months.

4) Not sure about this in terms of what hours you can list, as I did not have this experience, but definitely sell this HARD in your cover letters if you don't mention it in your APPIC form. This shows commitment to assessment for a long time, which is great.

 

[RxPsych]

Not a TD but I am a few years on the other side of neuropsych apps, so I figured I can offer some perspective.

1) I think usually the brochure is more accurate than APPIC, but APPIC should be updated. If in doubt, reach out to the TDs to ask.

2) My understanding is minimums are firm at many sites, but there could be some variability. However, in your specific example I would not consider 300 neuropsych assessment hours to be "high." I feel like most folks are coming in around 400-500, and many PsyD students I know are well into the low thousand because they do multiple pracs at once.

3) In short, no (IMO). If anything, see if your in-house training clinic can maybe give you 2-5 therapy patients a week that you can see in house with their supervision, assuming that this is how your training program works (it's how mine worked). I did this to boost my hours a bit because my biggest prac experience hours wise was the year COVID began and everything shut down for a solid few months.

4) Not sure about this in terms of what hours you can list, as I did not have this experience, but definitely sell this HARD in your cover letters if you don't mention it in your APPIC form. This shows commitment to assessment for a long time, which is great.

Thank you for your input! I definitely don't consider 300 neuro assessment hours to be high, I just meant relative to my intervention hours. Hopefully by the time internship apps are due I should have closer to 400. My understanding is that if you're above the minimum requirement, it's really diminishing returns much past that. Hopefully my publications, posters, and ABPP-CN LORs can make up for my lower clinical hours.

 

[WisNeuro]

FWIW, in my experience, neuropsych in the VA values good intervention experience to go with assessment experience more than non-VA neuro settings.

 

[RxPsych]

FWIW, in my experience, neuropsych in the VA values good intervention experience to go with assessment experience more than non-VA neuro settings.

Thanks, Wis! I've been strongly considering doing my next external practicum at a large hospital within their consulting health psychology group. I think this could provide some tangentially neuro intervention experience, and I've enjoyed my work in hospital settings in the past (post-acute TBI rehab).

 

[summerbabe]

However, on their brochure, they list a "minimum of 500 hours of total practicum experience" as the requirement, with no mention of the specific breakdown between intervention and assessment.

Defer to the brochure and email the TD if you have specific questions.

One thing about minimums is you won’t know how you stack against the applicant pool.

A very competitive site may use minimums to determine which applications will be fully reviewed and which will be cut to make the process more manageable.

I’m faculty at a decently selective VA (we expect to fill all our spots in Phase 1). We usually receive 10-12 applications for every spot we offer and invite ~40% for interviews but we still review every application. However some sites with more volume may not be able to do this.

Would the site overlook the lack of intervention hours in favor of the heavy assessment hours? Or would my application be thrown out based on not meeting the minimum intervention hours?

Keep in mind that internship is generalist so a solid app should ideally have some experience in all core competencies (ind therapy, group therapy, personality assessment, objective assessment, research).

If you’re short in one area, you’re probably fine but the more holes you have, the worse your chances at getting an interview (generally speaking).

I'm considering taking on a non-neuro practicum site to boost my intervention hours before applying this year, even though I would love to do another neuro practicum.

I would review your application holistically and try to get a couple different sources of feedback/input, including your TD, on what might be most helpful.

Over the course of my terminal master's degree, all practicum experience was supervised and signed off by licensed clinical psychologists and/or a neuropsychologist. I accrued over 300 direct (including 120 therapy/group therapy and 130 neuropsych assessment) hours. Does this matter at all when applying to internship programs?

You should be able to count the Master’s level therapy hours as intervention hours (but check with your TD). However those assessment hours may be better classified as support hours.

Even though some states allow midlevels to engage in assessment, our consensus is that assessment hours are accrued once we’ve completed our assessment coursework sequence.

But you should definitely highlight what you’ve learned and specific classes/didactics via things like your personal statement & CV.

My understanding is that if you're above the minimum requirement, it's really diminishing returns much past that.

That’s generally true but it can still matter. For example, my site rates every category on a 1-4 scale. So somebody with 650 well rounded hours would get a 4, somebody with 500 well rounded hours might get a 3, somebody with 500 hours but missing something major may get a 2 while somebody with 400 would get a 1.

And our interview offers are largely made to people who have the highest aggregate scores across all categories and then we add interviews performance to those original scores to largely determine our final ranked list.

Still, it’s not something to stay an extra year in school for but honestly, anything that can differentiate apps can theoretically be helpful. Good luck!

 

[AcronymAllergy]

1) I'd trust the brochure over APPIC, but when in doubt, ask the TD. Sometimes the website gets updated before APPIC (or vice versa). And sometimes TDs just forget to update the appropriate section in one or the other.

2) It's going to depend on the site. Some will have a firm threshold of those hours at the time of application, and others will potentially be more flexible. Again, when in doubt, email the TD.

3) I would encourage every neuro-focused applicant to complete a non-neuro practicum, assuming they already have a few neuropsych practica under their belts. I've seen some TDs recently complain that neuropsych trainees are becoming too focused on neuropsych and are leaving out a lot of the rest of psych. That said, the neuro experience is going to be most important. If you're worried, I'd suggest one of the alternatives mentioned above RE: seeing if you can pick up a handful of therapy patients at a neuro practicum (or elsewhere, assuming everyone involved is ok with that).

4) It's going to vary from one program to the next, but yes, the TD will at least see/look at those hours. Especially in a case where an applicant has a lot of assessment hours in grad school at the expense of intervention hours, those terminal masters program hours may help alleviate some concerns that an applicant has little to no intervention experience/skill.

 

[RxPsych]

Defer to the brochure and email the TD if you have specific questions.

One thing about minimums is you won’t know how you stack against the applicant pool.

A very competitive site may use minimums to determine which applications will be fully reviewed and which will be cut to make the process more manageable.

I’m faculty at a decently selective VA (we expect to fill all our spots in Phase 1). We usually receive 10-12 applications for every spot we offer and invite ~40% for interviews but we still review every application. However some sites with more volume may not be able to do this.

Keep in mind that internship is generalist so a solid app should ideally have some experience in all core competencies (ind therapy, group therapy, personality assessment, objective assessment, research).

If you’re short in one area, you’re probably fine but the more holes you have, the worse your chances at getting an interview (generally speaking).

I would review your application holistically and try to get a couple different sources of feedback/input, including your TD, on what might be most helpful.

You should be able to count the Master’s level therapy hours as intervention hours (but check with your TD). However those assessment hours may be better classified as support hours.

Even though some states allow midlevels to engage in assessment, our consensus is that assessment hours are accrued once we’ve completed our assessment coursework sequence.

But you should definitely highlight what you’ve learned and specific classes/didactics via things like your personal statement & CV.

That’s generally true but it can still matter. For example, my site rates every category on a 1-4 scale. So somebody with 650 well rounded hours would get a 4, somebody with 500 well rounded hours might get a 3, somebody with 500 hours but missing something major may get a 2 while somebody with 400 would get a 1.

And our interview offers are largely made to people who have the highest aggregate scores across all categories and then we add interviews performance to those original scores to largely determine our final ranked list.

Still, it’s not something to stay an extra year in school for but honestly, anything that can differentiate apps can theoretically be helpful. Good luck!

Thank you for your insights, particularly regarding how your site ranks candidates. As I stated above, I'm hoping to at least meet the minimums for intervention hours. If my master's hours (namely, experience with individual and group therapy at my prior university clinic and at the post-acute TBI rehab facility) would count towards total intervention, I wouldn't be nearly as concerned as I am now. However, with how Time2Track classifies them, they are considered "direct" and not intervention, since they were part of a terminal master's. But... the AAPI view shows the master's hours right next to doctoral and considers them as intervention, so I'm really hoping that's the case. If not, I'm planning on doing what I can for the remainder of my time before applying to up those intervention hours.

 

[singasongofjoy]

It has been about 10 years since I applied for internship but at the time after looking into it I ended up counting supervised intervention hours from my master's program as such. I doubt that has changed since it is relevant experience. I assume what you are saying T2T is doing is lumping all those hours (assessment + intervention) into one "direct" category, but I think you would be fine to pull intervention out and count it as such. Not everyone uses T2T (I didn't) and would assume that intervention hours in a masters program would count as such and enter them that way unless it's clearly stated somewhere in application materials that hours from a masters program are counted as one lump category. If there is incongruence between brochures for a program and what you see on APPIC, def consult the TD first.

I want to second @AcronymAllergy 's recommendation to do a non-neuro prac if possible. You might be surprised later in your career how relevant those "outside of my specific area" experiences and knowledge become extremely relevant and inform your course of action & recs with a client/patient.

 

[psych.meout]

It has been about 10 years since I applied for internship but at the time after looking into it I ended up counting supervised intervention hours from my master's program as such. I doubt that has changed since it is relevant experience. I assume what you are saying T2T is doing is lumping all those hours (assessment + intervention) into one "direct" category, but I think you would be fine to pull intervention out and count it as such. Not everyone uses T2T (I didn't) and would assume that intervention hours in a masters program would count as such and enter them that way unless it's clearly stated somewhere in application materials that hours from a masters program are counted as one lump category. If there is incongruence between brochures for a program and what you see on APPIC, def consult the TD first.

I want to second @AcronymAllergy 's recommendation to do a non-neuro prac if possible. You might be surprised later in your career how relevant those "outside of my specific area" experiences and knowledge become extremely relevant and inform your course of action & recs with a client/patient.

I'm on internship now but when I applied last year, we were told to keep terminal master's hours separate and only be counting F2F hours during one's doctoral program as intervention or assessment hours. Doctoral and terminal master's hours are also documented separately on the APPIC post-match survey.

It might be good to tag in @GregK on this.

 

[RxPsych]

In T2T under the "Activity Summary" section, all my master's hours are categorized under "Direct" as opposed to Intervention or Assessment. However, when I click, on the "AAPI View" tab, they are then in their own separate column next to doctoral hours and each item is categorized as either Intervention or Assessment. This makes me think that the TDs would see this and consider them holistically, but I definitely don't want to make any assumptions.

 

[AcronymAllergy]

In T2T under the "Activity Summary" section, all my master's hours are categorized under "Direct" as opposed to Intervention or Assessment. However, when I click, on the "AAPI View" tab, they are then in their own separate column next to doctoral hours and each item is categorized as either Intervention or Assessment. This makes me think that the TDs would see this and consider them holistically, but I definitely don't want to make any assumptions.

Master's hours are (or at least were) definitely presented separately from doctoral hours on applications. I don't recall if intervention vs. assessment hours were separated out; might've just been direct vs. indirect. I believe the master's hours tables were presented either side-by-side with the doctoral hours, or just after them. But it's been a little while since I've reviewed an application.

 

[PsyDuck90]

In T2T under the "Activity Summary" section, all my master's hours are categorized under "Direct" as opposed to Intervention or Assessment. However, when I click, on the "AAPI View" tab, they are then in their own separate column next to doctoral hours and each item is categorized as either Intervention or Assessment. This makes me think that the TDs would see this and consider them holistically, but I definitely don't want to make any assumptions.

I’m a current neuro postdoc at a VA, so my experience reviewing AAPIs is limited to the last 2 years, but the file the site gets still has the hours split into two separate columns of doctoral and terminal masters. At my current site, the masters hours didn’t factor heavily into the application score. Honestly, overall hours are more of “did you hit this benchmark or not” score. If the cover letter or one of the essays wove that experience in as evidence to a strong commitment to neuropsych, that would likely have more weight (at my site at least).

 

[LM02]

At our site, it is also more of a "did you hit this benchmark or not" assessment - once an applicant has met the threshold, it's more about the type of clinical experiences the applicant has had, how they fit into their professional goals and goals for internship, and how they have prepared them to deliver the type of services offered at our site. With that said, if a site has specified their minimums, I'd stick to them.

 

[RxPsych]

I’m a current neuro postdoc at a VA, so my experience reviewing AAPIs is limited to the last 2 years, but the file the site gets still has the hours split into two separate columns of doctoral and terminal masters. At my current site, the masters hours didn’t factor heavily into the application score. Honestly, overall hours are more of “did you hit this benchmark or not” score. If the cover letter or one of the essays wove that experience in as evidence to a strong commitment to neuropsych, that would likely have more weight (at my site at least).

Thank you! Follow-up question: Would the master's hours be considered as part of the overall hours? For example, if your site had a minimum of 300 intervention and an applicant had 200 from their doctoral program but 150 from their master's, would that meet the 300 minimum threshold since it's 350 combined?

 

[WisNeuro]

Thank you! Follow-up question: Would the master's hours be considered as part of the overall hours? For example, if your site had a minimum of 300 intervention and an applicant had 200 from their doctoral program but 150 from their master's, would that meet the 300 minimum threshold since it's 350 combined?

Depends a little. We did not count terminal masters hours in our totals, as the level of supervision and work usually does not purport to what we'd expect of doctoral level supervision and work.

 

[RxPsych]

Depends a little. We did not count terminal masters hours in our totals, as the level of supervision and work usually does not purport to what we'd expect of doctoral level supervision and work.

This makes sense. I'd like to think my situation is slightly unique, as my master's program also had a clinical psych PhD, and those students took the same courses (with a bit more homework), but had the same practicum opportunities and expectations. It's funny, while I was doing my master's external practicum at the TBI rehab facility, there was a doctoral internship at the same hospital and I would, on occasion, teach doctoral interns how to administer certain tests. Needless to say, I feel as though my master's experience was equivalent to doctoral experience, it just doesn't explicitly reflect that.

 

[PsyDuck90]

My site’s process is similar to Wis. We only looked at doctoral hours. Doctoral hours have to be primarily supervised by doctoral level providers, while masters hours can be supervised by other masters level providers. Another thing we looked at was hours of individual supervision vs group supervision. If someone’s supervision was primarily group and very little individual, that raises some eyebrows

 

[WisNeuro]

This makes sense. I'd like to think my situation is slightly unique, as my master's program also had a clinical psych PhD, and those students took the same courses (with a bit more homework), but had the same practicum opportunities and expectations. It's funny, while I was doing my master's external practicum at the TBI rehab facility, there was a doctoral internship at the same hospital and I would, on occasion, teach doctoral interns how to administer certain tests. Needless to say, I feel as though my master's experience was equivalent to doctoral experience, it just doesn't explicitly reflect that.

Fair, your experience is definitely an exception to the rule in most cases. Though, at my sites, most people were well above the hours listed on our site. So, if you are just meeting the numbers with having to use terminal masters + doctoral, that applicant would still be in in the lower end of applicants. For the most part we got 30+ applications per slot. You don't want to be an applicant who just barely ticks the boxes with that level of competition. Obviously dependent on the competitiveness of the site.

 

[RxPsych]

Fair, your experience is definitely an exception to the rule in most cases. Though, at my sites, most people were well above the hours listed on our site. So, if you are just meeting the numbers with having to use terminal masters + doctoral, that applicant would still be in in the lower end of applicants. For the most part we got 30+ applications per slot. You don't want to be an applicant who just barely ticks the boxes with that level of competition. Obviously dependent on the competitiveness of the site.

That makes sense and completely understandable. Given what everyone has been saying, I'll do my best to get extra intervention hours at my current neuro practicum (though no opportunities currently exist, I'll see if they can help out). I might end up seeking a non-neuro practicum beginning late summer to hopefully boost my intervention hours before the APPIC hours accrual deadline, which I believe has been moved up a month to October 1. It's hard to pass up a potential neuro VA practicum opportunity but sometimes you do what you have to do!

 

[Freud’sMommy]

In addition to the great advice given already, I strongly recommend you review this publication from APPIC. It contains several useful/interesting facts about internship derived from surveying 459 internship training directors. I was in a similar boat as you last year and this document gave me the confidence to apply to and match with a very competitive NP site despite having less than 400 direct hours. Some charts that are relevant to your questions:

Overall, acquiring 500 direct hours should make you eligible for most sites, 600 if you're more conservative (you'll absolutely smash "total hours" requirements either scenario). More hours doesn't necessarily make you more competitive as it looks like most training directors would rather you optimize other areas of fit. Also, doesn't look like training directors care about MS degrees (and by proxy, experience gained at the MS level) all that much relative to other characteristics.

Anecdotally, I and several people from my program have interviewed and matched with NP sites, most very desirable/competitive, despite not meeting their minimum requirements. YMMV, but you should shoot your shot anyway once you get to that stage! Personally, I do not think direct hours translate well to clinical ability. Anyone actually getting over 800 direct hours is compensating for something 😉.

 

[WisNeuro]

In addition to the great advice given already, I strongly recommend you review this publication from APPIC. It contains several useful/interesting facts about internship derived from surveying 459 internship training directors. I was in a similar boat as you last year and this document gave me the confidence to apply to and match with a very competitive NP site despite having less than 400 direct hours. Some charts that are relevant to your questions:

View attachment 382847
View attachment 382848
View attachment 382846

Overall, acquiring 500 direct hours should make you eligible for most sites, 600 if you're more conservative (you'll absolutely smash "total hours" requirements either scenario). More hours doesn't necessarily make you more competitive as it looks like most training directors would rather you optimize other areas of fit. Also, doesn't look like training directors care about MS degrees (and by proxy, experience gained at the MS level) all that much relative to other characteristics.

Anecdotally, I and several people from my program have interviewed and matched with NP sites, most very desirable/competitive, despite not meeting their minimum requirements. YMMV, but you should shoot your shot anyway once you get to that stage! Personally, I do not think direct hours translate well to clinical ability. Anyone actually getting over 800 direct hours is compensating for something 😉.

Anecdotally, in reviewing applications for the better part of a decade for internship slots, a decent percentage are over 800 hours. It's pretty common for NP students to do several NP practica in addition to their therapy hours, and NP hours accrue fairly quickly.

 

[Freud’sMommy]

Anecdotally, in reviewing applications for the better part of a decade for internship slots, a decent percentage are over 800 hours. It's pretty common for NP students to do several NP practica in addition to their therapy hours, and NP hours accrue fairly quickly.

How did you and other NP faculty value F2F/supervision ratio? I've seen internal data showing the metric to be quite predictive for match success of our applicants above and beyond total hours.

 

[WisNeuro]

How did you and other NP faculty value F2F/supervision ratio? I've seen internal data showing the metric to be quite predictive for match success of our applicants above and beyond total hours.

Biggest factor was probably the quality of the hours that were obtained. If they had prac sites that we knew to be high quality, that was definitely something that would boost their rankings.

 

[PsyDr]

Anecdotally, in reviewing applications for the better part of a decade for internship slots, a decent percentage are over 800 hours. It's pretty common for NP students to do several NP practica in addition to their therapy hours, and NP hours accrue fairly quickly.

I want to know where you rank "cultural responsiveness"

 

[WisNeuro]

I want to know where you rank "cultural responsiveness"

Can't say that was part of our ranking sheet.

 

[psych.meout]

In addition to the great advice given already, I strongly recommend you review this publication from APPIC. It contains several useful/interesting facts about internship derived from surveying 459 internship training directors. I was in a similar boat as you last year and this document gave me the confidence to apply to and match with a very competitive NP site despite having less than 400 direct hours. Some charts that are relevant to your questions:

View attachment 382847
View attachment 382848
View attachment 382846

Overall, acquiring 500 direct hours should make you eligible for most sites, 600 if you're more conservative (you'll absolutely smash "total hours" requirements either scenario). More hours doesn't necessarily make you more competitive as it looks like most training directors would rather you optimize other areas of fit. Also, doesn't look like training directors care about MS degrees (and by proxy, experience gained at the MS level) all that much relative to other characteristics.

Anecdotally, I and several people from my program have interviewed and matched with NP sites, most very desirable/competitive, despite not meeting their minimum requirements. YMMV, but you should shoot your shot anyway once you get to that stage! Personally, I do not think direct hours translate well to actual clinical ability. Otherwise, PsyD students would outcompete at NP sites, but that's just not the case 🙂.

Well, yes, but as others have said, that's because quantity =/= quality. Grinding through low quality hours at a single prac site (especially at something like your program's in-house clinic) isn't as competitive as a relatively smaller amount of hours across a diverse assortment of sites, especially those of greater rigor/complexity/difficulty. This doesn't mean you should have a low number of F2F hours overall and be far (i.e., hundreds of hours) from site minimums, but rather that you should be looking for the quality of hours as you're doing practicum throughout grad school and expanding your specific clinical skills, confidence, independence, etc.

How did you and other NP faculty value F2F/supervision ratio? I've seen internal data showing the metric to be quite predictive for match success of our applicants above and beyond total hours.

Maybe I'm misreading your chart, but it looks like half of the respondents were "neutral" about the F2F to supervision ratio.