Issues with externship observation

[NP112]

Hello all,

Long time reader, first time poster!

I have run into a difficult situation at my externship site. I am currently a third year PhD student and am in my first neuropsych. placement. I ultimately want to go into neuropsych.

I have been told by my supervisor that a psychology associate needs to always be in the room due to "insurance issues." I was wondering if anyone on here can confirm that's true? I can't seem to find anything online about my particular state and regulations for assessments. Other cohort-mates at assessment sites have not reported similar things. I am on the east coast, though that is not really helpful.

I ask as well because I have found the neuropsychometrists to be particularly picky in my administrations. It's come to the point where I have intense anxiety before having to give an assessment. I am sure this anxiety is feeding into any mistakes that I may be making. I was under the impression when I began this externship that eventually I would be able to administer on my own...but always having to have someone else in the room is a new development. I understand the need to ensure proper assessment administration, but it is severely negatively impacting my well-being and enjoyment of the this externship. I am unsure whether I am just being too paranoid and this is an honest requirement by this externship, or whether I should bring this up to my supervisor/DCT.

Thank you very much for any help,
NP112

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[CatsFan]

At my hospital a psychometrist always has to be in the room with prac students for most cases as well. Basically, they can’t bill for your testing time unless a psychometrist is also there.

 

[pediatric_psydoc]

Regarding my own experience, I was the one administering and scoring tests during psychological assessment and neuropsychological assessment externships I did, and I was alone in the room with the patient.

That being said, I know that CMS does not pay for services performed by students or trainees.

 

[cara susanna]

I did an assessment prac and didn't need a psychometrist in the room. Either way, it sounds like maybe the issue is more this psychometrist--perhaps talk to your supervisor about the issue?

 

[AcronymAllergy]

Depends on which insurance they're billing, but yes, there are situations in which someone might need to always be in the room with the trainee (e.g., with Medicaid).

Psychometrists are fairly notorious for being stricter about testing procedures than neuropsychologists. It's one reason neuropsychologists use them to help "train up" students on test administration.

In some ways, this could be a good training opportunity for you. Once you're able to correctly administer the measures in the presence of an anxiety-provoking stimulus, imagine how much easier it'll be once you're flying solo. Is the psychometrist doing anything during the actual testing session that makes you anxious, or is it primarily your reaction to their being in the room (and being evaluated)?

 

[WisNeuro]

Sounds pretty normal for learning to test. At my prac, we had to be able to administer and accurately respond, write down responses, and score a WCST at a rate of 1 card per second from the pt. Among other fairly stringent administration training. Best to become very adept at learning this now. I've almost had to put interns on formal remediation plans after they've come into internship with lots of supposed testing experience, but they have an incredibly hard time administering anything by protocol. Don't be that intern.

 

[AbnormalPsych]

I have not been at a place where there has been a psychometrist, but as a trainee if I was working in the office the neuropsychologist (supervisor) was also in the office for testing and available (but not in the testing room itself). We did the interview and feedback together. In other settings (bedside at hospital, in home) we would typically be in the same room. It was never an issue. Brings up an interesting dilemma between training and third party observer effects.

 

[WisNeuro]

Brings up an interesting dilemma between training and third party observer effects.

Definitely does. But, many places do not have two-way mirrors for testing, or video recording, especially when going into inpatient units. I'll take TPO effects over the effects of inaccurate administration any day.

 

[NP112]

Thank you all for your input. It sounds like having someone in the room depends on the site.

@ AcronymAllergy, probably a combination of the two. They have said stuff along the lines of "are you kidding me?" "what are you doing?" Not the nicest, but not exactly screaming at me either.

I am considering now whether to ask to not work with them. There are other psychometrists I get along better with.

Thanks again!

 

[pediatric_psydoc]

Thank you all for your input. It sounds like having someone in the room depends on the site.

@ AcronymAllergy, probably a combination of the two. They have said stuff along the lines of "are you kidding me?" "what are you doing?" Not the nicest, but not exactly screaming at me either.

I am considering now whether to ask to not work with them. There are other psychometrists I get along better with.

Thanks again!

Does the psychometrician make comments such as "are you kidding me?" etc that are audible to the patient?

 

[NP112]

Yes, very audible.

 

[AbnormalPsych]

Yikes, now that is a problem.

 

[jdawg2017]

I’m in my training now at a VA prac. Once I’ve gotten up and rolling, I’m on my own but will ask supervisors about tests I’m not aware of that I need to learn. AMCs are a different ball game, or so I’ve heard, due to billing. I personally prefer more, and not less, supervision, even though I’m fine with a lot of the core tests at this point. You’ll never have the opportunity to be so richly supervised once your training time comes to an end, so I’ve tried to cherish it, even when I’ve had hard supervisors.

That said, psychometrists or any supervisor need to be more subtle if they are correcting you during an administration. I’ve had supervisors text me or slip me a note to inform me of silly errors (e.g., one time I totally forgot the recall of the cvlt b/c i didn’t write the recall time down for checking). I would talk to your dct or director of training at your site about how to talk to the psychometrist doing that.

 

[psych.meout]

Yes, very audible.

Because a third party in the room exclaiming unprofessionally is part of the test protocol.

 

[AcronymAllergy]

Yes, very audible.

I agree with what others have said--this is problematic and, ideally, should be nixed immediately by the supervisor. I can only speak for myself, but as a supervising neuropsychologist, I would want to know if one of my psychometrists was doing this. Not just because of the effects on the test taker, but because it's an inappropriate means of providing feedback to a trainee.

It's interesting that a tester who is apparently a stickler for standardized administration seemingly has no qualms with breaking standardization in this manner.

 

[pediatric_psydoc]

Yes, very audible.

Agree with others that it needs to be brought up to the supervising neuropsychologist ASAP. It breaks testing standardization and also leads one to wonder about the psychometrician’s professional conduct overall if they have no qualms displaying this behavior in front of patients.

 

[NP112]

Thanks all!

Is there a difference in the psychometrist making remarks to me the tester ("are you kidding" etc. as mentioned above) versus jumping in to clarify a sentence/phrasing I just said (adding in "go as fast as you can" if I neglect to say it)?

 

[WisNeuro]

Is there a difference in the psychometrist making remarks to me the tester ("are you kidding" etc. as mentioned above) versus jumping in to clarify a sentence/phrasing I just said (adding in "go as fast as you can" if I neglect to say it)?

There is definitely a difference. In the latter case, they may need to jump in to maintain the proper administration. I've had to do it myself many times in training situations. In the former case, especially if the patient can hear, the psychometrist is out of line and is potentially damaging the validity of the data and rapport with the patient.

 

[NP112]

Thanks! Another question, what about the psychometrist grabbing my papers? Once two of the paper were stuck together and they dove over the table to cover something from being shown.

 

[WisNeuro]

Thanks! Another question, what about the psychometrist grabbing my papers? Once two of the paper were stuck together and they dove over the table to cover something from being shown.

Well, if you were about to possibly expose memory stimuli in a delay period, it's warranted.