Neuro track internship competitiveness?

[PsyNeuro37]

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[AcronymAllergy]

Short answer: yes, you're competitive. The upcoming intervention practicum (and VA experience) should help round your application out further.

I don't know that you'd be a good fit at the historically more research-heavy internships, but you should be competitive at many other sites. Just apply broadly (which I always recommend).

 

[str63]

I think you'd be fairly competitive with your experiences, but there are a few other things that are important (at least for our site). We would want to know how many face to face hours you have (total, and the break down of assessment vs. intervention), whether you were writing reports at your sites (versus just administering testing), and I know you didn't list your program name (probably to stay anonymous, which is fine), but this can have a strong influence. I agree with PP that you likely wouldn't be competitive for research-focused internships, but clinically-focused ones should be fine. You may also want to check with your program where previous students have interviewed and matched to see if it overlaps with the sites you're interested in (I think this is beneficial for any applicant). Good luck!

 

[AcronymAllergy]

Agree with everything said above as well, yep. Hours are a metric, at least up to a minimum threshold. And ratios of supervision (individual and group) to patient contact hours. And number and types of reports written.

 

[psych.meout]

Agree with everything said above as well, yep. Hours are a metric, at least up to a minimum threshold. And ratios of supervision (individual and group) to patient contact hours. And number and types of reports written.

Can you say more about this?

What's a good ratio of supervision to F2F contact hours?

What is competitive in terms of number of reports written and by type?

It would be helpful to get this kind of data about different specialties and types of internship sites, as the match survey data is in aggregate and doesn't really give this info.

 

[AcronymAllergy]

Frustrating as it'll probably be to hear, it's tough (for me) to give definite numbers or ratios. I like to see a relatively balanced proportion of supervision to patient care hours (e.g., don't have 1000 hours of face-to-face time and 100 hours of supervision). For reports, for folks without a neuro focus, I just want to see something. At least a handful. For neuro-focused folks, double digits. You can't specify the type of reports by number in the APPI, so finding out the kind of reports a trainee has written is discovered more via cover letters, essays, CV, and interviews.

 

[psych.meout]

I too have the same questions as the OP. I will use his format to streamline this, but I will also include numbers as well based on the feedback I am seeing in this thread.

My qualifications:

• Psy.D. student at a university-based program (also not Rutgers/Baylor level, but a solid program that typically matches 90-100% of applicants to APA-accredited sites).
• Currently authoring a book chapter for a well-known psychological encyclopedia.
• 10+ total posters at NAN/INS/AACN/Rehab. First author on about half of them.
• 1 paper presented at APA Div. 40
• Taught 8 didactic seminars (not sure if this counts or not)
• Was an ad-hoc peer reviewer with a previous supervisor for JAMA Neurology, Archives of Clinical Neuropsychology, and The Clinical Neuropsychologist
• Student volunteer for two conferences (1 in sports neuro, 1 in rehab.)
• I have a previous master's degree in cognitive neuroscience with at least a year of research and psychometric experience in neuropsychology at a medical school prior to my admission into the Psy.D. program. I also have practical work experience as both a psychometrist in private practice as well as experience working in private practice as a therapist (paid). My practicum work includes a year of outpatient clinical neuropsychology at a well known medical school in South Florida, a year at an outpatient, non-profit neuro-rehabilitation clinic with a major focus in rehabilitation (psychotherapy and cognitive rehabilitation) and my last year of practicum will be at a well known level-1 trauma center in adult inpatient neuropsychology. I also completed a year at my university's outpatient mental health clinic in general clinical psychology.
• 1 of my LORs will come from a supervisor of mine at the medical school, 1 will come from a professor of mine in the program, and 1 will come from an individual who is a professor in the program, was also a secondary supervisor at one of my practicum sites, is my dissertation chair and have worked with extensively in research.
• I've also been involved as the university's neuropsychology club research officer and president (ANST member)
• Numbers:
  • Intervention: 655
  • Assessment: (95% neuropsychological assessments): 812
  • Supervision: 180
  • Integrated Reports: 19

I am applying to 23-25 sites, mostly scholar-practitioner based, but some are "reach" programs like Brown and Dartmouth which are more research-oriented. Any feedback would be greatly appreciated. This process is intense, but I began the process early, so I am hopeful. Thanks, everyone!

Is that total supervision (i.e., individual and group) or just individual?

Why so few reports when your assessment hours are so high?

 

[str63]

I too have the same questions as the OP. I will use his format to streamline this, but I will also include numbers as well based on the feedback I am seeing in this thread.

My qualifications:

• Psy.D. student at a university-based program (also not Rutgers/Baylor level, but a solid program that typically matches 90-100% of applicants to APA-accredited sites).
• Currently authoring a book chapter for a well-known psychological encyclopedia.
• 10+ total posters at NAN/INS/AACN/Rehab. First author on about half of them.
• 1 paper presented at APA Div. 40
• Taught 8 didactic seminars (not sure if this counts or not)
• Was an ad-hoc peer reviewer with a previous supervisor for JAMA Neurology, Archives of Clinical Neuropsychology, and The Clinical Neuropsychologist
• Student volunteer for two conferences (1 in sports neuro, 1 in rehab.)
• I have a previous master's degree in cognitive neuroscience with at least a year of research and psychometric experience in neuropsychology at a medical school prior to my admission into the Psy.D. program. I also have practical work experience as both a psychometrist in private practice as well as experience working in private practice as a therapist (paid). My practicum work includes a year of outpatient clinical neuropsychology at a well known medical school in South Florida, a year at an outpatient, non-profit neuro-rehabilitation clinic with a major focus in rehabilitation (psychotherapy and cognitive rehabilitation) and my last year of practicum will be at a well known level-1 trauma center in adult inpatient neuropsychology. I also completed a year at my university's outpatient mental health clinic in general clinical psychology.
• 1 of my LORs will come from a supervisor of mine at the medical school, 1 will come from a professor of mine in the program, and 1 will come from an individual who is a professor in the program, was also a secondary supervisor at one of my practicum sites, is my dissertation chair and have worked with extensively in research.
• I've also been involved as the university's neuropsychology club research officer and president (ANST member)
• Numbers:
  • Intervention: 655
  • Assessment: (95% neuropsychological assessments): 812
  • Supervision: 180
  • Integrated Reports: 19

I am applying to 23-25 sites, mostly scholar-practitioner based, but some are "reach" programs like Brown and Dartmouth which are more research-oriented. Any feedback would be greatly appreciated. This process is intense, but I began the process early, so I am hopeful. Thanks, everyone!

I'm not saying this to be mean (I'm trying to save you money for the application costs!) but you won't be competitive for research-oriented sites since you don't have any publications (and especially being a PsyD without any pubs - take a look at APPIC and the specific sites you mentioned haven't matched with any PsyDs in the past several years). I think you have a good number of hours (higher than average), but if I were reviewing your application at a clinical site, there may be some hesitancy for a couple of reasons: 1) You didn't do as many reports compared to hours. This could suggest that you weren't interpreting/conceptualizing many of your cases (whether this is actually true or not). 2) Your number of supervision hours relative to your hours is also low. This suggests that you may not have been able to develop your skills under supervision as much as other students and/or your supervisors may have been too busy with other work/students, etc. to provide you with solid supervision (again, whether this is actually true or not). If there's any chance you can increase your supervision hours and number of reports, that could help bolster your application. You have other good experiences within neuro though (both inpt and outpt) as well as a decent number of intervention hours, so that will look desirable. Any reason you plan to apply to so many sites? If you look at the stats, that many doesn't improve your chances of matching and will end up costing you quite a bit. Good luck!

 

[psych.meout]

Those are my total supervision hours. My first site we did supervision twice weekly. The site I just finished up at I did once weekly for an hour. As far reports, my hours are a mix of just administration and administration plus report writing.

Wait, are you counting time spent writing reports as part of your assessment hours? Generally, assessment hours are the actual time spent face-to-face with patients (e.g., clinical interview, testing, feedback), while time spent writing reports are part of the support hours category.

I would test cases for other colleagues who were behind, scored their assessments and completed their scoresheets but they would ultimately write their reports.

As str63 pointed out, this could be a problem for you. Since you're just doing the testing and not the interpretation, conceptualization, and report writing, you're basically doing psychometrist work. It's the other parts besides the actual administration and scoring that are what internship sites want to see, because that's the training you should be receiving in grad school, while testing can be done by a psychometrist with just a bachelor's degree.

Thanks for the feedback and reply! You and the above poster make good points. After I posted last night I dug around and found some others I failed to count, mostly because I was confused on how APPI designates "integrated report." With that in mind, the other reports I dug up appear to meet those requirements and thus, rather than 19 reports, I have 30. The other ones would have subtests of WAIS, WMS, TMT, MCMI or MMPI-2. They were pretty abbreviated, but at least from what I gleaned from APPI, I need two or more tests (cognitive, personality, etc.). I could be wrong, and please tell me if I am! To answer your other question about supervision, I was at a site this year where I barely met with my supervisor as she splits her time between the outpatient clinic and the hospital we work with, thus, I really don't get a whole lot of supervision from her. When I was at the medical school I was getting it twice weekly, often 2 hours each (which was awesome).

As I've been told by supervisors and which has been echoed by other psychologists on the forums, I think this is another red flag. Inadequate supervision means that you're not getting regular feedback on how you're doing. Yes, you might be aware of where you make mistakes, need help, etc. and can ask for guidance when you do get some supervision, but, as they say, you don't know what you don't know.

Your hours are way above the norm for the face-to-face patient contact stuff, especially assessment, which is 3.5 SDs above the mean from the APPIC match survey, but you don't seem to have commensurate supervision, especially if that 180 hours is partially group supervision.

 

[AcronymAllergy]

After thresholds are established, the number of face-to-face hours generally isn't much of a factor in reviewing apps, at least based on my experiences. Except perhaps when they might count against a person.

As you've said, the amount of supervision you obtain is generally outside your control (although if you feel it's insufficient, you could consider reporting it to your program). It's just something you may want to prepare some ready-made talking points about for interviews. I personally probably wouldn't address it before then directly (e.g., in essays), but you could do so indirectly by talking about the types of clinical and supervisory experiences you've had.

Also, depending on where you attend internship, be prepared for a significant change in the amount and type of supervision obtained. Potentially for the better. Although even there, it can vary from site to site.

 

[psych.meout]

Absolutely! Great point. This past semester I took the "clinical supervision and professional consultation" course our program requires of us. It was funny because as I read chapters and articles I was reflecting on how this past year at my site was the opposite of what the readings espoused. Granted, in our class, it was somewhat validated that at times there may be supervisors who are so busy that it's just not practical to carve out 1 hour each week to discuss conceptualization, challenges of a case, etc. I miss my time at the previous site I was at because our supervision was group-based and it was the highlight of my week. Twice weekly we spoke about each members' case, new cases coming in to be distributed to us; we conceptualized presenting problems, talked about potential areas to investigate more, neuroanatomical implications, instruments to use to "tease" apart certain functions, and cultural and ethical components as well. I was spoiled there.

As you mentioned, I won't bring this up unless it becomes a problem. I actually met with my dissertation chair/faculty advisor about this and he said: "10% of your practicum devoted to supervision is fine." Not sure if others here hold that same opinion, but as stated earlier, there is little I can do about that. I will be going off to another site in 2 weeks where I will get more quality supervision and other experiences (grand rounds, brain cutting seminars, etc.), but the number of hours I can project up to November 1st will be limited.

I really do look forward to new/different supervision styles as I would like to better refine my professional abilities, demeanor, etc. I'm also excited for internship as I expect this will also provide me an opportunity to sit with some of those textbooks and articles I glossed over many moons ago.

I don't know that I agree. There are things you could do or at least could have done about this issue at the time. You could have selected external prac sites based on filling in gaps in your training, picking a site where you know you will get quality individual supervision, even if it meant you might get fewer face-to-face contact hours (which you already have in excess). Alternatively, you could have spoken to your supervisor(s) and told them that you needed more individual supervision. Any supervisor and prac site worth their salt should be willing to accommodate you as best as they can. If they aren't, then your program really shouldn't be using them as a training site. Based on what you've written previously, it sure seems like these sites were using you as a work horse to just get as many assessments done as possible (basically treating you as a psychometrist at times), instead of the work you're doing being focused on you getting the training you need. This problem is exacerbated when it keeps getting kicked down the road with you, your program, and your current supervisor assuming that you will get the supervision and other experiences you need at your next practicum, but it never really happens because no one takes the initiative to do anything about it.

And I also don't agree that it's not practical to get an hour a week of supervision. I did a neuropsych practicum and I was averaging at least an hour of supervision (not to mention having more integrated reports than you with a fraction of your hours). Honestly, how are you supposed to know if you're doing things correctly if you're not getting that supervision? You could be continually doing the wrong things, but not have an opportunity to have them addressed or may not even know what you're doing wrong to ask about them (again, you don't know what you don't know).

 

[WisNeuro]

I can't even fathom less than an hour a week of supervision. Usually with lower level students (prac, interns) there is their 1 hour of scheduled supervision, and at least 2 hours of non-scheduled supervision. Even with the ones with a good deal of previous experience. Anything less than that and you're asking for a lawsuit and/or bad patient experiences.

At the very least, your program needs to take that supervisor/placement off of the approved list for practicum,

 

[AcronymAllergy]

Which brings up a good point--was there unscheduled supervision, and if so, did you track it?

 

[WisNeuro]

To follow up with @AcronymAllergy . Last time I read the rules and regs for supervision, things that counted for unscheduled supervision

1) Discussing the case beforehand
2) discussing the case in the middle of testing when they check in with me
3) discussing the case afterwards.

People sometimes miss these. Also, if anyone has read the APPIC supervision guidelines more recently and this is no longer the case, please correct

 

[psych.meout]

I can't even fathom less than an hour a week of supervision. Usually with lower level students (prac, interns) there is their 1 hour of scheduled supervision, and at least 2 hours of non-scheduled supervision. Even with the ones with a good deal of previous experience. Anything less than that and you're asking for a lawsuit and/or bad patient experiences.

At the very least, your program needs to take that supervisor/placement off of the approved list for practicum,

This was what I was getting at. It's pretty apparent from what they described that at least the one practicum site is using prac students as psychometrist work horses to just churn out evaluations. It's not really acting as a training site and it's not all that surprising that other people in their program have more hours and some of them are failing to match at all.

 

[psych.meout]

This past semester I took the "clinical supervision and professional consultation" course our program requires of us. It was funny because as I read chapters and articles I was reflecting on how this past year at my site was the opposite of what the readings espoused. Granted, in our class, it was somewhat validated that at times there may be supervisors who are so busy that it's just not practical to carve out 1 hour each week to discuss conceptualization, challenges of a case, etc.

This is incredibly self-serving. It reeks of your program rationalizing that they are using external prac sites where they know students are not receiving adequate supervision. If the supervisor can't provide at least an hour of supervision and your program knows this, then they should not be sending their students to train there.

 

[AcronymAllergy]

Just a quick response: if the internship site is accredited and participates in the match, you'll likely be getting 4 hours of supervision weekly. The professor is correct in that the quality could of course vary, but the quantity, less so.

Edit: And yes, some degree of responsibility does fall on the student. But ultimately, particularly at the level of graduate practica, the majority of that responsibility falls on the supervisor to at least actively check in with his/her trainees. In part because the student may have no idea as to what an adequate amount of supervision, guidance, and proficiency should look like. Although a more hands-off approach certainly isn't unusual in grad school. In my experience, it's less common on internship, to the extent that interns can sometimes feel as though they're taking a step backwards in autonomy and/or are being over-supervised.

It sounds like the new site will be a great one. Even if you can't claim much of it on your applications, it can still go a long way toward furthering your training and professional development.

 

[psych.meout]

To be fair and honest, it could very well be that the practicum coordinator is unaware of this. We can't dismiss that as I know many students are often hesitant in addressing supervision-related concerns. Having just taken the course, it made me appreciate some of what I went through and things I wish I would have done/voiced differently. I probably should have raised some concern, however, at the moment I figured supervision was meant to discuss areas where I felt I struggled vs. areas to learn how to conceptualize better and other qualitative elements involved in supervising the development of a psychologist. Hindsight is 20/20. I know of other students in my program who rotated through here who also voiced this concern and they too did not voice their personal opinions in fear that the supervisor at that site might retaliate and rate them poorly at midterm and final evaluations, or, would leave there without a recommendation letter for internship.

I know that you think these are extenuating circumstances or somehow a justification, but it's really just further evidence of how bad things really are. Firstly, if students can't request further supervision or notify their program of issues with the practicum site without being afraid of retaliation, regardless of whether this fear is justified, that's a huge problem. Secondly, as AcronymAllergy pointed out, the onus is really on the supervisor, not the student. The supervisor is the licensed clinician who also went through the same process, so they know what the requirements are for training and know when they are insufficient, even if only for the purposes of internship matching. They also know when students are being used a workhorses for the purposes of churning out evaluations that make them money.

As it stands now, there is little that can be done between now and November 1st regarding my supervision hours. I think it's also fair to say based on what several professors I spoke to about this, is that this also tends to be practiced at the internship level too. Earlier today I pulled aside my professor who taught our supervision class and discussed much of yall's commentary with her and she said that to be fai, "it might be a bit better at the internship level, but not very much. You will still see many programs that could stand to improve in the quality and quantity of supervision provided."

Again, this is self-serving. It's your instructor rationalizing away concerns about the quality of training you're receiving at your practicum sites. This is a red flag for your program.

I am off to a new site in 2 weeks at a well-known teaching hospital with a great reputation for its supervision, sadly, I will only be able to clock/project a specific amount of hours until November 1. I am hopeful; I think I have a lot to offer to internship sites, so I will not get hung up on some of the other components. It will be up to them if they really want to scrutinize my application in that manner and completely ignore other areas that are considerable strengths. If so, I am probably better off not interviewing there in the first place as I would hate to be in an environment that espouses and practices that on a regular basis.

Just to be clear, you're insinuating that internship sites are wrong or even bad for "scrutinizing" applications in terms of the supervision and quality of F2F hours reported by applicants? That kind of sounds like their job to me.

At the same time, I feel that it's also up to the student to be self-reflective enough to know when and where they need supervision and to be responsible enough to voice that. Considering I did the opposite of that, I could have done things differently on my end. It's not just a supervisor issue here, it's also the student having enough maturity to know their own areas of strengths and weakness and knowing when to address it and the supervisor's ability to foster an environment that encourages that. I'm not saying she was innocent in all of this, she clearly had areas that could improve as a supervisor, but I could have spoken up and insisted on more regular and structured supervision. I think that captures that essence of what really has happened vs. it being mostly a systemic or dysfunction in the whole organization/program.

Again, the onus is on the supervisor, not the student, to make sure supervision is in line with the standards of the field. You don't know what you don't know, which is why supervision is necessary in the first place. Furthermore, you argued earlier that students were at least hesitant, if not avoidant, to bring up supervision concerns, so how could it also be up to the student to "voice" when they need supervision? These would seem to be at odds, no?