Professional quality control issues

[AlmostaPhD]

I learned this tidbit the other day and I knew it would freak out others on here as it did me.

An internship site with which I am familiar (an accredited one, with multiple slots) is electing to terminate their internship after this year (they did not accept anyone for the upcoming year) because, according to the TD, once the match imbalance corrected the quality of interns they received was so poor that it wasn’t worth the extra effort staff had to spend doing damage control and remedial training. It will not surprise anyone to hear that some FSPSs were called out by name.

Now, this is not an overly desirable geographic location (small city, not easy/west coast) and I don’t know how competitive these spots were in the first place, but this is nonetheless an accredited internship that provided (in my view) quality training with inpatient/outpatient options and various specialty rotations saying that trainees in our profession, coming from accredited programs, are coming to them so unprepared that they cannot maintain an internship where these folks would be semi-independent full-time clinicians after 4-6ish years of graduate school.

This is appalling! Is this an APA accreditation issue? Do we need some kind of additional layer of certification that can indicate if someone is coming from an actual legit program, since accreditation is not that? I don’t have a solution right now, but I know that this is not the direction I want to see my field going!

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[WisNeuro]

This is appalling! Is this an APA accreditation issue? Do we need some kind of additional layer of certification that can indicate if someone is coming from an actual legit program, since accreditation is not that? I don’t have a solution right now, but I know that this is not the direction I want to see my field going!

This train has already left the station. It's a good reason why I maintain my "blacklist" of programs when ranking applicants.

 

[Groupthink]

As a staff member at an institution that offers an internship fitting the aforementioned criteria, and as someone who sits on the internship selection committee, I understand the concern. That said, I continue to place the onus on the internship program itself to weed out unqualified applicants. I would rather risk the work of moving to Phase 2 than to play Gatekeeper because of a string of passive supervisors who just passed the student along because they paid their dues. You can get a good sense of the depth of an applicant's understanding, sensitivity, and formulation from a simple case presentation.

 

[PsyDr]

I have seen idiots from top ranked programs and idiots from bad schools. You can't keep them out. I believe that the way psychology is taught is wrong. The best thing to do is to strive to be much better.

One of the deans of one of top 10 clinical psych PhD programs literally told me, "I don't know anything about schizophrenia"... when we were discussing autism.

 

[Pragma]

I have seen idiots from top ranked programs and idiots from bad schools. You can't keep them out. I believe that the way psychology is taught is wrong. The best thing to do is to strive to be much better.

One of the deans of one of top 10 clinical psych PhD programs literally told me, "I don't know anything about schizophrenia"... when we were discussing autism.

Psychologist?

 

[964693]

I have seen idiots from top ranked programs and idiots from bad schools. You can't keep them out. I believe that the way psychology is taught is wrong. The best thing to do is to strive to be much better.

One of the deans of one of top 10 clinical psych PhD programs literally told me, "I don't know anything about schizophrenia"... when we were discussing autism.

That's a mature and responsible statement. Does he literally know NOTHING? Of course not. I spent many years researching one disorder - after that I would probably say I know "nothing" about most other disorders too, because I understand the standard to which one should hold themselves when communicating knowledge and expertise.

 

[futureapppsy2]

I have seen idiots from top ranked programs and idiots from bad schools. You can't keep them out. I believe that the way psychology is taught is wrong. The best thing to do is to strive to be much better.

One of the deans of one of top 10 clinical psych PhD programs literally told me, "I don't know anything about schizophrenia"... when we were discussing autism.

Talking with a friend who's a TD, I've heard similar things re:variable quality from different programs. An intern from a top program once said that they "didn't believe in receiving feedback," for example. Also, I think it's important to remember that internship is still training, and I think some sites do expect interns to be very cheap labor who don't need training.

 

[AlmostaPhD]

It's a good reason why I maintain my "blacklist"

I continue to place the onus on the internship program itself

I think it's important to remember that internship is still training

These points are well taken. It is on the internship site to ensure that they accept good interns through the interview process, and certainly they might notice patterns over time and learn to avoid certain programs. I also agree that interns should not be expected to not require supervision or training, but they should have a higher level of clinical skills and professionalism than what was described to me (not going into details for obvious reasons but it sounded pretty embarrassing to the profession and, again, the site is shutting it down rather than dealing with these headaches). By the time I reached internship I had years of seeing clients under my belt, including two years of fairly independent (off-site supervisor) forensic placements. I could be trusted to see clients alone in my office throughout the day and receive feedback on written docs and/or during my weekly supervision while on internship, and so could everyone else I worked with. I assume these problem interns either were not getting enough clinical experience, or were not getting feedback/training in how to actually do the work. Both of these things are terrible, especially from programs that are supposedly geared toward training clinicians, specifically.

Maybe I'm naive (and I don't train interns or postdocs and went to a university-based clinical PhD program, so all of that may skew my expectations) but I was just gobsmacked that people are entering the field with such inappropriate training and that APA apparently can't or won't control it. Is this why we need EPPP2? It seems like a lot of extra hassle for well-trained people but perhaps is required because of so many poorly trained ones? I worry very much for the (likely lower-income and in other ways vulnerable) clients that these people are seeing as trainees.

 

[erg923]

I recently had a neuropsychologist tell me they do not "believe in" individualizing testing/assessment. Everyone gets the same 12 hour npsych test battery regardless of their presentation or clinical needs.

The person also once told me they were unable to diagnose OCD without a full neuropsych battery.

 

[WisNeuro]

I recently had a neuropsychologist tell me they do not "believe in" individualizing testing/assessment. Everyone gets the same 12 hour npsych test battery regardless of their presentation or clinical needs.

The person also once told me they were unable to diagnose OCD with a full neuropsych battery.

This person must not take most insurances or medicare as most will not pay for near that length of test battery. Plenty of hack assessment people out there. Just makes it easier for me to take their referral sources.

 

[BuckeyeLove]

I recently had a neuropsychologist tell me they do not "believe in" individualizing testing/assessment. Everyone gets the same 12 hour npsych test battery regardless of their presentation or clinical needs.

The person also once told me they were unable to diagnose OCD with a full neuropsych battery.

There was this realllllly old dude who worked @ one of our prac sites in grad school (he wasn't supervising), who was known for doing this same thing. he was like 80ish, so I always thought maybe it was a generational thing in neuro.

 

[DynamicDidactic]

, once the match imbalance corrected the quality of interns they received was so poor that it wasn’t worth the extra effort staff had to spend doing damage control and remedial training. It will not surprise anyone to hear that some FSPSs were called out by name.

I've been trying to wrap my head around this anecdotal experience. Someone tell me where my logic is going awry.

There is no longer a crisis or severe imbalance in the internship bc:
A) More internships became accredited thanks, in part, due to availability of funding through the APA
B) Non-accredited graduate programs were barred from participating.

The ratio of FSPSs students from accredited programs hasn't changed significantly (maybe even been reduced).

Soooooo....

If the quality of there students has fallen off, the reason is either:
A) they recruited high-quality students from unaccredited programs who are no longer in the applicant pool or
B) their internship is less desirable b/c there is higher competition due to more accredited internship or
C) small sample-bias???

I would think option B is the more likely reason. Meaning, the TD is complaining about the students rather than being introspective of the limitations of their own training. Instead of saying the students suck, the TD could have tried to improve their own site.

Anecdotally, I didn't love my internship, my cohorts didn't either, and my friends at other sites had similar experiences. I was at a name brand place. With more options and less pressure, I think my old site would be matching to lower placements nowadays.

 

[WisNeuro]

I would think option B is the more likely reason. Meaning, the TD is complaining about the students rather than being introspective of the limitations of their own training. Instead of saying the students suck, the TD could have tried to improve their own site.

Anecdotally, I didn't love my internship, my cohorts didn't either, and my friends at other sites had similar experiences. I was at a name brand place. With more options and less pressure, I think my old site would be matching to lower placements nowadays.

I'd want to see a breakdown of where the new internships were added. I'd wager that there are quite a few people who would knowingly take a poorer quality/poorer fit internship just to stay in a certain geographic region.

 

[Sanman]

I recently had a neuropsychologist tell me they do not "believe in" individualizing testing/assessment. Everyone gets the same 12 hour npsych test battery regardless of their presentation or clinical needs.

The person also once told me they were unable to diagnose OCD without a full neuropsych battery.

Including children? Even staunch standard battery fanatics have some changes to their approach l. Ralph Reitan used an older child battery and the Reitan-indiana.

 

[erg923]

Including children? Even staunch standard battery fanatics have some changes to their approach l. Ralph Reitan used an older child battery, the Reitan-indiana. Don't know of a more staunch standard battery advocate than that.

Not an HRB guy and relatively recently trained. Its very much an "every nail needs a hammer, because "hammering" is what I do/my specialty." No actual ROI or clinical justification for it was noted.

 

[ClinicalABA]

... Its very much an "every nail needs a hammer, because hammering is what I do/my specialty.

I'll admit that I basically only have a hammer in my tool bag, and that's why I refer out anything that doesn't look like a nail. While I also know how to use a wrench, screwdriver, and drill, i really prefer to hammer things, so I stick to that as much as I can.

As to the OP- this really seems like and issue with the internship. They either are a) having difficulties recruiting the interns with the skills they need; b) having difficulties training the interns they get in the skills that they need; or c) a combination of both. I also think some of this can be related to training sites looking for interns to be primarily productive (e.g., reimbursible) staff, vs. primarily being trainees. Back when i was faculty on at APA approved internship, we worked very hared to establish a pipeline with specific training programs and specific mentors within those programs. This allowed us to accurately predict the skillset (both strengths and weaknesses) on incoming interns and choose/plan accordingly. The good relationships we had with the "referring mentors" were also conducive to our getting a pretty accurate description of the prospective intern's abilities and areas that needed improvement, which allowed us to better address the interns training needs and career goals. I could not imagine the intern selection process if we did not have the insight provided by these relationships and, instead, had to deal with a pool of relative unknowns.

 

[WisNeuro]

I'll admit that I basically only have a hammer in my tool bag, and that's why I refer out anything that doesn't look like a nail. While I also know how to use a wrench, screwdriver, and drill, i really prefer to hammer things, so I stick to that as much as I can.

In erg's example, I think it's more that the person has a "every nail needs a sledgehammer" approach.

 

[erg923]

In erg's example, I think it's more that the person has a "every nail needs a sledgehammer" approach.

Yes.

And...and unwillingness to recognize that not every symptom or suspected disorder needs a hammer to asses it or make a tentative diagnosis. I mean, a full WMS for social phobia VS OCD? There is an (unfortunate) running joke that this provider is afraid to actually talk to patients.

 

[WisNeuro]

Yes.

And...and unwillingness to recognize that not every symptom or suspected disorder needs a hammer to asses it or make a tentative diagnosis. I mean, a full WMS for social phobia VS OCD? There is an (unfortunate) running joke that this provider is afraid to actually talk to patients.

Eww, who even uses the full WMS for anything? Some of the new tests can produce average scaled scores by chance responding.

 

[ClinicalABA]

In erg's example, I think it's more that the person has a "every nail needs a sledgehammer" approach.

Got that. I was trying to emphasize his point from the other direction- if you can/want to do is one thing, then you better refer out if they don’t need what you can/want to do. Fortunately for me, there are more than enough nails out there in need of my hammer.

 

[erg923]

For sometime, perhaps since the 60s, I think people in training positions have complained of this, no? Programs becoming "more loose"...less rigorous in their scientific/research training competencies at the very least? Meehl talked about this in the early 60s.

Most recently, as I heard, the depthness of one's MMPI training and interpretation skills. Some of it may be rightfully so. But I agree, some of this is on the internship...whether its just their expectations or suboptimal supervision on their part? Who knows?