What comes after dismissal after failure to remediate on internship?

[hr3]

I’m having trouble locating the information of what happens if you fail a remediation plan while on internship? I know someone who matched last year and is currently on internship and was placed on a remediation plan within the past month. All supervisors seem to be already seeing their willingness to improve and results from resources provided, with the exception of one supervisor. I personally feel that if the majority is saying there is improvement while one is saying the opposite that it can’t swing a decision for dismissal, but I’m trying to find out what the process is if they do wind up failing and dismissed. I have not gone through the matching process yet and can’t find much just from general searching on AAPIC/Reddit/here.
Does anyone have any insight? I’m trying to offer comfort that no matter what this isn’t the end of it all and years wasted. They’ve already been offered and accepted a postdoc fellowship and have job offers for after postdoc from prior supervisors at their(our) graduate program... so this is very surprising that this remediation plan is even occurring.

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[WisNeuro]

Well, if they are dismissed, they try to find positions that do not require completion of an accredited internship, and they hope that they can convince their state licensing board that they are licensable despite being kicked out of internship.

 

[hr3]

Well, if they are dismissed, they try to find positions that do not require completion of an accredited internship, and they hope that they can convince their state licensing board that they are licensable despite being kicked out of internship.

So, you can reapply for internships to finish your doctorate, just not an APA accredited one?

 

[Sanman]

So, you can reapply for internships to finish your doctorate, just not an APA accredited one?

This will really depend on the program. Mine required an APA internship for graduation. If the program approves it, they might be able to find a postion outside of the match to complete internship. That said, failing internship is a big deal for the internship program and the student. Like get a lawyer and sue them for damages unless they documented everything very carefully big. If one supervisor is against it without evidence to back up their assertion, the internship program may remove them as supervisor and pass the person anyway.

 

[hr3]

This will really depend on the program. Mine required an APA internship for graduation. If the program approves it, they might be able to find a postion outside of the match to complete internship. That said, failing internship is a big deal for the internship program and the student. Like get a lawyer and sue them for damages unless they documented everything very carefully big. If one supervisor is against it without evidence to back up their assertion, the internship program may remove them as supervisor and pass the person anyway.

I did see that it’s the students right to contest a dismissal, and with the lack of information out there of what happens after I kind of assumed this was just as big of a deal for the internship site as the student. I appreciate your response, it confirms my thoughts on it. The only real documentation from my understanding is the remediation plan because quarter evaluations and feedback were positive from everyone (prior to the remediation plan) EXCEPT the one supervisor I mentioned in my initial post.

 

[borne_before]

I think it depends on the reasons for remediation and why they aren’t meeting them. I was actually put on a corrective action plan on my internship. It kind of messed me up. Later, I found out later that one of my supervisors was an alcoholic and probably wasn’t even going to several of my placements so I actually wasn’t getting good supervision.

 

[foreverbull]

I know through word-of-mouth of someone who failed an APA-accredited internship. They had to wait a year and reapply, but eventually got another APA-accredited internship in another state, I believe (I'm not 100% certain about the APA-accredited part, but I think it was). This person had a very strong CV and looked great on paper, so they got interviews even with answering the red flag question about having been on internship before and having to explain what happened. This person had self-awareness issues that impeded practice and the remediation plan wasn't enough.

So there's hope, long story short. The person needs to be completely honest and show growth and self-awareness of what went wrong. The person also needs a great CV.

 

[beantownpsych]

What is the nature of the remediation plan? Risk to patients is obviously weighed more heavily than showing up late to supervision or a seminar. Does the negative supervisor have more (or a different) level of contact then the other supervisors (if they have more, then their opinion will likely weigh more)? If it's a multirotation/site/service internship did the intern have difficulty on all the rotations? Trouble on multiple rotations is not a good sign.

As a Internship TDs our goal is help interns reach competency to graduate. As an aside it's a major, major headache to fail someone so it's typically a last resort. Sometimes we get an intern that is a train wreck clinically (d/t lack of experience or lack of interest). We really work with them to be competent enough to graduate. We also make it pretty difficult to fail a remediation plan. The only reasons I can really think of failing someone is if they are danger to the field/would be incompetent to practice or if they simply refused to participate in the remediation.

 

[hr3]

What is the nature of the remediation plan? Risk to patients is obviously weighed more heavily than showing up late to supervision or a seminar. Does the negative supervisor have more (or a different) level of contact then the other supervisors (if they have more, then their opinion will likely weigh more)? If it's a multirotation/site/service internship did the intern have difficulty on all the rotations? Trouble on multiple rotations is not a good sign.

As a Internship TDs our goal is help interns reach competency to graduate. As an aside it's a major, major headache to fail someone so it's typically a last resort. Sometimes we get an intern that is a train wreck clinically (d/t lack of experience or lack of interest). We really work with them to be competent enough to graduate. We also make it pretty difficult to fail a remediation plan. The only reasons I can really think of failing someone is if they are danger to the field/would be incompetent to practice or if they simply refused to participate in the remediation.

The main feedback for the remediation plan was writing skill. Nothing related to patients, absences, or ethics, which is the only thing I’ve seen related to dismissal from just searching. It is multiple rotations, and they have received the writing feedback in supervison but thought it had improved since there wasn’t much feedback or anything on the quarterly evaluations... The one supervisor was equally involved originally but has now been put as the “lead” of the remediation plan, I guess you could say. They are trying to take the feedback from each supervisor and hitting deadlines for the extra coursework that was added through the remediation. This really helps I’ll pass it along, I’m just trying to ease their anxiety about it all 😕

 

[AbnormalPsych]

I have nothing to add at the moment other than to just say that there are bad supervisors out there. I know of them. Some are removed. Some not...yet. It is a big problem in the field in my opinion. Particularly when gatekeeping matters so much at some stages and an impaired or vengeful gatekeeper wields so much power.

 

[WisNeuro]

I have nothing to add at the moment other than to just say that there are bad supervisors out there. I know of them. Some are removed. Some not...yet. It is a big problem in the field in my opinion. Particularly when gatekeeping matters so much at some stages and an impaired or vengeful gatekeeper wields so much power.

This is definitely true, but there are bad supervisors in different ways. Some are bad due to toxic behaviors towards trainees, some are bad because they see glaring deficiencies and problems in trainees, but pass them anyway to avoid conflict or the work that comes with remediation. Both are problemmatic. I see more of the latter than the former.

 

[Sanman]

This is definitely true, but there are bad supervisors in different ways. Some are bad due to toxic behaviors towards trainees, some are bad because they see glaring deficiencies and problems in trainees, but pass them anyway to avoid conflict or the work that comes with remediation. Both are problemmatic. I see more of the latter than the former.

In either case, you get what you pay for more often than not. I certainly see nothing but the occasional "thank you" for it.

 

[thebalmofhurtminds]

I'm surprised to hear that writing skill is the main reason for remediation. Many notes tend to be heavily templated, whether assessment or therapy. Other than the supervisor potentially being overly nitpicky, I would certainly be concerned that multiple supervisors think that this intern's writing is so poor that it needs significant remediation. I guess I'm just very curious about what this would look like.

 

[WorkLifeBalance]

I'm surprised to hear that writing skill is the main reason for remediation. Many notes tend to be heavily templated, whether assessment or therapy. Other than the supervisor potentially being overly nitpicky, I would certainly be concerned that multiple supervisors think that this intern's writing is so poor that it needs significant remediation. I guess I'm just very curious about what this would look like.

Some internships are very assessment heavy. In those cases, having significant difficulties producing a report (not just a note) despite support and feedback, could result in a remediation plan.

 

[thebalmofhurtminds]

Some internships are very assessment heavy. In those cases, having significant difficulties producing a report (not just a note) despite support and feedback, could result in a remediation plan.

Certainly, I have just only seen this be more of a problem with conceptualization/diagnostic skills rather than specifically writing skills. If that makes sense.

 

[WisNeuro]

The one time I had to initiate one, it was due to careless mistakes. Messing up scoring, incorrect details in reports from chart records, incorrect patient birthdates and age.

 

[thebalmofhurtminds]

The one time I had to initiate one, it was due to careless mistakes. Messing up scoring, incorrect details in reports from chart records, incorrect patient birthdates and age.

Ah, yes, that makes sense. I guess that falls under "writing skills," although certainly not what I would initially think falls under that construct.

 

[WisNeuro]

Ah, yes, that makes sense. I guess that falls under "writing skills," although certainly not what I would initially think falls under that construct.

Aside from that experience, though, I would agree that the single biggest issue that interns have, is writing a report. Even following a template is difficult for many. I've probably spent an equal amount of time working with trainees on writing skills as I have in clinical conceptualization skills.

 

[thebalmofhurtminds]

Aside from that experience, though, I would agree that the single biggest issue that interns have, is writing a report. Even following a template is difficult for many. I've probably spent an equal amount of time working with trainees on writing skills as I have in clinical conceptualization skills.

That does not make me excited as a new supervisor.

 

[mind_over_matter277]

I think remediation and probation plans generated during internship may be easier to handle than those given to postdoctoral fellows. The stakes are much higher for interns and it is in the best interest of the program to help the student succeed.

 

[AcronymAllergy]

From the internship site's perspective, more often than not, a remediation plan (I actually believe, per APA or APPIC, they're called something other than "remediation plan" now, but I can't remember what off-hand) is a tool toward fostering improvement. It sometimes "unlocks" training options that might not otherwise be available when more support is needed, such as a reduced caseload. I certainly can't speak for all internship sites, but in my experience, a site really wants an intern to succeed and meet the conditions of the remediation plan whenever one is enacted. Sites do not want to, or enjoy having to, dismiss interns. If dismissal occurs, it will probably involve APPIC and various contacts between all involved parties.

I also agree--the only dismissals I've heard of have had to do with to patient-related concerns (e.g., improper patient interactions, severely deficient clinical skills, violations of patient confidentiality/information protection protocols). Also, sometimes a site may work with an intern to withdraw rather than be dismissed. I'd be pretty surprised if someone were dismissed related solely to writing, unless that also involved skills like conceptualization. Or if the intern just flat out refused to respond to feedback and basically ignore the stipulations of the remediation plan.

As was said, after dismissal, I believe you are able to re-apply for internship if you have APPIC's permission; you'd just need to list the dismissal on your application and explain its nature. If not, you'd need to apply for a non-APPIC internship and also seek approval from your graduate program (assuming they required completion of an APA-accredited internship). If the graduate program doesn't grant an exception, I imagine they might dismiss the student from the program, similar to if they failed a class twice.

And finally, I also agree with WisNeuro that the biggest skill in need of development I saw in many interns was reporting writing. I imagine it has to do with the diminishing amount of assessment experience many graduate programs are offering/requiring. It was not uncommon for me to review applications for trainees who'd completed only 1 or 2 integrated assessments.

 

[mind_over_matter277]

From the internship site's perspective, more often than not, a remediation plan (I actually believe, per APA or APPIC, they're called something other than "remediation plan" now, but I can't remember what off-hand) is a tool toward fostering improvement. It sometimes "unlocks" training options that might not otherwise be available when more support is needed, such as a reduced caseload. I certainly can't speak for all internship sites, but in my experience, a site really wants an intern to succeed and meet the conditions of the remediation plan whenever one is enacted. Sites do not want to, or enjoy having to, dismiss interns. If dismissal occurs, it will probably involve APPIC and various contacts between all involved parties.

I also agree--the only dismissals I've heard of have had to do with to patient-related concerns (e.g., improper patient interactions, severely deficient clinical skills, violations of patient confidentiality/information protection protocols). Also, sometimes a site may work with an intern to withdraw rather than be dismissed. I'd be pretty surprised if someone were dismissed related solely to writing, unless that also involved skills like conceptualization. Or if the intern just flat out refused to respond to feedback and basically ignore the stipulations of the remediation plan.

As was said, after dismissal, I believe you are able to re-apply for internship if you have APPIC's permission; you'd just need to list the dismissal on your application and explain its nature. If not, you'd need to apply for a non-APPIC internship and also seek approval from your graduate program (assuming they required completion of an APA-accredited internship). If the graduate program doesn't grant an exception, I imagine they might dismiss the student from the program, similar to if they failed a class twice.

And finally, I also agree with WisNeuro that the biggest skill in need of development I saw in many interns was reporting writing. I imagine it has to do with the diminishing amount of assessment experience many graduate programs are offering/requiring. It was not uncommon for me to review applications for trainees who'd completed only 1 or 2 integrated assessments.

Remediation and probation seems to be different with apa accredited postdoctoral programs. In these cases, such actions are set up to ensure failure rather than success.

 

[AcronymAllergy]

Remediation and probation seems to be different with apa accredited postdoctoral programs. In these cases, such actions are set up to ensure failure rather than success.

That was not my experience within postdoctoral training programs (i.e., that the plans are setup for failure). But I certainly can't speak for every program, and I imagine there are some bad actors (or individually bad faculty) out there.

 

[mind_over_matter277]

That was not my experience within postdoctoral training programs (i.e., that the plans are setup for failure). But I certainly can't speak for every program, and I imagine there are some bad actors (or individually bad faculty) out there.

So in most cases such plans are fool proof? Even at the postdoctoral level?

 

[AcronymAllergy]

So in most cases such plans are fool proof? Even at the postdoctoral level?

Nope, not at all; they certain can result in dismissal. My experience was just that they were not initially setup for failure and were instead implemented with the hope that the trainees would meet the conditions of the plan and have it resolved.

 

[mind_over_matter277]

Nope, not at all; they certain can result in dismissal. My experience was just that they were not initially setup for failure and were instead implemented with the hope that the trainees would meet the conditions of the plan and have it resolved.

Yeah that was not my case.

 

[psych.meout]

So in most cases such plans are fool proof? Even at the postdoctoral level?

Not being "foolproof" doesn't mean that they "are set up to ensure failure rather than success."

 

[mind_over_matter277]

Not being "foolproof" doesn't mean that they "are set up to ensure failure rather than success."

My situation was very different. The program I was in didn’t really follow due process guidelines and didn’t give enough time to reach the expected competencies.