Robert Hatcher, PhD
At their February 2006 meeting, the APA Council of Representatives approved the following policy:
The American Psychological Association affirms the doctorate as the minimum educational requirement for entry into professional practice as a psychologist.
The American Psychological Association recommends that for admission to licensure applicants demonstrate that they have completed a sequential, organized, supervised professional experience equivalent to two years of full-time training that can be completed prior or subsequent to the granting of the doctoral degree. For applicants prepared for practice in the health services domain of psychology, one of those two years of supervised professional experience shall be a predoctoral internship.
The American Psychological Association affirms that postdoctoral education and training remains an important part of the continuing professional development and credentialing process for professional psychologists. Postdoctoral education and training is a foundation for practice improvement, advanced competence, and inter-jurisdictional mobility.
In adopting the preceding policy statements, the Council supports further development of competency goals and assessment methods in the professional education and training of psychologists.
The practicum has become an increasingly important step in professional training in psychology. This report offers a view of current thinking and knowledge about the practicum, and gives some suggestions about how supervisors or trainers might further help our young colleagues as they begin their practical training towards becoming a psychologist. This may be particularly helpful to Registrants who serve as supervisors in practicum sites, or are interested in becoming supervisors. This article will acquaint you with the latest developments in defining and assessing competencies at the practicum level.
What is the practicum? “The practicum is the first set of supervised practical training experiences in the sequence of professional training in psychology that extends from initial classroom education to internship and licensure. The practicum is designed to meet the training goals of the graduate program. The practicum comprises all supervised pre-internship training experiences conducted under the auspices of the graduate program in settings providing professional psychological services. The practicum promotes the integration of academic knowledge with practical experience, and prepares the student for future training in professional psychology, particularly for the internship that follows. On practicum, students apply and extend the knowledge, skills and attitudes learned in the program’s didactic and classroom-based experiential components to produce increasingly sophisticated levels of understanding and skill.” This quote is from a draft statement prepared by the Practicum Workgroup of the Council of Chairs of Training Councils (CCTC), and it reflects our field’s increasing need to define and understand the practicum portion of professional training in psychology. The practicum has gained increasing importance in our field more recently for two main reasons. First, the competition for internship placements is strong, and of the 3210 applicants in the Association of Psychology Postdoctoral and Internship Centers (APPIC)-sponsored internship match held in February, 2006, 731 applicants, or 33%, did not match. Under these conditions, students seek whatever advantage they reasonably can, and a widespread but unsubstantiated belief among applicants is that more practicum experience will strengthen their applications. As a result, the number of reported practicum hours has increased greatly over the last decade, from an average of 1500 in 1994 to an average of 2274 reported by applicants for the 2006 match. The average number of hours of practicum training has grown to equal the required number of internship hours.
The second reason for the increased importance of practicum in our field is the revised model licensing act policy adopted by the APA Council of Representatives at its February 2006 meeting. (See below) The previous model licensing act required an internship year and a post-doctoral year of experience to meet the jurisdictions’ training standards for admission to licensing. The 2006 policy statement enacted one of the main recommendations of the 2000 APA Commission on Education and Training Leading to Licensure in Psychology. The 2006 policy changed the suggested supervised training requirement for licensure to the equivalent two years of full-time supervised practice, and stated: “For applicants prepared for practice in the health services domain of psychology, one of those two years of supervised professional experience shall be a predoctoral internship.” Since the most common trajectory towards licensure is practicum training followed by internship training, the equivalent of a year of practicum training, plus an internship, has become the APA Council’s recommended minimum requirement. (However, as one can see by reading the model language, it does not preclude the applicant for licensure submitting a year of postdoctoral experience for the second year of needed experience. That year will be needed for advanced competency, specialization or mobility purposes, anyway.)
These model act changes have brought new attention to the practicum, and new calls for better understanding of the entire sequence of education in professional psychology. In the fall of 2006, the APA Education Directorate (ED) and the APA Board of Educational Affairs (BEA) convened a Competencies Benchmarks Workgroup with the task of beginning a comprehensive mapping of the growth of core competencies in professional psychology through the entire sequence of training, from initial graduate instruction, through practicum, to internship, licensure, to advanced competency and specialization. Practicum training is a key and first element in this sequence, as it bridges graduate students’ program-based didactic experience and the internship that follows, ideally providing the basic skills or competencies needed to make optimal use of the internship experience and beyond.
What is known about the practicum, and what is the current thinking about what should happen in it? Many Registrants contribute to graduate training through supervision and mentorship of practicum students. What should we know about practicum, and how can we contribute to its greater success?
Significant steps towards addressing the goals and expected competencies of practicum training began in 2004 through the efforts of two workgroups, the first sponsored by the Association of Directors of Psychology Training Clinics (ADPTC), the national organization for university-based practicum clinics, whose work was followed up by the CCTC’s Practicum Competencies Workgroup. Working in tandem, these workgroups prepared a comprehensive outline of pre-practicum competencies needed to begin practicum training, and of competencies that are addressed in the practicum itself. The competencies document that resulted was endorsed first by the ADPTC, and then by the CCTC, in 2005. The Report on Practicum Competencies (RPC) is available at www.adptc.org. We describe and discuss the highlights of this extensive work below.
The second avenue to these questions is through research and data regarding the actual practice of practicum training in the field. In this sense, the practicum is a vast, largely undocumented territory in the world of professional psychology. Practica are under the aegis of the individual graduate programs, and no central record is kept of any feature of these sites, including their client populations, their supervisory and didactic programs, or the number of hours students spend at them. The APA Office of Research conducted a survey in 1999 (Lewis, Hatcher, & Pate, 2005) which gave some indication of the range and focus of sites at that time, although we can’t be sure that the responding group accurately reflects the real range of practicum sites, then or now. This survey found that 35% of practicum sites were hospital based, 29% were university-based training clinics and counseling centers, 25% were community mental health centers and other social service agencies, including prisons and schools. The major focus of these training sites was assessment and intervention (98% of the sites provide these experiences), with program development and evaluation, community consultation, quality assurance, and supervision generally falling into the 20% range across sites. A major finding of this study is that there is quite limited understanding and communication between practicum sites and graduate programs regarding the training goals for the students at the sites. New accreditation criteria are likely to emerge from the Committee on Accreditation (COA) requiring graduate programs to keep better track of practicum training goals, experiences, and competencies achieved by graduate students, and to document communication between the program and the practicum sites. There is much to be learned about what actually happens in practica across the nation.
We also know that, across graduate programs, there is a wide range of expectation regarding how much time should be spent in practicum training. At present, the only requirement from the COA is that the practicum training should match the educational goals of the graduate program. The actual range of practicum training as reported on A P P I C ’s internship application form is from 500 hours to several thousand. Graduate program directors generally favor a lower number of practicum hours in comparison to internship directors. Similarly, whereas half of the responding graduate program directors favored placing a cap on the number of practicum hours reported on the application form, only one quarter of the internship directors did so. The most frequent cap supported by program directors was 1000 hours, and by internship directors, 1,500 hours (Kaslow, Pate & Thorn, 2005). The most likely explanation for this difference is that graduate program directors want their students to move through their programs expeditiously, and to have time for research, whereas internship directors gain from having more experienced interns.
The key features of practicum identified by educators are that the practicum helps students apply their classroom-based knowledge of professional psychology in practical settings, in order to prepare them for their internship and beyond. The RPC is intended to flesh out this basic structure.
The first issue is whether the student is ready to begin practicum work. The beginning section of the RPC is intended to help graduate programs and practicum sites determine whether the student has the educational grounding and personal attitudes and skills needed to begin practicum training. In addition to successfully mastering coursework in assessment, intervention, ethics, and multicultural issues, the student should also possess the personality characteristics and intellectual and personal skills needed to function as a professional psychologist providing direct services. These skills are outlined here:
Personality characteristics: intellectual and personal skills that students should possess prior to their practicum training experience.
Interpersonal skills: ability to listen and be empathic with others; respect for/interest in others’ cultures, experiences, values, points of view, goals and desires, fears, etc. These skills include verbal as well as non-verbal domains. An interpersonal skill of special relevance is the ability to be open to feedback.
Cognitive skills: problem-solving ability, critical thinking, organized reasoning, intellectual curiosity and flexibility.
Affective skills: affect tolerance; tolerance/understanding of interpersonal conflict; tolerance of ambiguity and uncertainty.
Personality/Attitudes: desire to help others; openness to new ideas; honesty/integrity/valuing of ethical behavior; personal courage.
Expressive skills: ability to communicate one’s ideas, feelings and information in verbal, non-verbal and written forms.
Reflective skills: ability to examine and consider one’s own motives, attitudes, behaviors and one’s effect on others.
Personal skills: personal organization, personal hygiene, appropriate dress.
The basic idea is that graduate programs and practicum sites should evaluate students for their readiness for practicum. This is an important first step in monitoring students for their ability to perform effectively as professional psychologists, and to help decrease the problem of passing students who are having difficulty, rather than facing and dealing with these difficulties when they become apparent. On this issue, the RPC has already been found useful by a number of graduate programs and practicum sites.
The practicum is a significant element in the sequence of training, a fact that can be easily overlooked by both the student and the practicum site in the midst of the demands of practical work with clients. The BEA and ED have been keenly interested in promoting thinking about the sequence of training, and have supported the development of what has been called the competencies movement in our field, that seeks to identify the competencies that professional psychologists should possess when they become independent practitioners. Psychology is beginning to catch up with the other health professions in this regard. National organizations in medicine (including psychiatry), dentistry and nursing have identified their core competencies and have begun to develop curricula and assessments based on these competencies. Competency-based curricula are designed to teach core competencies, and trainees must demonstrate their mastery of these competencies on written exams, but also in assessments that come close to actual performance settings. These include the use of standardized patients, actors who follow a standardized script to present various symptoms and complaints for the trainee to diagnose and propose treatment plans; and objective structured clinical exams (OSCE), which involve rotating through a series of smaller-scale diagnostic challenges that are rated and summed.
The effort to identify competencies in psychology, and to consider how these competencies can develop through the stages of training, began in earnest at the APA’s first Education Leadership Conference in 2001, which was followed by APPIC’s Competencies Conference in 2002, that brought together more than a hundred psychologists involved in training to begin to define core competencies for the field. Most recently, the BEA and the ED sponsored a Competencies Benchmarks Workgroup in the fall of 2006. This meeting brought together 32 psychologists actively involved in competencies issues to articulate benchmarks for 12 core competency areas, derived from the Competencies Conference, at four stages of professional development, including readiness for practicum and readiness for internship. The RPC is part of this effort to develop competencies for psychology, and adds to it a specific focus on what can be learned during the practicum. Overall, the competencies approach has been less warmly received in psychology than in other healthcare fields, primarily because of the concern that nationally-endorsed competencies would encroach on the freedom of graduate programs to develop their own educational plans. However, because accreditation in psychology is chiefly based on judging how effectively any given program carries out its own educational model, these concerns may turn out to be less serious than feared.
The RPC describes a comprehensive set of competencies that can be addressed in practicum training. The report can be used by graduate programs and practicum sites to determine which competencies the program wishes its students to work on, and to determine which combination of practicum sites would best address the training goals for the program and for the individual student. Lewis et al (2005) reports on the 1999 APA survey of practicum training which discovered that problems in the understanding and communication between practicum sites and graduate programs regarding the training goals for students, even for practicum clinics located within the graduate program. These authors strongly recommended that greater attention be paid to this communication so as to improve the quality of training for students.
The RPC can also be used to create a plan with the supervisee at the start of supervision, which in turn can serve as a basis for evaluating the supervisee’s progress and achievement in the practicum. Evaluation takes place at three different levels with expected level indicated for exit of practicum on each competency. That is, not every competency must be performed at the advanced level for the student to pass the practicum.
The format for these plans is likely best set up in collaboration with the graduate program and according to graduate program training goals. The RPC has a number of potential uses, many of which have been put into action in clinics and graduate programs across the country, including helping programs to link their overall training philosophy and plan to the specific goals and objectives of their training program. This is an important step in meeting the requirements of the APA’s Guidelines and Principles for Accreditation of Programs in Professional Psychology for Domain B. Defining competency goals may help programs to develop their plans for practicum training. To accomplish this, individual programs may select from the RPC the competencies that best reflect their own particular missions and training goals. The RPC can play an important role in conducting a gap analysis, that is, in determining which competencies are not covered by the program. Then the program can decide whether the identified gaps should be addressed. The RPC helps the program think about how competencies are operationalized and assessed. Descriptions of specific competencies may be elaborated to fit the needs and values of individual programs (for example, “appropriate dress” as a pre-practicum requirement) and programs may choose to develop their own administrative policies around these topics.
The RPC may serve as an informed consent document when shared with applicants to the program, by making explicit the fact that their personal and emotional functioning will be subject to evaluation during professional training, as when personality and cognitive functioning is reviewed pre-practicum. This is consistent with the CCTC guidelines on assessment of personality functioning in students. A number of programs have found that a review of the Report with entering students and beginning practicum students helps make clear the expectations of the program, helps them understand the trajectory and organization of their clinical training, and reduces the level of anxiety over what is expected of them. It helps counter the unrealistic idea that a practicum student should know everything!
Competency assessment is an important application of the Report. Once the skills and abilities students are expected to master have been identified, a plan for assessment may be developed. We concur with Kaslow et al.’s (2006) statement in the Report of the APA task force on the assessment of competence on professional psychology that “no single assessment model can evaluate all competencies” (p. 58) and that competencies must be defined in clear and measurable terms to make them amenable to valid and reliable assessment. The RPC may be employed as a comprehensive tool for instructors and supervisors to evaluate student trainees and track their progress. Competency evaluations may be completed following each training experience, making periodic systematic reviews easier to conduct. Evaluations may be compiled periodically to determine student progress, areas of strength to be optimized and areas of relative weakness to be addressed or remediated. This serves the following purposes: (1) it provides a method for structuring professional development discussions between students and faculty mentors; (2) it promotes the use of a multi-informant evaluation process; and (3) it helps track improved students and provides a history for students whose difficulties emerge later. Such documentation is particularly helpful in facilitating remediation or dismissal of an insufficiently competent student.
The clinical portfolio is another useful extension of the RPC. A portfolio is a collection of information about a student’s activities during their training, demonstrating progress and achievement over time. The portfolio may become a guide for discussing and planning professional development. It may contain other relevant materials, such as evaluations, statements of clinical philosophy, work samples and reprints of articles. Programs might choose to establish a procedure whereby students and their faculty mentors meet periodically during the academic year specifically to review the portfolio, plan future training opportunities, and encourage articulation of the student’s own training goals. The portfolio may help programs assess student readiness for internship. Ultimately, the portfolio could be a part of the student application for internship.
The RPC may provide a basis for evaluating outcomes for practicum training programs. By looking across evaluations of student progress for each practicum site, programs may assess which sites provide desired and effective training experiences, and may identify areas for improvement. The results can provide objective data for use in placing students in settings that best meet their training needs. The Report may be used to facilitate communication between practicum sites and graduate programs regarding training goals and priorities.
Overall, the Report may help stimulate thoughtful discussion regarding competency goals for more advanced training.
Sample Practicum Competencies
One of the key practicum competencies is the ability to make good use of supervision. This competency is a subset of Interpersonal Skills, and is of special interest to supervisors. It includes the following skills.
With supervisors, the ability to make effective use of supervision, including:
Ability to work collaboratively with the supervisor. Collaboration means understanding, sharing and working by a set of common goals for supervision. Many of these goals will change as the student gains professional competence, although a core goal, of working cooperatively to enhance the student’s skills as a clinician, will remain constant. It is this aspect of collaboration that is expected to be at the “Advanced” level by the end of practicum training. Competencies 2 & 3 below may be considered aspects of collaboration with the supervisor.
1) Ability to prepare for supervision.
2) Ability/willingness to accept supervisory input, including direction; ability to follow through on recommendations; ability to negotiate needs for autonomy from and dependency on supervisors.
3) Ability to self-reflect and self-evaluate regarding clinical skills and use of supervision, including using good judgment as to when supervisory input is necessary. This skill is expected to be at an “Intermediate” level at the end of practicum.
A second set of competencies of special interest are in the category of “Practical Skills to Maintain Effective Clinical Practice,” and include the following:
1) Timeliness: completing professional tasks in allotted/appropriate time (e.g., evaluations, notes, reports); arriving promptly at meetings and appointments.
2) Developing an organized, disciplined approach to writing and maintaining notes and records.
3) Negotiating/managing fees and payments.
4) Organizing and presenting case material; preparing professional reports for health care providers and agencies.
5) How to self-identify personal distress, particularly as it relates to clinical work.
6) How to seek and use resources that support healthy functioning when experiencing personal distress.
7) Organizing one’s day, including time for notes and records, rest and recovery, etc.
The expectation is that practicum students will have fully mastered the first two skills by the conclusion of practicum, and have made considerable headway towards regular, skilled performance in the remaining five.
There are a number of other competencies that are the focus of practicum training listed in detail in the RPC, easily accessed at www.adptc.org.
The resource guide published by the American Psychological Association of Graduate Students (APAGS), “Succeeding in Practicum,” is an excellent reference for practicum trainers as well as for students seeking practicum experience. It has chapters on the definition of practicum, on how to plan a sequence of practicum training to prepare for one’s later career. It lays out an excellent plan for identifying and applying to a practicum site. It discusses how to prepare for and behave in an interview, and lists various questions that practicum supervisors and directors may choose to ask, such as, “What are you looking for in a supervisor?” “What was the most difficult aspect of your former job?” It offers questions that students might wish to ask their practicum interviewers, such as, “What is your approach to training students?” and “What is the typical day like for a practicum student?” (APAGS, pp. 34-35). It has chapters on ethics and practicum, on self-care, and three different chapters on how to use supervision effectively. Altogether this is a valuable source for practicum students and supervisor/trainers alike.
As the importance of practicum experience grows in our profession, the contributions of practicum supervisors and trainers such as Registrants will be increasingly recognized, as will the challenges to participate fully and effectively in nurturing the growth of future psychologists.
Definitions of Competency Domains*
• Practice conducted within the boundaries of competencies, commitment to lifelong learning, engagement with scholarship, critical thinking, and a commitment to the development of the profession.
• The ability to understand research, research methodology and a respect for scientifically derived knowledge, techniques of data collection and analysis, biological bases of behavior, cognitive-affective bases of behavior, social bases of behavior, and lifespan human development.
• Capacity to relate effectively and meaningfully with individuals, groups, and/or communities.
• Awareness and sensitivity in working professionally with diverse individuals, groups, and communities who represent various cultural and personal background and characteristics.
• Identification and involvement with one’s colleagues and peers. Knowledge of key issues and concepts in related disciplines and the ability to interact with professionals in them.
• Assessment and diagnosis of problems and issues associated with individuals, groups, and/or organizations.
• Interventions designed to alleviate suffering and to promote health and wellbeing of individuals, groups, and/or organizations.
• The ability to provide expert guidance or professional assistance in response to a client’s needs or goals.
• The generation of research that contributes to the professional knowledge base and/or evaluates the effectiveness of various professional activities.
• Supervision and training of the professional knowledge base and/or evaluates the effectiveness of various professional activities.
• Managing the practice of mental health services and/or the administration of health organizations, programs, and agencies.
Definitions of level of performance on practicum competencies
1. Novice (N): Novices have limited knowledge and understanding of (a) how to analyze problems and of (b) intervention skills and the processes and techniques of implementing them. Novices do not yet recognize patterns, and do not differentiate well between important and unimportant details; they do not have filled-in cognitive maps of how, for example, a given client may move from where he/she is to a place of better functioning.
2. Intermediate (I): Psychology students at the intermediate level of competence have gained enough experience through practice, supervision and instruction to be able recognize some important recurring domain features and to select appropriate strategies to address the issue at hand. Surface level analyses of the Novice stage are less prominent, but generalization of diagnostic and intervention skills to new situations and clients is limited, and support is needed to guide performance.
3. Advanced (A): At this level, the student has gained deeper, more integrated knowledge of the competency domain in question, including appropriate knowledge of scholarly/research literature as needed. The student is considerably more fluent in his/her ability to recognize important recurring domain features and to select appropriate strategies to address the issue at hand. In relation to clinical work, recognition of overall patterns, of a set of possible diagnoses and/or treatment processes and outcomes for a given case, are taking shape. Overall plans, based on the more integrated knowledge base and identification of domain features are clearer and more influential in guiding action. At this level, the student is less flexible in these areas than the proficient psychologist [the next level of competence] but does have a feeling of mastery and the ability to cope with and manage many contingencies of clinical work.
Robert L. Hatcher, PhD, is Director of the Institute of Human Adjustment and Director of the Psychological Clinic at the University of Michigan. He is past president of the Association of Directors of Psychology Training Clinics and Chair of the Practicum Workgroup of the Council of Chairs of Training Councils.