I 1 PILOT STUDY OF CLIKICAL ISTERNSHIP TRAISISC; HALL PSYCHIATRIC IXSTITUTE A T T H E WILLIAM S.

ARTHUR L. ROSENKRANTZ AND GEORGE H. HOLMEH

It'illiam S. Hall Psychiatric lnsiitrrlc

PROBLEM This research project was designed as an exploratory study in the area of

clinical psychology internship training. It uses as its sources of data ratings from supervisors and interns from one APA-approved clinical internship. The basic questions that this project attempted to answer were: (1) Do interns feel they gain in skills as a result of their internship? (2) What is the relationship between intern achievement ratings of themselves and supervisor ratings of intern achievement? (3) Is intern achievement as perceived by the intern related to intern interest? (4) Where do interns feel they make the most gains and the least gains during their internship? (.?) What areas of interest do interns have after they have completed their internships?

Clinical training has been the subject of a number of papers, notably Clement and Sartoris('), who looked a t the whole question of training as opposed to just internship training. These authors obtained data on 692 graduate students in APA-approved clinical training programs throughout the country. Out of the 692 respondents only 367, had completed their internship, which makes the data only somewhat related to this study. The respondents, however, were asked to rate the adequacy of their training in a number of areas. The trainees felt that too much emphasis was placed on research and diagnosis and too little emphasis placed on psychotherapy, teaching and administrative skills. This is a major deficit when one considers that Ross and Lockman@) reported that, based on the :&mount of time spent in each major work activity by psychologists, psychotherapy ranks first, teaching and training second, research third, administration fourth, diagnosis fifth and consultinr sixth. Clement and Sartoris ( l ) report that there can be no question that a large proportion of those who are being trained in clinical psychology feel that their training is less than satisfactory. Tucker(3) has shown that APA-approved clinical internships frequently do not provide traininp that meets APA standards.

XETHOI) Sub.jejects. The 51s were five 1'h.D. clinical psychologists, iiicludiiig the authors,

and eight cliriical psychology interns. The study was conducted during 2 years of training in an APA clinical internship a t the William S. Hall Psychiatric Institute in Columbia, South Carolina. The clinical psychologists were the supervisors of the interns during their internship training. The interns came from the University of Georgia, St. Louis University, University of South Carolina, Georgia Stntc University, George Washington University and Colorado University.

Materials. Two rating forms were devised, Form S and Form T, which were to be completed independently by supervisors and trainees. These two forms were basically the same and covered 13 areas (listed in Table 1) deemed important by the authors to intern progress during the internship.

Procedure. At the end of the internship, each supervisor was asked to com- plete a Form S for each intern that would rate the intern with regard to achieve- ment level on the 13 areas of functioning listed. At the same time each intern was asked to complete a Form T rating of himself 011 the same dimensions. The intern also was asked to estimate his level of achievement prior t o the internship and his interest level on the dimensions examined on Form T a t the end on the intership (it was pointed out to the intern that this would have no influence on his status

41s ARTHUR L. ROSENKRANTZ ABD GEORGE R. HOLhIES

in the internship’and was for research purposes only). Ratings for level of achieve- ment were: 0 = none, 1 = minimal, 2 = average, 3 = good, 4 = excellent. Ratings for level of interest were: 0 = none, 1 = minimal, 2 = average, 3 = strong, 4 = major interest area..

RESULTS The eight interns felt that they had made significant changes in achievement

in the 13 areas listed on Form T (t = 2.61, p > .05). The interns’ ratings of their individual levels of achievement were not significantly different from the mean achievement rating by their five supervisors (the t tests varied from .33 to 1.74). It should be pointed out that the ratings of the individual supervisors on intern achievement level did not correlate significantly with one another (the interrater correlation coefficients varied from .09 t o .55). The interns’ final interest levels did not correlate significantly with the interns’ final achievement levels (r = .20).

T-LBLI. I . INTLKN HATINGS ~ ~ _ _ -

Meaii Iiiitial Mean Final Level Mean Level Level of Achievement Of Achievement Of Interest

1.

2. .J.

4. .). 6. 7 . 8. 9.

10. 11. 12. I S .

Conceptual grasp of cases I hgnostic workrip5 Written report \ Innovative diagiiostic procedures Staff pr eseiital ioii5

Participation in staff meetiiigs Individual pychotherapy ( houp psychotherapy Family psychotherapy Iiiiiovative treatment approache* Community consultatioiis 1 (eseai r h ac.tivitie\ Personal growth

2.16 I .83 2.6ti 1.42 1 66 1 .33 1 . 7 5 I .83 1.33 1 (Xi

1 .00 2 .33 2.17

3.33 2.94 8 13 I .69 2.63 2.31 3.1s 2.75 2.60 2.58 3.06 2.00 3 . 7t i

3 . 2 5 2.2.5 1 .7?5 2.7.i 1 .7.i 2. ::8 3 .50 3.2.5 3.38 3.63 3.00 2.69 3.88

A tabular presentation of the intern ratings of the 13 areas assessed is presented in Table 1. These interns felt that they had made the most gains in their achieve- ment in individual psychotherapy, community consultation, and personal growth, and the least gains in innovative diagnostic procedures and research. They were most interested in conceptual grasp of cases, psychotherapy, innovative treatment, and personal growth a t the end of their internships.

DISCUSSION In their discussions of the five questions that this study addresses, the eight

interns obviously felt that they gained in clinical functioning as a result of their internship. It is also interesting that their self-perceptions in terms of level of attainment were not significantly different from that judged by the mean achieve- ment rating of their supervisors. This was the case despite the fact that the super- visors differed significantly in their evaluations of individual interns. This finding may be attributed to the written feedback that was provided by supervisors after each rotation in the internship. It is somewhat difficult t o explain why the interns’ final level of interest did not correlate with their final achievement levels. One possible explanation may be that the interns were interested in moving on to new areas of competency, a significant theme in the internship.

A PILOT STUDl- O F CLINICAL INTERNSHIP TRAINING 419

In an examination of the tabular presentation of the intern ratings, the interns felt that they came to their internships fairly well prepared to write reports, conduct research, and make a fair conceptual assessment of cases. In the other 10 areas assessed the interns felt that they had a minimal level of achievement prior to their internship. I n contrast, there was only one area (innovative diagnostic pro- cedures) in which interns felt a minimal level of achievement after their internship was completed and only one area (research) in which they felt they had a decreased level of achievement. In addition, after their internship the eight interns felt that they were functioning well in six areas, (conceptual grasp of cases, diagnostic workups, written reports, individual psychotherapy, community consultations and personal growth) and a t least on an average level in six more (staff presenta- tions, participation in staff meetings, group psychotherapy, family psychotherapy, innovative treatment approaches and research activities).

After their internship, the interns were strongly interested in seveii areas (conceptual grasp of cases, individual psychotherapy, group psychotherapy, family psychotherapy, innovative treatment approaches, community consultation and personal growth) and had an average level of interest in four more (diagnostic workups, innovative diagnostic procedures, participation in staff meetings and research).

The results of this study suggest that in contradiction to studies by Clement arid Sartoris ( l ) and Tucker ( 3 ) the eight interns assessed felt positively about their professional experiences and training. There are some more favorable areas of comparison, particularly with the Clement and Sartoris study. In that study, their graduate student Ss felt adequately prepared to do research, diagnosis, psy- chotherapy and consultation. The interns in this study felt prepared from their final achievement ratings to do diagnostics, individual psychotherapy and con- sultation, but not as well prepared to do research. This can be explained easily because of the strong clinical orientation to the internship and lesser concern with research skills.

A study with a larger number of interns in other internship settings probably would clarify several questions not answered in the present pilot study. I n addition, however, it might further cloud the issue, since it appears to these authors that clinical internship training varies considerably with internship setting and staff.

SUMMAR1

Clinical psychology interns (X = 8) and their supervisors ( N = 5 ) from one APA-approved clinical internship were asked to act as Ss in a pilot study to examine internship training st one training facility. It was found that these eight interns felt that they had made significant changes in their clinical skills as a result of their training experiences. I n addition, the interns’ ratings of themselves in terms of achievement during their internship did not differ significantly from the consensus rating of their supervisors. The intern interest level a t the end of internship did not correlate significantly with the interns’ final achievement levels in the areas assessed. Suggestions with regard to reasons for these results were made, and the results of the study were compared to prior investigations of internship training.

REFERENCES 1. CLP:MICNT, P. W. and S.LHTOH.IS, P. C. Clinical students evaluat,e preseiit APA approved traitiiiig

2. Ross, S. and LOCKM.IN, It. F. A Career in Psychology. Washington: Americttti Psychologicd

3.

programs and make suggest.ions for changes. J . elin. Psychol. , 1967, 23, 57-62.

Association, 1963. TUCKER, R. C. %rangers in Paradise. J . consult. clzn. Psycho/. , 1970, $4, 140-143.