Return to APA Collection Inventory Page
Text of document:
students come to internships with some variability in their training
in these areas and also because the survey of doctoral programs (Hannay,
1996) indicated that there is great variability in the opportunity for
such training at the doctoral level. The motion to drop the sentence did
not carry. Section VIII was approved.
The questions of internship training was brought before the delegates.
The requirement that the doctoral dissertation be completed prior to internship
resulted in extensive discussion. It was suggested that this requirement
may place undue burdens on the prospective intern. An amendment was made
stating the completion of the dissertation be listed as desirable but not
required. Some suggested in the discussion that followed that support for
completing the dissertation prior to internship would not be found in the
clinical departments. Others said that there was a similar requirement
in medicine for completing all medical school requirements prior to internship.
Furthermore, an uncompleted dissertation was thought to be an interference
to training. Additional comments included the following: The requirement
would put too much stress on the student. A previous conference had voted
to keep internship training at the predoctoral level. The medical model
might not be appropriate since there are no research/dissertation requirements
for the medical student. It was pointed out that the proposal was a model
for the future not for immediate change. Further, it was noted that a student
trying to meet dissertation requirements could not benefit from all that
was offered during the internship. Requiring the neuropsychology intern
to have completed the dissertation would set up two separate categories
of graduate students. It was also noted that since interns are selected
in February, they would have to know that they could complete the dissertation
in the following 6 months. Several references were made to the need for
policy change that would require students to complete the dissertation
prior to internship and that the current document was the spearhead for
such change. The burden would fall to the faculty to assure that the requirement
was met.
A two-thirds vote of the delegates called the question of the
amendment stating that "completion of the doctoral dissertation prior to
entry was recommended" should replace the statement that "completion was
required." The majority of the delegates agreed with this amendment, which
became part of section IX.
Discussion about the residency standards began with entry level
criteria. Since entry to the internship programs was predicated on completion
of a doctoral program accredited by APA or CPA, it was proposed that entry
to residency be predicated on completion of an APA or CPA accredited internship
program. This motion carried without discussion.
The plenary session next addressed the issue of the expected
period of residency extending for the equivalent of two years of full-time
education and training. This generated considerable discussion, particularly
with regard to the specificity it included relative to other areas of the
document and seeming rigidity of the expectation. Those concerned with
the apparent rigidity of the two year residency standard reminded the group
of the guidelines in the Reports of the INS-Division 40 Task Force on Education,
Accreditation, and Credentialing (1987), which allowed exceptions to the
2-year standards for students who came to the residency with extensive
training and experience in the specialty, a circumstance in which a 1-year
residency was acceptable. It was noted that requiring 2 years of residency
for these students would impose an undue hardship. Also, it was pointed
out that if the model is to emphasize competency-based criteria, then a
residency of fixed duration is not congruent with such. Delegates expressing
these concerns proposed changes in the wording to enable more flexibility
in the standards and adaptability to student needs, as well as improve
the perception of flexibility in the standards. Examples of proposed wording
changes included replacement of the word "expected" with such words as
"typical," "ordinary," "anticipated," and "prototypical."
Delegates in favor of preserving the original wording argued
that it is better not to write in exceptions to the standards, particularly
when these may apply to a small portion of students. Residency training
directors argued that the knowledge, skills, and breadth of experiences
that are now required to meet end-point goals often take a full 2 years
to achieve. One year is not sufficient time to see many neuropathological
conditions with low incidence and prevalence rates, nor see a sufficient
number of common neurological conditions to appreciate the full range of
clinical presentations. Advantages of erring on the side of overtraining
to assure competency were also offered. Having the expectation of completing
2 full years, enables better development of curriculum at the residency
level and greater justification for arguing for sustained funding from
departments or government funding sources. Lastly, it was argued that leaving
the issue of length of residency ill-defined creates a hardship for the
residency program. In the same way that internship programs cannot allow
interns to leave their internship early, even when they have worked overtime
and met their 1800 hour requirement or desired exit competencies prior
to the end of their 12-month cycle, residency programs could not be expected
to sustain a program that had continuous clinical service demands in favor
of providing flexibility in this issue. After much discussion, the majority
of the delegates voted to preserve the original wording, recognizing that
exceptions to this standard might be justified in select circumstances.
To reinforce the life-span emphasis of the specialty, a motion
was made to include wording that would require education and training across
the full human life span at the residency level. It was further suggested
that what was necessary here was, at minimum, exposure to the full human
age range and not necessarily development of practice competencies with
every age range. Other delegates argued that to require training in child,
adult, and geriatric populations at the residency level created an unreasonable
burden on the residency programs and did not recognize the practical limitations
in terms of resources that most programs have in providing such training.
Indeed, many residency programs have an exclusive focus on children or
adults. Still, the need to have a life-span exposure was recognized. It
was suggested that those residency programs that had an exclusive focus
in one area in their training programs and could not provide the full life-span
training/exposure should be required to make sure that students accepted
into their programs had exposure to non-provided ages prior to the residency
level. The motion did not carry.
The delegates then began to discuss the merits of more explicit
definition of the essential requirements of a residency. The concern here
was that a residency had to have a sufficient intensity in order to achieve
the desired training goals. Two aspects of the residency were initially
discussed, on-site versus off-site supervision requirements and the minimum
time requirement or pace at which the residency should proceed in order
to be an effective residency. It was argued by one delegate that a residency
that involved supervision of cases in a remote (off-site) setting from
the training program would not provide a satisfactory training experience.
Others thought that a portion of supervision could occur with off-site
cases, particularly if such cases were in geographically proximal and administratively
affiliated settings. It also was argued that residency programs that occurred
on less than a halftime basis jeopardized the training experience. While
there was general agreement amongst the speakers that more explicit guidelines
were needed on these issues and that these guidelines should be worded
in such a way as to state what a program should be rather than what it
should not be, no consensus was achieved on specific wording. A motion
was made to table these items in favor of having a small work-group prepare
text for consideration later in the plenary session.
A motion was made to accept the two initial paragraphs of the
residency section with the approved wording revisions. The motion carried.
Then a reorganization of the sequence of text in the residency section
was proposed. After discussion it was thought best to identify the purpose
and essential components of the residency in the first two paragraphs of
the section, then the means of assuring these, and finally the exit criteria
for the residency.
47
(End of text)
| ||||
