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Other suggestions of reordering sentences within paragraphs were also
made.
Attention then turned to exit criteria for the residency. Clarification
was requested on the word "formal" in the phrase "formal evaluation." The
breakout group chairs indicated that discussion had occurred about this
detail and that the words "oral and written (examinations)" had been considered.
Ultimately the chairs thought it best to connote the notion that a structured
evaluation was important, but the form of that evaluation would be left
up to individual programs.
The matter of requiring eligibility for licensing or certification
for independent practice in the state or province of the program was discussed.
Concerns for imposing this requirement on residency programs included the
fact that (I) some residents do not intend to practice in the state where
the residency program exists and thus meeting the eligibility would impose
an unnecessary burden; and (2) a particular state might have requirements
that lie outside the purview or control of the residency program, e.g.,
issues related to doctoral degree requirements. It was thought unreasonable
to expect residency programs to be able to insure eligibility for licensing
in every state. Still, others argued that residency directors, at a minimum,
should be knowledgeable about general state requirements and sensitive
to the intentions of their residents. Incorporating some language on this
issue was thought important in order to protect the student. A motion carried
to include wording on eligibility, but dropped the reference to the specific
state or province, thereby giving the residency program some leeway in
interpreting this clause.
Considerable discussion occurred regarding improvements and clarification
of wording in the first three exit criteria, in part to make parallel constructions
amongst them and to maintain the notion that advanced knowledge and skills
were relevant at this level rather than basic requirements. A subcommittee
was asked to prepare the text for this section and to present it during
the plenary session that reviewed the entire policy statement,
The illustration of a competency-based model, was then discussed.
This later became section XV. Debate ensued about whether this illustration
should be included in the final product, included as an appendix or an
addendum, kept in its current location, or placed in an alternate location
in the text (since it was referenced earlier in the text). Several delegates
thought that the section and its heading were both confusing and misleading
since it was already recognized by the group that the described model of
training was not simply competency-based, but had time requirements too.
Others thought that the illustration seemed out of character with the remainder
of the document. Opposing view points conveyed the notion that the illustration
provided a simple, but elegant illustration of integration of education
and training "across levels of training," even if the model was not fully
competency-based. The illustration was thought to complement the text.
One delegate thought the illustration was the most "visionary" contribution
of the conference.
After much discussion it became clear that most of the dissension
in the discussion concerned the illustration s heading and caption, rather
than the illustration itself. The group voted to retain the section, and
recommendations were made for improving the heading. The figure s caption,
however, was thought to require further work. It was decided to turn this
over to a committee to work on improved wording.
C. WHAT ARE THE NATURE AND PLACE OF SPECIALTY-SPECIFIC PROFICIENCIES
WITHIN CLINICAL
NEUROPSYCHOLOGY?
CHARGE TO THE DELEGATES
Kerry des Harnsher
The definition of a proficiency in professional psychology as outlined by the Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP), was reviewed and contrasted with the definition of a specialty. It was noted that little thinking had developed in the specialty of clinical neuropsychology with regard to the enumeration of specialty-specific proficiencies and that it was not necessarily advantageous to parcel the professional activities of a specialty into component parts. It was indicated that to petition for formal recognition of a segregated proficiency presupposes it can be demonstrated that such segregation and recognition serves the public interest. Furthermore, it was noted that the concept of, and definition for, a sub-specialty had not been introduced into the nomenclature used by CRSPPP. A sub-specialty holds an intermediate position between a specialty and a proficiency. Generally, sub-specialties refer to substantive areas of knowledge and skill that are acquired through education and training beyond the specialty residency, such as through a sub-specialty fellowship program. One important parameter of a proficiency is that it provides the basis for service with respect to a specific population, or a specific clinical problem, or specific procedures or techniques. In principle, child and adolescent clinical neuropsychology, or pediatric neuropsychology, potentially could be considered a specialty-specific proficiency.
PLENARY SESSION AND VOTE
Immediately, concern was expressed that sub-specialization not be confused
with a proficiency. It was recognized that there are clinical neuropsychologists
whose practice and scientific activities were concentrated within relatively
focused areas of the specialty and these could be considered de facto sub-specialties.
However, since sub-specialties are not a recognized designation for a field
of practice or specialty application within professional psychology, it
appeared beyond the scope and purview of this conference to attempt to
introduce and develop this conceptual entity. Thus, it was proposed that
this agenda item be dropped, in its place, endorsement of the Commission
for the Recognition of Specialties and Proficiencies in Professional Psychology
(CRSPPP) guidelines (American Psychological Association,1995) for the definition
of a proficiency could be substituted. Since the specialty, itself, did
not recognize any specialty-specific proficiencies, delegates questioned
the idea of making any comments. Discomfort with sidestepping this issue
was evident since there was then the inherent potential for some pitfall
to be overlooked.
Resolution of the dilemma was obtained when it was deemed appropriate
for the conference to envision the possibility of recognized sub-specialties
within professional psychology. Delegates were informed that CRSPPP actually
had broached the subject of sub-specialties but decided not to pursue it
at the time. It was further noted that the impetus for identifying proficiencies
usually came from some threat to the practice from external, not internal,
forces. Nevertheless, this should not discourage the delegates from breaking
new ground and considering what might be foreseen as sub-specialties within
the specialty of clinical neuropsychology.
When consideration turned to including specific exemplars of
possible sub-specialties within clinical neuropsychology, a variety of
positions were taken. For example, some equated the "child" and "pediatric"
areas and thought that a single reference would be preferable. For those
working in medical settings, "pediatric" seemed to be favored over "child."
Others felt "pediatric" would be better understood as referring to a medical
patient population, whereas "child" was a broader term and encompassed
children and adolescents seen in other venues. On this position there was
disagreement. Also, there was concern that "pediatric" could be understood
as referring to certain medical practitioners within the health-care arena
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