Journal of Pediatric Psychology, Vol. 28, No. 6, 2003, pp. 433-441
© 2003 Society of Pediatric Psychology
Training in Pediatric Psychology: A Survey of Predoctoral Internship Programs
1 The Ohio State University, 2 Columbus Children's Hospital
All correspondence should be sent to Laura Mackner, Psychology Department, Children's Hospital, 700 Children's Drive, Columbus, Ohio 443205-2696. E-mail: MacknerL{at}chi.osu.edu.
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Abstract |
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Objective To describe internship training in pediatric psychology and to determine its correspondence with the recommendations of the Society of Pediatric Psychology (SPP) Task Force on Training. Methods A survey based on the Task Force recommendations was sent to all internship programs that reported offering a major rotation in pediatrics. Results Opportunities in a wide range of assessment and intervention strategies were available. Training in disease process, medical management, and consultation/liaison with a variety of disciplines was also offered. Interns interacted with individuals from a range of developmental stages and ethnicities. Many professional issues were addressed. Experiences in research methods and prevention were less well represented. Conclusions Despite some variability, experiences in a wide range of areas were offered by many programs in several of the training domains recommended by the SPP Task Force. However, there is room for improvement in training in research and prevention and health promotion.
Key words: professional training; predoctoral internship; pediatric psychology.
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Introduction |
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Despite the rapid growth of pediatric psychology, little has been written about the training of pediatric psychologists (Drotar, 1998
;
La Greca, Stone, Drotar, & Maddux,
1988). A large part of the training process takes place during the
predoctoral internship, when didactic and experiential training opportunities
are offered. Anecdotally, current and past interns in our training program
have reported discovering marked variability in the training opportunities
offered by pediatric internship programs. However, there has been no
systematic research describing predoctoral internships that offer experiences
in pediatric psychology.
Recently, the Society of Pediatric Psychology (SPP) commissioned a Task
Force on Training in Pediatric Psychology to develop training recommendations
for the field, and a report was issued in March 2001. The report builds on
recent recommendations from the National Institute of Mental Health (NIMH)
work group to define clinical training guidelines for services to children and
adolescents (Roberts et al.,
1998). The NIMH group identified several important training
domains and provided recommendations within each. Likewise, the SPP Task Force
provided recommendations for training in pediatric psychology within each of
the training domains identified by the NIMH work group, as well as
recommendations in the additional areas of consultation and liaison (C/L) and
disease process and medical management, which are specific to pediatric
psychology. Within each domain, the Task Force provided a description of the
domain and listed examples of specific experiences recommended for training in
pediatric psychology. Consistent with the NIMH work group, three levels of
training were described: exposure, experience, and expertise. According to the
Task Force, exposure refers primarily to didactic methods;
experience refers to the actual practice of an activity; and
expertise refers to mastery and ability to practice
independently.
The guidelines may result in more uniformity in training and ensure that pediatric psychologists possess a core set of competencies. Training guidelines may also contribute to addressing any confusion about what pediatric psychology is and what pediatric psychologists do. The training guidelines have the potential to impact all areas of training in pediatric psychology from graduate programs through postdoctoral training. However, it is unknown how the training experiences that are currently available at the predoctoral internship level compare with the training recommendations of the SPP Task Force. Such information is important in developing training experiences that adequately prepare trainees for careers in pediatric psychology. Therefore, the current survey of predoctoral internship programs was undertaken to describe the current state of internship training in pediatric psychology in an attempt to examine the correspondence between the Task Force recommendations and the actual training opportunities currently offered in the United States and Canada.
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Method |
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The Association of Psychology Postdoctoral and Internship Centers (APPIC) Web site (www.appic.org) was used to identify internship programs that offer training experiences in pediatric psychology. The APPIC website lists several training specialty areas. Each program indicates whether training in each area is available and whether the training opportunity is considered a "major" rotation or an "informal/minor" rotation. According to the APPIC Web site, 72 internship programs reported offering a major rotation in the specialty area of pediatrics, and surveys were sent to the training directors of these programs in January 2002. After 2 weeks, a second survey was sent to nonresponders, followed by reminders by phone call or e-mail.
The survey instrument was developed by the authors by utilizing the Task Force report to generate items designed to measure the presence of specific training topics or activities within each of the recommended training domains. The specific training topics and activities listed by the Task Force in each training domain were included as items on the survey. Additional items were developed based on the general descriptions of each domain provided by the Task Force and based on the current authors' knowledge of common training experiences in pediatric psychology. For the appropriate training domains, specific training topics or activities were listed, and respondents indicated whether training was offered through didactics and/or through experience for each item. Respondents were also asked to indicate whether each specific training topic or activity was optional or required and whether the topic was considered an area of emphasis or expertise within the program. Specific pediatric populations (e.g., hematology/oncology) were also listed, and respondents indicated whether each population was available for consultation or intervention experiences and whether it was considered an area of emphasis. In addition, items describing the internship setting, expectations of interns, supports available to interns (e.g., computer resources, support groups), supervision, and ages and ethnicities of the clinical populations were developed.
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Results |
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Surveys were returned from 43 of the 72 internship training directors (59.7%). Eight of these training directors responded that their internship programs do not offer experiences in pediatric psychology. Given that some programs may be listed as providing a major rotation in pediatrics when experiences in child health psychology are not actually offered, the original 72 programs were reviewed via the APPIC Web site, program-specific Web sites, and returned surveys. Internship programs were determined to offer experiences in child health psychology if (a) their program-specific Web sites or returned surveys indicated clinical experiences with specific populations of children with health conditions, and/or (b) they reported offering rotations in health psychology and C/L (in addition to pediatrics) on the APPIC Web site's list of specialty areas. Upon review, 52 of the original 72 programs were confirmed to offer experiences in pediatric psychology. Of these, 35 surveys were returned (67.3%). Results from the 35 confirmed pediatric psychology internship programs are reported below.
Internship and Supervision Characteristics
Most pediatric psychology internship programs were in major metropolitan
areas (85%), with less than 10% in rural areas. Most training directors
identified their settings as university-affiliated hospitals (72%) and/or
free-standing children's hospitals (52%). There were an average of 2.8
pediatric psychology interns in each program, with a range of 1 to 18. Interns
worked an average of 47.5 hours per week, with a range of 38 to 60 hrs/wk.
Fifty-seven percent of internship programs provided interns with individual
office space, and 63% provided individual computers. A university-based
library was available for 77% of internship programs. Supervision and therapy
tools included one-way mirrors (80% of programs), videotape equipment (83%),
biofeedback equipment (26%), and bug-in-the-ear equipment (11%; a wireless
earpiece that allows the intern to receive verbal prompts from a supervisory
observer). A faculty advocate or mentor was provided by 67% of programs, and a
support group was offered by 38%. Travel funds were provided by 54% of
programs, with a mean of $389.06 (range, $75-$1,000) available for interns.
Planned social events were offered by 97% of programs, with a mean of 3.27
events per year (range, 1-18).
Interns spent an average of 5 hours per week in supervision (range, 2-10). All internship programs reported having at least one supervisor with a cognitive-behavioral theoretical orientation, followed by family systems orientation (86% of programs), behavioral orientation (77%), and psychodynamic orientation (54%). Group supervision was offered by 88% of programs. Direct supervision, such as videotape or direct observation, was required by 86% of programs.
SPP Task Force Training Recommendations
The training recommendations are described briefly, and the survey results
are presented within the training domains below. Tables
I,
II,
III,
IV
V list specific survey items in
each domain of training and the percentage of training directors who reported
that training opportunities were available in each area or activity. Both
didactic and experiential opportunities are listed, as well as whether the
activity was required by the program and/or considered to be an area of
emphasis or expertise in the program. Program-level information, such as the
median number of topics covered within each domain by programs, is presented
in the text below.
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Developmental Psychology and Psychopathology and Diversity
The Task Force recommended that trainees participate in supervised clinical
activities with individuals at various developmental levels and of diverse
ethnic and cultural backgrounds. Almost all programs offered opportunities to
work with school-age children (100%), adolescents (97%), and preschoolers
(91%), with fewer opportunities with infants (63%) and adults (60%). Each
training director reported the proportion of time interns spent with various
age groups and ethnicities. Interns interacted primarily with school-aged
children (average 40% of their time) and adolescents (27% of their time), with
some experience with infants (5%), preschoolers (15%), and adults (10%).
Interns received very little experience with older adults (1%). Almost all
programs offered opportunities to work with white (97%) and African American
(97%) individuals. Eighty-nine percent offered opportunities with
Latino/Hispanic individuals, and 74% offered opportunities with Asian
individuals. Other ethnicities were reported by 54% of programs. Interns
worked primarily with white individuals (average 50% of their time), followed
by African Americans (29%), Latinos/Hispanics (13%), and Asians (4%).
Diversity training was offered by almost all programs (see
Table IV).
Child, Adolescent, and Family Assessment
The Task Force recommended that trainees participate in activities that
promote knowledge in appropriate assessment procedures and instruments for
intellectual, personality, behavioral, family, and sociocultural assessment
across disease, context, and developmental levels. The median minimum number
of assessment evaluations required by internship programs was 13.8 per year
(range, 0-65). See Table I for
the percentages of internship programs offering training in each survey topic
related to assessment. All programs offered experiential opportunities in
intellectual assessment, feedback to parents and medical staff, and report
writing. Of the 22 topic areas listed on the survey, 40% of internship
programs offered opportunities for experiences in all areas. The median number
of assessment topics offered by programs was 21 (range, 10-22).
Intervention Strategies
The Task Force recommended that interns receive training in empirically
supported intervention methods unique to pediatric psychology (e.g., adherence
to medical regimens, coping with stressful medical procedures) that account
for developmental processes and social contexts. See
Table II for the percentages of
programs that offer training experiences in topics related to intervention.
All programs offered training in group intervention, and almost all offered
opportunities in family, parent-focused, and empirically supported
interventions. Approximately three quarters of the programs required interns
to gain experience in empirically supported treatments (ESTs). Of the 24 topic
areas listed on the survey, 29% of internship programs offered experiential
opportunities in all areas. The median number of intervention topics offered
by programs was 21 (range 2-24).
Research Methods
The Task Force recommended that training include an integration of
empirical research experience, including training in conducting and publishing
clinical research. Participation in research was encouraged by 60% of programs
and required by 23%. Forty-one percent provided protected time for research
(mean = 4.75 hours per week, range = 3-10). See
Table III for percentages of
programs offering training opportunities in research-related topics. Training
in each topic was offered by two thirds or fewer programs, and grant
preparation was the most commonly offered training opportunity. Twenty-six
percent of programs did not offer any opportunities for experiences in
research. Of the 10 topic areas listed on the survey, the median number of
research topics offered by programs was 6 (range 0-10).
Professional, Ethical, and Legal Issues Pertaining to Children,
Adolescents, and Families
The Task Force recommended training in a variety of professional, ethical,
and legal issues as they pertain specifically to the practice of pediatric
psychology. Table IV lists
those areas of training and the percentages of programs offering training in
them. Topics such as interdisciplinary care, managed care, informed consent,
child abuse reporting, confidentiality, and legal/ethical issues specific to
pediatric psychology were offered by 80% or more programs. Of the 20 topic
areas listed on the survey, 40% of internship programs offered experiential
opportunities in all areas. The median number of topics offered by programs
was 17 (range 3-20).
Multiple Disciplines in Service Delivery Systems
The Task Force recommended that trainees work with a variety of disciplines
in the delivery of health care. All of the internship programs reported that
their interns interacted with physicians, and at least 80% reported that their
interns interacted with nurses, social workers, child life personnel, school
personnel, and occupational therapists. At least 50% reported that their
interns interacted with physical therapists, pastoral care personnel, and
dietitians. Fewer interns had opportunities to interact with emergency medical
technicians, dentists, recreational therapists, hospice personnel, and
lawyers. All programs provided opportunities to participate in an ongoing
interdisciplinary medical team and 89% required such experience.
Prevention and Health Promotion and Social Issues Affecting Children,
Adolescents, and Families
The Task Force recommended that trainees participate in activities
promoting healthy lifestyles, preventing the development of high-risk
behaviors, and promoting advocacy for pediatric health care and social issues.
See Table V for the percentages
of internship programs offering training in the areas listed on the survey.
With the exception of the areas of child abuse and suicide prevention,
opportunities in prevention and health promotion were offered by 60% or fewer
internship programs, and very few programs considered this domain an area of
emphasis. Twenty percent of programs did not offer any experiences in
prevention and health promotion. Of the 16 topic areas listed on the survey,
the median number of topics offered by programs was 6 (range 0-16).
Consultation and Liaison
The Task Force recommended that internship training in C/L experiences be
offered in a number of different settings, with professionals from a variety
of disciplines and involving multiple intervention approaches. All programs
reported opportunities in C/L. The average number of consults received by
departments was 362 per year (SD = 343; range, 10-1,430). Forty-two
specialty areas were listed on the survey, and the median number of specialty
areas available for C/L experiences was 20 (range 1-37). See
Table VI for percentages of
internship programs offering various experiences in C/L services. With regard
to consultations among specific subspecialty pediatric services,
hematology/oncology was most commonly reported, followed by neurology,
gastroenterology, adolescent medicine, and pulmonary medicine. Over half of
the participating internship sites identified a subspecialty emphasis in
hematology/oncology, and approximately one fourth offered an emphasis in
neurology, adolescent medicine, and primary care.
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With regard to C/L services provided to disease-specific pediatric populations, diabetes was most commonly reported, followed by developmental disabilities, traumatic brain injury, and cystic fibrosis. A training emphasis in developmental disabilities was most common amongst the training sites. Over one third of training sites emphasized C/L services for children who have experienced a traumatic brain injury or are living with diabetes.
Specific C/L service interventions were also identified in the survey. Pain management was the most common intervention reported, followed by feeding interventions and psychological support services during rehabilitation and transplant (e.g., bone marrow, renal). The most common training emphasis among C/L interventions was in rehabilitation.
Disease Process and Medical Management
Recommendations of the Task Force emphasized the importance of a basic
understanding of various disease processes such as training in the
pathophysiology and standard medical treatment of common childhood diseases.
In the present survey, internship training directors were asked to indicate
the modalities in which pediatric interns were provided with this information.
Responses indicated that training was provided by all programs, typically
through readings (94%), medical rounds (86%), seminars (80%), and lectures
(77%). Other methods included teaching and bedside rounds (63% and 46%,
respectively), and journal clubs (26%).
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Discussion and Conclusions |
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The results of this survey revealed substantial variability in the structure of internship programs and their supports for interns. The range of hours worked per week, hours of supervision per week, number of assessment evaluations required, and number of consults received varied considerably across programs. The number of specialty areas available for C/L, and the number of experiences available within each training domain also ranged across programs. Approximately two thirds or fewer of programs provided supports such as individual offices, individual computers, faculty mentors, or support groups. Given the demanding nature of the internship experience, interns would likely benefit from supports such as these. In addition, provision of a private office will likely become even more important given the increased privacy concerns of the regulations of the Health Insurance Portability and Accountability Act of 1996.
It is interesting to note that 20 of the 72 programs that reported offering a major rotation in pediatrics on the APPIC Web site did not actually offer training experiences in child health psychology. Different interpretations of terminology may have contributed to this. The APPIC website lists pediatrics rather than child health psychology or children's health. Whereas the current authors consider the specialty area of pediatrics to be equivalent to child health psychology, some training directors may interpret "pediatrics" as referring to the age range of childhood. Trainees seeking an internship program with opportunities in child health psychology should obtain additional information about the nature of the training experiences offered before applying to any internship program that reports a rotation in pediatrics on the APPIC Web site, and APPIC may want to consider changing the name of this specialty area to prevent any confusion.
Within the training domains of development and diversity, most internship programs offered opportunities to work with developmental levels ranging from preschool through adolescence. Infancy was less well represented, and interns spent the majority of their time with school-aged children. Most programs offered experiences with at least one ethnic minority population, and half of interns' time was spent with ethnic minority individuals, primarily African American. Other ethnicities were less well represented, which may reflect the populations available to the interns. Almost all internship programs required diversity training.
In the training domain of assessment, interns had opportunities to
participate in experiences in a wide range of areas. The specific topic areas
listed on the survey were offered by most internship programs, and many
programs offered experiential opportunities in all of the surveyed areas. For
the most part, these assessment experiences are similar to those reported in a
prior survey that did not differentiate between pediatric psychology and
general child clinical psychology (Clemence
& Handler, 2001). One exception is neuropsychological
assessment: It was a focus in 41% of rotations in child facilities in the
previous study, whereas 97% of pediatric psychology programs reported offering
such experiences in the current study. This difference is not surprising since
the need for neuropsychological assessment is often precipitated by a health
condition (e.g., head injury).
Similarly, in the domain of intervention, experiences in a wide range of
areas were offered by many programs. Training in ESTs was offered by almost
all internship programs, and experience in such treatments was required by
almost three quarters of them. Hays and colleagues
(2002) reported similar results
for training in ESTs among child-focused sites and medical schools, and
slightly lower rates among other types of internship sites.
In the domain of professional, ethical, and legal issues, topics such as confidentiality, child abuse, managed care, and informed consent for treatment were addressed by many programs, and topics such as confidentiality in relation to third-party payers, precertification procedures, and medical neglect were addressed by slightly over half of the programs. In the domain of multidisciplinary systems, interns had opportunities to interact with a variety of disciplines, and participation in ongoing interdisciplinary medical teams was offered by all programs. In the domain of C/L, the number of consults received by each program varied, but most programs listed several specialty areas available for intern C/L experiences. Training in disease process and medical management was offered by all programs through a variety of modalities.
Training in the domain of research was less well represented. Although
research was encouraged or required by 83% of internship programs, training in
research-related topics was typically offered by half or fewer programs, and a
quarter of programs offered no experiences in research. Protected time for
research was offered by less than half. The Directory of Clinical
Internships (SSCP, 1998)
reported a lower rate of programs encouraging or expecting involvement in
research (64%), but a similar rate and amount of protected time for research.
These results are not surprising given the focus on clinical experiences
during internship and the financial need for interns to generate clinical
revenues. However, as Lejuez, Read, Gollan, and Zvolensky
(2001) point out, the lack of
attention on research during internship is not consistent with the
scientist-practitioner model or with training experiences prior to internship.
They recommend that internship applicants who are interested in research
obtain additional information about the feasibility of conducting research
during internship from each program, and they suggest that APPIC could list
more research-related information on its website. In addition, internship
programs can encourage research-minded clinicians by facilitating their
involvement in ongoing studies, providing opportunities to assist faculty in
manuscript writing and reviews, and in assessment of outcomes in clinical
practice, such as pre- and postintervention symptom assessment.
Training in the domain of prevention and health promotion was also less
well represented. Experiences in this area were offered by roughly half or
fewer programs, with the exception of child abuse prevention, which was
offered by two thirds of programs. One fifth of programs offered no experience
in any of the areas listed. The neglect of prevention and health promotion at
the internship level likely reflects the continued neglect of this domain in
the field of pediatric psychology overall
(Roberts, 2000). Financial
realities likely play a role, since prevention efforts are not typically
reimbursed by third-party payers. However, internship programs could explore
alternative funding sources such as grants, government contracts, school
systems, and community agencies. Even if financial concerns prevent
experiential training, didactic training can certainly be offered in these
areas. Providing training in prevention and health promotion is necessary to
ensure that this area will be addressed by future pediatric psychologists.
This study was limited by its descriptive nature. The survey was not designed to make comparisons between domains, and the multisite nature of many internship programs prevented site-based comparisons. Although the response rate was adequate, limited information was available on the programs that did not respond, preventing analysis of nonresponders. Finally, no specific criteria exist for determining which specific topics should be included in each domain, or for classifying domains into particular levels of correspondence to the recommendations (e.g., <60% = poor correspondence). In summary, despite some variability among internship programs, experiences in a wide range of areas were offered by many programs in several of the training domains recommended by the SPP Task Force. However, there is room for improvement in the domains of research and prevention and health promotion.
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Acknowledgments |
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We would like to thank the training directors for taking the time to complete and return the surveys.
Received August 15, 2002; revision received November 20, 2002; accepted December 30, 2002
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References |
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TopAbstractIntroductionMethodResultsDiscussion and ConclusionsReferences |
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Clemence, A. J., & Handler, L. (2001). Psychological assessment on internship: A survey of training directors and their expectations for students. Journal of Personality Assessment, 76, 18-47.[CrossRef][ISI][Medline]
Drotar, D. (1998). Training students for careers in medical settings: A graduate program in pediatric psychology. Professional Psychology: Research & Practice, 29, 402-404.[CrossRef]
Hays, K. A., Rardin, D. K., Jarvis, P. A., Taylor, N. M., Moorman, A. S., & Armstead, C. D. (2002). An exploratory survey on empirically supported treatments: Implications for internship training. Professional Psychology: Research and Practice, 33, 207-211.[CrossRef]
La Greca, A. M., Stone, W. L., Drotar, D., & Maddux, J. E.
(1988). Training in pediatric psychology: Survey results and
recommendations. Journal of Pediatric Psychology,
13,
121-139.
Lejuez, C. W., Read, J. P., Gollan, J. K., & Zvolensky, M. J. (2001). Identifying, obtaining, and completing a predoctoral psychology internship: Research considerations. Professional Psychology: Research and Practice, 32, 650-654.[CrossRef]
Roberts, M. C. (2000, April). The scolding of pediatric psychology: Why not more commitment to prevention? Paper presented at the Great Lakes Regional Meeting on Child Health Psychology, Cleveland, OH.
Roberts, M., Carson, C., Erickson, M., Friedman, R., La Greca, A., Lemanek, K., et al. (1998). A model for training psychologists to provide services for children and adolescents. Professional Psychology: Research and Practice, 29, 293-299.[CrossRef]
SSCP (Society for a Science of Clinical Psychology) (1998). Directory of clinical psychology internships (5th ed.). Fargo, ND: Author.
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