Northwestern
Northwestern
Psychology
Predoctoral Internship and Postdoctoral Fellowship
2004–
2005 Academic Year
Candidates
are admitted for the two year period each year on July 1st. The first year
is a predoctoral internship that concentrates on skill development
in the essential areas of assessment, diagnosis, and effective treatment of
a broad range of psychopathology.
ORIENTATION
AND GOALS
The psychology
internship program is based upon the
We are committed
to maintaining an internship program that facilitates learning and professional
growth for interns. The training staff places a high premium on creating a
work environment that is professionally stimulating, open to change and sufficiently
flexible to accommodate individual needs and requirements. Fundamental to
a successful training experience is the provision of ongoing feedback to interns
that facilitates professional and personal growth.
The predoctoral internship has been approved by the American Psychological Association since 1955. Students
admitted to the program are expected to have completed the oral defense of
their dissertation prior to the July 1st starting date or be near enough to
completion by that date that the dissertation defense can be reasonably anticipated
during the internship year. Three students are admitted each year.
The second
year of the program is postdoctoral fellowship training in areas of specialization
selected by the student. Students receive
an opportunity to acquire the supervised postdoctoral training hours necessary
for licensing eligibility as well as research skills needed for work as a
clinical researcher. Northwestern's internship program is a member
the Association of Psychology Postdoctoral and Internship Centers (APPIC).
Admission requirements for the second year of the program include completion
of all professional doctoral degree requirements from a regionally accredited
institution of higher education or an APA/CPA-accredited program and predoctoral
internship meeting APPIC standards. This requirement is defined as having
on the first day of the fellowship either the diploma in hand or a letter
from the director of graduate studies verifying the completion of all degree
requirements pending institution graduation ceremony.
The goals of
this combined two year program are: 1) to provide excellent generalist training
at the predoctoral internship level; 2) to augment
the broad based internship training in a seamless fashion with postdoctoral
specialized clinical skill development; 3) to support the development of clinical
scholars, in one setting, both the clinical and research skill development
necessary for a career in academic health care settings.
The predoctoral internship offers advanced graduate students in
clinical psychology a wide range of experiences upon which to build their
theoretical and applied clinical skills. These include opportunities to work
with patients representing a broad spectrum of psychopathology (from mild
neuroses to severe character disorders and psychotic conditions), to conduct
diagnostic evaluations and learn a variety of treatment approaches (individual
psychotherapy, couple and family therapy, group therapy, brief and crisis
treatment), and to collaborate with colleagues from other disciplines. Breadth
of training is emphasized to help interns establish a solid foundation for
continued development and subsequent specialization.
Theoretical
orientations at Northwestern include psychodynamic, cognitive behavioral,
interpersonal, family systems and integrative approaches. Clinical training
is provided through individual and group supervision, complemented by an extensive
curriculum of case conferences and seminars. In most instances one hour of
supervision is provided for approximately every two hours of direct patient
contact, making this a supervision intensive environment.
Interns receive
evaluations from their supervisors twice during the training year; midyear
and end of year. At both of these points in time, the director of the internship
integrates the written supervisor evaluations into one document, a copy of
which is sent to the intern's home graduate institution. Interns provide feedback
about all aspects of the internship. In the event of a grievance, interns
have access to the due process procedures outlined in the
Interns, along
with the postdoctoral fellows, meet weekly as a group with the director of
the internship.
Goals & Objectives
Our goal is to assist in the development of professional
psychologists who are educated, compassionate, ethical, scholarly, intellectually
disciplined and who demonstrate wisdom and judgment through an awareness of
larger professional and social issues. It is expected that by the conclusion
of the internship year, clinical psychology interns will have accomplished
the following objectives:
1.
Theory: Demonstrate familiarity with concepts and techniques of contemporary psychodynamic
and cognitive-behavioral models of psychopathology and psychotherapy;
2.
Assessment: Demonstrate familiarity with contemporary approaches to objective and
projective assessment;
3.
Diagnosis: Demonstrate an understanding of DSM-IV nosology
and contemporary approaches to differential diagnosis;
4.
Formulation: Demonstrate an ability to develop a parsimonious and sophisticated case
formulation based upon the extant clinical and empirical literatures;
5.
Psychological Testing: Demonstrate an ability to independently conduct a
diagnostic evaluation and psychological testing, and to prepare a cogent,
organized and clinically-useful report based upon the results obtained;
6.
Feedback: Demonstrate an ability to provide feedback to patients on the results
of psychological and psychodiagnostic testing, to
present treatment options and the rationale for specific interventions;
7.
Treatment: Demonstrate an ability to provide effective psychotherapy services based
upon the case conceptualization developed;
8.
Assessment of clinical progress: Demonstrate an ability to monitor treatment gains;
9.
Consultation: Demonstrate an ability to function as a member of a multidisciplinary
team and to provide consultation services to other mental health professionals;
10.
Ethics and Professional
Issues:
Demonstrate an understanding of professional ethics and of contemporary issues
facing the field of clinical psychology;
11.
Individual & Group
Differences: Demonstrate an understanding and sensitivity to individual differences,
and to the important influence of variables such as race, ethnic background,
gender, and sexual identity on human adaptation and response to treatment;
12.
Research: Demonstrate an understanding
of clinical research methodology, and an ability to critically evaluate empirical,
clinical and theoretical manuscripts.
The Outpatient
Treatment Center (OTC) provides assessment and treatment services to patients
whose problems and psychological capacities span a wide range of diagnoses.
Interns are expected to develop a high level of proficiency in both
traditional and empirically supported forms of psychotherapy. Each intern
carries a caseload (ten to fifteen patient contact hours per week) that ranges
from mild to moderately severe psychopathology. Interns typically have the
opportunity to conduct long term, intensive insight-oriented psychotherapy
as well as briefer forms of treatment. The OTC also offers interns experience
in providing treatment within a managed care environment. Each intern has
five individual therapy supervisors. Interns may also elect to receive clinical training
in group, couple, and family therapy. Supervision is one hour weekly with
each supervisor.
Interns conduct
full initial diagnostic assessments of patients presenting to the OTC. Supervision
includes consideration of biopsychosocial factors,
descriptive diagnosis, and treatment planning. Each intern participates in
a weekly interdisciplinary diagnostic team that broadens his or her exposure
to the diagnostic issues and provides experience in case presentation. Individual
supervision is provided by faculty assigned as the intern's OTC supervisors.
A didactic and case conference curriculum supplements the direct clinical experience and supervision. Interns participate with postdoctoral fellows in an ongoing case conference. In addition, interns attend several seminars over the course of the year. Theses include:
Interns join
with third year psychiatry residents in a seminar that covers each of the
following topics for one quarter: Brief psychotherapy, group, and family-marital
therapy. The third seminar for interns begins during the first quarter with
crisis intervention theory and technique, and then concentrates on psychological
testing (scoring, administration, and special topics) for the greater portion
of the year. All fellows attend the weekly departmental Grand Rounds series
during which both nationally and locally prominent faculty present.
Interns and fellows also participate in a weekly seminar in Cognitive
Behavioral Therapy.
Interns accept
referrals for psychological testing from inpatient and outpatient services
within
Each intern
is assigned a minimum of five supervisors from the core internship faculty.
Our intent is to expose interns to multiple theoretical perspectives and technical
approaches. Supervision is one hour
weekly with each supervisor.
Depending on
the status of the individual's dissertation research upon entering the internship,
the Director will provide necessary support or coordination with the intern's
home university in order to assist completion of the defense by the end of
the internship training year. Available to support individual dissertation
projects are senior research faculty who can provide assistance through consultation
as well as computing resources. Interns are encouraged to participate in on
going research with the faculty.
The second
year of the program is designed to build upon the foundation of general skills
developed in the internship year. Fellows continue with a portion of their
OTC psychotherapy caseload and select specialized rotations to refine their
clinical skills. Admission requirements for the second year of the program
include completion of all professional doctoral degree requirements from the
regionally accredited institution of higher education or an APA/CPA-accredited
program and predoctoral internship meeting APPIC
standards. This requirement is defined
as having on the first day of the fellowship either the diploma in hand or
a letter from the director of graduate studies verifying the completion of
all degree requirements pending institution graduation ceremony.
Postdoctoral
fellows receive evaluations from their supervisors at both the mid and end
of year points in their training. The director of the fellowship integrates
these written supervisor evaluations into one summary document. In the event
of a grievance, fellows have access to the due process procedures outlined
in the
Psychotherapy
Fellows continue
with cases from their internship year assigned through the OTC. This caseload
mix may be supplemented with family, marital, or group therapy experiences.
Eight hours of psychotherapy per week are expected with four faculty supervisors
assigned. Supervision is one hour weekly with each supervisor.
Psychological
testing experience becomes optional in this second year of training. The opportunity exists for fellows to select
specific types of specialized training that may build upon interests developed
during the internship year. Supervised
training for specialized batteries in the areas of adolescence, geropsychology, and neuropsychology
are available, as well as experience with cognitive behavioral assessment
and shortened forms of more traditional protocols. The frequency of administrations
is determined individually with each fellow.
Specialty rotations
are elected by each fellow and represent an intensive training experience
with one of the hospital programs treating a particular population. One rotation
is chosen by each fellow and accounts for approximately twenty hours of the
weekly work load. In general, each rotation allocates a minimum of two hours
per week of supervision for the fellow's clinical activities. Some specialty
sites offer a limited rotation commitment, making it possible for the fellow
to select two rotation sites by reducing the participation within each site
to ten hours per week.
A)
Older Adult Program: This specialty program draws upon developmental theory
to provide comprehensive assessment and treatment for persons who are fifty
five years and older. The Older Adult Program views the mature stages of the
life cycle as a time in which there is potential for psychological growth
in the face of new challenges. Fellows electing this rotation have numerous
opportunities to learn through individual supervision, clinical rounds and
case conferences, and direct patient contact including psychological testing,
individual, group, couple, and family therapy.
B)
C)
Rehabilitation Program: This program offers a comprehensive range of assessment
and treatment services to individuals with severe and persistent psychiatric
disorders. Fellows have the opportunity to gain experience in the area of
community mental health by participating in an innovative program that comprehensively
addresses the mental health needs of this traditionally under served population.
The program offers its own affiliated housing component and satellite clinic,
fostering an important integration of service components. The populations
served by this community mental health center program include patients with
long standing deficits and patients who have had multiple hospitalizations.
The program's goals include helping patients improve the subjective quality
of their lives, assisting them in returning to meaningful roles and adaptive
functioning in the community, and minimizing rehospitalization. Clinical services offered include diagnostic
assessment and psychological evaluation, psychiatric consultation and medication
management, individual, group, milieu, and group therapy, as well as outreach
and housing resources. Fellows participate on the multidisciplinary diagnostic
teams reviewing all intakes and treatment planning.
D)
Health Psychology: The
Two year long
seminars form the nucleus of the curriculum; these are supplemented by the
weekly departmental Grand Rounds presentations and other lectures offered
around the medical center. Additionally, the fellows have a special topics
weekly seminar, the content of which is designed by the fellows depending
on their clinical and research interests. Lastly, the fellows continue in
the weekly case conference attended by interns.
In summary,
a minimum of five supervisors are assigned for the postdoctoral year of the
program. Again, supervision is one hour weekly for each supervisor.
Each fellow
is required to submit an article to a refereed journal by the end of the fellowship
training year. Interns and fellows are encouraged to join one of the ongoing
research projects here at the medical center and work closely with their research
mentor to refine their research skills and to define a personal area of scholarly
interest. Again, our goal in this regard
is to provide the support necessary for the fellow to graduate from the program
with a publication under review and to be fully prepared to secure the position
of her or his choice.
Documentation
of clinical and research competency is necessary for the successful completion
of the internship and fellowship programs. Clinical competency is demonstrated
at the conclusion of the internship year on the basis of reviews by each of
the trainee’s supervisors, their clinical mentor, and the Director of
Training. Research competency at the conclusion of the internship year is
based upon the presentation of an empirical study at a professional conference,
Departmental Grand Rounds, or by submission of a manuscript for publication.
Most often, this presentation will be based upon the intern’s dissertation
research. Their research mentor serves as a discussant for their presentation.
In
addition to reviews by each of the trainees supervisors,
their clinical mentor, and the Director of Training, clinical competency is
documented at the conclusion of the internship year by the successful presentation
and defense of clinical cases to a committee of three faculty members. The
intern’s clinical research mentor serves as the chair of this committee.
The fellow presents a diagnostic evaluation, psychological testing report
(including original data), and a written case formulation they have prepared
on a patient seen during the past 12 months. In addition, they present an
audio or videotape of a representative psychotherapy session with this patient.
These materials are reviewed by the committee and are discussed with the fellow.
The fellow is required to demonstrate an advanced and sophisticated understanding
of diagnosis, assessment and psychotherapy, as well as an ability to critically
and sensitively use information derived from the empirical literature to guide
the development of their treatment plan and the selection of clinical interventions.
The clinical competency evaluation completed at the conclusion of the fellowship
year is similar, in many ways, to that used by the American Board of Professional
Psychology (ABPP) and the Academy of Cognitive Therapy (ACT). We endeavor
to organize our training experiences such that graduates of the
Research competency
is demonstrated at the conclusion of the fellowship year by the presentation
of an empirical study at a Departmental Grand Rounds. Trainees are encouraged
to work with their research mentor to develop an independent investigation
during the fellowship year. Their research mentor serves as a discussant for
their presentation. As noted, each
fellow is required to submit an empirical article to a refereed journal by
the conclusion of their fellowship year.
Internship:
Two Year Model
Distribution
of Hours
Predoctoral Internship
|
Hours |
Site |
Clinical Activity |
||||||||
|
12 |
OTC |
Psychotherapy; diagnostic interviewing |
||||||||
|
5.5 |
OTC |
Didactics:
|
||||||||
|
4 |
OTC |
Psychological Testing |
||||||||
|
4 |
Urgent Care / Triage |
Screening and Short Term Tx; |
||||||||
|
7 |
|
Supervision: OTC (5); Crisis (1); |
||||||||
|
1 |
OTC |
Diagnostic Team Meeting |
||||||||
|
33.5 |
Total |
|
|
Hours |
Site |
Clinical Activity |
||||||||
|
8 |
OTC |
Psychotherapy |
||||||||
|
20 |
Rotation |
Specialty Population and Treatment: |
||||||||
|
2 |
Crisis |
Short Term Tx: (2 cases) |
||||||||
|
4 |
OTC |
Didactics:
|
||||||||
|
8 |
|
Supervision: OTC (4); Crisis (1) |
||||||||
|
|
|
Testing: Optional |
||||||||
|
|
|
Research |
||||||||
|
42 |
Total |
|
The first year
of the program, the predoctoral internship year,
is a full time, APA-approved training program and the annual salary is $18,500
plus benefits (health insurance and two weeks vacation). The second year of
the program, the postdoctoral fellowship year, is also a full time, APPIC
member program and the annual salary is $19,500 plus the same benefits as
the internship year. As budgets for the upcoming fiscal year are
under review, the exact amount of the salary increase has not yet been determined.
Uniform Notification:
Our training program is a member of the Association of Psychology and Internship
Centers (APPIC). We strongly support the goals of this organization and endorse
the guidelines that are reprinted below. This internship site agrees to abide
by the APPIC policy that no person at this training facility will solicit,
accept, or use any ranking-related information from any intern applicant prior
to Uniform Notification Day.
Applicants
need to obtain a Request for Applicant Agreement Package from National Matching Services, Inc. who are
conducting the matching program for all internship programs that are members
of the Association of Psychology Postdoctoral and
Application
Requirements: We will only consider graduate students who are enrolled in
APA-approved training programs in clinical psychology who have been admitted
to candidacy for the doctoral degree before making application to the internship.
We therefore expect applicants to have taken graduate level courses in personality
theory, psychopathology, psychotherapy, psychological testing, professional
ethics, and to have completed practica in psychotherapy
and psychological testing.
Application
Materials: Applicants are asked to gather all supporting documents (transcripts,
testing report, and transcripts) and submit them in one mailing with the rest
of their completed application materials. This procedure gives you more control
over the completion of your application, ensures that all segments of your
application reach us in a timely manner, and facilitates our review of your
application. Letters of recommendation should be sent under separate cover
by the sponsoring psychologist directly to Mark A. Reinecke, Ph.D. at the address listed below. The full packet
of application materials must be received by November 1st, 2003. Applications
that are incomplete will not be considered, as faculty begin
their review of applications during November. The application itself is the
universal form (Application for Psychology Internship) developed by APPIC
and can be downloaded from the APPIC website at http://www.appic.org/i03forms.html. The application is formatted
so that it may be completed on a computer. Please see the "Forms and
Document Downloads" section of the APPIC Web site for further instructions
on working with the application form on your computer.
Do not send
your completed application packet by registered mail, as this will delay arrival.
Standard and express mail are fine, but we must receive
your packet by November 1st, 2003. All materials become the property of
The following
is a checklist of the application materials that you are asked to submit:
1) APPIC Application
for Psychology Internship
2) Sample psychological
testing report, incorporating intellectual and projective test data. All identifying
information must be deleted from this report.
3) Offical transcripts of all graduate courses.
4) Three letters
of recommendation mailed directly to us from faculty and supervisors who are
familiar with your clinical work.
Candidates
whose applications have been passed on to the interview phase of the admissions
process will be contacted by mid-December to schedule an interview in January.
Interviews cannot be conducted during the December holiday period. Interviews
for the 2003 admission year will be held on Thursday (January 16th), Friday
(January 17th), Monday (January 20th), and Tuesday (January 21st).
Mark A. Reinecke, PhD, ABPP, ACT
Division of Psychology
Northwestern University Medical School
Abbott Hall,
Attn: Psychology
Internship Application
Questions regarding
the application should be directed to 312.908.8262
PROGRAM RESPONSIBILITIES
The clinical
psychology internship program has the responsibility to assess the progress
of each intern throughout his or her training. In order to maximize intern
growth and clinical development, it is important that such assessment be done
on a continuing basis at timely intervals. It is also important that an intern's
expected performance be explained in advance along with the provisions for
interns' feedback if dilemmas or problems arise. In order to provide pertinent
information and to derive supportive measures or appropriate remediations, it is necessary for the internship program,
in concert with the individual intern, to have an accurate sense of how the
intern is progressing in relation to standardized criteria or norms. Thus,
this document lists the training program's expectations of interns' performance
followed by a discussion of issues related to intern impairment and the procedures
designed to deal with such situations if they arise.
INTERN RIGHTS AND RESPONSIBILITIES
Intern Rights
1) The right
to a clear statement of general rights and responsibilities upon entry into
the internship, including a clear statement of goals and parameters of the
training experience,
2) The right
to be trained by professionals who behave in accordance with the APA ethical
guidelines.
3) The right
to be treated with professional respect, that recognizes the training and
experience the intern brings with him/her.
4) The right
to ongoing evaluation that is specific, respectful, and pertinent.
5) The right
to engage in an ongoing evaluation of the training program experience.
6) The right
to initiate an informal resolution of problems that might arise in the training
experience (supervision assignments, etc.) through discussion or request letter
to the faculty/staff member concerned and/or to the internship Director.
7) The right
to due process and appeal to the Director to deal with problems after informal
resolution has failed or to determine when rights have been infringed upon.
8) The right
to respect for one's personal privacy.
9) The right
for sufficient workload to acquire adequate clinical training in the domains
specified by the program’s goals.
Intern Responsibilities
1. The responsibility
to read, understand and clarify, if necessary, the statement of rights and
responsibilities. It is assumed that these responsibilities will be exercised
and their implementation is viewed as a function of competence.
2. The responsibility
to behave within the principles set forth by the statutes and regulations
of the American Psychological Association. These Principles are set forth
in the American Psychological Association's pamphlet entitled "Ethical
Principles of Psychologists and code of conduct".
3. The responsibility
to be open to professionally appropriate feedback from faculty supervisors,
as well as professional staff and personnel of Northwestern Memorial Hospital/Northwestern
University.
4. The responsibility
to behave in a manner that promotes professional interactions.
5. The responsibility
to give constructive feedback that evaluates the training experience or other
training experiences within the internship.
6. The responsibility
to conduct oneself in a professionally appropriate manner if due process is
initiated.
7. The responsibility
to participate actively in the training, clinical services and the overall
activities of the internship.
8. The responsibility
to meet training expectations by developing competency in (1) assessment skills,
(2) psychotherapy skills, (3) crisis intervention/triage skills, and (4) psychological
testing skills, and 5) other areas as delineated in the evaluation forms.
INTERN COMPETENCY EXPECTATIONS
The internship
training program expects the intern to achieve the following competencies:
Legal and
Ethical Issues
1) Demonstrate
knowledge of and behavior consistent with APA ethical principles.
2) Demonstrate
awareness of individual and ethnic/cultural differences (e.g., age, disability,
gender, race, religion, sexual orientation, and social class) and how these
affect psychotherapy behavior and assessment.
3) Demonstrate
awareness of when and how to seek legal and medical consultation appropriately.
4) Demonstrate
awareness of emerging ethical and legal issues.
Professional
Behavior
5) Demonstrate
awareness of professional issues currently occurring in professional psychology.
6) Demonstrate
the ability to function effectively as a member of an interdisciplinary treatment
team and as a member of the intern group.
7) Demonstrate
professional self-direction and integration of the various aspects of the
training experience throughout the year.
8) Demonstrate
appropriate timely maintenance of all charting and relevant documentation
requirements.
Psychological
Assessment and Referral
9) Demonstrate
ability to conduct an intensive and comprehensive diagnostic interview.
10) Demonstrate
competent, treatment planning, and case disposition skills.
11) Demonstrate
ability to refer appropriately for testing, medication and/or specialized
treatment.
12) Demonstrate
the ability to write a narrative psychological report integrating assessment,
diagnosis, formulation, and treatment planning.
13) Demonstrate
knowledge of a conceptual model of psychotherapy that incorporates assessment,
case formulation, and treatment goals for problem focused (e.g. crisis), time
limited, and longer term interventions.
Psychotherapy
and Crisis Intervention Skills
14) Demonstrate
competence in crisis intervention and on-call work.
15) Demonstrate
psychotherapy skills across range of modalities (e.g., individual, couple,
and group).
16) Demonstrate
proficiency in both psychopdynamic and empirically supported
forms of psychotherapy.
17) Demonstrate
awareness of personal biases and their effects on the process of psychotherapy.
Personal
and Interpersonal Functioning
18) Demonstrate
ability to discuss in supervision those behaviors, personal characteristics,
and concerns which might aid or interfere with one's effectiveness as a psychologist.
19) Demonstrate
ability to establish appropriate professional and collegial relationships
e.g., seeking consultation appropriately, providing consultation effectively
to peers and staff, respecting privacy, and functioning as part of an interdisciplinary
team.
20) Manage
personal stress/adjustment problems and/or emotional responses in a way that
does not result in inferior professional services to patients or interfere
with job responsibilities.
21) Demonstrate
sincere desire to learn through self- reflection and continued academic involvement
(e.g., reading, seminars).
Clinical
Scholarship
22) Demonstrate
the ability to independently develop and complete a clinical research study.
Supervision
23) Demonstrate
professional behavior in supervisory activities. This includes preparedness
for supervision meetings, consideration of patients' needs and openness about
clinical dilemmas.
24) Demonstrate
knowledge of one's strengths and limitations as a diagnostician and psychotherapist.
25) Completion
of all patient chart records and other paperwork pertinent to the training
experience.
SCHEDULE
OF INTERN EVALUATION PROCEDURES
July: Individual meetings with
Director and Assistant Director to assess training background/needs and planning
for current year.
October: Evaluation forms are
sent to all intern supervisors to initiate review process for each intern.
November/December: Director and Assistant
Director collect Evaluation forms and meeting is scheduled with each intern
to review progress on core competencies during first half of training year.
The Director prepares a written summary of review meeting feedback and a copy
sent to the intern and his/her doctoral program. The intern’s feedback
regarding the entire training experience is discussed.
May: End of year evaluation forms are sent to all faculty supervisors.
June: Evaluation forms are
collected and an individual meeting is scheduled with the director and Assistant
Director to review the entire year’s progress regarding core competencies.
The intern’s feedback regarding the complete set of training experiences
is discussed. A written summary of the end of the year review is sent to the
intern and his/her doctoral program.
DUE PROCESS IN ACTION: THE IDENTIFICATION
AND MANAGEMENT OF INTERN
AND POSTDOCTORAL PROBLEMS OR IMPAIRMENT
This document
provides interns and faculty a definition of impairment, a listing of possible
sanctions and an explicit discussion of the due process procedures. Also included
are important considerations in the remediation of problems or impairment.
I. Definition
of Impairment
Impairment
is defined broadly as an interference in professional functioning which is
reflected in one or more of the following ways: 1) an inability and/or unwillingness
to acquire and integrate professional standards into one's repertoire of professional
behavior; 2) an inability to acquire professional skills in order to reach
an acceptable level of competency; and/or 3) an inability to control personal
stress, strong emotional reactions, and/or psychological dysfunction that
interfere with professional functioning.
While it is
a professional judgment as to when an intern or fellow’s behavior becomes
impaired rather than problematic, a problem refers to a trainee's behaviors,
attitudes or characteristics that, while of concern and requiring remediation,
are not unexpected or excessive for professionals in training. Problems typically
become identified as impairments when they include one or more of the following
characteristics:
1. the intern or fellow does not acknowledge, understand, or address
the problem when it is identified;
2. the problem is not merely a reflection of a skill deficit that
can be rectified by academic or didactic training;
3. the quality of services delivered by the intern or fellow is
sufficiently negatively affected;
4. the problem is not restricted to one area of professional functioning;
5. a disproportionate amount of attention by training personnel
is required; and/or
6. the trainee's behavior does not change as a function of feedback,
remediation efforts, and/or time.
II. Remediation
and Sanction Alternatives
It is important
to have meaningful ways to address impairment once it has been identified.
In implementing remediation or sanction interventions, the training staff
must be mindful and balance the needs of the impaired or problematic intern
or fellow, the patients involved, members of the intern training group, the
training faculty/staff, and other hospital/university personnel.
1. Verbal
Warning to the intern or fellow emphasizes the need to discontinue the
inappropriate behavior under discussion. No record of this action is kept.
2. Written
Acknowledgment to the intern or fellow formally acknowledges:
a) that the Director is aware of and concerned with the performance
rating,
b) that the concern has been brought to the attention of the intern
or fellow,
c) that the Director will work with the intern or fellow to rectify
the problem or skill deficits, and
d) that the behaviors associated with the rating are not significant
enough to warrant more serious action.
The written
acknowledgment will be removed from the intern or fellow's file when they
respond to the concerns and successfully complete the training year.
3. Written
Warning to the intern or fellow indicates the need to discontinue an inappropriate
action or behavior. This letter will contain:
a) a description of the intern or fellow's unsatisfactory performance;
b) actions needed by the intern or fellow to correct the unsatisfactory
behavior;
c) the time line for correcting the problem;
d) what action will be taken if the problem is not corrected;
and
e) notification that the intern or fellow has the right to request
a review of this action.
A copy of this
letter will be kept in the intern or fellow's file.
4. Schedule
Modification is a time-limited, remediation-oriented closely supervised
period of training designed to return the intern to a more fully functioning
state. Modifying an intern's schedule is an accommodation made to assist the
intern in responding to personal reactions to environmental stress, with the
full expectation that the intern will complete the internship. This period
will include more closely scrutinized supervision conducted by one or more
faculty supervisors in consultation with the Director. Several possible and
perhaps concurrent courses of action may be included in modifying a schedule.
These include:
a) increasing the amount of supervision, either with the same
or other supervisors;
b) change in the format, emphasis, and/or focus of supervision;
c) recommending personal therapy (a list of community practitioners
is available).
d) reducing the intern or fellow's clinical or other workload.
e) requiring specific academic coursework.
The length
of a schedule modification period will be determined by the Director in consultation
with the primary supervisor(s) and the Internship Training Committee. The
termination of the schedule modification period will be determined, after
discussions with the intern or fellow, by the Director in consultation with
the primary supervisor(s) and the Internship Training Committee.
5. Probation
is also a time limited, remediation-oriented, more closely supervised training
period. Its purpose is assess the ability of the
intern or fellow to complete their training year and to return the intern
or fellow to a more fully functioning state. Probation defines a relationship
that the Director systematically monitors for a specific length of time during
which the intern or fellow addresses, changes and/or otherwise improves the
behavior associated with the inadequate rating. The intern or fellow is informed
of the probation in a written statement that includes:
a) the specific