From the Office of the Executive Director
APPIC Central Office provides several different services including dues and fee billing; eMembership applications for new and continuing programs and; website updates; issues with membership applications to name a few. Another service is the Informal Problem Consultation service. Many times, an APPIC Board member responds to the individual that submits an IPC, but sometimes the Executive Director works with the TD, intern, postdoc or DCT.
It is not unusual for a training program to experience a “problem” with an intern or postdoc. Normally, it is a developmental issue that may only need informal notification to the trainee by the clinical supervisor or the training director keeping it at an informal level. Clearly identifying what issues need to be addressed is just a normal part of supervision feedback. If the intern or postdoc immediately and appropriately responds to the feedback, the issue is resolved.
Psychology training is a continuous quality improvement process. These minor concerns are not atypical and may involve issues such as arriving late a couple of times; inappropriate dress; spending too much time socializing in a waiting area or delays in completing clinical notes in a timely manner. These issues are typically immediately remediated when the intern or postdoc is given feedback about what needs to be improved. The discussion takes place in supervision and not much more is made of the concern. Professionalism requires that the trainee be responsive and adjust their behaviors (actions) at the training site. Most are more than willing to make an adjustment and appreciate the feedback when given in a supportive matter.
However, if these problems persist or worsen, it likely means it is time to develop a formal remediation plan with specific goals, objectives and timelines. A specific plan is developed by the training director in conjunction with the training team, reviewed with the trainee, possibly revised and then signed by all parties. The timeline for demonstrating improvement might be 30 days, though it can also be monitored weekly. In addition, it is also important to clearly identify the specific behaviors and the expected outcomes. For example, if an intern or postdoc is late for work on a consistent basis, it is important to review professional expectations and the impact it has on others such as clients waiting, staff rearranging their schedule or others delaying the start of a training seminar waiting for the late arrival. Those behaviors are then quantified in a remediation plan such as the trainee is expected to be on time for all training activities and patient appointments unless there is a call or text requesting a sick day or rationale for being late such as car trouble. Even that can be limited to state that up to two exceptions would be allowed within the next 30 days. This is a performance contract and trainees are entitled to know what is expected of them. In addition, it would be important to identify consequences of not meeting the expected outcomes. The trainee may have the remediation plan extended and/or modified as well as the possibility of it moving to probation. It is expected that this remediation plan would address these minor issues and the feedback system has worked even though it moved to a more formal action.
There are times when behavior at the training program indicates it is more than the minor issues identified above and there is concern about the skills and knowledge of the trainee. They may be deficient or lacking certain expected skills such as developing a relationship with the patient; performing psychological assessment with minimal errors; or unprofessional behavior such as talking about other trainees or supervisors in an open setting. In cases like these, a remediation plan similar to what was stated above would be important. Again, specific behaviors with timelines need to be clearly identified. Even some of these can start off as informal, but if not addressed quickly (in the next two reports or interactions) then a formal remediation plan should be developed.
A remediation plan should be designed to ensure the opportunity for success of the trainee. Specific expectations, timelines and outcomes are very important for everyone to be “on the same page.” This step would normally include notification of the DCT at the home doctoral program. This step makes sure they are in the loop and are aware there are some concerns. The idea is “no surprises” and a clear demonstration that the training program is working to be supportive and quickly address concerns. It is important to provide an opportunity for the trainee to make the expected changes, meet the expected outcomes and move forward towards successful completion of the training program.
However, there are many times when the issues are more than minor and may be far beyond a remediation plan. These are likely to involve ethical or legal issues. At this stage it is very important to include Human Resources and Legal. In those cases, the trainee may have their clinical work “suspended” until the issues are addressed or thoroughly investigated. If the trainee is not successful in addressing those concerns the result will likely result in termination and a “release” from the APPIC match agreement. In all cases APPIC requires these decisions to be “appealable” with due process giving the trainee an opportunity to have their side of the story told. Even in an egregious situation, if the trainee has not resigned, then they should be provided an opportunity to appeal the decision to terminate the trainee. A hearing can be held, even if they have been “removed’ from the training site. The appeal hearing can be held by Zoom or telephone conference call. Due process and appeals are part of the requirement for APPIC membership. Internships and Postdocs are required to be gatekeepers and when trainees do not meet expectations, cannot respond to remediation or commit highly unethical or legal violations, they should be subject to termination from the training program.
Following these remediation guidelines can help trainees move towards success and when they don’t, help protect the public which is likely a goal of all psychology training programs. Consultations can be requested by completing the IPC form on the APPIC website at https://www.appic.org/Forms/APPIC-Informal-Problem-Consultation.