CHALLENGES FOR EARLY CAREER PSYCHOLOGISTS IN
DEVELOPING A TRAINING PROGRAM
Julie N. Germann, PhD, Jamie A. Grollman, PhD, Jami N. Gross, PhD,
Crista E. Wetherington, PhD, Gabriela Reed, PhD, & Mary C. Lazarus, PhD
Center for Pediatric Psychiatry, Children’s Medical Center Dallas & Department of Psychiatry, UT Southwestern Medical Center
Introduction
Developing a new pediatric psychology training program requires a great deal of
initiative, organization, and competence. Such an endeavor presents a unique set
of challenges for early career psychologists, who are establishing their
professional identity while also just beginning to gain supervisory experience.
Such challenges for early career psychologists may include obtaining training and
competency in supervision, achieving confidence in supervision, navigating a
change in roles and boundaries (when changing from a trainee to a supervisor),
establishing credibility as a supervisor with past trainee peers, professional rolemodeling, and artfully giving feedback.
This presentation highlights the challenges and skills needed for early career
psychologists in developing a training program while drawing on the experiences
of the early career psychologists in the newly developed Pediatric Psychology
service at Children’s Medical Center Dallas (CMCD).
Needs Assessment
• Rapid growth in the CMCD psychology training program over the past 5 years
– 2006-2007: First pediatric psychology fellow
– 2007-2008: 2 fellows, 1 intern
– 2008-2009: 1 fellow, 3 interns
• Need to develop a more formally structured training program
• Needs identified for developing a quality training program
– Form an organization (Training Team) to develop and oversee the training
program, while considering:
• Needs and support at an institutional level
• Balancing clinical needs of patients/families with the training/supervisory
needs of the trainees
• Identification of team members
• Professional development of team members
Program Development
Need #1: Develop a Training Organization
Need #3: Ensure Adequate Supervisory Skills
• Weekly Training Team meetings:
– Review trainee progress, accomplishments & concerns
– Address program development advancements or needs
• Improvement of training experiences
• Modifications based on trainee feedback
– Provide opportunities for peer consultation on trainee-supervisor issues
– Foster cohesion among psychologists who primarily function independently within
their respective medical teams
• Goal of providing excellent supervision to trainees
– Foster the supervision skills of early career psychologists
– Further develop the skills of more experienced supervisors
• Maintain identity and autonomy for psychology training while balancing integration
within the multi-disciplinary psychiatry C/L team
• Training and supervision are different for psychology & psychiatry fellows
• Each discipline maintains independent paperwork that addresses the unique
aspects of their consultations
• Balance clinical needs of medical services while ensuring depth and breadth of
training
– Five services have embedded psychologists: cystic fibrosis, gastroenterology,
oncology, sickle cell disease, & solid organ transplant
– Two services include psychology in multidisciplinary clinics (endocrinology & pain
management)
– Embedded psychologists spend approximately 48-65% of time in patient care
and 12-14% engaged in training-related activities
– Trainees conduct psychology consults triaged by the C/L psychiatry service and
supervised by the pediatric psychologist on the general consult team
– Trainees rotate through 3 four-month elective placements of the more than 15
available in specific clinics or medical services of interest
• Supervised by specialist psychologist or their primary supervisor
• Patient care and training efforts often overlap, presenting unique challenges,
including role conflict and role ambiguity (Campbell, 2000), which can be especially
demanding on the skill sets of newly-supervising psychologists
Pediatric Psychology Training Components
– Identify and detail a training model and structure
– Ensure adequate supervisory skills, as the majority of the potential supervisors
were early career psychologists who had just completed fellowship
Pediatric Psychology Team
• Formed in 2008
• Comprised of the 6 current pediatric psychologists at CMCD:
– All hired in 2007 (2) and 2008 (4)
– 5 embedded within specific medical teams
– 4 recently completed fellowship
– 3 currently licensed in the state of Texas to provide independent supervision
– 2 provisionally licensed and supervise via umbrella supervision
• Diverse training backgrounds (e.g., Clinical, Counseling, School Psychology) with
commonality of training in pediatric psychology
• Faculty appointments in the Department of Psychiatry at UT Southwestern Medical
Center (UTSW)
• Postdoctoral trainees: Traditional interview and selection process for a one-year
clinical fellowship
• Predoctoral interns: Placed through the UTSW Clinical Psychology Ph.D. program
which has an encapsulated internship
– All interns are UTSW graduate students in the 3rd & 4th year
– Internship placement is a 20-hour/week half-time position for one year
concurrent with a half-time research placement
– Supervising psychologists maintain ongoing dialogue with the UTSW program
through participation on both Clinical and Research Training Committees
• Psychology encouraged to focus a portion of time on training due to faculty
appointments and involvement with the Clinical Psychology program
Program Development (cont’d)
Training Activities
Pediatric Psychology Didactics
Consult/Liaison Grand Rounds
Consult/Liaison Patient Rounds
Professional Development Seminar
Supervision
Live supervision
Individual w/primary supervisor
Individual w/rotation supervisor
Group supervision
Clinical Services
Psychiatry C/L Team
Psychology elective rotations
Area of specialization for fellows
• Weekly Training Team meetings
– Peer consultation on supervision skills, feedback methods, challenges
• Constructive yet direct verbal and written feedback
• Broaching difficult topics
• Intervening with trainees who are not meeting expectations
• Feeling credible and confident with advanced trainees, with whom there
may be a small developmental difference from trainee to supervisor
– Observe others’ conceptualization of supervisory issues
– Utilize supervisors’ skills in diverse knowledge and competency areas
• Weekly trainee-focused meetings
– Group supervision: Opportunities to role-model and observe others’
supervisory skills
– Multi-disciplinary C/L rounds: Opportunities to learn feedback and teaching
styles of other disciplines
• Psychiatry: “Teaching moments” to provide feedback in a group format
• Psychologists: Role-model the process of case conceptualization to
trainees and professionals in other disciplines (e.g., play therapy,
psychiatry)
• Monthly didactic supervision seminar
– Early career psychologists from Pediatric Psychology, Outpatient Clinical
Psychology and Neuropsychology; 2 senior psychologists to provide guidance
and experience
– A supervision workbook (Campbell, 2000) guides learning and discussion
topics
• Participants reflect on how readings apply to past experiences as trainees,
current experiences as supervisors, and how past trainee experiences
have influenced their current supervisory style
– Anecdotal reports of feeling invigorated by readings and discussion
• Increased focus on implementing specific supervision skills/strategies
immediately after the seminar
• Senior psychologists report helpfulness of seminar as their supervisory
responsibilities continue to evolve
Future Directions
• Serve as a model for psychology training at CMCD: Expand educational
components to incorporate trainees & supervisors from other areas
• Promote more formal opportunities for teaching and role-modeling (e.g., case
presentations by faculty and trainees)
• Continued program evaluation to assess and modify the program to meet the
needs of trainees, supervising psychologists, and the patient families
• Promote visibility of the CMCD pediatric psychology training program
• Pursue APA-accreditation for the pediatric psychology fellowship
• Develop recommendations for other newly formed training programs
• In forthcoming years, monitor the needs of mid-career psychologists and adapt
supervisory support to continued professional development
Need #2: Identify a Training Model
• Adhere to APA Guidelines for Internship
• Draw on past experiences and models as supervisors/supervisees
• Handbook detailing concrete framework
– Establish organization and divide responsibilities among psychologists
– Reference for trainees, outlines expectations
• Solicit feedback throughout training year about structure and components
• Two-way evaluation at regular intervals
– Trainees completed self-evaluation at the start of the training year, reviewed at
each interval
– UTSW evaluation forms from the encapsulated internship
– Trainees completed supervisor evaluations
The 2008-2009 Pediatric Psychology Faculty