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Reconceptualizing Internship Training Within the Evolving CPXXXX10.1177/2167702613501308Atkins et al.Clinical Science Internship 501308research-article2013 Special Series Clinical Psychological Science 2014, Vol 2(1) 46 –57 Reconceptualizing Internship Training © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav Within the Evolving Clinical Science DOI: 10.1177/2167702613501308 Training Model cpx.sagepub.com Marc S. Atkins1, Timothy J. Strauman2, Jill M. Cyranowski3, and Gregory G. Kolden4 1Institute for Juvenile Research, University of Illinois at Chicago; 2Department of Psychology and Neuroscience, Duke University; 3Department of Psychiatry, University of Pittsburgh Medical School; and 4Department of Psychiatry, University of Wisconsin-Madison Abstract As changes in health-care delivery impel us to refine clinical science training, the opportunity arises to reconceptualize internship training to align more closely with clinical science values and outcomes. We present observations on the evolution of internship training with a focus on the following issues. First, we highlight the significance of a public- health perspective for clinical science as a basis for refining training goals and practices. Second, we briefly review how internship training evolved (where it has come from) to set the context for continuing evolution (where it might go). Third, we discuss the need for an expanded definition of clinical competence for clinical science training to better align with innovations in health care and to prepare graduates for new career opportunities. Finally, we present examples of new models for internship training that might accommodate the continuing redefinition of internship training in clinical science. Keywords psychological clinical science, internship training, public health, clinical standards Received 4/15/13; Revision accepted 6/26/13 Psychological clinical science has made enormous prog- training opportunities associated with expanded clinical ress both in terms of scientific contributions and as a science career trajectories and identifying proximal and source of continued development for improving how distal measures of training and career success. psychologists are trained for the future. At this crucial Among the core goals for clinical science training is juncture, we see not only great challenges but also great the effective integration of science and clinical practice. opportunities, not the least of which is rethinking and However, although the clinical science model has done a expanding how internship training could be conceptual- commendable job of defining and measuring key stan- ized within clinical science training. As ongoing changes dards for scientific training (with well-articulated out- in the health-care delivery system impel psychological comes measures that allow program directors to meet clinical scientists to continue the process of redefining identified training goals in a flexible way), the model has themselves as a field, so have those changes brought into yet to fully meet the challenge of defining, measuring, relief the limitations of the traditional internship model. and incentivizing key clinical practice standards. We pro- Redefinition and reconceptualization are in order, and pose that the assessment of clinical competence within this article is intended to encourage and facilitate that the clinical science model requires an appreciation for process. Three of the authors are currently directors of clinical science internships and the fourth previously Corresponding Author: served in that role. As we articulate later, we see an Marc S. Atkins, Institute for Juvenile Research, University of Illinois at opportunity for internship experiences to integrate more Chicago, 1747 W. Roosevelt Rd., Room 155, Chicago, IL 60608 seamlessly with graduate training by providing unique E-mail: [email protected] Downloaded from cpx.sagepub.com by Thomas Oltmanns on June 24, 2014 Clinical Science Internship 47 varied opportunities for clinical research and clinical Services, 1999). Although it is highly likely that one practice careers beyond the traditional individual psy- aspect of such a paradigm shift will be to broaden avail- chotherapy model. We argue that internship-training sites able intervention paradigms beyond the dominant model are ideally situated to respond to the need for innovative of individual psychotherapy, no single change in practice clinical and clinical research service settings and to con- or policy will suffice to meet the demand for more tribute to the identification of key clinical practice train- effective mental-health services. As Kazdin and Rabbitt ing standards that codefine the clinical science model. (2013) noted, these calls for change highlight the need to We have organized our observations and comments expand current toolkits for mental-health treatments to on the continuing evolution of internship training around encompass novel models of service delivery and the the following issues. First, we highlight the significance development and management of a new service-delivery of a public-health perspective for clinical science (and workforce. clinical science training) as a basis for the continuing Public-health advocates have further highlighted the refinement of training efforts. Second, we review briefly current science-to-practice gap in mental-health care, as how internship training evolved (where it has come well as the need to create and disseminate prevention and from) to set the context for continuing evolution (where intervention strategies that are comprehensive, readily it might go). Third, we discuss the central role of stan- accessible, and relevant to a broad range of mental-health dards for clinical competence within the clinical science needs (e.g., Funk et al., 2010). Such models emphasize training model, particularly as it highlights the contribu- the crucial yet underrepresented field of implementation tions of internship-training settings. Finally, we offer sug- and dissemination science (Proctor et al., 2009), including gestions for new directions that might be part of the the need to bring mental-health interventions into settings continuing redefinition of internship training in clinical in which individuals routinely receive care by developing, science. adapting, and testing interventions within active patient populations and care settings (e.g., American Academy of The Primary Challenge for Clinical Child and Adolescent Psychiatry, Committee on Health Science: Reducing the Public Mental- Care Access and Economics, Task Force on Mental Health, 2009; Druss et al., 2010). Health Burden One particularly noteworthy response to these con- The worldwide mental-health burden in developed as well cerns is the Delaware Project, a cooperative effort spon- as developing countries has persisted for decades and sored by the National Institutes of Health (including the appears to continue unabated (Funk, Drew, Freeman, & National Institute of Mental Health, the National Institute Faydi, 2010; Kessler, Chiu, Demier, & Walters, 2005). Most on Drug Abuse, and the Office of Behavioral and Social people who experience mental-health problems do not Science Research), the Academy of Psychological Clinical receive psychological treatment services, and the relatively Science, SAGE Publications, and the University of few who do obtain services too often receive suboptimal Delaware. The Delaware Project was the first organized interventions lacking scientific support or delivered with effort to assist directors of clinical science training poor treatment fidelity (Kataoka, Zhang, & Wells, 2002; programs in incorporating implementation and dissemi- Wang, Lane, Olfson, Pincus, & Wells, 2005). A consensus nation science within their curricula and training experi- has emerged over the course of the past decade that the ences. One of the dominant themes at the Delaware adoption of a comprehensive and integrated public-health conference, held in October 2011 at the University of approach is essential to address the extant mental health Delaware (http://www.delawareproject.org/wordpress/ both nationally and internationally (Druss, Mays, Edwards, 1011-conference/), was that most clinical science graduate- & Chapman, 2010; Saraceno et al., 2007). training programs have been slow to react to the chang- In response to this public mental-health crisis, multi- ing demands highlighted by a public-health perspective, ple calls have been raised to improve the scientific basis and there was strong encouragement for clinical science and fidelity of current mental-health interventions (e.g., program directors to examine and modify their training T. B. Baker, McFall, & Shoham, 2009; Drake et al., 2001) practices (see Shoham et al., 2013, this issue). As we and also to broaden prevention and intervention para- hope to demonstrate, recognition of the unmet needs for digms needed to address the growing mental-health bur- mental-health services also represents a unique opportu- den (e.g., Funk et al., 2010; Insel, 2009; Stiffman, Stelk, nity for significantly greater synergy between graduate Evans, & Atkins, 2010). The well-documented inadequa- training and internship training as a laboratory for cies of current mental-health models in the face of the development, assessment, and dissemination of service- enormous public-health burden of mental illness under- delivery models. score the need for a major shift in mental-health interven- A related point regarding the importance of a public- tion research (U.S. Department
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