Educational Implementation Plan
The MCG-Charlie Norwood VAMC Internship makes use of the following educational components
in efforts to achieve the identified Goals of the Internship:
- Overall Supervisor- Due to the complexity of internship training and the diverse interests and educational
needs of interns entering internship training, the MCG-Charlie Norwood VAMC Internship
provides an Overall Supervisor (OS) for each intern prior to the beginning of the
internship. The OS is charged with the duty to develop an understanding of the unique
educational needs and interests of the Intern and to develop and monitor a yearlong
strategy to maximize the training experience available. Thus for example, an intern
might desire or require a special emphasis on psychological assessment. The OS would
be responsible for helping the intern devise a sequence of trainings to meet this
need that might begin with basic training in test administration and then move forward
to more interpretive and integration training experiences. These special needs and
sequence of training would be communicated with rotation supervisors to ensure that
the necessary training experiences are provided. In general, the OS plays a vital
role throughout the year in addressing rotational schedules and within rotational
experiences to insure that target areas of need and interest are adequately addressed.
To facilitate this developmental process, at the beginning of the training year the
intern completes the Intern Self-Study and the Self-Assessment of Cultural Competency
forms and discusses the results with the OS to determine specific areas of need for
competency development. At the completion of each rotation, the intern completes
the Intern Performance Milestones Self-Evaluation form in order to assist in monitoring
progress and self - identifying competency development needs. This completed self-evaluation
form in reviewed and discussed with the OS. The OS is responsible for completing
the Intern Performance Milestones Tracking form at the midyear and end of year evaluations
– providing a cumulative record of the completion of requirements and obtainment of
required competencies. Also, the OS is responsible for completing the evaluation of
the intern’s Case Presentation that is completed by the end of the first month of
the third rotation. When training issues/deficiencies are identified, the Internship
Director of Internship Training will address these with the OS and the Core Committee
so that effective educational interventions can be planned. In this regard, the Internship
policies under the heading of “Due Process: The identification and management of Intern problems/impairment” stipulate that the OS plays an important role in dealing with problems that may arise
with the Intern’s behavior or performance. Similarly, the OS plays an important role
in responding to any Intern Grievance. The OS is required to serve as a member of
the Core Committee. Finally, the OS insures that guidance is being provided in regard
to career planning including strategies for identifying and applying for postdoctoral
fellowships or professional positions in a timely fashion. The OS is responsible for
providing the following assessments of the Intern during the training year:
- By the end of the first month of the third rotation, Interns are required to present
a Case Presentation to Faculty and Interns. This case presentation must demonstrate: (1) presence of
key biopsychosocial data that includes psychological testing data; (2) integration
of the data into an effective “theory of the patient”; (3) application of cultural
competence in the collection of and use of the data; (4) application of recovery principles
as denoted by use of person centered goals and identification of strengths; (5) an
empirically based and interdisciplinary approach to treatment; (6) the case presentation
must reflect an appreciation of the unique life goals and strengths of the patients
as they guide the development of an effective treatment plan. Proficiency of this
case presentation will be judged by the responsible clinical supervisor (s) and the
Overall Supervisor.
- Interns are required to complete one research-scholarly project in which there is
a written product authored or co-authored by the interns. The Overall Supervisor is
responsible for helping the intern develop with his/her research mentor a research-scholarly
project and review the project plan and timetable. Progress and successful completion
of the research-scholarly product will be judged by the responsible project supervisor,
the Overall Supervisor, and the Internship Training Director.
- At the Mid-Year and End-of-the Year evaluations the OS is expected to complete the
Intern Performance Milestones Tracking form. This form provides valuable tracking
of the Intern’s progress and insures the internship that we can accurately report
the educational outcomes for our Internship.
- Director of Internship Training and Core Committee. To insure that interns are progressing in areas of program competencies and individualized
educational interests/needs, the Director of Internship Training reviews all rotational
and seminar evaluations, intern self-evaluations, and the Intern Performance Milestones
Tracking form of all the interns in a timely manner. When training issues/deficiencies
are identified, the Director of Internship Training will address these with the OS
and the Core Committee so that effective educational interventions can be planned.
At midyear, each intern’s progress is reviewed with the Director of Internship Training
and the Core Committee and specific educational goals for the remainder of the training
year are devised. At the end of the year, each intern’s performance is reviewed with
the Director of Internship Training and the Core Committee to insure that all required
training experiences have been completed and all required competencies have been obtained.
The Director of Internship Training provides a summary letter of the intern’s progress
to the respective Graduate School Training Director at the midyear and end of year
evaluations.
- Practicum Experiences and Supervision. The Rotational/Track supervisors are responsible for establishing and communicating
clear educational goals for the rotational/track experience, identifying and delegating
appropriate clinical assessment/treatment cases for the Intern, supervising all clinical/professional
activities on the rotation/track, maintaining on-site presence during all Intern clinical
encounters, verifying the accuracy and timeliness of all clinical documentation, and
providing routine verbal and written feedback regarding the Intern’s rotation/track
performance. Interns are required to document all patient encounters in the appropriate
electronic records that must be reviewed and signed by the appropriate supervisor.
Typically, interns will have 2-4 rotational/track supervisors for all rotations and
tracks. At a minimum, as a component of the rotational/track training interns must
receive 4 hours of supervision per week with a minimum of 2 hours of individual supervision
(one-on-one) per week and 1.5 hours of group supervision per week (supervision with
multiple interns and a supervisor). It should be noted that additional group supervision
is provided in the Psychotherapy Process Seminar.
In regard to rotation/case supervision, the MCG-Charlie Norwood VAMC Internship emphasizes
the following supervisory activities that facilitate a sequential and cumulative training
experience that is graded in complexity:
- Initial assessment of the Intern’s skills/competencies and training needs is essential
and the data obtained should guide the supervisor in regard to the training experiences
assigned.
- For new areas of skill development, didactic instruction and reading materials need
to be provided prior to patient-care training activities. There should be provision
of a bibliography with continually updated research-oriented articles and articles
specific to the cultural issues relevant for the clinical populations served. Instruction
should include not only the teaching of specific techniques but also the general principles
that underlie them.
- In early stages of skill development, conjoint clinical/professional activities in
which the Intern can observe the Supervisor in action should be emphasized. This observational
experience can then be followed by the Supervisor observing live or via video recording
the Intern engaging in the targeted skill/competence. Effective skill/competence development
in professional psychology is dependent upon practice in patient care activities.
- A feedback model of supervision should be provided as the Intern progresses in the
early phases of skill/competence development. This model emphasizes: 1. A clear understanding
of what constitutes a “correct” and “incorrect” conceptualization or treatment intervention.
2. Immediate, unambiguous and consistent supervisory feedback regarding the specific
relevant behaviors observed. As the Intern progresses in the skill development this
feedback model of supervision should also progress in regard to the level of supervisor-intern
collaboration pertaining to what was observed and the relevant evaluations associated
with the observed behaviors.
- As much as possible, assignment of patient care experiences should begin with the
less complex and less high acuity cases and move according to demonstrated competencies
toward the more complex and higher acuity cases. Some services, however, may not have
the patient care complexity/acuity range to enable such a progression. Therefore,
in such circumstances a weaning process is encouraged in which the Supervisor initially
is highly visible and engaged in the clinical care and then gradually allows the Intern
to take more significant roles in the patient care activity.
- To enhance transfer and maintenance of skills/competencies, the Supervisor should
increase the variability or range of training experiences to which the Intern responds.
- A reflection-driven model of supervision should increasingly be incorporated in the
middle to latter phases of skill development. This model emphasizes: 1. The Supervisor
encourages the Intern to engage in a reflective process in which the Intern pays deliberate
attention to his or her experience, critically analyzes feelings and observations,
and engages in more of a self-evaluative process. The Supervisor actively teaches
the Intern how to learning from his or her own experience. Supervisory input and
teaching is guided more and more by the Intern’s own inquiry and conceptualization
of case material. Supervisory discussions should increasingly become more about collaborative
reflections on skills and strategies, personhood issues, and conceptualizations.
- Within the legal limitations of practice of psychology, the Intern should increasingly
become more and more independent in the clinical care training opportunities afforded
as skills/competencies are successfully obtained.
It is required that the Rotational supervisor(s) and Intern have a relatively formal
discussion of the Intern's progress six weeks after beginning the rotation. Each supervisor makes a report not less than every four months to the Internship
Core Committee after discussion between the supervisor and supervisee concerning the
evaluation of the Intern’s performance. These evaluations are used to assess educational
progress and further develop educational plans for the Intern.
Case Supervisor
If special expertise is needed on a case, or if the Intern has a special interest
in working with a faculty person, a Case Supervisor can be added at any time. This
includes supervision of a research project. The Case/Research Supervisor, though not
responsible for most of the Rotational or Track experiences, would be responsible
for the appropriate supervision of the case or research project and must provide feedback
in verbal and written form to the Intern and to the Training Director and Core Committee
each 4-month block.
Mentor
After the Intern gets to know the faculty, we encourage, but do not require, the Intern
to seek a personal mentor relationship with a faculty person. In the past, the faculty
mentor has acted as a friend, informal counselor, ombudsman, role model, and case
supervisor. Mentors can be changed
There are two rotations required of all Interns: (1) The General Practice Rotation
– located at Uptown VA, MCG/AU, or East Central Georgia Regional Hospital sites, and
(2) the General Health Psychology Rotation – located at the Uptown VA, Downtown
VA and MCG sites. The third rotation -Emphasis Track Rotations - is selected prior
to entry into the internship program and represents one of the bases upon which Intern
are selected in the APPIC match (i.e., Intern apply to and are matched according to
emphasis training interest). Due to the size and diversity of the internship classes
and the complexity of the training program, rotations cannot be sequenced to facilitate
a particular progression of skills/competencies. Nevertheless, within each rotation
training experiences and supervisory priorities are intended to reflect the anticipated
progression in the skills/competencies of the Interns such that Interns practice more
independently as the rotations progress and supervision increasingly become more reflective
and collaborative.
ROTATIONS
- A. THE GENERAL PSYCHOLOGY ROTATION
By providing a blend of inpatient and outpatient services at the Uptown VA Medical
Center and/or MCG/AU, and/or East Central Georgia Regional Hospital (ECRH), we have
developed a broad-based clinical training experience designed to maximize both the
range of patient diagnostic categories and the variety of clinical training experiences.
During the 4-month General Practice Rotation, Interns will have opportunities for
development of their psychological assessment skills, skills pertaining to rapid assessment,
de-escalation/stabilization, and triaging in individuals with acute psychiatric conditions,
co-leadership of time-limited evidence-based psychotherapy groups and, individual,
and possibly couple, and family psychotherapy. Interns have opportunity to gain experience
in assessing and treating various mood, psychotic, and dementing conditions, as well
as Posttraumatic Stress Disorder, adjustment to serious injury, and substance abuse
problems. The Interns will also take an active role in treatment planning as part
of an interdisciplinary team.
At the CNVAMC, psychological assessment and treatment are provided in the context of interdisciplinary
teams. Within Mental Health there are five Behavioral Health Interdisciplinary Program
(BHIP) team, a suicide prevention team and disruptive Behavior Committee, and two
specialty teams – Trauma Recovery Clinic (PTSD) and Substance Use Recovery Clinic
– that, together, offer the bulk of Internship training in the VA General Practice
site. Additional behavioral medicine and trauma training opportunities are offered
through the Medical Rehabilitation units, and the OEF/OIF/OND Primary Care. The Intern
will spend two to three days per week at the VAMC.
BHIP Teams: Interns in consultation with the supervising psychologist will conduct psychological
assessment for patients with a range of disorders including, schizophrenia, bipolar
disorder, major depressive disorder, various cognitive disorders and personality disorders.
Instruments frequently used include the WAIS-III, WMS-III, other brief measures of
intelligence and cognitive functioning, MMPI-2, MMPI2 RF, MCMI and, PAI. In the VAMC
Walk-In Clinic, interns are provided opportunities to learn the skills of rapid assessment
of and stabilization of patients in crisis. Patients range in age from 18 to 80+ and
frequently have multiple psychiatric diagnoses. Consultation/interaction with a
multidisciplinary team is a typical component of the rotation as is exposure to a
range of psychopharmacological interventions. Intern will gain experience with suicide
risk assessment.
Trauma Recovery Clinic Team (TRC): The comprehensive trauma recovery team serves male and female veterans who
have encountered a variety of psychologically traumatic events. In addition to incidents
occurring during war or other dangerous military assignments, treatment can focus
on sexual assault, criminal assault, accidents, disasters, and child abuse. Program
elements include assessment, crisis intervention, Trauma orientation class, time-limited
skills training groups, evidence based psychotherapy (EBP), couples therapy, and case
management. Interns will learn and be supervised in the delivery of EBP as part of
their experience. Interns work closely with other disciplines as part of the clinic
team. TRC also cares for veterans with trauma and substance use disorder history.
Program elements include assessment and evidence based treatment for this population.
During the General practice rotation interns become proficient in:
at least a neurocognitive screening instrument, one broadband psychological test,
and symptom specific instruments that can be used for screening and/or treatment progress
monitoring.
Neuro-Cognitive Assessment Options
All Interns are required to receive neuro-cognitive assessment training. The Intern
depending upon site (ECRH, MCG/AU, CNVAMC) will have exposure to and minimally become
proficient in the use of one of the following instruments:
- RBANS
- MOCA
- MMSE
- TOMM
- SIMS
- Trail Making test
- WAIS- IV
- WASI-2
Broadband Personality Assessment Instruments
- All Interns must become minimally proficient in one of the following broadband personality
assessment instruments:
- Personality Assessment Inventory (PAI)
- MMPI-2 and/or MMPI RF
- Millon Clinical Multiaxial Inventory III
Screening/Treatment Progress Monitoring Instruments
Specific instrument proficiencies will be determine by the specific site of training
within the internship.
Child/Family Evaluation
For Interns obtaining emphasis training in child/family psychology, proficiency in
the following assessment instruments must be demonstrated:
One of the following Intellectual Assessment Instruments:
- WISC-V or WPPSI-III or DAS-II
One of the following Academic Achievement Instruments:
One of the following Broadband Symptom/Personality Assessment Instruments:
Screening/Treatment Progress Monitoring Instruments
Specific instrument proficiencies will be determine by the specific site of training
within the Child and Family Track.
Forensic Evaluation
For Interns obtaining emphasis training in forensic psychology, will receive training
and be asked to administer/score measures in the following categories. The administration
of these instruments will be determined on a case by case basis:
Measure of Response Style:
- TOMM
- VIP
- MFAST
- SIRS-2
- ILK
Competency to Stand Trial Instruments:
Mental Status/Intellectual Functioning:
- MoCA
- MMSE
- WAIS-IV
- WASI-II
Personality Assessment:
Risk Assessment:
- HCR-20 V3
- PCL-R
- SORAG
- VRAG
- COVR
At the MCG/AU Psychiatric Outpatient Clinic, psychological assessment and treatment are provided in the interdisciplinary contexts
of the Child, Adolescent, and Family Psychiatry Division and/or the Behavioral Health
Team. Practicum experiences include diagnostic interviewing, psychological assessment,
and individual/group psychotherapy.
Child, Adolescent, and Family Child Psychiatry: This program entails services for children and their families with a broad array of
problems/disorders and focusing on a biopsychosocial approach to treatment that often
includes the integrated services of child psychiatry faculty and trainees along with
psychology faculty and trainees. In assessment work, the Interns become proficient
in the use of WISC-5, WRAT-3 or WIAT-III, the PAI-A, and the BASC-3 instruments. Treatment
focuses on cognitive behavioral/ ACT approaches of care as well as to a variety of
psychoeducational approaches to treatment that include DBT Skills groups, Peer Friendship
Skills Training, and Parent Training.
Behavioral Health Team: This program provides psychological assessment and treatment in the context of interdisciplinary
teams. The adults served have a broad array of problems/disorders including mood
disorders, trauma-related disorders, and eating disorders. Treatments include individual
and group therapies using CBT/ACT/DBT models.
At the ECRH, assessment and treatment are also provided in the context of interdisciplinary teams
within the General Mental Health Unit- a unit dedicated to the rapid assessment and
de-escalation/stabilization care for individuals with serious mental illness and the
Forensic Unit – this unit serves patients who are determined to be Incompetent to
Stand Trial (IST) or Not Guilty by Reason of Insanity (NGRI). The clinical training
experience in these units focus on a cross training curriculum (with psychiatry interns,
medical students, nurses, and social workers) that address the following skills/ competencies:
- Skills pertaining to rapid assessment, de-escalation/stabilization, and triaging in
dealing with individuals with acute psychiatric conditions.
- Crisis intervention skills related to suicide prevention and reduction of dangerousness
to self and/or others.
- Treatment engagement skills – able to effectively use motivational interviewing and
shared decision-making.
- Application of the recovery principles of empowerment, holistic care, support, and
hope in addressing the stresses of serious/chronic illness.
The Competencies addressed in the General Practice rotation are:
- Ability to select appropriate psychological instruments for assessment of the presenting
question and to score and interpret a variety of instruments to include neurocognitive,
personality, and screening assessments.
- Ability to write a comprehensive, integrated psychological assessment and to provide
feedback to the requesting team as well as the patient.
- Ability to rapidly assessment and provide stabilization of patients in crisis.
- Deliver evidence based psychotherapy interventions in group and individual formats.
- Develop identity as a team psychologist with a defined role and collaborating with
other disciplines in the delivery of professional patient care.
- Apply recovery skills in all interactions with patients regardless of setting.