Commentary: Internship Training

Avi Madan-Swain, PhD, and Jan Wallander, PhD

University of Alabama at Birmingham

Spirito et al. (this issue) provide a blueprint for discus- sites: life span developmental psychology and life span
sion regarding the programmatic as well as competency- developmental psychopathology. Few distinct formal ele-
based skills necessary for psychologists to be recognized as ments in internship training focus on these areas. Most
pediatric psychologists. The purpose of the internship interns obtaining specialty training in pediatric psychology
year is to complete training in the general practice of clin- will have had at least one course each in developmental
ical psychology and to extend specialty preparation in di- psychology and psychopathology. Internship experience
dactic instruction, research, and clinical practice in pedi- might provide opportunities for observing normally de-
atric psychology. In this intensive year of primarily clinical veloping children as well as employing a developmental ap-

Downloaded from http://jpepsy.oxfordjournals.org/ by guest on August 23, 2016

experience-based training, an intern prepares for the role proach in the supervision process.
of a practicing pediatric psychologist within the scientist- Thus, internship training will primarily reinforce the
practitioner model and eventually assumes responsibility acquired knowledge base in the context of clinical expe-
for providing direct patient care. riences both in settings (e.g., hospital-based inpatient,
We will now briefly discuss how the 11 areas of outpatient, ambulatory hospital clinic), as well as specific
knowledge and skill competency proposed by Spirito et al. therapy cases. An example would be conceptualizing an in-
may be addressed during the year of predoctoral internship dividual child’s reaction to medical treatment for cancer in
training. We have addressed these issues in our child view of demonstrated cognitive toxicities and emotional is-
internship program at the University of Alabama- sues related to the disease. Another example might be
Birmingham (UAB). basing a diagnostic assessment protocol on a particular
Foremost is the stipulated clinical supervision pro- contemporary theory of attention-deficit hyperactivity dis-
vided by internship faculty. Most internship sites provide order (ADHD). Moreover, many supervisors will have the
didactic training in the form of attendance at seminars or intern review empirical literature in developmental psy-
grand rounds routinely provided to all faculty and trainees, chology and psychopathology relevant to each case. How-
in addition to seminars specifically provided to the pre- ever, the coverage of these two areas will vary across in-
doctoral psychology interns. Some internship sites also ternship sites as well as between supervisors within a
support other training activities, such as attendance at participating internship site.
scientific-professional meetings, and allow for a specific Few internship sites have formal training components
percentage of effort for research. At UAB, all interns par- devoted to research methods and systems evaluation.
ticipate in weekly didactic seminars ranging from pres- Adding explicit research training at the site is not the
entation of current research by faculty members, to issues norm at the majority of internship sites. Nonetheless,
in professional development and review of empirically some sites allow for research activities, by setting aside
based treatment interventions. Interns also are required up to 1 day per week to be devoted to research and re-
to formally present their research (e.g., dissertation, proj- quiring all interns to complete a project during the year.
ect with a faculty member at UAB) to the faculty. In The site may also support the intern presenting research at
addition, child psychology interns participate in weekly a conference. We believe this approach is valuable for re-
specialty seminars focusing on neurodevelopmental disabil- inforcing the scientist-practitioner role as the intern tran-
ities as well as monthly seminars in pediatric psychology/ sitions from graduate school where research may have
neuropsychology. been readily espoused. The absence of some attention de-
The first two areas outlined by Spirito et al. typically voted to research training can suggest to the trainee that
receive little or no formal attention at most internship this role is only a theoretical notion. Therefore, even pri-

All correspondence should be sent to Avi Madan-Swain, Department of Pediatrics, University of Alabama at
Birmingham, 1720 7th Avenue, Birmingham, Alabama 35294-0017. E-mail: [email protected].

Journal of Pediatric Psychology, Vol.  No. , , pp. – ©  Society of Pediatric Psychology
 Madan-Swain and Wallender

marily clinically-orientated internships should provide tions for minority clients. While there is some debate on
training in conducting clinical research. At UAB, we en- how multicultural issues should be addressed in graduate
courage the development of clinical research skills by pro- coursework, at the internship level, they are often ad-
viding interns with didactic seminars as well as training op- dressed formally through seminars and informally through
portunities using clinical and research protocols for supervision of individual cases with minority patients. At
neurocognitive and psychosocial assessment related to UAB, diversity exposure is provided in several formal
specific chronic illnesses (e.g., bone marrow transplant, ways. Interns are required to participate in a 2-day work-
cancer late effects). shop with medical residents on multicultural issues.
Child, adolescent, and family assessment interview Additionally, to enhance both knowledge and skill com-
strategies typically receive a good deal of attention at the petency in conducting psychotherapy with minority
internship site. Assessment, whether at the individual populations, interns also are provided with didactics taught
child or family level, is of course one of the major activi- by minority faculty and are strongly encouraged to in-
ties of the practicing pediatric psychologist. Typically, in- clude patients from diverse backgrounds in their clinical
terns conduct supervised assessments throughout the year caseload.
through a variety of formats including rotations devoted There is no better way to learn about the role of mul-

Downloaded from http://jpepsy.oxfordjournals.org/ by guest on August 23, 2016

specifically to assessment (e.g., neuropsychology), out- tiple disciplines in service delivery systems than being
patient pediatric settings, or consultation to pediatric in- mentored by a supervising pediatric psychologist in both
patient services. Some internship sites offer seminars ad- the hospital and community clinic setting. Interns should
dressing current practices in diagnostic assessment with be encouraged to work closely with other team members
various medical populations. Case conferences are also by participating in both medical and psychosocial rounds.
common at internship sites, where discussion of assess- This provides them with an appreciation of the roles and
ment is notable. Thus, through experience, feedback, and practices of other members of the multidisciplinary team
seminars, competence in assessment usually increases (e.g., social worker, child life specialist, speech/language
substantially during the course of the internship year. At therapist). After the pediatric psychology rotation at UAB,
UAB, child psychology interns have three major rotations the interns are assigned to a specific medical team (e.g.,
that allow for experience in both outpatient and inpatient bone marrow transplant) and are able to staff patients in-
settings with a variety of clinical populations (e.g., ADHD, dependently with the psychosocial team. They also be-
brain tumor, bone marrow transplant, leukemia, traumatic come more proficient in learning how to communicate
brain injury, spinal cord injury, newborn follow-up) across effectively with a variety of professionals through written
the life span. Initially through observation of faculty and consultations. Other systems in which pediatric psychol-
more senior trainees (e.g., postdoctoral fellows) and later ogy interns might gain additional experience include
more autonomously, interns learn how to design appro- schools, health maintenance organizations, day cares, and
priate assessment batteries, sensitive to the child’s devel- community organizations.
opmental level, ethnic background, and medical condition. With increased emphasis on prevention, family sup-
Graduate coursework provides some initial foundation port, and health promotion, interns need to be provided
for professional, clinical, and legal issues pertaining to with opportunities to participate in clinical settings where
children, adolescents, and families, upon which the in- they are assigned the task of teaching and supporting
tern can build during the internship year by learning more health promotion activities (e.g., smoking cessation) for
about the intricacies and potential obstacles when work- chronic illnesses. However, this activity often is neglected
ing with chronically ill children and adolescents within in internship training. Health promotion programs for
a medical or community setting. Interns can fill gaps in children are more typically provided through the public
their knowledge through assigned readings and seminars, schools rather than tertiary medical centers. The exception
but the best form of instruction is ongoing mentoring by might be a specific grant-funded program (e.g., screen-
a seasoned pediatric psychologist. At UAB, as an observer, ing and prevention of high-risk sexual behavior) con-
the intern becomes increasingly more independent and ducted at the medical center.
is able to identify potential concerns (e.g., the right of the Over time, the consultation and liaison role of the
adolescent to participate in treatment decisions) in the pediatric psychologist has expanded from providing ser-
design of appropriate interventions (e.g., management of vices in the tertiary care or hospital setting to providing
acute procedural distress). consultation and working closely with pediatricians in
Sensitivity to issues of diversity is a crucial component the primary care or community setting. The key to suc-
for ensuring appropriate use of assessment and interven- cessful consultation in either the primary care or com-
 Internship Training 

munity setting is the development of effective oral and tating the child’s reentry into the community is a crucial
written communication skills. Interns need to observe the component for the long-term adjustment of the child. Ac-
pediatric psychologist in several roles to gain a better un- cordingly, the intern is integrally involved in the process.
derstanding about how to present cases, communicate In conclusion, the proposed training goals provide a
with professionals, and educate the community (e.g., pro- good formulation. However, because of the variability
viding teachers with a school reentry program for a child across internship training sites in this country, we need
who has been treated for cancer, burn injury, traumatic to progress toward developing consistent guidelines for
brain injury, or spinal cord injury). Our interns at UAB both the horizontal and vertical elements of specialized
learn to serve as liaisons between the medical team and training in pediatric psychology. It is time for pediatric
school personnel and to facilitate the community reentry psychology to develop a set of consistent training criteria
process for chronically ill children as well as those youths so that we may assure adequate internship training for
who have sustained a traumatic brain injury. the next generation of pediatric psychologists. We are
To work effectively with medical personnel and fam- grateful for the efforts of Spirito et al. in developing the
ilies, the intern must understand specific disease processes foundation for training criteria.
and medical management. For most trainees, the intern-

Downloaded from http://jpepsy.oxfordjournals.org/ by guest on August 23, 2016

ship year is the first opportunity to learn more about spe- Received October 1, 2001; accepted October 8, 2001
cific illnesses and their treatment (e.g., leukemia). At UAB,
this is achieved through readings, seminars, and partici-
pation in clinical activities. Interns also are provided with References
opportunities to actively participate on specific medical Bronfenbrenner, U. (1977). Toward an experimental
teams (e.g., bone marrow transplant, pulmonary), to fol- ecology of human development. American Psycholo-
low patients from diagnosis through hospitalization, and gist, 32, 513 –531
to continue to participate in children’s care on an outpa- Wallander, J. L., & Varni, J. W. (1998). Effects of pedi-
tient basis. Trainees learn to conceptualize cases both at an atric chronic physical disorders on child and family
individual and systems level utilizing existing models of so- adjustment. Journal of Child Psychology and Psychia-
cial ecology, biopsychosocial, and family systems (e.g., try, 39, 29 – 46.
Bronfenbrenner, 1977; Wallander & Varni, 1997). Facili-
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on August 23, 2016