What's the best way for interns to get through internship evaluations? By knowing what to expect, being open to strengthening their weaknesses and accepting a little praise about their strengths, say training directors.

In this internship roundtable, the Monitor polls five training directors on what interns should expect their supervisors to evaluate them on and how they can make the most out of feedback they receive.

Steve McCutcheon, PhD, director of psychology training at the Seattle Veterans Affairs Medical Center, secretary of the Association of Psychology Postdoctoral and Internship Centers (APPIC) Board of Directors and a site visitor for APA's Committee on Accreditation.

Rick Weinberg, PhD, internship director at the Louis de la Parte Florida Mental Health Institute at the University of South Florida.

Linda Campbell, PhD, director of the University of Georgia's Center for Counseling and Personnel Evaluation, a member of APA's Board of Educational Affairs and former chair of APA's Ethics Committee.

Jenny Cornish, PhD, internship consortium director for the University of Denver Graduate School of Professional Psychology.

Ira Grossman, PhD, training director at Sharp HealthCare in San Diego, chair of the APPIC Membership Committee and a site visitor for APA's Committee on Accreditation.

Q. How do programs explain the evaluation process?
The competencies should be laid out in the site's selection materials so that when an intern is applying to the site, the intern will have a general idea of what the goals are. [At our consortium,] we give them our exit criteria during orientation so that they know exactly what they have to do to graduate from our program. Those criteria are tied in to the competencies [in our program literature].

Weinberg: For example, our program is a little different than the mainstream internship program. Because we are preparing interns to serve the underserved, we talk a lot in our supervision about some of the more structural and system issues in our society that make life more difficult for people who are poor. We want our interns in conceptualizing their cases to look beyond intra-individual factors, so part of their evaluation is how well they've done their homework.

Campbell: This comes within the larger point of informed consent. The APA Ethics Code clearly emphasizes the importance of us as trainers and faculty making sure that we explain to students what the expectations are of them for their performance.

Grossman: APA's Ethical Guidelines are a good place for supervisors and supervisees to begin to think about those topics that are germane to the supervision process. The relevant passages are Standards 7.04, Student Disclosure of Personal Information, and 7.06, Assessing Student and Supervisee Performance [see box, page 64].

Q. How often should interns be formally evaluated?
Interns should at minimum receive written feedback semiannually about their progress and the level of performance regarding their competencies.

Weinberg: We have two six-month rotation periods, so we evaluate at three months and at six months for each--for a total of four times a year.

Cornish: The interns in our consortium start by doing a self-evaluation of all of the different competency areas that we teach and train in. Then three times during the year, their supervisor evaluates them on how they are doing with their competencies.

Grossman: Our interns go through three four-month rotations, and they get a written evaluation at the end of each. Halfway through the rotation they meet with their rotation supervisor and--using the end-of-rotation evaluation form--receive a verbal evaluation.

Q.What kinds of feedback should be in the evaluation?
At the beginning of the rotation, our supervisors and interns meet and create a training plan, and that plan forms the basis of the evaluation. For example, if one of the training plan goals is obtaining experience with the older adult population, the evaluation would include an assessment of the intern's competence with that population.

Cursory feedback--such as "Everything's fine, you're doing a good job"--is insufficient. Better feedback should reflect upon progress. For example, "When we met in September, we talked about developing X competency, and here's some feedback about that, and now let's talk about where to go from here."

McCutcheon: The feedback should be specific and concrete and behaviorally anchored. The evaluation should be affirming of students' strengths but deal directly and tactfully with areas in need of improvement. Any areas of difficulty that might endanger a student's standing in the program should be identified explicitly and clearly as soon as possible...not be brought up late in the year when the student doesn't have the chance to correct those problems. There should be guidance about how to fix those problems and then feedback [on the intern's progress].

It's also helpful if evaluation [includes feedback on] the individual goals that an intern has for him or herself.

Q. What do you mean by behaviorally anchored?
Content areas that we provide feedback about can sometimes be vague or abstract, and that leaves room for misunderstandings. Therefore the most effective feedback is specific and based in observable behavior. For example, if a supervisor provides feedback about an intern's ability to establish and maintain positive therapeutic relations, that skill is composed of many specific behaviors that can be identified and discussed. For example, an intern's personal warmth and empathy.

Q. Is there anything off the table?
: In professional practice, our personal behavior and conduct is an important element of our effectiveness, so frequently there's a need to comment upon the personal behavior of someone in training. However, evaluation that is of a personal nature that isn't relevant to the intern's professional performance is questionable.

Cornish: If an intern is going through a divorce, for example, that's not supposed to be part of evaluation unless it's really interfering with their work with clients. The behaviors [evaluated] should be clear and measurable. Things like the ability to handle stress, relates well with colleagues, is dependable, is flexible, comes to work on time.

Campbell: If a supervisor doesn't quite know where to go with a supervisee and their situation, they could inadvertently begin moving toward a therapeutic stance with the student, exploring and making psychodynamic connections. That's quite unfair for the student because the student is already a person of lesser power and then would be also vulnerable to exploitation and having to [disclose personal information] that they should not have to share, as per Ethical Standard 7.04.

Weinberg: It's not uncommon for supervisors to inquire about and discuss issues related to our trainees' countertransference reactions, but it's always important [for supervisors] to be sensitive to the power imbalance between intern and supervisor.

Cornish: Another thing is, if, for example, an intern has some type of disability that they have asked for accommodations for, reasonable accommodations should always be given. [Interns] shouldn't be graded down for needing or asking for accommodations.

Q. How can interns make the most of the feedback they receive?
Interns are oftentimes reluctant to talk about areas that they don't feel competent in. The assumption that interns have is that "I'm supposed to know what I'm doing." So what you [often] get are interns who come in and don't take advantage of supervision. They say, "Everything is fine. I had a great session." What a waste of a year if you do that all year long.

Campbell: I can't emphasize enough how important it is to stay in a learner role, and that means being able to risk being seen by your supervisor as needing to learn something. Those who stay in a learner role and continue to take feedback, use it and modify what they're doing become the most competent among the students.

Cornish: Everybody has some anxiety about being evaluated, but expect evaluation during the internship year and try to use it to grow. As a training director, I am always being evaluated. I like that because it makes me grow. It's a useless evaluation if it's totally glowing.

Weinberg: It's equally important to accept and savor supervisory feedback about one's strengths. Too often interns' humility and modesty get in the way of truly appreciating their own gifts and talents, with corrective feedback seeming to bear more emotional weight than praise. Most supervisors wish this was the other way around.

Grossman: Try to reframe things. Develop a mindset that contributes to a lifelong process of consulting with other professionals about your clinical work.