New psychology licensing exam expands

An October 2022 decision from a key regulator will broaden the use of the skills portion of the Examination for Professional Practice in Psychology (EPPP) over the next several years, allowing clinical practice skills to be uniformly tested as part of the state licensing process in more states.

Created by the Association of State and Provincial Psychology Boards (ASPPB), the new test—known as the EPPP-2—aims to create a standardized clinical skills evaluation for licensure, bringing the field of psychology in line with other doctoral health professions.

However, concerns have been raised over whether the new test is a good measurement of clinical skills and whether it creates more barriers to entry for applicants, particularly those with marginalized identities. Almost 7,000 people have signed an online petition to stop the adoption of the test over concerns it “will further restrict diversity in the field.”

The new skills test complements the EPPP Part 1 (EPPP-1), which evaluates applicants’ knowledge. ASPPB’s board first announced plans to add a second part to the exam in March 2016. The goal was to create a multipart exam to standardize clinical skills evaluation for entry to practice, rather than rely exclusively on graduate programs’ judgments and other nonstandardized measures such as an oral exam.

The EPPP-2 was adopted by several jurisdictions in 2018. By January 1, 2026, it will be a mandatory part of licensing requirements for all jurisdictions currently using the EPPP. Psychology candidates are required to pass the knowledge test before taking the skills test.

Regulators view this as a necessary step to ensure a competent workforce. “We’re finding particularly since Covid, when so many trainees did a good chunk of their training virtually, they’re entering their internship or practicum program with less preparation than students had prior to Covid,” said Robin McLeod, PhD, 2022 chair of the Minnesota Board of Psychology.

The EPPP-2 is 45% multiple choice, like the EPPP-1, but includes other question types better at measuring “applied, real-world situations that psychologists face in practice” and “provides valuable information to licensing boards as it assesses the candidate’s ability to show what they would do in an applied setting,” according to the ASPPB website.

Jeff Baker, PhD, executive director of the Association of Psychology Postdoctoral and Internship Centers (APPIC), said a competency test like EPPP-2 is essential. “APPIC has seen a significant increase in the number of informal problem consultations and formal complaints as well as withdrawals or termination from internship related to clinical competency,” said Baker. “Moving to more formal assessment of clinical competence increases public safety to ensure that all licensed psychologists have been assessed for both content knowledge and clinical competence.”

Until the launch of EPPP-2, graduate programs, clinical supervisors, and licensing boards were responsible for measuring an applicant’s competency. For licensing boards, this can involve counting practice hours, an oral exam, and letters of recommendation. Yet ASPPB officials said these methods have known reliability concerns and proposed moving to a more formal assessment to ensure all licensed psychologists have been assessed for both content knowledge and clinical competence.

“With the support of ASPPB’s membership, the EPPP has been further refined to continue to assist licensing boards with their mandate to protect the public through the responsible licensing of competent individuals to practice psychology,” said Mariann Burnetti-Atwell, PsyD, CEO of the ASPPB. “Like many other health care professions, the EPPP Part 1-Knowledge and the addition of the EPPP Part 2-Skills provides jurisdictions with a universal, standardized, objective, and reliable tool for regulators to ensure candidates for licensure have both the knowledge and the applied skills necessary for independent practice.”

McLeod said the field needs to evaluate applicants’ competency in a more standardized way. “I’ve heard from some interns that they get very little supervision in their applied clinics,” said McLeod. “Without an exam that assesses skills at the end of training, we won’t really know whether they are ready for independent practice.”

Other psychologists who teach and train graduate students have concerns. “I’m a big proponent of the competency movement in psychology,” said Danielle Keenan-Miller, PhD, director of the University of California, Los Angeles Psychology Clinic and creator of the online petition opposing the exam. “I would agree that it’s absolutely essential that we have mechanisms in place that prevent people who are not prepared to provide high-quality, evidence-based care from entering the field. We just disagree about whether or not that’s what this exam is and whether the evidence that would be necessary for us to roll it out has been gathered.”

The EPPP-2 has not been subjected to a validation process to see whether it is actually evaluating applicants’ clinical skills, said Jennifer Callahan, PhD, codirector of the Center for Psychosocial Health Disparities Research at the University of North Texas (American Psychologist, Vol. 75, No. 1, 2020opens in new window).

“The big issue from a scientific standpoint is there is no evidence of any incremental test validity,” said Callahan. “Adding a second test doesn’t appear to provide any benefit above and beyond what is provided in exam 1.”

Additionally, there is a disagreement as to whether a multiple-choice test can properly examine one’s clinical skills, said Keenan-Miller. “There’s a pretty good reason when you go to take your driver’s license test, for example, that there is a part that’s a multiple-choice exam and then a part where you’re in the car,” she said. “If we want to become more in line with other health professions, most other health professions do have hands-on exams, many of which are now possible to take through technology that wasn’t available even five or 10 years ago.”

Psychologists have also raised concerns that the EPPP-2 may discriminate against marginalized groups who have an additional barrier to entry to become clinicians. Research on the EPPP-1 has shown discrepancies in exam performance based on applicants’ ethnicity. A Freedom of Information Act (FOIA) request showed that of 4,892 individuals in New York who took the EPPP-1 for the first time, significantly more Black and Hispanic applicants who took the test for the first time failed compared to White applicants (Sharpless, B., The Journal of Psychology, Vol. 153, No. 2, 2019opens in new window).

“I found similar results using Connecticut state board data,” said Brian Sharpless, PhD, a clinical psychologist practicing in the Washington, D.C. area, who conducted the FOIA study. “From my perspective, these replicated findings on race and ethnicity should serve as additional impetus to further assess the overall validity of the EPPP.”

McLeod noted that differential pass rates between groups may suggest problems with the exam; however, they also suggest a need to understand inequities that happen to graduate students prior to taking the exam. Several studies have indicated underrepresentation of Black or African Americans, Hispanics/Latinos, individuals with disabilities, and men being admitted to psychology doctoral programs.

These groups, in addition to Native Hawaiian or Other Pacific Islanders, are also less likely to finish their doctoral education (Callahan, J. L., et al., Training and Education in Professional Psychology, Vol. 12, No. 4, 2018opens in new window). Some researchers have pointed to potential bias in graduate school admissions processes (Woo, S. E., et al., Perspectives on Psychological Science, Vol. 18, No. 1, 2023opens in new window).

Some graduate students wrote about experiences with institutional racismopens in new window and other discriminatory factors that cause underrepresented students to have poorer educational experiences that may impact performance on the EPPP.

“The EPPP is an outdated and overly expensive examination that disadvantages Black, Indigenous, and people of color,” said Desmond Warren, a clinical neuropsychology PhD student at Georgia State University. “In conjunction with current barriers, the EPPP-2 is unreasonably expensive, thus forming new barriers—financial, time, yet another hurdle to entering the field—for all psychology candidates, especially candidates who are from racially marginalized groups and low-income backgrounds.”

Rachel Fenton, PsyD, who received her doctoral degree in clinical psychology from George Washington University last year, said she worries the EPPP-2 will further homogenize an already very White field. “I feel that this is going to set us back. As a Black woman, I already belong to the less than 8% of clinicians in this field,” she said. “I feel like if this extra test is implemented, that percentage is going to decline even more. What types of clinicians is this field really looking to vet? Those who come from privilege. Yes, race is a part of that, but when you think of this from an intersectional viewpoint, class is absolutely at the top as well. Unfortunately, classism frequently gets left out of conversations on diversity in psychological spaces.”

ASPPB representatives said there were many steps involved in making the EPPP, including those to reduce test bias. Subject matter experts from diverse backgrounds reviewed each item and the exam’s construction.

Additionally, Hao Song, PhD, ASPPB’s associate executive officer of examination services, said the test’s validation “is an iterative process that is repeated over time for continuous quality improvement.”

“The validation process includes a robust standard setting procedure where a representative panel of licensed psychologists evaluate the difficulty of each item in reference to psychologists who “just qualify” to enter independent practice and collectively recommend a psychometrically sound and defensible pass point to the licensing boards,” Song said.

Matt Turner, PhD, former senior director of examination services at the ASPPB, said they make sure that the individuals writing the exam questions are representative of the psychology community. They also receive implicit bias training, Turner said. Additionally, each test question is carefully evaluated for racial, ethnic, or other biases before being officially put in the exam.

“Essentially what we’re looking at is the question: Is that item performing differently for a certain group?” Turner said. If the question does exhibit bias, a panel of a diverse range of experts takes an even closer look at it. So far, the ASPPB has evaluated 1,300 questions and flagged 32 of them, and the panel has removed seven. “These data suggest limited evidence of possible item bias,” said Turner.

The ASPPB underwent a rigorous process to create this licensing exam that complied with the testing methodology outlined by APA, the American Educational Research Association, and the National Council on Measurement in Education, Turner said.

Turner noted that, according to the Standards for Educational and Psychological Testing, these types of exams “are not intended to predict individual performance but rather to provide evidence that candidates have acquired the knowledge, skills, and judgment required for effective performance.”

To address apprehensions raised by the psychology community, the ASPPB also formed an Examination Stakeholder Advisory Group (ESTAG), a partnership of 12 members whose goal is to “identify common concerns regarding examination-related matters, to communicate updates, and to serve as a ‘think tank’ for potential research on the EPPP,” according to the ASPPB website.

Sharpless, who is a member of ESTAG, said his personal goals for the group are “to test the overall validity of both parts of the EPPP and determine if scores are valid, associated with relevant performance criteria, and incrementally add to the process of licensure for all applicants.”