A National Survey on Didactic Curricula in Psychology Internship Training Programs

Abstract

Didactic curricula in psychology doctoral internship training programs in health service psychology are important components of the training experience. However, the nature of didactic curricula, including how they are developed and implemented, is not well understood. The purpose of this study was to describe characteristics of didactic programs, better understand their development, and identify barriers to implementation. This study surveyed psychology doctoral internship program directors about didactic training in their programs. A total of 122 internship directors consented to participate. On average, internship didactics were held for 11 hr per month, during regular work-day hours, and on a weekly basis. Internal faculty members were the most common didactic speakers. Didactic curricula were typically developed to meet profession-wide competencies as established by the accrediting body, the American Psychological Association. Identified barriers to didactic program development and implementation included lack of protected release time for faculty and trainees, presenter- and facility-related challenges, and difficulty addressing learner needs. Ideas for future research in this area are suggested.

Didactic seminars are a core component of health service psychology education and training, allowing for trainees to learn a specific skill set or gain exposure to a particular knowledge base, complementing clinical experiences. This is also true during the doctoral internship, where didactics ensure trainees receive knowledge about a core set of domains, competencies, and skills. However, although the graduate school learning schedule is clearly defined for trainees, required didactic training during internship is less specified. Internship applicants may know little about the content and nature of didactics at sites to which they apply, and internship training directors may have little knowledge about what is offered at sites other than their own. The goal of the current study was to gain a better understanding of characteristics of doctoral internship didactic curricula and begin to explore barriers to enhancing didactic seminars.

The American Psychological Association (APA) defines didactics on internship as “planned sessions of instruction that are included within the internship training curriculum” (APA, 2015a, para. 1). The Association of Psychology Postdoctoral and Internship Centers (APPIC) describes didactics as “actual training opportunities” that “should include training activities beyond Intern Case Presentations” (APPIC, 2018a, p. 1). Didactics are often considered de facto aspects of training within internship sites but have few requirements or guidelines. The APA does not specify duration, content, or frequency of didactics. The APPIC (2018a) requires member programs to provide an average of at least 2 hr of didactics per week and 8 hr per month. Overall, the APA and APPIC provide programs significant latitude on the content, duration, frequency, and nature of the didactic curriculum. Given this broad scope, internship training programs develop and implement their didactic curricula to meet the goals and constraints of their individual programs, while attending to APA profession-wide competencies and to the mission of the training site. The APA’s (2015b) Standards of Accreditation in Health Service Psychology mandate that interns demonstrate competence in nine core profession-wide competencies: (a) research; (b) ethical and legal standards; (c) individual and cultural diversity; (d) professional values, attitudes, and behaviors; (e) communication and interpersonal skills; (f) assessment; (g) intervention; (h) supervision; and (i) consultation and interprofessional—interdisciplinary skills. To achieve APA accreditation, internship programs must “have a clear and coherent plan for educational activities that support interns’ achievement of both profession-wide and any program-specific competencies” (APA, 2015b, p. 18). Internship programs may use didactic training to provide education to trainees related to these competencies. The mission of the training site also shapes the didactic curricula. For example, internships at Veterans Affairs (VA) Medical Centers may emphasize training in empirically based psychotherapies related to veteran care and, thus, may prioritize didactics that help trainees learn these specific treatments. The mission of the training site may also include providing education to meet facility, local, and/or state guidelines. For example, obtaining psychology licensure in Massachusetts requires that internship training provide “at least four hours (total) in structured learning activities on issues related to racial/ethnic bases of behavior with a focus on people of color” (Board of Registration of Psychologists, 2016, p. 7). Massachusetts internship programs may meet this requirement via didactics.

Despite the importance of the didactic curriculum during internship training, little has been published about the content, frequency, duration, method of delivery, and evaluation procedures of the entire didactic curricula. Several studies have explored how didactics are used to train interns on specific topic areas. For example, Murphy, Wright, and Bellamy (1995) found that didactic seminars (77.4%) are the primary avenue for multicultural training during internship. Simiola, Smothers, Thompson, and Cook (2018) explored how internship didactics are used to teach trainees about trauma-related work. Meltzer, Phillips, and Mindell (2009) surveyed graduate programs and internships to understand how trainees were being educated about sleep-related disorders. However, generalization to broader internship didactic curricula from these studies is limited. To our knowledge, only one study examined the entire psychology internship training program didactic curricula.

Monti, Wallander, and Delancey (1983) mailed a two-page survey of checklists and open-ended questions about didactic curricula to 175 training directors of APA-accredited doctoral internship psychology programs. The authors used the term seminars in lieu of didactics and defined seminars as “any structured and regular group learning experience excluding direct clinical supervision and staffings” (p. 491). In their study, 110 training directors completed the survey. Results indicated high variability in both how didactics were implemented and the frequency with which certain topic areas were covered. On average, interns received training in six of the 18 topic areas identified in the survey. The most common didactic topics included assessment, professional issues, neuropsychology, psychopharmacology, and psychotherapy. No significant differences existed between types of internship site and required hours of didactics. The authors identified only one significant difference among sites. They found that among community internship sites, physicians led seminars on the topics of crisis intervention and behavioral medicine more frequently than other disciplines. On average, 143 hr of didactics were required during internship training, which the authors equated to three to four graduate classes. Monti and colleagues highlighted the importance of communication among internship programs and graduate school programs to ensure didactic topics are not duplicated across settings and so that training gaps can be met by a coordinated curriculum between the levels of training.

We are not aware of additional publications that examine program-wide didactic curricula among psychology doctoral internship programs. To our knowledge, there are no national data on practices programs used to develop, implement, and evaluate didactic curricula. The purpose of the current study was to better understand didactic curricula development, including content, duration, frequency, selection of presenters, teaching methods, evaluation of sessions, and barriers to implementation.

Method

Participants

Psychology doctoral internship program training directors, as identified by membership on the APPIC electronic mailing list of training directors, (n = 781), were recruited to be study participants. A recruitment e-mail was sent to electronic mailing list membership. The e-mail explained the purpose of the study and asked training directors to complete a SurveyMonkey survey. Of those contacted, 123 (15.7% response rate) internship training program directors responded to survey questions. One program director completed the survey but did not complete the written consent to participate; these data were excluded from analyses, leaving 122 program directors consented and responded to at least one survey question. Training program characteristics, including APA accreditation status, APPIC membership, and facility type, are shown in Table 1. Eighty-five programs (73.3%) were APA-accredited, and almost all (98.4%; n = 120) were APPIC members. Internship programs ranged in size from two to 30 trainees (M = 6.0, SD = 4.7; n = 121). The size of program faculty ranged from two to 200 (M = 21.4, SD = 24.7; n = 121).

Table 1.

Description of Internship Program Participants

Program characteristic	n	%
Internship program	122
Accreditation
APA-accredited	85	73.3
Nonaccredited	16	13.8
In the process of APA accreditation	15	12.9
APPIC member
Yes	120	98.4
No	1	.8
Other	1	.8
Training facility
Veterans Affairs Medical Center	27	22.1
Community Mental Health Center	25	20.5
Othera	25	20.5
Medical school	17	13.9
University counseling center	13	10.7
State/county/other public hospital	11	9.0
Private psychiatric hospital	6	4.9
Correctional facility	5	4.1
Private general hospital	4	3.3
General hospital	3	2.5
Other medical center	3	2.5
School district/system	3	2.5
Independent practice	2	1.6

Note. APA = American Psychological Association; APPIC = Association of Psychology Postdoctoral and Internship Centers.

^aThirteen respondents who chose Other used open-ended comments to specify their programs as a consortium, three described their programs as residential centers, and three as nonprofit organizations.

Survey Instrument

This study developed and used a multisectioned survey that included multiple choice and open-ended response questions covering a variety of topics related to didactics. A list of these topic areas is presented in Table 2. The survey assessed broad characteristics of training programs (e.g., type of training program, size of program, accreditation status) and specific didactic-related questions, including (a) source of speakers, (b) frequency and duration of didactics, (c) content of didactics, (d) teaching methods used, (e) assessment of didactics, and (f) challenges of didactics implementation. For the purposes of the survey, didactics was defined as “a formal, educational, series of seminars designed to enhance trainees’ knowledge, skill sets, and/or achievement of core competencies.”

Table 2.

Overview of Survey Questions Administered to Participants

Program descriptions

APA accreditation

APPIC membership

Type of program (i.e., internship or fellowship)

Size of program—trainees

Size of program—faculty

Didactic descriptions

Shared internship and fellowship didactics

Source of speakers (e.g., internal faculty)

Percentage of mandatory didactics

Hours of didactics per month

Frequency of didactics

Time of day of didactics

Methods of didactics assessment

Feedback of assessment results

Frequency of topics

Difficulty obtaining speakers

Learning activities used in didactics

Decision-making in curricula development

Challenges to implementation

Note. APA = American Psychological Association; APPIC = Association of Psychology Postdoctoral and Internship Centers.

Procedure

The VA Boston Health care System Research and Development Committee provided approval for this study. The VA Boston Institutional Review Board (IRB) determined IRB approval was not needed for this study. The APPIC Central Office provided approval to one of the authors (Amy K. Silberbogen) to access the APPIC electronic mailing list for the purposes of this study. One author (Risa B. Weisberg) sent an e-mail to training program directors on the APPIC electronic mailing list in November 2016 with an invitation to participate in a 20-question online survey regarding didactic training. One follow-up recruitment e-mail was sent approximately one month after the initial e-mail to the same training director electronic mailing list. Informed consent was obtained at the beginning of the survey. Study participation was anonymous and voluntary. Respondents could skip questions or exit the survey at their discretion.

Data Analysis

Data were analyzed using IBM SPSS Statistics Version 20. When participants responded to a survey question with a range of numbers, the mean was used in the analysis. For example, when asked for the number of faculty members in a program, if the training program director responded 3–5, the mean (4) was used in the analysis. Responses to each question were analyzed based on the number of participants who responded to the question. Data were examined to determine whether there were significant differences in responses between APA-accredited and nonaccredited programs. No significant differences were identified. Thus, results are not separated by program accreditation status. Qualitative data were examined for themes across responses by two of the authors (Shelby E. Zuckerman and David R. Topor). Differences between raters was resolved through discussion of the response.

Results

Descriptive Data of Didactic Training

Most programs (93.4%; n = 113) held didactics on a weekly basis. The number of monthly hours of didactic training ranged from 1 to 20, with a mean of 11 hr 19 min (SD = 5.2 hr; mode = 8). These data are presented in Figure 1. All programs (100.0%; n = 122) held didactic sessions during regular work-day hours. Three programs (2.5%) held additional didactics outside of typical work hours. Almost all didactics were mandatory for interns (M = 90.6%; n = 120).

Figure 1.

Hours of formal didactic seminars per month. Std. Dev. = standard deviation.

Didactic Content and Speakers

Approximately 75.0% of didactic speakers (M = 75.3%, SD = 20.7; n = 121) were faculty members internal to the program. Training directors ranked factors that guided selection of didactic topics. Training directors identified that the most important variable in selecting didactic topics was the desire to cover topics consistent with APA profession-wide competencies. The least important factors were tradition of what has been covered in the past and speaker availability. These data are presented in Table 3.

Table 3.

Factors That Determine Didactic Topics

Factor	M	SD
Topics that map directly to core training competencies	2.0	1.6
Areas that are of importance for future psychologists	3.3	1.8
Trainee feedback	3.8	1.6
Attempts at providing a broad range of topics	4.0	1.8
Trainee needs assessment	4.2	1.9
Tradition of what has been covered in the past	4.9	1.8
Speaker availability	5.4	1.7
Other	7.0	2.0

Note. Training directors were asked to rank eight factors that guide decision-making when selecting topics for didactics, with a 1 signifying the most important factor.

Program directors were asked how often didactic content related to each of the APA competencies (see Figure 2). Didactic topics most frequently focused on topics related to the intervention (27.9%; n = 34); individual and cultural diversity (27.3%; n = 33); and professional values, attitudes, and behaviors competencies (19.7%; n = 24). Some programs reported they do not cover topics related to research (7.4%; n = 9), communication and interpersonal skills (5.0%; n = 6), consultation and interprofessional-interdisciplinary skills (3.3%; n = 4) assessment (1.6%; n = 2), intervention (.8%; n = 1), and supervision (.8%; n = 1).

Figure 2.

Frequency of standard of accreditation topics. Participants were asked on a Likert-type scale to “Please look at the most recent schedule of a full year of didactic seminars for your program and use this schedule to estimate your answers to the following questions. Please indicate how often each of these topics related to APA’s Standards of Accreditation Competencies are covered in didactics during the current training year. Please indicate if you have tried to schedule a speaker for a specific topic, but were unable to identify one.” APA = American Psychological Association.

Teaching Methods Used in Didactic Training

Training directors noted that didactic speakers used a variety of teaching methods, including PowerPoint (96.7%; n = 118), lectures (95.1%; n = 116), active learning strategies such as debates or small group discussions (91.8%; n = 112), audio and video material (83.6%; n = 102), clinical case conferences (83.6%; n = 102), and role plays (63.1%; n = 77).

Evaluation of Didactics

Program directors reported using a number of methods to evaluate didactic training. Most programs (88.4%; n = 107) used satisfaction surveys completed by trainees, whereas 28 programs (23.1%) used peer observation to evaluate didactics. Eight programs (6.6%) reported no evaluation of didactics. Open-ended responses about evaluation indicated that about 20 programs asked trainees to provide feedback about didactics during discussions or meetings (e.g., training director meetings), two programs administered posttests to assess specific knowledge gained, one program used an online evaluation program, and one program held a focus group to assist with assessment of didactics.

Training directors were asked to identify how feedback was provided to speakers by selecting from several response options. Respondents were able to select multiple feedback methods. Many training programs (72.5%; n = 87) provided written feedback to speakers. About half of programs (49.2%; n = 59) provided verbal feedback to speakers, and 16 programs (13.3%) reported they did not provide feedback to speakers.

Barriers to Didactic Implementation

Training directors responded to open-ended questions about barriers to implementing didactic training. Responses (n = 39) were grouped according to topic area, and themes were developed based on these response groupings. Response themes are presented in Table 4. The most common barriers were lack of protected release time for both trainees and staff to participate in didactics (n = 11) and presenter-related challenges (n = 11), such as last-minute cancellations. When asked to identify barriers for didactics related to APA profession-wide competencies, only one program director (.8%) reported being unable to identify a speaker (for the research competency).

Table 4.

Barriers Faced When Implementing Didactics

Barrier	No. of responses
Lack of protected release time (e.g., related to site’s decreased operating revenue)	11
Presenter-related challenges (e.g., cancellations; lack of expertise)	11
Learner needs (e.g., difficulty creating curricula for learners with varying needs and previous experiences; concerns about generality of training vs. specificity)	9
Facility-related barriers (e.g., space issues; lack of technology)	8

Note. Participants were asked to provide open-ended comments regarding challenges faced related to didactic training. Not all participants provided a response.

Discussion

Didactics play an important role in the training of psychology interns. These seminars provide opportunities to increase trainees’ skills, knowledge base, and readiness for licensure and independent practice. Didactics can also be adapted to help trainees understand the everchanging nature of practice and regulation within the field of psychology. However, few studies have explored the development and implementation of an entire didactic curricula for doctoral internship training programs in health service psychology. This study follows from the recommendation of Monti et al. (1983) regarding the importance of surveying normative practices of didactic training and disseminating these data to faculty members and trainees.

The current study found a number of common implementation practices across sites. These commonalities included mandatory didactic attendance, weekly didactic seminars during regular work hours, and internal training program faculty providing the teaching. PowerPoint, lectures, and activity-based learning (e.g., debates) were the primary teaching methods. Satisfaction surveys were the most common method of assessing didactics, and most programs provided written feedback to speakers.

Although many similarities regarding program curricula existed, there were also a wide range of responses to several survey questions. For example, the percentage of didactics presented by internal speakers ranged from none to 100. There was also wide variability in the total hours of didactics held each month (1–20). Further, although didactics were primarily mandatory for trainees, 11 programs reported didactics were mandatory 50% or less of the time.

Interns spend, on average, 136 hr in didactics per year, a slight decrease from the 143 hr reported by Monti et al. (1983). Programs selected didactic topics that reflected APA profession-wide competencies, with intervention; individual and cultural diversity; and professional values, attitudes, and behaviors being the most common focus areas. It appears that research, supervision, and consultation are covered less than are intervention and assessment in didactics. This may be due to a number of reasons, including emphasis on training interns on direct clinical work or difficulty identifying speakers to cover these topics. As a comparison, the most common didactic topics identified by Monti et al. were assessment, professional issues, neuropsychology, psychopharmacology, and psychotherapy. It is worth noting that our data were collected as training directors were in the process of implementing the APA’s (2015b) updated Standards of Accreditation for Health Service Psychology, which mandated new profession-wide competencies that were not part of prior requirements outlined in the Guidelines and Principles for Accreditation of Programs in Professional Psychology (APA, 2006). This transition may have impacted the results because some training directors may have started to align their curricula to meet training goals outlined in the new competencies and requirements, whereas other programs were functioning under the previous competencies and requirements.

Training program directors identified several barriers to developing and implementing didactic curricula. These barriers included lack of protected time for faculty and trainees to participate in didactics, difficulty identifying speakers, space and funding limitations, and challenges associated with creating the curriculum to meet diverse learner needs. Four training directors reported pressure by institution administration to generate direct and billable services as a barrier to protecting time for didactics. Specifically, one program director noted,

Our training program is being eyed by the administration as a potential drain on the agency’s ability to provide direct service. Interns want and deserve didactics, but the more time our staff spends in training the more likely the administration is to dislike having the internship program.

Balancing competing demands of interns’ time and the needs of a complex health care system is a continuing challenge for training program directors as they implement didactic training.

Programs also described challenges related to limited resources, speaker cancellations, space, and funding. Five programs reported challenges identifying qualified speakers to talk about newer areas of practice in psychology (e.g., telehealth). An example of a comment related to this barrier was “technology and/or times moves faster than the psychologists.” Because most programs stated that speakers were internal program faculty members, finding qualified speakers for specific topics may be a greater barrier at smaller training programs, where there are fewer potential internal speakers. This was demonstrated in the study conducted by Meltzer et al. (2009), which highlighted that training programs are often limited in specific trainings (i.e., sleep) that can be offered by the faculty who specialize in such topics at that site. More encouraging was that despite difficulty identifying speakers, only one program reported being unable to find a speaker to present on a required competency area (i.e., research).

Training directors reported challenges organizing the didactic curriculum. That is, training program directors found it difficult to balance the depth and breadth needed to teach each topic, because trainees often have had diverse learning experiences prior to internship. Other challenges included balancing didactics with clinical activities, selecting didactic topics, and ordering the presentation of didactic topics to meet the developmental needs of trainees.

Training program directors can use a number of existing resources to overcome these challenges. These resources include collaborating with other training sites to use teleconference and online technologies to share didactic presentations. Training programs can create online repositories of training activities, including recordings of presentations, and didactic implementation guides. Current examples of these resources include the VA Psychology Training Council SharePoint (VA Psychology Training Council, n.d.) and the Training Resources section on the APPIC website, which includes useful information for both trainees and training directors, such as articles, various guidelines, online trainings, and more (APPIC, 2018b). Training program directors can also work with local, state, and national psychological organizations to establish grants to cover travel expenses to allow speakers with specific content expertise to present at programs where that expertise is currently lacking.

Study Limitations

This study had several limitations. One limitation was the variability of training program settings and facilities. This may limit the generalizability of the findings and the recommendations. Further, we assessed only whether certain training activities were occurring but not the frequency. For example, we asked what types of learning activities were used in didactics but not how often each activity was used in the curriculum.

Additionally, participants may not have used the definition of didactics as provided in this study. Open-ended comments suggested that some program directors included training activities outside the intended scope of our definition, such as informal case conferences, when responding to survey questions. Several survey questions could have benefitted from further specificity. For example, when asked “How many total faculty members are associated with the psychology training program?” training directors may have included faculty from all disciplines (e.g., physicians, social workers) or only clinical psychologists. It is also possible that a selection bias existed such that training program directors who completed the survey did so because they highly value training and educational research and didactics. Results may therefore not be representative of all programs or generalizable.

Further, the response rate for the current study was 15.7%, whereas Monti et al. (1983) achieved a 62.9% response rate. This low response rate prevented the authors from being able to meaningfully compare data by program setting and other program characteristics. Future studies could benefit from larger sample sizes that would provide the opportunity to perform these analyses.

Future Directions

There are many requirements training programs need to meet during the internship year. Although the training competencies are defined, there is little guidance on how didactics can be designed to help trainees meet these competencies. Further, there is little data on how didactics are currently used to teach and how they can be enhanced in the future. The goal of this study was to provide a greater understanding of didactic curricula in psychology internship training programs. More research is needed to better understand how to increase effectiveness of didactic curricula, how to assess changes in intern knowledge as a result of didactics, how to overcome barriers such as lack of protected release time, and how to align didactic sessions with other learning activities during the internship year. This research should also include the trainee perspective on didactic training.

Further, research is needed to assess the impact of using different methods of providing feedback to didactic speakers to enhance future teaching sessions. Future studies could aim to survey a greater number of training programs, which would allow for increased generalizability of the results and the ability to analyze data by a number of program variables, including accreditation status and type of training site. Future research may also examine the composition of didactic teachers, including which professions teach sessions. It may also be beneficial to assess the standards that internship programs use to identify qualified speakers for didactics (e.g., board certification, specialization, years in practice). Finally, future work in this area can continue to meet the recommendation by Monti et al. (1983) that the field continually assess and publish normative didactic practices and identify ways to coordinate didactics across levels of psychology education training to develop a coordinated learning experience for trainees.

Public Significance Statement.

Didactics are an important part of the doctoral internship year. However, little has been published about the nature of didactic curriculum development and implementation. This study identifies common practices among internship didactic programming, barriers programs face, and suggestions for future research.