Riding on a wave: reflections on a new era in psychology training

Changes to Australian Psychology Accreditation Council’s Accreditation Standards for Psychology Programs (the Standards) (Australian Psychology Accreditation Council, 2019) came into effect on 1 January 2019 and brought with them very significant changes both to the structure and expression of the standards with the potential to result in significant changes to the training of clinical psychologists in Australia. The principal change encapsulated in the new Standards is a shift from measuring inputs to articulating the competencies that graduates at different levels should be able to demonstrate, reflecting a sea change in higher education more broadly. In addition, this is the first time that the Standards have included the specific competencies required for specialised areas of practice, including clinical psychology. Importantly, as a co-signatory to a Statement of Commitment in relation to cultural responsiveness to Aboriginal and Torres Strait Islander people in both the higher education and training of the psychology workforce, the Standards refer specifically to competencies required to work effectively with Aboriginal and Torres Strait Islander people rather than referring more general to cultural competence only. The Standards also allow for additional pathways to clinical psychology area of practice endorsement through stand-alone programs for registered psychologists as well as those with other areas of practice endorsement.

This special issue of Clinical Psychologist is designed to provide a valuable resource for both clinical psychology trainers and others involved in delivering clinical psychology training, such as placement supervisors. The intent was to examine some of the key changes brought about by the implementation of the new Standards, including competency-based assessment, preparing clinical psychologists to deliver culturally responsive psychological services to Aboriginal and Torres Strait Islander peoples, and innovations in providing programs leading to area of practice endorsement in clinical psychology for registered psychologists.

Gonsalvez et al. (2021a) provide us with a comprehensive overview of the current status of competency-based professional psychology education in Australia and set it in its international and historical context. Overall, the authors conclude that the shift from inputs to outputs and from content to competency has been well made, while some elements of the former have been retained mainly to ensure alignment with other regulatory frameworks, for example, in relation to volumes of learning (Australian Qualifications Framework Council, 2013). They highlight that assessment methods consistent with this approach are beginning to emerge in Australia, however there is considerable scope for developing a greater level of sophistication and evidence base for choice of the most appropriate methodology in a given circumstance.

Sheen et al. (2021) explore the role of simulation in the training of clinical psychologists, and Yap et al. (2021) discuss how four universities have applied simulated assessment methods, such objective structured clinical examinations (OSCEs), and offer tips for implementation. Simulation is historically an under-researched and utilised approach in clinical psychology training, and COVID-19 has pushed us to consider more fully the educational opportunities provided by it. Rather than a second best, evidence from other disciplines suggest that this approach may in fact be preferable at the early stages of skill development. With pressures on organisations impacting on their capacity to support students on placement, making full use of simulation to ensure the achievement of essential competencies that enhance the capacity of the student to contribute to the work of the placement hosts is essential.

A key component of clinical psychology training, that of developing skills in conducting clinical psychology assessment and treatment through participation in practica, is a particularly crucial aspect of training, giving as it does the best opportunity to determine whether students have successfully developed the competencies necessary for safe and effective practice. Setting specific hours of practica required could be considered at odds with a competency-based approach, whereby students who can demonstrate successful acquisition of required competencies are, nevertheless, required to complete a specified number of hours. Deane et al. (2021) examine the insights that may be afforded as part of the electronic logging of these practicum hours This approach allows the data to be interrogated and important patterns identified, including the extent to which graduates have been exposed to work with clients in areas of need, such as work with older adults.

Gonsalvez et al. (2021b) address the enduring issue of the status of supervisor ratings of students’ competencies on placement. There is high value placed upon the judgment of supervisors, regarded as experts in the conduct of psychology, and this is often privileged above other methods of competence assessment. Gonsalvez, Terry et al. challenge us to engage with their findings that supervisors are passing students where competency-based criterion would suggest that a pass grade is not appropriate. While this has implications for the psychology workforce, in those students who have not yet demonstrated the required level of competency for independent practice are progressing to registration, it is also important to understand its implications for training programs both in terms of the design of courses, including assessment of competencies and the role of supervisors in this regard. The sensitivity of reflective practice as a marker for those who would be considered not to have achieved competence using norm-based criterion has important implications for training not only at the postgraduate level but also in undergraduate and honours curriculum. It is notable that the 2019 Standards introduced a requirement for reflexivity from the undergraduate level, and perhaps this will result in a greater capacity for this core competency among those entering clinical psychology training in future years and potentially contribute to increased capacity to develop other core competencies dependent upon it.

As the emphasis shifts from prescribing curriculum content to specifying required competencies on graduation, the question arises about whether the content of the curriculum might be able to respond more rapidly to shifts in the evidence-based and societal needs. Sadusky et al. (2021) provides a baseline assessment of the inclusion of trauma training in postgraduate psychology training, which finds that coverage is generally focused on pathological conceptions of trauma, and only one example of trauma among culturally and socio-economically diverse peoples was reported. This is particularly pertinent, perhaps, to the extent to which contemporary professional psychology training in Australia adequately prepares graduates to work with diverse populations, in particular with First Nations peoples where a trauma-informed perspective is essential and needs to be positioned within the historical and intergenerational trauma inflicted upon them by settlers.

While clinical psychology training is currently the most common professional psychology training program in Australia, both in terms of the number of courses and graduates, the majority of the challenges and opportunities are common to all types. During the time that this special issue has been in development we have also felt the effects of the COVID-19 pandemic which has challenged us to question preconceived assumptions about how clinical and other psychologists should be trained, not least in terms of the role of simulated learning. In many ways it was a blessing that the Standards have explicitly adopted a competency-based approach as the flexibility inherent in them to follow any defensible pathway to ensure graduates acquire the necessary competencies permitted courses and both academic and professional staff to modify traditional approaches to ensure the continuation of training courses. At a time when there is increasing recognition of the need for more mental health professionals, including but not only clinical psychologists, this flexibility is essential. It has also demanded that we create a space for considering the necessity for all psychologists to have competencies in conducting services via telehealth as a core requirement rather than as an advanced competency. The absence of a paper directly addressing preparation of professional psychology graduates for effective work with First Nations peoples is a matter of regret. As a profession we clearly have much to learn about how to address this, as well as how we ensure the profession reflects the diversity of the Australian community and ensure that we are able to provide an equitable and inclusive service for all.