Case Comprehensive Exam
Background and Purpose
In 1996-1997, the former comprehensive examination process involving three sit-down examinations (in assessment, therapy, personality, and psychopathology) was replaced with a requirement for a single 40- to 60-page essay integrating these domains in a review of a topic of the student's choice.
In 1999-2000, because of comments that the essay requirement did not accomplish the goal of integration and that it constituted just another time-consuming term paper, the essay was replaced with a requirement to do a clinical case presentation as part of the program's clinical psychology seminar series. The purpose of the oral case presentation was to show that the student is in the process of meeting these goals and has achieved a level of proficiency that will qualify him or her to apply for the internship. This served as a very satisfactory model for the comprehensive examination process for approximately 15 years. During this time frame, over 70 high quality comprehensive case presentations would be generated and presented by our doctoral students.
Over time, concerns developed that the case presentation in its original form was no longer fulfilling its objectives. Not uncommonly students would prepare an inordinate amount of material, often with numerous supplemental slides, and proceed to read quickly from their presentation notes for nearly an hour, prior to undergoing a vigorous period of examination. Faculty were thus also concerned about the high levels of pressure and anxiety students often reported regarding the process. While students are expected to present clinical cases under more relaxed circumstances (e.g., in a grand rounds type of manner) in clinical seminar, as this is a valuable professional skill, this is no longer a component of the comprehensive examination process. In consultation with the clinical psychology student body, the CEC revamped this component of the comprehensive examination process, to be an oral sit-down examination on a clinical case that the student has prepared from a previous practicum, along with two case vignettes prepared by clinical faculty. The examination would cover the MRA competency domains and was intended to be a closer simulation to the oral examinations.
An oral exam in ethics remains the second component of the comprehensive exam.
Case Comprehensive Exam Policy (Approved February 2, 2015)
The oral case comprehensive examination will provide students with an opportunity to apply and integrate classroom-based knowledge, practicum based knowledge, and information from a standardized reading list. It also contains elements of the process students will experience throughout their careers (e.g., residency interviews, registration, grand rounds, consultation).
The purpose of the case comprehensive examination is to broadly examine students’ clinical knowledge and experience. It will ask students to integrate classroom-based knowledge, practicum-based knowledge, and information from a standardized reading list. The case comprehensive exam will still take place generally in the third year of the program following students’ assessment and therapy coursework, clerkship, and two practicum placements. It will consist of an oral examination related to three clinical vignettes, one of which is supplied by the student and based on his or her previous work with a client. Examiners will supply the other two vignettes at the time of the exam. The case comprehensive exam will be scheduled for late April/early May each year, occurring at least one week before or after the Oral Ethics Comprehensive Exam.
A. Student Preparation and Submitted Documents
1. Comprehensive Exam Reading List. Students will be provided with a comprehensive exam reading list, which was prepared by faculty and students (via the Clinical Executive Committee student representatives) in the Fall 2014 semester. This reading list will be placed on the program website so that students can access it at any time. Any minor annual changes to the comprehensive exam reading list (i.e., additions or removals of readings) will be done by January of each year.
2. Student submitted written documents. Students will provide faculty examiners with a deidentified written case example for use in their examination. This case should be a client that students have been through the course of their practicum experience. There are no restrictions on whether or not this client is primarily assessment or intervention focused, although students should be prepared to answer questions related to both assessment and intervention. For example, students might be asked what interventions they might choose for an assessment client, or what assessment tools would have been helpful for an intervention client. Client permission to be used for the case comprehensive exam must be obtained. The purpose of this document is to provide examiners with material from which to prepare questions for the student. While it is expected that this document will be written in a clear manner, students will not be examined on the document per se. At least two weeks prior to their exam, students must provide the DCT and both examiners with a 5-8 page (double spaced, typed, 12-point font) case example, consisting of the following components:
(Note: This policy is adopted from the SKCP Candidate’s Handbook)
- Non-identifying descriptive information
- Presenting problem
- Diagnosis (if applicable)
- Brief History
- Other sources of information
- Summary of assessment
information (if applicable)
- Number and nature of sessions, including rationale for interventions used (if intervention client)
- Outcome and evaluation of intervention (if applicable)
- Appendix with any supplemental score information for assessment tools discussed in the work sample
3. Selection of Examiners. Students are permitted to select one of their examiners, from the Clinical faculty. The Clinical Executive Committee will assign the other examiner. If students have concerns regarding a potential conflict of interest with their examiners they are advised to discuss this with the DCT. Research supervisors will not be permitted to examine their own students.
B. Student Examination and Evaluation Criteria
1. Procedure for Exam. The examiners will provide students with the 2 faculty-selected vignettes for examination. Students will be given up to 60 minutes of time to prepare for the examination and may use their materials (e.g., standardized examination reading list, notes) to do so. Students will be permitted to bring a test booklet (provided by the examiners) of notes, created during the preparation period, into the examination. Students will not, however, be permitted to bring other materials into the exam (e.g., articles from the reading list or notes prepared prior to the exam date). Both examiners will be provided with opportunity to examine and evaluation students. No time limit is placed on the examination; examiners are permitted to ask students for as much information as they deem necessarily to be able to evaluate students. However, similar to the previous case comprehensive exam format it is expected that exams might take 60- 90 minutes, as a rough guideline.
2. Examination Questions. Students will be examined using broad-level questions adopted from the SKCP Candidate’s Handbook, examiner’s previously prepared questions related to the students’ vignette, and additional questions that arise during the exam. That is, although examiners will have a core list of potential questions they are not restricted to asking only questions from this list. The examination is focused on the broad-based application and integration of knowledge the student has learned and is expected to know given his or her level of training. It is focused on the 4 Mutual Recognition Agreement Competency areas used by the SKCP Oral Exam for independent registration.
The 5 MRA Competency Areas evaluated are (definitions from the SKCP Candidate’s Handbook):
A) Interpersonal Relations: Examines ability to form and maintain constructive relationships with clients and families. Essential is for the Candidate to: 1) form respectful, helpful, professional relationships; 2) develop working alliances; 3) deal with conflict; 4) maintain appropriate professional boundaries; and, 5) incorporate an understanding of diversity in the practice of psychology. Relationships with colleagues also fall within this domain including providing and receiving feedback from colleagues and other professionals. (e.g. What diversity issues were relevant to this case? What personal or professional limitations do you think could potentially affect your work with this client?)
B) Assessment and Evaluation: Assesses Candidate’s ability to gather and integrate information (tests, observations, clinical interviews, collateral sources and context) to evaluate the patient’s functioning as well as the outcome of psychological services. Candidate should demonstrate an understanding of populations served, multiple assessment methods, and psychometric theory. Candidate should be able to integrate findings, formulate hypotheses and action plans, explain any apparent inconsistencies in the clinical data and present a comprehensive description of the patient. Should also have knowledge about the nature and impact of diversity on the assessment process. (e.g. What areas were not fully assessed? What assessment tools would you consider? What diagnoses did you have to rule out for this client? What additional information do you need to confirm a diagnosis?)
C) Intervention and Consultation: Tests the Candidate’s ability to plan and implement a course of treatment that is: consistent with the case formulation; sensitive to the patient’s background, needs and values; theoretically based; empirically justified; and, designed to resolve the problem(s). Should have knowledge of a variety of interventions and select appropriate interventions from these. Candidate should demonstrate the ability to integrate/coordinate services from other care providers and community resources into an overall intervention plan. Furthermore, the Candidate should be able to evaluate the progress and outcome of interventions. (e.g. What methods of intervention would work with this client? What other professionals might you have to work with the best help this client?)
D) Research: Designed to examine a core research knowledge base, and training in assessing and applying research knowledge in clinical practice. Clinical practice in all health-care fields is based on accumulating research knowledge and using good judgment in applying this knowledge. Candidate should have a basic knowledge of research methods and critical reasoning skills. Should be able to demonstrate how research findings are integrated into their practice, and as such should be prepared to discuss the research that has informed their practice. (e.g. What research is there to support your intervention? What research is there to support your choice of assessment tools?)
E) Ethics and Standards ß this MRA competency is covered by the Ethics Oral Exam and not the Case Comprehensive Examination
3. Evaluation Criteria and Procedure. The evaluation criteria for the case comprehensive exam are based on the competency benchmarks developed by the American Psychological Association and adopted by professional psychological agencies such as APPIC, which are outlined in Fouad et al., 2009. Competency benchmarks focus on preparation for health care service. In this model, foundational and functional core competencies are operationally defined and assigned behavioural markers to evaluate students and candidates at various levels of practice (i.e., readiness for practicum, readiness for internship, readiness for independent practice). These functional competencies include four that overlap with the MRA competencies and are the focus of the case comprehensive exam: assessment, intervention, consultation, research and evaluation. Students completing the comprehensive exam will be just prior to their final practicum placement in their training, and thus the “Readiness for Internship” standards were deemed closest to expectations for the case comprehensive exam. However, students are advised that the examiners do not expect them to be fully prepared for internship given that they have one remaining practicum placement.
The exam will be audio recorded and audio files stored by the Director of Clinical Psychology Training.
Following completion of the oral exam, students will be asked to leave the room. Both examiners will independently rate the student on the core competency benchmarks using the evaluation form. Following this, the examiners will discuss and reach consensus ratings. The final consensus ratings sheet will be provided to the DCT. The comprehensive exam is rated on a Pass/Fail basis (see below). After reaching consensus the student will be asked to return to the examination room where the examiners will provide the student with his or her exam results and feedback on his or her examination. The examiners will provide the DCT with the evaluation sheet and a summary of the student’s exam results via email.
Pass: Assigned when it is clear to both examiners that the student’s work is of sufficient quality, both in terms of breadth and depth, to demonstrate the student’s competency and preparedness for the final practicum placement and PhD Candidate Status
Pass Pending Revisions: Assigned when it is clear to both examiners that the student has a specific area of gap in his or her knowledge that would be expected to be known by any clinical psychology trainee at his or her level (e.g., based on classes and clinical training to date and knowledge covered in the standardized reading list). This is also assigned when it is suspected the student has sufficient knowledge but requires another opportunity to demonstrate this knowledge. Specific revisions are assigned at the discretion of the examiners.
Fail: Assigned when it is clear to both examiners that the student lacks sufficient knowledge and/or integration of comprehensive knowledge in clinical psychology (based on training to date and the standardized reading list) to be prepared for the final practicum placement and PhD Candidate status. Students who fail the case comprehensive exam will be provided with another oral examination opportunity. A second failure will result in the student being asked to withdraw from the program, consistent with CGSR policy.
The student and field supervisor are collectively responsible for ensuring that confidentiality and dignity are respected by applying the appropriate combination of the following means, among others:
- Review of the Canadian Code of Ethics for Psychologists as it pertains to the case presentation
- Prior approval from the agency through which the client was served
- Consent of the client for the student to do the presentation -- the client has the option to refuse or to restrict certain information from being presented
- Disguise of personal information in such a way as to make it impossible to identify the client
- Prior to the examination, the field supervisor will review the information to be presented as further protection of privacy and confidentiality.
- The field supervisor, with input from the student, will evaluate the appropriateness of the work sample occurring either during, or after, the student's contact with the client, giving consideration to the particulars of both the client and the treatment modality and giving highest consideration to the wellbeing of the client and also to aspects of the client-student relationship. This may often result in the examination occurring only after contact between the student and client has terminated.
- The possibility of using a client's clinical material for the case comprehensive examination will first be discussed in individual supervision with the field supervisor and, if considered appropriate, broached with the client at a point in the clinical services mutually agreed upon by the supervisor and student. A primary consideration around the appropriateness and timing of such a request will be the impact on the client and on the clinical relationship. It must be noted that the client's consent would not constitute the primary supervisor's approval of use of the clinical material in this manner.
- Decisions by practicum agencies about the appropriateness of particular cases for use as part of the comprehensive examinations will be made on a case by case basis, in a manner consistent with the agency's policies concerning cases referred to practicum students, in general. Although agencies are not able to guarantee the availability of appropriate cases for this purpose, efforts will be made by those involved in training to ensure that students are able to gain direct-contact clinical experiences which will provide the necessary context for their case presentation requirement.
- In certain circumstances (e.g., when the client is not from the student's current caseload, or when a current client is experiencing crisis), it may not be possible - or ethical - to approach a particular client about attaining their consent for the student to use client information for the examination. In such circumstances, the student will need to consult with the field supervisor, and may also need to consult with the presentation adviser, the DCT, and/or the Clinical Executive Committee (CEC), to receive guidance.
Recommendations for Students and Practicum Settings:
To minimize logistical difficulties in students being able to present current clinical cases, and to ensure that free and informed consent is obtained from clients, the following recommendations are made:
- Agencies should be made aware of the case comprehensive examination requirement and guidelines, and their input into this process should be encouraged and welcomed.
- The student should discuss his/her need to be examined on a clinical case with the field supervisor. Such discussion should take place as a matter of course at the beginning of each practicum placement (i.e., after completion of the summer clerkship).
- As part of the routine solicitation of consent from clients (e.g., to videotape, discuss case material in clinical team, etc.), the student will discuss and solicit specific consent from the client to have his/her case material presented to faculty and graduate students in the graduate program in clinical psychology, as part of his/her training requirements.
- It is advisable that separate documentation forms and processes be developed for the purpose of recording clients' consent for the purpose presenting their case.
- In consultation with the field supervisor the student will identify particular cases that might be suitable for presentation.