By Christine Jehu, Ph.D., APAGS Chair
You may have heard that the Association of State and Provincial Psychology Boards (ASPPB) is currently developing a second examination (EPPP Step 2) for psychology licensure to assess clinical competency. This exam would follow the Examination for Professional Practice in Psychology (EPPP).
This exam may feel like a massive surprise to students and Early Career Psychologists. Unbeknownst to many of us, our field has been moving toward competency assessment since the Competencies Conference in 2002 and subsequent publications highlighting the importance and value in competency assessments (e.g. Rodolfa, Bent, Eisman, Nelson, Rehm, & Ritchie, 2005). During the 2013 updates to the APA Commission on Accreditation’s Guidelines and Principles, the APAGS Committee provided a comment that supported the development of competencies based assessment, but had concerns about cost, the process of assessing competencies, and the fair implementation of a new exam to psychology license applicants.
Given that ASPPB has started development of a clinical competencies exam, the APAGS Committee has discussed this issue at length. A number of concerns and issues arose that we would like to highlight:
- Cost – The cost of the current EPPP is $687 in most jurisdictions. This is substantial to graduates who may owe a median debt of up to $200,000 (Doran et al., 2016). Students have reported that finances are the #2 stressor they face in graduate school (El-Ghoroury et al., 2012). To be fair to the next generation of psychologists, APAGS believes the cost of the EPPP Step 2 needs to be as low as possible, with serious consideration given to cutting costs in other areas as well (e.g., current EPPP).
- Sequence of Examinations and Training –
- The EPPP typically is administered after the doctorate degree has been awarded and all requirements for licensure have been completed, including postdoctoral requirements in over 35 US jurisdictions. The ASPPB proposes the EPPP Step 2 be administered after the first exam. APAGS is concerned that this would add substantially to the time it takes to get licensed, and psychologists already have the longest time to licensure when compared to other health professionals (Olvey, Hogg, & Counts, 2002).
- APAGS strongly recommends that applicants have the option to take the EPPP Step 1 (the knowledge based exam) as soon as possible after completing coursework, and ideally before internship. This would put the EPPP in line with the United States Medical Licensing Examination (USMLE) Step 1 knowledge based exam, and would place the exam substantially closer to when coursework had been completed. Given that length of time from graduation is positively associated with a higher fail rate (Schaffer et al, 2012), moving the EPPP Step 1 before internship should substantially increase the first time
- Finally, with a clinical competency exam such as the EPPP Step 2, APAGS would encourage ASPPB and jurisdictions to adopt the APA policy on sequence of training, recommending the doctorate as the entry level into the profession. Functionally, this would mean that training prior to the internship could be counted towards hours required by jurisdictions for licensure, and would eliminate the need for a full year postdoctoral supervised experience. This would allow licensure to occur sooner, and have substantial positive financial implications for new graduates.
- Test Development – APAGS would like to know the data on the validity of exams such as the proposed EPPP Step 2. The ASPPB website currently has references for the history of the competency movement, but does not list references for the type of exam it hopes to develop. APAGS is also concerned that the time frame for the test development is fast; and that, in an effort to reach the completion date goal, the test may not be as fully developed or as valid as it could be with more time.
- Test Preparation – Finally, APAGS is concerned that the EPPP Step 2 is being developed without appropriate training for students in the pipeline. It is unfair to pose a test to students without training materials and information to the education and training community. Therefore, implementing a test would need to come after materials were distributed to the training community so that rising psychologists would be aware of the exam and have experience with components of the exam. Distributing these materials widely also provides accurate informed consent to students entering the psychology pipeline.
An additional exam, and the associated costs that come with it, without other changes in the process, are not ideal for students who are in the process of becoming a psychologist. However, if this exam could allow for the EPPP Step 1 (the knowledge based exam) to be moved before the internship, and if jurisdictions adopted the APA policy on sequence of training to allow psychologists to get licensed earlier, there would be substantial advantages for future psychologists. An earlier EPPP Step 1 would result in more applicants passing the exam on the first attempt (which is a better outcome). Earlier licensure could have substantial positive financial implications for psychology graduates, such as being eligible for the National Health Service Corps Loan Repayment Program a year earlier, or having a better paying position with possession of a license. Such changes to the licensure processes would make the addition of the EPPP Step 2 much more bearable and also put psychology’s licensure process in line with that of many comparable professions.
Hi Christine,
Thank you for your thorough response on this issue. I appreciate your ability to see the issue from multiple angles. I wanted to note that the article you cite as highlighting the importance and value of competency assessments (Rodolfa et al, 2005) provides a model to follow, but does not provide any research to support the conclusion that a competency exam in psychology would “enhance services provided to the public” as the article concludes. I wonder if there is any research on this in other professions or on whether the EPPP itself enhanced services to the public. I figure one way to measure this might be to track ethics complaints before and after the installment of the EPPP. I know the literature has not found a clear correlation between increased training and positive outcomes in psychotherapy, which makes me wonder whether standardized exams are correlated with improved outcomes. In short, I think its crucial to establish that the EPPP2 would indeed achieve the goal it is designed to achieve, i.e. enhance services to the public, before implementation.
A couple of other things that you did not address in your post. While all doctoral students are harmed by the increased level of debt, students of color are disproportionately harmed, as they are less likely to have access to the resources their white counterparts have access to, and already have to face obstacles put in their way in the form of individual and institutional racism. Thus, this additional barrier to entry to the profession would disproportionally harm students of color, which goes against the APA’s stated goal of increasing the number of minority practitioners.
In addition, I think its no coincidence that, practicum hours have increased dramatically and new new tests have been introduced, at the same time that women have become psychologists in increasing numbers. Considering the history of patriarchy in this country and its continuation in the present, it makes me wonder why the requirements for competency were lower when the field was dominated by white males. Why do women, and the increasing number of people of color in the field, have to meet stiffer requirements than the white males who preceded us? These are questions that would need to be addressed before I am convinced that the EPPP2 is necessary.
Respectfully,
Luciano Lima
Illinois School of Professional Psychology
American Psychological Association of Graduate Students (APAGS) Shares “Thoughts” On The Eppp-2 #NoEPPP2
While We Are Toughest On These Type of Organizations, We Must Admit, We Agree With Most Points Made Here By Dr. Christine Jehu.
Our Main Differences Is… That We Put Your “Thoughts” Into “Actions.” There is a HUGE Difference Between What You “Think” and What You “DO.” #Psychology101 That’s Where We Stand Out!
This Shows You That Your Call For Social Justice Is Pressuring The System. Without Your Efforts and “Raising Hell.” We Would’ve Been Shoved Down Our Throats With This Unnecessary Exam Already.
Still #NoEPPP2 #APA2016
Pingback: Modern Psychologist "Thoughts On The EPPP-2" (Finally) By The American Psychological Association of Graduate Students (APAGS) - Modern Psychologist
Agreed with all of your comments. Medical students get one month off to prepare for the USMLE Step 1. There is also a plan made with Student Affairs if a failure is made.
Psych folks are expected to pass with no support from their institutions and competing with work or training as well as other life responsibilities to study for the EPPP. I hope there is more vocal opposition for a delay in the EPPP Step 2. I’m still not convinced the EPPP itself is a good marker of one’s ability to practice psychology.
Thank you for alerting us to this issue! The APAGS stance raises all important points I considered when I heard about this–1) money, 2) time, and 3) a test that actually assesses competencies vs. rote memorization that standardized testing has become known for.
Hi Christine,
Thank you for your thorough response on this issue. I appreciate your ability to see the issue from multiple angles. I wanted to note that the article you cite as highlighting the importance and value of competency assessments (Rodolfa et al, 2005) provides a model to follow, but does not provide any research to support the conclusion that a competency exam in psychology would “enhance services provided to the public” as the article concludes. I wonder if there is any research on this in other professions or on whether the EPPP itself enhanced services to the public. I figure one way to measure this might be to track ethics complaints before and after the installment of the EPPP. I know the literature has not found a clear correlation between increased training and positive outcomes in psychotherapy, which makes me wonder whether standardized exams are correlated with improved outcomes. In short, I think its crucial to establish that the EPPP2 would indeed achieve the goal it is designed to achieve, i.e. enhance services to the public, before implementation.
A couple of other things that you did not address in your post. While all doctoral students are harmed by the increased level of debt, students of color are disproportionately harmed, as they are less likely to have access to the resources their white counterparts have access to, and already have to face obstacles put in their way in the form of individual and institutional racism. Thus, this additional barrier to entry to the profession would disproportionally harm students of color, which goes against the APA’s stated goal of increasing the number of minority practitioners.
In addition, I think its no coincidence that, practicum hours have increased dramatically and new new tests have been introduced, at the same time that women have become psychologists in increasing numbers. Considering the history of patriarchy in this country and its continuation in the present, it makes me wonder why the requirements for competency were lower when the field was dominated by white males. Why do women, and the increasing number of people of color in the field, have to meet stiffer requirements than the white males who preceded us? These are questions that would need to be addressed before I am convinced that the EPPP2 is necessary.
Respectfully,
Luciano Lima
Illinois School of Professional Psychology
Hi Christine.
Psychiatry stopped doing these several years ago. I sympathize with the students and feel that the step 2 is unnecessary. I am unfamiliar with any evidence of validity and don’t really understand why things seem to be going backwards with this.