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Advancing Competency at the Formative Level of Training: Assessing the Needs of Practicum Supervisors

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Michelle S Anderson
Abstract:
The training literature shows significant progress in the definition of clinical competency; however, the extent to which practicum supervisors implement competency based training is not clear. This qualitative study explored practicum supervisors' perspective of the competency model including relevance, perceived confidence in their ability to implement the model, and their training needs. Five semi-structured interviews were conducted with supervisors selected to represent a variety of practicum sites. Data were analyzed using a combination of grounded theory and descriptive statistics. Results indicated that practicum supervisors consider the competency-based model "very relevant" to practicum training and are confident in their ability to use the model. Supervisors prefer training materials that are applied, include operational definitions and identified thresholds, and provide opportunities to facilitate trainees' professional development.

Table of Contents

Approval ................................ ................................ ................................ ................................ .......... ii

Abstract ................................ ................................ ................................ ................................ ........... iii

Chapter 1 : Introduction ................................ ................................ ................................ .................... 1

A C ulture of C ompetenc e ................................ ................................ ................................ .... 1

Competence V er s us Competenc y ................................ ................................ ........................ 2

Conference Outcomes ................................ ................................ ................................ ......... 3

Assuring C ompetence by A ssessing C ompetenc y ................................ .............................. 5

Challenges in the A ssessment of C ompetency ................................ ................................ .... 6

Practica as a Venue for Training in Clinical Competency ................................ .................. 7

Practica Supervisors: Essential Partners in Training ................................ ........................... 8

Challenges A ssociated with A dvancing C ompetency

D evelopment at the P ractica

L e vel ................................ ................................ ................................ ........................ 9

Confusion about T raining E xpectations O ccurs on M ultiple L evels ................................ 10

Current Study ................................ ................................ ................................ ..................... 11

Chapter 2 : Method ................................ ................................ ................................ ......................... 12

Participants ................................ ................................ ................................ ........................ 12

Procedure ................................ ................................ ................................ ........................... 13

Measures ................................ ................................ ................................ ............................ 13

Data Analysis ................................ ................................ ................................ ..................... 14

Chapter 3 : Results and D isc ussion ................................ ................................ ................................ 16

Director of Clinical Training Interview ................................ ................................ ............. 16

Practicum Supervisor Interview s ................................ ................................ ....................... 16

Advancing Competency in Practicum Supervision v

Part 1 : Relevance ................................ ................................ ................................ ... 16

Cultural shift ................................ ................................ .............................. 17

Optimize training "fit" ................................ ................................ ............... 18

Bridge goals for training and service delivery ................................ .......... 19

Part 2:

Confidence ................................ ................................ ................................ . 21

Reliance on subjective methods of assessment ................................ ......... 22

Assessment of f oundational versus functional competencies ................... 23

Integration of broader professional development with the competency

model ................................ ................................ ............................. 25

Part 3: Training ................................ ................................ ................................ ...... 26

Communication using a shared competency language .............................. 27

Training should delineate concrete behavioral anchors and thresholds .... 27

Focus on "real life" application ................................ ................................ . 28

Training should facilitate ongoing professional development .................. 29

Summary ................................ ................................ ................................ ............................ 30

Relevance ................................ ................................ ................................ .............. 30

Confidence ................................ ................................ ................................ ............. 31

Training ................................ ................................ ................................ ................. 31

Conclusions and Recommendations ................................ ................................ .................. 32

Limitations of the Study ................................ ................................ ................................ .... 3 3

Fu ture Directions in Research ................................ ................................ ........................... 34

References ................................ ................................ ................................ ................................ ..... 35

Advancing Competency in Practicum Supervision vi

Appendix A : Semi - Structured Interview: Direct or of Clinical Training ................................ ....... 39

Appendix B : Semi - Structured Interview: Practicum Supervisor ................................ .................. 42

Appendix C: Curriculum Vitae ................................ ................................ ................................ ..... 45

Advancing Competency In Practicum Supervision

1

Chapter 1

Introduction

A C ulture of C ompetence

Within the last decade, there has been strong consensus that embracing a competency - based approach to the training and evaluation of students is becoming the “gold standard” in multiple fields of professional health care, including clinical psyc hology . In 2006, a report from a task force formed by the A merican P sychological A ssociation (APA) Board of Educational Affairs described this professional movement as “ culture shift within the profession toward a high value on the assessment of competence across the professional life - span ”

(A merican P sychological A ssociation [APA] , 2006) .

Traditionally, clinical and professional competency ha s reflected a core value in the psychological discipline ( APA, 2000; Belar & Perry, 1992) . However, over the last 20 years a

dynamic process led by multiple stakeholders has led to a more definitive understanding of clinical competenc e . Consensus has emerged in the definition of competence as a broad construct that goes beyond the acquisition of knowledge or skill to include the active use of clinical judgment, attitudes, skills, and decision making “ in a manner consistent with standards and guidelines of peer review, ethical principles, and values of the profession, especially those that protect and otherwise benefit the public ” (Rodolfa et al. ,

2005 , p. 349). The definition of competence most commonly used in clinical training is “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection

Advancing Competency in Practicum Supervision 2

in daily practice for the benefit of the individual and community being served” (Epstein & Hundert, 2002, p.

227). This definition represents significant progress when one considers that until recently clinical competenc e

was a relatively abstract construct due to a lack of consensus in the field as to how it should be operationally defined, measured, and evaluated (Roberts, Borden, Christiansen, & Lopez, 2005).

Competence Ver s us

C ompetency

Competence is a comprehensive , developmental construct that is inadequate t o describe the wide range of services provided by a professional psychologist. In 1986, t he National Council of Schools of Professional Psychology (NCSPP) led an effort to move beyond the general construct of competence to the delineation of discrete eleme nts or competencies

consisting of the knowledge, skills, and attitudes requisite for professional function ing (Kaslow et al, 200 4; Peterson et al., 1992; Peterson, Peterson, Abrams, & Striker, 1997 ) . As a result of this effort, NCSPP created a competency - b ased core curriculum for graduate programs in clinical psychology.

The desire to standardize professional training maintained the momentum of what has been described as a “cultural shift” toward competency in the field of clinical psychology (Roberts et a l . , 2005) . The culture shift toward competency development has encompassed the full developmental range, beginning with the necessary requirements or competencies to enter a doctoral training program and continuing through independent practice (Kaslow et a l. , 2004). In an historical event

that solidified the profession ’ s commitment to the competency movement, the Association of Psychology Postdoctoral and Internship Centers (APPIC) hosted the Competencies Conference: Future Directions in Education and Psych ology in Scottsdale, AZ in

Advancing Competency in Practicum Supervision 3

2002 . Following the conference, stakeholders representing academic programs, training programs, and credentialing organizations were invited to join a pivotal “steering committee” with the goal of achieving consensus on domains a nd levels of competence to be achieved during the course of training in professional psychology (Hatcher & Lassiter, 2007). Although much was accomplished during the conference and in the follow - up meetings of this steering committee , the formative contrib ution was likely the identification of major competency domains relevant to all levels of professional development. Examples of said competencies include: individual and cultural diversity, ethical practice, relationship skills, critical thinking, and know ledge of self or “metawareness.” Also recognized at this conference, was a need to identify corresponding “subcompetencies,” or components that would further elucidate each domain.

Conference Outcomes

The conference generated a series of important outcome s that influenced the understanding of clinical competencies by academic programs, training sites, a nd accredi ti ng organizations (Roberts et al., 2005 ) . One outcome was the

identification of three core assumptions that helped to guide future discussions of

competency - based education, training, assessment, and credentialing in professional psychology. These assumptions include the following: (a ) core foundational and functional competencies can be identified, (b ) individuals can be educated and trained to de velop these core competencies, and (c ) core competencies can be assessed, (Kaslow et al . , 2004).

In addition to the identification of the core assumptions, the conference participants devoted a significant amount of time and effort to the definition of th e multiple domains of competency. This effort led to the development of the competency “cube model” developed by

Advancing Competency in Practicum Supervision 4

Rodolfa

et al. (2005). In the model, the authors used a three - dimensional cube to illustrate the primary elements of competency. The x - axis of the cube illustrated foundational or baseline competencies , which according to the model are essential prerequisites for all other competencies. The y - axis illustrates the functional or performance - based competencies, (y - axis). The z - axis in the model repr esents various stages of professional development (Fouad et al., 2009) , suggesting that foundational and functional competencies continue to develop throughout practicum, pre - doctoral and post - doctoral training.

T he Assessment of Competency Benchmarks Work Group , another outcome from the conference, convened in September of 2005 with the central purpose of defining “benchmarks,” or behavioral anchors for the foundational and functional competencies. The benchmarks would then be used to determine readiness f or practice at various levels in the training and education process, (Fouad

et al., 2009). After synthesizing the literature and soliciting input from multiple stakeholders, the workgroup generated the Benchmarks Document which defined 15 core competencies . The document also identified the basic components of each competency as well as behavioral anchors to indicate readiness for each of the three levels of professional development: practicum, internship, and independent practice. A complete review of the B enchmarks document is beyond the scope of this research, (see Kaslow, et al., 2009 for comprehensive review). The competencies and behavioral anchors are observable, mea surable, containable, and derived by experts ; thus, their applicability to professional development in this field is unparalleled (Grus, 2009).

The effort expended to create a shared language for a complex construct corresponds with the importance of the construct to the field of psychology (Rubin et al. , 2007). T he

Advancing Competency in Practicum Supervision 5

Competencies Conference of 2002 ha s had a significant impact on graduate training in psychology ; and is likely to continue to shape our understanding of the skills, knowledge and attitudes required of a professional psychologist.

Assuring Competence by Assessing Competency

It ha s been well established that traditional evaluation models may not adequately answer the most relevant question in clinical training: “Is this student ready to practice?” Contributing to the confusion is the fact that doctoral programs, and internships may have incongruent methods for deciding whether or not a student is prepared for internship, (Lichtenberg et al. , 2007). The literature indicates that this lack of clarity regarding a student’s independent performance in clinical situations may be partially due to limitations of traditional evaluation methods, (Willet et al., 2009) . Traditionally, a graduate student’s fitness for internship has been defined by a variety of indicators including the number of hours accrued in various practicum settings, the as sessment of acquired knowledge via exams and the practicum supervisors’ subjective evaluation (Hager & Gonczi, 1994; Ko &

Rodolfa, 2005). Despite their high utilization, these methods of evaluation are limited and provide little information about actual

pe rformance.

One does not have to wander very far across disciplinary literature to find assertions that traditional evaluation

measures

are inadequate surrogates for the assessment of clinical performance in the profession of health - professions (Willett et al., 2009) . Uncertainty as to whether a student’s knowledge, skills, and attitudes generalize to unobserved, clinician - patient encounters creates tension on multiple levels . Included in this tension is the frustration students express with the limited uti lity of some traditional training markers ( e.g., the number of accrued practicum or performance on multiple - choice tests). Rather than departing from knowledge -

Advancing Competency in Practicum Supervision 6

based assessment , however, the literature suggests the use of competency - based assessment may pr ovide a level of clarity traditional means lack; including an emphasis on both synthesis and

application of knowledge (Hager & Gonczi, 1994).

Challenges in the A ssessment of C ompetency

The professional literature asserts that traditional methods of assess ment do not adequately capture clinical competence: “Within professional psychology, our abilities to assess across the areas of knowledge, skills, and attitudes are not equal . . . . Although professional psychology does have tools for evaluating knowledge and skills, it is generally held that these often lack reliability, ecological validity, and fidelity to practice” (Lichtenberg et al., 2007 , p. 476 ). Hence, there remains a significant need for more reliable methods of competency assessment that is clear , objective, accurate, and standardized across training settings.

Limited or variable opportunities to observe students in direct - patient interactions may also contribute to the challenges inherent in the assessment of competency . In particular, variabilit y in the amount of direct intervention provided by each site may also partially responsible for limited opportunities to assess direct - patient intervention . In their survey of 263 practicum sites, Lewis, Hatcher, and Pate, (2005) discovered that the emphas is on service delivery and direct intervention was varied in relation to the degree of affiliation practicum sites had with the corresponding graduate program. Seventy - seven percent of university - based practicum sites reported that direct service and inter vention was “very consistent” with organizational goals, whereas a s light majority (53%) of hospitals and medical settings report direct service and intervention as “moderately to somewhat” consistent. Unfortunately, the

Advancing Competency in Practicum Supervision 7

supervisor has fewer opportunities for an ecologically valid assessment of the trainees’ skill when there is limited opportunity to provide direct service .

Responding to the challenges associated with assessment of clinical competency, the Benchmarks Workgroup (described in previous sectio n) proposed two specific recommendations for academic programs and training sites to use in the assessment of competency development. Their recommendations included: (a ) a frequent assessment of individual competency to help provide trainee with the educat ional experiences to allow them to develop the needed competencies, and (b ) a mechanism to identify and address trainee concerns about the development of competencies. Essentially, the ability to assess competency may assure its development, (Kaslow et al. , 2004) . Needless to say, the continual education, training, and assessment of practicum students has been described as a “particular challenge” facing graduate programs, (Hatcher & Lassiter, 2007).

Practica as a Venue for Training in Clinical Competency

Practicum training is an ideal venue for maximizing the development of clinical competency of graduate students (Hatcher & Lassiter, 2007). The practicum site is where knowledge, skills and attitude converge to meet clinical needs. Research suggests that s tudents with “extensive” practicum experiences feel more secure in their vocational preference, and confident in their professional confidence (Carless & Prodan, 2003, p. 91).

Moreover, practicum sites and supervisors that are aware of training competencie s are more likely to approximate the internship training experience (Lewis et al. , 2005) . Despite the known benefits of a competency - based training model, research findings have indicated a discrepancy between the expected and actual training experiences o f students at the practicum level (Gross, 2005). This discrepancy is

Advancing Competency in Practicum Supervision 8

disconcerting when one considers that the majority of a graduate student’s practicum training (approximately 1 , 500 hours) takes place in off - campus, practicum sites .

Practica Supervisors : Essential Partners in Training

Because the skills and abilities a student displays at the practicum site are more closely related to clinical competence, practicum supervisors have an optimal opportunity to assess the student within a context that holds more ecological validity. For this reason, practicum supervision has been highlighted as an integral part of competency development (Barnett, Cornish, Goodyear, & Lichtenberg, 2007). Practicum supervisors are in many ways gatekeepers of competence because they are in a position to discern whether or not trainees are fit to practice (Barnett et al. , 2007). Somewhat disconcerting however, is the lack of research regarding off - site, practicum supervisor’s clarity of clinical competencies (Kaslow, Pate, & Thorn , 2005; Lewis et al., 2005).

Given the far - reaching benefits one would expect from an integration of competency at the practica level, it is surprising that clinical supervisors might be overlooked in the push toward competency development. As indicated p reviously, because practicum supervisors are generally unclear of training expectations, their ability to evaluate progress against those expect ations is consequently limited (Lewis et al., 2005 ) . Given the ongoing training relationship, the graduate progr ams in collaboration with the practicum supervisors, are in a prime position to provide educational opportunities that would improve understanding, clarity, and assessment of competency in practicum students .

Advancing Competency in Practicum Supervision 9

Challenges A ssociated with A dvancing C ompete ncy

D evelopment at the P ractica L evel

Competency in supervision is a particularly complex goal because the psychologist needs to not only demonstrate skill in the supervision of the trainee; but it is also assumed that the supervisor has sufficient knowled ge of the broader competency domains including both foundational values as well as the functional skills necessary to begin practice as a psychologist. Although challenging, this expectation gains increasing importance when one considers the ethical respon sibility psychologists have to remain competent in the area of supervision

(Harrar, VandeCreek, & Knapp,

1990; Kaslow et al. , 2004), and the role academic institutions can play in this accountability (Nelson, 2007).

Despite the collaborative effort on beh alf of accreditation bodies to promote awareness, definition, and tools for the assessment of competencies at the practicum level, research indicates clinical supervisors may not be aware of the competencies, which could have a significant impact on their confidence in terms of assessing them. One reason proposed for this lack of clarity is the poor communication between academic programs and external practicum sites regarding competency training goals, (Lewis et al . , 2005).

It has also been hypothesized t hat conflicting goals for the trainee may be at the root of disparate attitudes between graduate programs and practicum sites; the former being primarily concerned with the quality of training and the later with service delivery, (Gross, 2005) . In particul ar, the literature indicates that when practicum site supervisors are confronted with the pressure to decide whether the cost of training a graduate student outweighs the benefit of potential services, valuable training opportunities may become compromised (Lewis et al., 2005).

Advancing Competency in Practicum Supervision 10

Confusion about T raining E xpectations O ccurs on M ultiple L evels

In a survey of 245 internship training directors (ITDs) and 148 graduate Directors of Clinical Training (DCTs), Kaslow et al. , (2005) discovered significant discrepancy between perceptions of the importance of practicum training. Forty - eight percent of DCTs indicated that this was an area of “high importance” whereas only 19% of ITDs felt similarly (Kaslow et al, 2005) .

The literature indicates that discrepancy extends to the training level. In a parallel study, Lewis et al. (2005) surveyed 263 practicum site coordinators representing health/ medical, community - based mental health, school, and university - based sites. Findings indicate that only 19.4% of health/medical si tes, ( n =

93), and 30.8%, ( n

=

67) of community mental health settings reported being “very clear” about the graduate programs expectations for practicum training. Despite their close affiliation with graduate programs, only 44% of 74 university - based trai ning programs, ( n

=

32) endorse being "very clear" about training expectations , which although greater, suggests close affiliation with a graduate program does not assure clarity on training expectations .

Similar findings were also extended to site’s awar eness of internship requirements for practicum training, for example, only 19.4% of health/medical related practicums surveyed, ( n

=

93) reported being “very clear” on the competency thresholds required by internships . It is not difficult to imagine the re sulting co nfusion when multiple stakeholde rs hold incongruent training expectations.

Advancing Competency in Practicum Supervision 11

Current Study

The combination of increased expectations for competency development and the corresponding assessment of those competencies may challenge the limited resou rces of many practicum sites . This study responded to this challenge by conducting a qualitative analysis of the existing competency - based training programs offered by graduate programs in professional psychology. Given the limited number of such tr aining programs, this study a lso explore d the practicum supervisors’ need for competency - based training . The goal of the investigation is two - fold; (a ) to explore what has been attempted on behalf of graduate Directors of Clinical Training (DCTs) to educate pract icum supervisors in competency - based training , and (b ) exploration of the perceived need of practicum supervisors for training in the competency - based model .

Expanding on this area of research will contribute to the literature on competency development at the practica level . Because this study addresses the shift toward competency - based training, findings will likely benefit students, educators,

supervisors, and consumers. Specifically, outcomes of this research may identify the training needs of practicum supervisors who have an optimal perspective from which to assess students . To this end, the ongoing cultural shift toward competency development may expand to include an essential member of the training team, the practicum supervisor .

Advancing Competency In Practicum Supervision

12

Chapter 2

M ethod

Participants

Participants for this study included one Director of Clinical Training (DCT) affiliated with Na tional Consortium of Schools and Programs in Professional Psychology graduate programs and five practicum supervisors in the greater Portland , OR region selected as part of a convenience sample to reflect different training domains and length of supervisory experience .

Each participant represented one of the five, following practica domains: public service psychology (Veteran’s Administration), medical environment (primary care medicine practice) ,

school environment (rural, K - 12 district), u niversity c ounseling

Center, and an adult f orensic institution. Two of the five participants had a close degree of affiliation with the graduate program (pra ctica supervision was funded through the university and supervisors were also part - time faculty); the other participants supervised practica that were not affiliated with the university . P articipants had an average of eleven years , ( M

=

11)

experience as l icensed clinical psychologists ; years of experience as a licensed professional rang ed from 1 - 20 . Participants represented a ran ge of 2 - 10 years

experience supervising, ( M

=

10) . All of the particip ants identified as Caucasian; their stated ages were 34, 48 , 50, 50, 58 and 60; ( M

= 50 y ears ) . The sample consisted of one male and five female participants. All participants were treated in accordance with the ethical standards of the APA (see Principles 6.1 - 6.20 in the “Ethical Principles of Psychologists and C ode of Conduct,” APA , 1992).

Advancing Competency in Practicum Supervision 13

Procedure

Approval for the proposed study was received from the Human Subjects Review Committee at George Fox University. Following committee approval, the Director of Clinical Training (DCT) of the Graduate Department of Clin ical Psychology (GDCP) at George Fox University posted a request on the National Council of Schools of Professional Psychology (NCSPP) list - serve asking if other DCT’s have provided competency - based training or materials for practicum supervisors. Only one (DCT) responded to the posted query and she was contacted by the researcher and asked to participate in a semi - structured interview (Appendix A) regarding the training.

All five supervisors were initially contacted via an electronic introduction by the DCT of the GDCP at George Fox University . Following the email introduction, the five practicum supervisors were contacted via electronic mail and asked if they were willing to participate in a twenty minute, face - to - face, semi - structured interview (Appendi x B) with the goal of exploring practicum supervisors’ need for competency - based training. In total, six (one DCT and five practicum supervisors) participants completed audio - recorded interviews (ranging from 20 - 30 minutes, X = 25 minutes) .The interviews were then transcribed and imported into an electronic database for analyzing qualitative data (NVIVO - 9) .

Measures

The primary measures used in this study consisted of two semi - structured interviews: one was designed for Directors of Clinical Training, (Ap pendix A), and the other for practicum site supervisors, (Appendix B) . Findings from the professional literature significantly influenced the framing and organization of the questions. The interview for the Director of Clinical Training

Advancing Competency in Practicum Supervision 14

(Appendix A) used a combination of closed and open - ended questions to address the following areas: ( a) perceived needs in the area of advancing competency - based supervision at the practica level, ( b) exploration of what has been attempted in the way of educating supervisors , and ( c) investigation of the outcomes of said attempts. The semi - structured interview for practicum supervisors explored three general areas, ( a) perceived awareness and relevance of the competency - based approach to supervision, ( b) perceived confidence i n terms of utilizing a competency - based model to train and assess students at various developmental levels, and ( c) and exploration of supervisor’s training and resource needs in competency - based supervision . The semi - structured interview for the practicum supervisor was piloted and revised to increase clarity. The supervisors participating in the structured interview were asked to provide demographic information, including years spent supervising, years licensed, therapeutic orientation, the type of practi cum site in which they provide supervision, as well as information on age, gender, and ethnicity (see Appendix B).

Data Analysis

In essence, a whole - part - whole analysis was completed in order to compare the identified needs of practicum supervisors with t he barriers to competency training that were identified in the literature. The qualitative software program NVIVO - 9 was used to code and analyze the data . Questions in the semi - structured interview provided a “top - down” structure which was used to analyze the themes and patterns across site supervisors . A “bottom - up” synthesis was also performed by analyzing each interview or source for significant themes and labeling these with “nodes.” In sum, there were 50 different node categories, with a total of 272 coding references acr oss five transcribed sources, ( M = 5.4 references per node). Node categories were reviewed by

Advancing Competency in Practicum Supervision 15

another researcher for consistency with interview content. Acc ording to a calculation of the Cohen’s K appa coeff icient, there was excellent i nter - rater agreement, ( K

=

0.92 ).

For the central purpose of organizing the analysis, nodes with m ore than five coding references, ( M

=

5.4) were considered to be main themes. The 21 main themes were clustered within one of the three over - arching construct s in the practicum supervisors’ interview (perceived relevance, confidence and training needs) and cited within the discussion.

Three rating - scales questions on the practicum supervisor semi - structured interview resulted in a total of 15 items of quantitat ive data. Descriptive statistics were performed on these data and also presented in the Results/Discussion section.

Advancing Competency In Practicum Supervision

16

Chapter 3

Results and Discussion

Director of Clinical Training Interview

What has been attempted to promote competency at the practica level? The single Director of Clinical Training interviewed for this study reported that she designed a web - based, video training for practicum supervisors associated with her graduate program. Although continuing education units were offered, no practicum supervisors had participated in the training at the time of this interview . This Director of Clinical Training felt strongly that competencies need to be built more concretely into practica - level training . Specifically, she

asser ted that it is the role of Clinical Training Directors to initiate this movement by (a ) educating practicum supervisors about the competency - based

model , and (b ) establish ing

competency - based evaluations of practicum students a s standard protocol .

The fact that this DCT is the only one who has attempted to pr ovide competency - based education for practicum supervisors , coupled with t he lack of outcome data for said efforts indicates this as an area for future endeavor and research.

Full document contains 62 pages
Abstract: The training literature shows significant progress in the definition of clinical competency; however, the extent to which practicum supervisors implement competency based training is not clear. This qualitative study explored practicum supervisors' perspective of the competency model including relevance, perceived confidence in their ability to implement the model, and their training needs. Five semi-structured interviews were conducted with supervisors selected to represent a variety of practicum sites. Data were analyzed using a combination of grounded theory and descriptive statistics. Results indicated that practicum supervisors consider the competency-based model "very relevant" to practicum training and are confident in their ability to use the model. Supervisors prefer training materials that are applied, include operational definitions and identified thresholds, and provide opportunities to facilitate trainees' professional development.