Being An Internship Supervisor: Competencies as the Core of ALL Internship Experiences

As you know, I am bound and determined that my internship program be competency-based as close as possible to the ideas of William G. Spady, the original author of competency-based education as a pedagogical structure. To that end, I have coordinated my evaluation, assignments, and the entirety of my internship program to the American Music Therapy Association (AMTA) Professional Competencies. This is a system that I started in 2000 when the competencies were first adopted by AMTA, and I have revised it many times in the last 22 years. I am changing it now to accommodate parts of the new reality for us as music therapists - the reality that includes the possibility of telehealth as a definite part of our future as therapists. The point that I would like to make, however, is that I use the Professional Competencies to provide my interns with information that they need to know and to provide me with a more objective way to determine when they are ready to head out into the entry-level world.

So, how does it all work?

I started with the competencies, and I spent significant amounts of time reading them, trying to understand them, and then identifying where music therapy students learn the knowledge for each one of them. I used my own educational process to figure out where specific topics were started - there was a matrix and everything. During that initial process (class project in 2000), I was dismayed to see how many things my professor stated were "part of internship - we don't talk about that during coursework." As an internship director at the time, I realized that much of the foundational information that I was expecting my students to know when they walked into my facility on their first day was not there at all! Fortunately, my professor seemed to feel the same thing, so we started making courses more focused on the competencies. I wonder what an audit of any educational program, using the competencies as the evaluation tool, would indicate. Where and how are students demonstrating their competence in all of these things?

My premise is that students should be exposed to all the skills, knowledge, theory, and expectations of the AMTA Professional Competencies throughout their educational process. Now, notice that I said, "exposed," not "mastering." As with everything else that is involved in education, the Competencies are a developmental system. The benefit to using the competencies as a basis of all educational coursework, assignments, and clinical experiences is that there is a continuum of learning that can occur. If students know that they have to be able to demonstrate "Apply basic knowledge of:...10.2 Principles and methods of music therapy assessment, treatment, evaluation, and termination for the populations specified in the Standards of Clinical Practice" (2013) during their pre-internship clinical experience through the completion of the documentation indicated above, then they have an understanding of what they have to do in order to pass the course.

Now, I find that the AMTA Professional Competencies, as they are presented to us as professionals, are still very subjective and somewhat nebulous. Not all of them are cloudy when it comes to exactly what has to be demonstrated, but many of them are. There are significant errors in some of them - too many elements to demonstrate or difficult to evaluate as an observer - but that is my criticism of these particular competencies, but that means more work for me - fortunately, I love this type of work.

If we take competency 10.2 as an example, as written, students have to apply basic knowledge of evaluation steps and structures. So, as the professional, I have to decide how my students will demonstrate this basic knowledge. (By the way, what is basic knowledge of assessment? What is basic knowledge of treatment? What is basic knowledge of evaluation? What is basic knowledge of termination? Why can't we delineate that a bit more?) For my educational process, this was accomplished (now, keep in mind that my education happened before the AMTA Professional Competencies was actually a thing) by finishing assignments as directed by my clinical supervisors. Each supervisor had different criteria for demonstration, and I didn't know what was appropriate or sought until the assignment was graded and returned.

Imagine starting off your first ever pre-internship clinical experience. You get a list of things that you have to demonstrate during your semester. Under the list of things, you see 10.2  As part of your experience, you will need to write an assessment for your client. You get a template along with instruction about why music therapists look at things like motor planning and cognitive function and reflexes and medication responses and all sorts of other things. You have to write an assessment that follows a specific model. You see that you will write a treatment plan for your client, but you also see that your supervisor will work on this aspect with you, providing instruction and discussion about how to write goals and develop treatment. In addition, you will be adding in information that you learned in coursework. You will be writing therapeutic music experiences like in course #226, so you can do that without direct instruction from your supervisor. Oh, and you have to play accompaniment patterns on both the guitar and the keyboard in five keys. You know this when you start your clinical experience, so you can make a checklist. Something that can help you figure out your own work on this.

Now, when you move from your first pre-internship experience into your second, you see that there is less direct instruction and more independence in the tasks included in 10.2. This time around, you are expected to know how to write goals and objectives with less discussion with your supervisor. Your supervisor is going to provide more flexibility and instruction with the assessment form itself. You will be designing your own form to evaluate this client rather than having to stay with the template. 

The problem with competency-based education is that the people evaluating have to do lots of work before students even start their education. I, as the supervisor, have to decide what needs to be learned and demonstrated when. What is the scaffold of learning that is already present and what needs to be explicitly taught? 

I can tell you, from direct experience, that once the work of operationally defining each one of the competencies based on the experience or course is finished, then evaluation becomes easy. I have a 29 page evaluation that takes me about an hour to complete on each one of my interns - that includes both indicating areas of focus and writing comments. One hour.

So here is my professional dream. I would LOVE to act as a consultant to educational programs and to internship programs to coordinate their use of the AMTA Professional Competencies in all student encounters. I would love to assist in setting up developmental programs that indicate where music therapy students learn and then demonstrate all of the competencies. I would love to help others decide what skills are essential, and I would enjoy being able to start others on that path. I know of several people who have used my competency-based evaluation as a starting point. I would be happy to help others to do this as well.

If you are interested in talking to me more about this, please do not hesitate to comment or contact me!