End-of-placement failure rates among clinical psychology trainees : exceptional training and outstanding trainees or poor gate-keeping?

Objectives: The objective of this multisite study was to examine failure rates across placements during clinical psychology training. Method: Placement supervisors from nine clinical psychology programmes used the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS) to rate trainees’ competencies at the end of one of four placements (P1, P2, P3, P4). Results: Out of a total of 1449 placements, seventeen (1.17%) placements were failed, with fail-rates reducing as trainees progressed from P1 (2.45%) to P2 (0.77%), P3 (0.33%) and P4 (0.37%). CΨPRS norms used to identify competence as Much Below Standards generated similar fail-rates: 1.04% for all placements; 0.61% for P1; 1.28% for P2; 1.33% for P3; and 1.12% for P4. A larger subgroup (6.97% for all placements; 9.41% for P1; 4.34% for P2; 5.65% for P3 and 7.87% for P4) were also categorised as falling Somewhat Below Standards. The majority (88%) of these “Below Standards” placements received a pass grade from their supervisor. Conclusions: Supervisors tend to pass trainees who fail to meet competence thresholds on the CΨPRS. Placement supervisor assessments are essential but insufficient to ensure trainee competence, and supplemental assessments such as objective structured clinical examinations or competency assessment portfolios are important to complement supervisor assessments. KEY POINTS (1) The study reports end of placement failure rates for clinical psychology trainees across nine training institutions. (2) A number of trainees who received scores below competency thresholds were passed by their placement supervisors. (3) The study raises serious concerns about the sole reliance on placement supervisors’ assessments, and recommends additional independent assessments such as the use of standardised objective structured clinical examinations (OSCE) to ensure safe and competent practice among clinical psychology trainees.