The trainees' perspective: assessing beginning gero-competence in graduate level psychology students

Introduction There exists a severe shortage of qualified mental health professionals to provide services for the increasing number of adults aged 65 and over in America. One attributable explanation highlighted throughout the research is the limited exposure to experiences and clinical training involving older adults. A clinician's unconscious bias may be influenced by stereotypes reinforced throughout their life that fill voids in their understanding of older adults. Implicit bias develops over time as a result of observing how older people are treated. In a time of heightened uncertainty, agism reached a new level as pervasive ageist attitudes were portrayed in the media and society's response to the impact of the COVID-19 pandemic on older adults. It is well known that negative attitudes towards older adults and aging contribute to poor mental health, impaired cognitive function, and slower recovery from illness. Understanding how students' self-perceived competencies shifted throughout a global pandemic is essential for clinical trainees, supervisors, and the older adults they serve. Information from the responses can assist in identifying areas where programs may need to be revised to maximize geropsychology consultation, assessment, and intervention competencies. An essential component of geropsychology training is learning to gain self-awareness about one's responses to aging, which vary according to health status, cultural identity, and historical cohort. The study aimed to evaluate clinical psychology graduate students' self-reported foundational competency and bias before beginning clinical training with older adults by examining entrance scores between 2017 and 2022. Methods The current study utilized the "Pikes Peak Model for Training in Professional Geropsychology" training scale. Graduate students were eligible if they completed the Pikes Peak before starting their clinical psychology practicum in a counseling center for older adults. The participants (n = 28) used a five-point Likert scale to score their perceived competence (1 = Novice, 2 = Intermediate, 3 = Advanced, 4 = Proficient, 5 = Expert). Averaging responses to each grouping resulted in five domain-level scores: general knowledge, foundation, assessment, consultation, and intervention. The analysis of potential bias was assessed from the foundational self-reflection scale, which incorporates the awareness of biases, assumptions, stereotypes, and potential discomfort associated with working with older adults. Two one-way between-groups analyses of variance (ANOVA) were conducted to examine the effects of year on competency ratings for the foundation domain and self-reflection scale. To assess the impact of the COVID-19 pandemic, competency ratings from 2017 to 2019 were compared to those from 2020 to 2022 using two independent samples t-tests. Alpha level of .05 was used for all analyses. Results One-way ANOVA revealed that there was not a significant difference among the foundation domain means, F(5, 22)=1.059, p = .409, R² = .194. The year factor was comprised of six years: 2017 (M=1.95, SD=0.63), 2018 (M=1.86, SD=0.37), 2019 (M=1.58, SD=0.52), 2020 (M=1.52, SD=0.54), 2021 (M=2.20, SD=0.99), and 2022 (M=1.98, SD=0.51). A second one-way ANOVA indicated there was not a significant difference among the self-reflection scale, F(5, 22)=1.470, p = .240, R² = .250. The years as follows: 2017 (M=2.73, SD=0.94), 2018 (M=2.76, SD=0.48), 2019 (M=2.25, SD=0.96), 2020 (M=1.72, SD=.90), 2021 (M=2.87, SD=.12), and 2022 (M=2.96, SD=1.09). The results of the independent samples t-tests were not significant. Expanding the descriptive analysis to all substantive scales among the five domains, the highest average among subscales was the foundational self-reflection scale (M=2.54, SD=0.89). Conclusions Graduate students in clinical psychology reported their foundational self-reflection as their highest competency. The graduate students' awareness of biases and assumptions associated with working with older adults is among the highest competency before they begin clinical practicum. The average competencies values displayed a u-shaped relationship with the lowest values in 2020, although not statistically significant. Limited exposure may make graduate students more likely to reflect on their potential discomforts, biases, and stereotypes as they prepare to work with older adults. The lack of significant findings suggests that clinical psychology graduate students consistently reflect early in the practicum process at an intermediate to advanced level despite any socio-cultural changes. A future assessment will compare baseline reported competencies to additional time points throughout the student's clinical practicum training. Implications for the current presentation contribute to an increased understanding of initial trainee perspectives to help guide geropsychology training and improve teaching tools.