Time to rewrite the rules

Rachel Holt on the clinical psychology training process, and inclusion.

I started my clinical psychology training 20 years ago; I now participate in the selection process for new doctoral trainees. I note, with a sinking heart, that the selection process has changed very little since I was a candidate. Application forms are rated against ever-higher standards and selection days still include interviews, a research task and group task. Some candidates shine. Others spend the day seemingly stunned, unable to display the abilities their referees have carefully described.

In 2018 (the most recent year for which data is published), psychology doctoral applicants roughly matched the population demographics on some measures, however successful applicants were much more likely to come from certain groups.

Applicants roughly matched the general population in terms of ethnicity (80.9% of applicants were white, compared to 86.0% of the general population; 7.0% were Asian, compared to 7.5% of the general population; 4.3% were Black, compared to 3.3% of the general population). 

However, success rates varied hugely between ethnic groups. Of the white applicants, 16.7% were successful in gaining a place, but only 9.1% of the Asian applicants and 8.6% of the Black applicants had the same result. 

When you look at applicants’ socio-economic backgrounds, 26.6% came from Quintile 5 (the highest socio-economicbackground), but only 8.0% came from Quintile 1. The disparity grew when it came to actually gaining a place: 20.6% of applicants from Quintile 5 were successful, but only 9.0% from Quintile 1 (University of Leeds, 2018).

The need to dismantle structural racism is rising up the public agenda, following findings that BAME people are at increased risk from Covid-19, the murder of George Floyd and corresponding growth of the Black Lives Matter movement. So how do we rise to this urgent challenge and ensure that clinical psychologists match the demographics of the population we serve? Doctoral courses use a variety of tests and assessments to choose between hundreds of well-qualified applicants for a small number of places, yet fail to select trainees who are representative of the population. The current system isn’t working. It is time for radical thinking.

Instead, we could group all applicants who meet the minimum criteria, make a stratified random selection, and offer places to applicants in line with population demographics. Barts and the London School of Medicine used a similar system in 2003 to select doctors for training. At the time, outrage ensued. ‘It makes a mockery of equal opportunity policy,’ the media reported. However, the reverse is true. This system removed any bias – conscious or unconscious – for or against applicants. Similarly, stratified random selection for psychology trainees would remove the prejudices within the current system.  

Questions remain. How would you test interpersonal skills? How could you assess values? 

Yet, the current system can also be questioned. How well does the over-emphasis on interview really assess interpersonal skills on the job itself, instead of in the interview room? In addition, won’t my own biases will mean that, as an interviewer, I will understand ‘good interpersonal skills’ as ‘being as similar as possible to me – a middle class white woman’? And, as for assessing values, there are already online values assessments for people applying for NHS jobs, as part of minimum criteria.

There is a more fundamental objection – fairness. Wouldn’t this system be no more than a prize draw which some people would never win no matter how hard they try? In the current system, you can always work harder, get more experience and qualifications, or do more research. However, I’m not convinced that these things, which make winning more likely, are indicators of candidates who are more likely to be good clinical psychologists. The system is already unfair. It’s already a prize draw that most people don’t win. It’s time to rewrite the rules.  

Dr Rachel Holt

Consultant Clinical Psychologist & Approved Clinician 

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