Excerpted from the ASPPB publication, Oral Examination Guidelines (August, 1999).
In order to be considered valid, an oral examination should include the following measures of the examinee's ability as defined by the Practice Analysis: define problems; observe and interview effectively; assess client/ patient/ organizational needs; diagnose/formulate problems accurately; design, implement, and evaluate interventions; gather information from related sources; make appropriate referrals; and follow professional and ethical standards and guidelines and state/ provincial and national laws and regulations. One method of assessing these abilities measures each skill in relation to a standardized case vignette that presents a general, generic scenario followed by a standardized format of questions. This method can be used to address both reliability and validity issues. The use of a generic case vignette addresses validity; the standardized format in which each examinee answers the same basic questions addresses reliability. The content of the questions is related to the Practice Analysis, and this provides content validity .
Case Vignette. Given that most psychology licenses are generic, case vignettes should describe clients / patients that would be familiar to most practitioners. Case vignettes should be written to describe clients/ patients suffering from common psychological disorders such as depression, anxiety, adjustment disorders, etc. Each case vignette should describe the client/patient demographically (e.g., age, sex, ethnicity, social economic status (SES), occupation, education, marital status, family configuration), the presenting problem(s), and relevant history (social, developmental, medical, family, career, educational, etc.). As the examination proceeds, further prepared details may be added to the vignette including: formal test results; a crisis situation; a cultural diversity change in the demographic information, and legal/ ethical issues to consider.
Pass point. In the following sections and in the examples in the appendices, performance standards expected of examinees for independent practice at the entry level to the profession are developed. These performance standards are established by identifying responses from previous minimally competent candidates that represent varying levels of candidate performance. The responses are arrayed along a continuum to create rating scales used by examiners to evaluate candidate performance. Responses to the questions relating to the vignette presented are assigned a numerical value, and a score representing minimal competence is established. To achieve a passing score, candidates must earn a score equivalent to minimal acceptable competence on the rating scale used. In Appendix I scoring procedures relating to the sample vignette are given.
Examination Format. Each examination on a case vignette would be organized in the same format. The common sections that have been derived from the direct service role of the Practice Analysis are as follows:
Identifies Problems/Diagnosis would assess the examinee's ability to utilize relevant data in the case vignette to reach empirically based and theoretically consistent differential diagnoses. The section would assess the examinee's knowledge of the range of diagnostic nomenclature and criteria in standard systems (e.g., DSM-IV, ICD, Relational, etc.) and use these systems to conceptualize and describe the problem(s) and functioning of the person taking into account the problem context and situation. The examinee must utilize all information in the case vignette to formulate a diagnosis (diagnoses ).
Assessment and Evaluation is designed to assess the examinee's ability to identify appropriate sources of information (e.g., clinical interviews, observations, forma assessment data including testing, structured histories, genograms, medical records collateral sources and contexts, etc.) to evaluate the clients/patients functioning in a variety of areas including affective, cognitive, and interpersonal. The examinee must be able to integrate information from various sources into a coherent whole and be conversant with differential diagnoses. If psychometric test instruments are used the examinee must understand psychometric theory, apply statistical techniques, and explain the meaning of test results.
Treatment Planning, Implementation, and Outcome Assessment is designed to test the examinee's ability to describe, implement, and evaluate a course of treatment that is consistent with the case formulation, empirically justified, sensitive to the clients/patients needs and values, and designed to resolve the problem(s) Examinees must be able to describe the treatment; provide theoretical and empirical rationales for the treatment choices; and describe an appropriate plan to evaluate treatment results, including functional assessments for monitoring progress, process and outcome of interventions. They must be able to apply quality assurance measurement techniques (e.g., sampling, instrumentation, data collection procedures client tracking, formative and summative evaluation, program evaluation).
Crisis Evaluation/Treatment/Management introduces a crisis situation to the case vignette to assess the examinee's ability to assess and intervene in a crisis event. Crises may include danger to self, danger to others, child/ spouse/ elder abuse psychotic decompensation, drug/ alcohol abuse, etc. Examinees must identify crisis risk factors and take appropriate actions and precautions. Examinees must be aware of personal and professional limitations and know how to refer client/ patient to appropriate resources (e.g., hospital, emergency room, psychiatrist, etc.).
Human Diversity is designed to test the examinees' knowledge of the range of individual and group diversity and the ability to incorporate the knowledge o diversity into practice. This concept is introduced by changing a demographic characteristic of the client/ patient in the case vignette, such as ethnicity, socioeconomic status (SES), sexual orientation, gender, physical and psychological abilities/ disabilities, etc. The examinee is then asked how this change would affect his/her diagnosis and treatment plan. Examinees must demonstrate adequate knowledge, awareness of professional limitations and need for consultation OJ referral, lack of stereotyping and bias, and awareness of the importance of differences
Professional Ethics and Standards tests the examinee's knowledge of professional standards and ethics and the ability to integrate them into professional conduct and practice. Examinees may be asked to discuss ethics and standards that they perceive to be relevant to the case vignette, or a particular ethical or professional dilemma ma) be presented for them to consider. Examinees must demonstrate clear knowledge of ethics and standards and apply them appropriately.
Legal and Regulatory Mandates is designed to test the examinee's ability to integrate and apply federal/national and state/provincial laws and regulations related to professional conduct to professional practice. Examinees may be asked to discuss legal/ regulatory issues that they perceive to be relevant to the case vignette, or a particular legal/regulatory issue may be presented for them to consider. Topics may include confidentiality, record keeping, abuse reporting, etc.
Professional Limitations and Judgment is designed to allow the examiner to assess any professional or personal characteristics or behavior on the part of the examinee likely to interfere with professional performance and to test the examinee's awareness of areas of professional expertise and limitations. These assessments may be used to avoid licensing/ registering an examinee who may be incompetent or a danger to the public or to define the limits of practice and competencies of the examinee. These may be measured by a combination of observations and structured questions. The examinee should be able to assess his/her personal and professional expertise and limitations and take actions that are consistent with skills, knowledge, experience, and limitations. Examiners may assess professional limitations by structured questions regarding examinee limitations and by observing limitations in answers to prior questions in the examination.
Jurisdictions should develop a procedure for examiners to use when confronted with an obviously mentally ill examinee. Some jurisdictions, such as California, have such a procedure established and can refer examinees to a mental competence review committee.
Vignette Writing Outline
1. IDENTIFIES PROBLEMS/DIAGNOSIS a). What are your initial impressions of the client's problems? What possible diagnoses would you consider? On what information do you base your hypotheses?
2. ASSESSMENT AND EVALUATION
a). What further information do you need from this client/ patient to confirm a diagnosis / problem conceptualization?
b). How would you obtain this information?
*Note: Some jurisdictions may choose to specify an assessment instrument and provide a protocol for interpretation.
3. TREATMENT PLANNING, Implementation, AND OUTCOME ASSESSMENT
a). Give diagnostic/ problem information -DSM or other. How would you design and implement a course of treatment that is consistent with this case formulation, sensitive to the client's/ patient's needs and values, and empirically justified?
b). How would you evaluate the results of your intervention(s)?
4. CRISIS EVALUATION/TREATMENT/MANAGEMENT
a). Present a crisis situation related to the vignette.
(Candidate must identify crisis risk factors, take appropriate actions and precaution and know how to refer client/ patient to appropriate resources [e.g., hospital emergency room, psychiatrist, etc.]. Candidate must also demonstrate awareness (relevant confidentiality issues.)
b). What are your personal and professional limitations in dealing with this crisis?
5. HUMAN DIVERSITY
a). Supply diversity by changing race, ethnicity, sexual orientation, gender, disability etc. How would that change your case conceptualization and treatment plan?
(Candidate must demonstrate adequate knowledge, awareness of professional limitations and need for consultation and referral, lack of stereotyping and bias, and awareness of importance of difference [i.e., does not respond as if individual and group differences make no difference].)
6. PROFESSIONAL ETHICS AND STANDARDS
a). Present a questionable behavior on the part of the client, a colleague or coworker, a family member of the client, etc., which raises an ethical dilemma.
b). What professional ethics and standards inform your response?
7. LEGAL AND REGULATORY MANDATES
a). Describe a situation that has legal and/ or regulatory implications. Ask what the client would do.
b). What legal issues are relevant?
8. PROFESSIONAL LIMITATIONS AND JUDGMENT
a). You have heard about a new type of treatment that could be useful in treating persons such as your client. How would you go about evaluating and learning this new treatment?
b). In what continuing education experiences have you participated in the past year?