Utilizing Community Partners to Enhance Quality Intern Training

Psychology internship programs expand the knowledge of trainees using creative strategies and are required to reflect on whether or not their strategies are effective. Teaching and training while on internship should incorporate various methods of learning, i.e. experiential, lecturebased and/or collaborative learning. Collaboration with professional community partners into didactic lectures is an opportunity for trainees to gain exposure to unique specialty areas within psychology. A quality improvement initiative was conducted to evaluate the effectiveness of this training method. Interns’ evaluations of didactic lectures given by faculty members and community partners between 2010 and 2016 were compared. Results indicated interns rated faculty presentations higher overall compared to community partner presentations; however, the differences may be of low practical significance indicating commonalities between the quality of faculty and community partners presentations. Overall, results from the current study appear to support the use of utilizing community partners to support quality training in internship programs.

Psychology internship training programs use a variety of modalities and teaching methods in order provide competency-based training to psychology interns. Various parts of an internship program might include case conferences, direct service, clinical supervision, didactic lectures and scholarly activities to foster learning. Faculty and staff who are employed by the institution generally provide most training opportunities for interns and are well-versed in the areas of study with which interns are gaining competence and expertise. However, psychology can be a broad field, and there are times when topics or areas of interest arise among the intern cohort that are outside of the faculty's competency. Internship training aims to cover a breadth of knowledge and skill in psychological science by using a variety of teaching methods to meet the interns' needs.
One consistent area of training that occurs weekly throughout the year is didactic lectures. Didactic lectures are often used by training programs to further the intern's education by expanding their clinical knowledge base and exposing the intern to various subject areas, such as theoretical orientations, therapeutic techniques or multi-cultural awareness. The faculty and staff within the institution who are in regular contact or supervisory roles with the interns often teach didactics. However, the number of faculty varies between training programs, and some programs possess a limited number of faculty to present lectures, which may leave the same faculty presenting regularly on a limited range of topics. There is limited information available in the literature to guide programs' decisions in how to create a robust and quality didactic series. Zuckerman, Weisberg, Silberbogen, and Topor (2019) recently acknowledged the importance of learning more about the nature of didactics and their role in training. In their study, they found that 75% of lectures were taught by faculty members, and they documented common practices among programs who incorporate didactics into their teaching curriculum. One of the challenges that was reported related to programs being able to find presenters with knowledge in specialty topic areas, such as telepsychology or research. Meltzer, Phillips, and Mindell (2009) also noted that training experiences can be limited at times depending on the faculty's area of expertise and reported the benefits of having formal didactics to provide effective education in a clinical area.
In order to expand the potential areas for training, an internship program could benefit from including professionals outside of the institution for a program to fully meet the training needs of the interns. They can also offer the interns an opportunity to stimulate interest in a different area of the field that may not have otherwise been considered. Collaborating with professionals or community partners in the local community offers an opportunity to expose interns to a diverse range of topics and perspectives.
To date, few studies have examined the effectiveness of utilizing community partners specifically in the training of psychology interns. However,, other disciplines, such as education and public health, have shown utility in collaborating with community partners to enhance outcomes for the community as well as individuals (Barrera, 2015;Parker et al., 2017). In Hawaii, Kimura et al. (2011) studied the importance of working across disciplines and developing partnerships as a way to expand training programs for students in education, law, nursing and social work. They found that using a collaborative and multi-disciplinary approach was beneficial to the students' professional development. While some programs have focused on partnerships in training, others have focused on research initiatives and clinical interventions that are enhanced through partnerships with community agencies.
For example, Youn et al. (2019) examined the relationship between an academic setting and community agency to create a model for sustainability when research on clinical interventions is being conducted. Researchers aimed to improve evidence-based cognitive-behavioral treatment in high needs communities and also addressed the barriers that arise when working alongside community agencies. In the area of mental health, research has indicated collaborations between rural and urban mental health providers is not only welcomed, but can also teach alternative perspectives to use in clinical practice (Barbopoulos & Clark, 2003). This provides evidence for the benefit of exposure to various disciplines, and how professionals can learn valuable skills when working outside their own field. Furthermore, Renninger et al. (2015) indicated exposure to a diverse group of professionals enhances a trainee's experiences through recognition of accomplishments and developing interpersonal relationships. The authors also highlighted how diversity in training promotes new career paths, an increased sense of community, as well as, encouragement and inspiration to pursue professional goals to trainees.
In addition, Johnson et al. (2013) outlined the benefits of a communitarian approach to clinical practice. The authors argue that professionals who had a diverse constellation of mentors, supervisors, community partners, and collegial acquaintances reaped a number of benefits including: additional support, increased competence, and well-formed professional networks. Johnson et al. (2012) further explained the importance of psychologists acknowledging their limitations to competency and being aware of how practicing or training others when you are not competent could pose ethical problems. Therefore, faculty should seek out the support of community partners to teach trainees in specialized areas of psychology rather than taking on lectures that are not within their skill set or limiting the range of topics presented.

Community-University Partnership
The Section of Psychology, which is housed within the Department of Psychiatry, established relationships with various community partners ten to fifteen years ago in an effort to increase diversity of presenters and offer the psychology interns a rich training experience. For the purposes of the current study, the authors define community partners as mental health professionals who have expertise in a specific area of psychology and are actively practicing psychology or related mental health practice in the larger community. The department has created valuable relationships with community partners in the greater metropolitan area who are willing to volunteer their time and offer their expertise to train psychology interns.
Most community partners work in a private practice setting, but others work within community agencies that have established relationships with the department. For example, a local psychologist working in private practice that specializes in sex therapy and couples therapy has taught an annual didactic for the intern classes for the last ten years. Her expertise in sex therapy and couples therapy are unique, and the department does not have a faculty member who specializes in this area. Each year interns rate her presentations favorably and report that she presents new information that they did not receive in graduate school training. Another example is a licensed clinical social worker that works for a local charter school as well as in private practice. She teaches the interns about custody evaluations with children. Custody evaluations are not a typical skill learned at this particular internship site, but the interns have found the information learned relevant and complementary to other work they are doing with children and families, which makes the didactic a valuable learning experience.
The department has also found that community partners are eager to share their knowledge with interns who represent the future of the profession and offer their knowledge of a real world perspective of the psychology profession to trainees. Their involvement in didactics is on a volunteer basis, but these professionals do receive informal benefits through partnership with the university such as networking in the mental health community, their own professional development and being listed as gratis faculty in the department. The gratis faculty affiliation is a position appointed by the Department Chair. The position is designated for individuals who contribute to the university through scholarly teaching but are not compensated financially for their time. Gratis faculty have access to the university library system and can report their affiliation with the institution on their curriculum vitae. By collaborating with the internship training program, community partners also have the opportunity to enhance their teaching and presentation skills, which is an added benefit for the partners. Further, most individuals in private practice have reported a desire to remain connected to a training community as an opportunity to give back to the profession and enjoy the opportunity to connect outside of their independent practice. While the development of these individual partnerships has provided clear benefits for the internship program, community partners benefit as well.
As previously noted, several community partners have been presenting annual didactics for the internship for over ten years since the partnership started, which highlights the positive, long-standing relationship the department has formed with professionals. In addition, many of the community partners have worked alongside faculty members in professional organizations or committee involvement. The relationships that have been formed with community partners often started on a committee for a state organization or local community program. As faculty members met professionals in the community who expressed interest in the activities of the training program, the faculty and the community partner together would determine what expertise the community partner had that would be of special interest to the interns as well as what topic areas were not currently in the curriculum. Therefore through the networking of the department's faculty members, many of the partnerships have been formed and sustained.
In addition, some community partners are also alumni of the internship program who are now working in a private practice setting or community agency outside of the university. The alumni have working knowledge of the interns' experiences at this internship site and offer an additional level of support and familiarity, which is beneficial to the program and the interns' training. When the alumni provide presentations as community partners, the interns can envision what the next phase of their career might entail and feel a sense of hope for their career aspirations. For example, one alumni who graduated eleven years ago and is now on faculty at another university continues to present an annual didactic on Acceptance and Commitment Therapy, which is a specialty therapeutic technique not commonly taught in graduate programs. His presentation has been consistently well-received, and interns report that he stimulates interest in a new area of therapy.
The creation of the community-university partnership has achieved the Section of Psychology's goal of providing diversity in presenters as well as offering a wider breadth of topics for interns. The partnership aids the internship program in meeting accreditation expectations and improving the foundation for the training program's lecture series. Community partners have provided interns with the opportunity to learn from individuals actively engaged in a specific area, which provides the intern with a more knowledgeable presenter with a unique interest in a topic. A wider spectrum of training didactics provides the interns with a broader range of experiences, which they might not receive in all training programs if they are narrowly focused. On several occasions, interns have reached out to community partners regarding possible job opportunities following internship, which has been another advantage for the community partners as well as the interns.
The internship program reviews the effectiveness of the program and training opportunities on a yearly basis. Thus, a quality improvement initiative was created to ensure that the internship program was providing quality training experiences to interns. The initiative aimed to examine the influence of community partner led didactic lectures on intern training experiences. Researchers analyzed interns' ratings of a series of didactic lectures taught by faculty and community partners.
Overall, the current study hypothesized that interns would rate both faculty and community partner presentations equally on weekly rating forms in regards to the following criteria, including: relevance to current clinical work, presenting useful skills, presenting up-to-date information and stimulating further interest in the area. In other words, the study sought to determine if there were perceived differences between didactics led by faculty and those led by community partners. A positive outcome would solidify the programs decision to continue inviting community partners to participate in didactic lectures and enhance the quality of training throughout the internship. These findings could be beneficial to other internship training programs whether established or in development to provide a framework for creating quality learning opportunities. Additionally, this study could be influential in expansion of education outside of faculty specialization in training programs that have a smaller number of core faculty to provide lectures.

Method Participants
Participants consisted of 35 psychology interns who participated in a psychology internship training program at an institution in a metropolitan area between 2010 and 2016 who evaluated 72 community partners' presentations and 65 faculty presentations. The internship program lasts approximately one year and contains six interns per year, with the exception of year 2012-2013 (i.e., 5 interns). Most interns were female (88.6%; male = 11.4%) and White (82.9%; Black = 8.6%; Asian = 5.7%; and Middle Eastern = 2.9%).
Over the course of each training year, the interns participate in weekly didactic lectures. Presenters are a combination of faculty members at the institution and community partners who specialize in the mental health field, i.e. psychologist, psychiatrist, social worker or counselor. The interns also present once during the training year but their didactics are not evaluated with rating forms. Table 1 represents the educational level and discipline of the presenters over the 2010-2016 training years.

Measure
The psychology didactic evaluation form was created by the training program to assess the effectiveness of didactics provided to interns based on the interns' objective and subjective feedback of the presentation and presenter. The form consisted of nine items in which participants provided responses using a 5-point Likert scale (1 = Unsatisfactory, 5 = Excellent). Six items were related to the content of the presentation, whereas three items were associated with the presentation style of the presenter. Examples of presentation items included, "Relevance to current clinical work" and "Presenting useful skills," whereas examples of presenter-related items were "Receptive to feedback" and "Stimulates further interest in the area." Two additional options were available if the participant did not wish to respond to the item (Not Observed; Not Applicable). Interns also were given the option to provide qualitative responses about the presenter's strengths and/or weaknesses. Internal consistency for the current study was excellent (α = .91). A total rating score was calculated by summing all items. Subscale scores for presentation content and presenter style were calculated by summing items associated with each domain.

Procedures
As part of the internship program, interns participated in a once-weekly didactic lecture presented by a faculty member or community partner. Faculty members presented on topics in their area of expertise and community partners were sought out for topics that were outside of the faculty's scope of practice. Community partners with specialty areas of training, who did not have a specific relationship with a faculty member, were recruited via email and phone calls to mental health professionals in a metropolitan area to teach in areas that were outside of the expertise of the faculty within the institution. If community partners agreed, then they volunteered their time and presented a one-time lecture for the academic year. Many community partners often returned the following year if requested by the faculty and if they were rated highly by the interns. Community partners who were rated poorly be the interns on numerous areas of the evaluation form were generally not invited the following year to present. Therefore, interns' evaluations and feedback was very important in the program's decision as to whether or not to retain community partners in the training program. The presentations covered a variety of topics, including therapeutic modalities, psychological disorders, assessment, cultural diversity, ethical issues, and supervision. After each didactic, interns were given a paper and pencil rating form and anonymously rated the presentation. Completed forms were then turned into the department administrative assistant to ensure anonymity and for data entry. Interns were encouraged to complete rating forms as soon as possible after the presentation was completed to provide the most useful feedback. Rating forms were reviewed by the Coordinator of the didactic series as well as the Training Director for the internship program. Following didactics, presenters are given feedback about their presentation. For the current study, researchers reviewed existing data that was completed from July 1, 2010 through June 30, 2016. All research protocols were approved by the Institutional Review Board.

Descriptive Statistics
During the project period (2010-2016), 72 presentations were given by community partners and 65 presentations were given by faculty. Interns completed 727 evaluations over the course of six years. Of the 727 evaluations collected, three-hundred and seventy-eight (378) evaluations were completed for the community partners, whereas 343 were completed for faculty presentations. See Table 1 for additional descriptive statistics regarding presenter discipline and educational level. Overall, the majority of both community and faculty presenters held a doctoral degree in psychology.
An independent samples t-test was conducted in order to test the hypothesis that there would be no difference in intern ratings of presentations given by those of community partners and faculty. Missing data was handled with listwise deletion. Using a total score (M = 39.02; Min. = 14, Max. = 45; SD = 5.65), the results revealed a significant difference between community partner (M = 38.64, SD = 5.78) and faculty (M = 39.47, SD = 5.45) presentations, such that faculty presenters received higher overall ratings than community partners, t(719) = -1.97, p = .04.
Next, additional independent samples t-tests were conducted to determine if there were significant differences between community partners and faculty on specific areas of evaluation (i.e., presentation content and presenter style). Overall, presentations given by faculty were rated significantly higher on presentation content, such as relevance to interns' clinical work, organization, presentation of useful skills, and handouts/ visual aids. However, no significant difference was found between faculty and community partners regarding presenter style. See Table 2 for results.

Qualitative Data
Qualitative responses from interns' rating community partners were examined to understand the perceived benefits of utilizing community partners in training didactics. Thematic responses highlight the strengths of community partner's Presentation Content and Presenter Style.
Interns found Community Partners to be very knowledgeable in their content area and often commented as such. Interns often coupled their expression of knowledgeable presenters with an assertion of their use of personal experience, and their ability to tailor the information to the specific needs of the audience. Example of this can be seen here: "Very knowledgeable about topic," "Offered great examples," "[the presentation] was tailored to our knowledge/needs" and "He asked for our needs [in] the discussion and altered his presentation accordingly." Personal experience being used by presenters was an often recorded strength such as this intern's feedback: "Appreciate his openness and willingness to share personal anecdotes." Community partner's Presentation Styles were often recorded as being highly interactive for interns. Such as this presenter on being described as "Fun and experiential." The presentations were seen as dynamic, often blending interactivity with an ability to utilize their community experience as case examples to demonstrate the topic. Interns described this in multiple ways including: "Good use of case examples. Really enjoyed the hands on examples" and "Interactive. Nice use of creative expression." This qualitative data highlights that community partners may be an appropriate solution in cases of limited faculty-led lectures even though they do not provide specific advantages over faculty didactics.

Discussion
The current quality improvement initiative examined the impact of community partner led didactics on intern training experiences by comparing interns' ratings of community partner and faculty led didactics presented during an internship training program. The use of community partners in internship training may provide a quality teaching method to expand the clinical and theoretical knowledge base of psychology interns in particular for programs who have a limited number of faculty within their institution. Community partners provide interns with exposure to diverse areas of training that might otherwise not be covered during the training year. This model of expanding on training initiatives could be generalized across other disciplines who are looking for alternative teaching methods to improve quality training experiences for trainees and students. Results from the current initiative indicated interns rated faculty presentations higher overall compared to community partner presentations. Furthermore, interns reported greater satisfaction with the content of faculty presentations, such that faculty presentations may be more related to their own clinical work, organized, and useful (via skills presented and handouts) than community partner presentations. This may be due to a number of factors, including interns' familiarity with the faculty presenters and faculty teaching experience. In addition, faculty may have more familiarity with the specific populations the interns are currently treating and, as a result, may tailor their lectures to those populations.
There were no differences between community partner and faculty presentations regarding presenter style (i.e., perceived knowledge about the topic, effective use of time, and receptivity to feedback). In addition, while there were no significant differences between ratings of community partner and faculty presentations regarding the presentation of updated information; thus, both faculty and community presenters appeared to provide the interns with relevant, up-to-date information about their chosen topic. Intern feedback recorded strengths such as: "Presented new information with rich examples." This further suggests that incorporating community partners into training can provide a positive, quality impact and benefit to interns' experiences in cases where a lack of faculty-led lectures exist.
The study was beneficial to the internship program because it solidified the programs decision to utilize the resources and knowledge of community partners in the training of interns. The quality improvement initiative was effective in deciding to continue this aspect of the training program while also providing a foundation to support the decision to have community partners teach intern didactics. While this model may be unique to one program, it has the potential to assist training programs who are determining how to provide quality training that is engaging to trainees.

Limitations
Although the results from the current initiative are promising, they are not without limitations. The current project utilized data collected from presentations and evaluations at one internship site in a metropolitan area. Thus, the results may not be generalizable to other internship sites, particularly sites that may be located in more rural settings and that lack access to a large community of mental health providers. In addition, the average ratings for both faculty and community presentations were close to the maximum rating, suggesting a ceiling effect may have occurred. Ratings could also be higher due to the fact that the faculty review evaluations each year and closely monitor intern feedback on presenters. When the feedback is negative or suggests that the presentation lacked quality, the presenter was not asked to return the following year. Moreover, results cannot make any claim regarding the effectiveness of using community led presentations on intern competency, skills or achievement. Nevertheless, results are encouraging in that interns appeared to find community led presentations as useful and as beneficial as faculty led presentations.
Future research should include examining the effectiveness of using community partner didactics on intern competencies. Studies could compare intern competencies pre-and post-internship to determine the influence of community led didactics on competency level It may be that interns would prefer for community partners to be more knowledgeable about the intern skill level and case load prior to conducting the didactic. Lastly, future studies could examine the role of presenter and intern demographic characteristics (e.g., gender, ethnicity, age) to determine how these variables may influence perceptions of presentations.

Implications
The current initiative highlights one potential avenue to enhance the training of interns by incorporating members of the community. Other training programs may consider this approach to broaden the scope of training, especially for programs with limited numbers of faculty members available to teach the interns. This model could apply to training across a variety of disciplines and is not specific to only psychology training. Community partners provide another perspective to trainees, which may aid in professional development and personal growth for both interns and community partners. Presenters are provided with feedback following their didactics, so they are given the opportunity to enhance their own presentation skills and understand how their time and expertise are beneficial to the growing profession of psychologists. These presenters may also expose the intern to an area of expertise that was previously unknown or unfamiliar. In addition, community partners could be utilized as an opportunity for networking and connecting trainees with potential future employers. Results from the current study appear to support the use of community partner didactics in the education of psychology interns. There may be future benefits with broader implications, which may not be apparent in the present study. Future studies should examine the role of community partner didactics on intern competency level as the effectiveness and quality of teaching for psychology interns is vital to the sustainability of an internship program.