The hidden curriculum of gatekeeping: Dismissal experiences of health service psychology trainees

Health service psychology (HSP) programs, encompassing clinical, counseling, and school psychology, play a pivotal role in shaping the U.S. healthcare workforce. Practicum and internship sites are critical gatekeepers within this training. However, there is limited empirical evidence available regarding the prevalence of clinical dismissal and its consequences for affected trainees. To bridge these gaps in our understanding of clinical dismissal during HSP training, Study 1 conducted an analysis of a quantitative survey involving HSP training directors (N = 123). The results revealed that 28% of HSP programs reported at least one trainee having been dismissed from a practicum or internship site within the past seven years, with an overrepresentation of racial minority and international trainees. In addition, Psy.D. programs (56%) exhibited a significantly higher likelihood of having dismissed trainees compared to Ph.D. programs (23%) over the same period. In Study 2, qualitative interview data were collected from ten trainees who had experienced dismissal during their HSP training. Using the Consensual Qualitative Research (CQR) method, we identified six distinct domains, each comprising unique categories and subcategories: Antecedents to dismissal, reasons for dismissal, process of dismissal, chain reactions, trainee impact, and recommendations. Taken together, this mixed-method study highlights that the clinical dismissal is not an uncommon occurrence in HSP training and raises significant concerns about the current implementation process. We illuminate structural issues and offer recommendations to improve the process of clinical dismissal within the HSP field.