Before I wrote this, I did some research. Based on what I could find online, in an ideal scenario, there appears to be approximately 240 internship sites available across all internship cycles. However, during the most recent summer round, there appeared to be less than 40. While summer internships are often less available, this felt like a new low. Furthermore, barriers to application, like cost, exclusive affiliation agreements, and location, mean the number of sites realistically available to most students could have been drastically less.
While the reverberating effects of COVID-19 on the internship process felt previously unimaginable, for many students it seemed as though the pandemic merely exacerbated what had long been boiling beneath the surface. The lack of placement opportunities simply took the traditional barriers to internship to new heights, creating a culture of unrealistically high standards that left students with advanced degrees and thousands of hours of experience debating pursuing certification. I personally know dozens of highly qualified students who experienced shocking rejections from first round interviews, rejections that, one could argue, may not have occurred even just a few cycles ago. Moreover, as child life programs continue to remain understaffed and overwhelmed by equally qualified applicants, the system as-is leaves internship committees without the resources, support, or tools to further create or pursue solutions. This added strain means overwhelmed programs are also probably subject to higher degrees of stress and subconscious bias during decision making which may contribute to the reality that the profession remains overwhelmingly white, female, and able-bodied. Coupled with the growing prominence of video submissions, where students are forced to spend hours on their appearance and video editing skills, being told presentation is just as important as content (often while also being asked to meet difficult submission deadlines), the current system just simply does not function in a way that will allow us to begin to break the cycle of compounding inequities.
The uncomfortable reality here is that not securing an internship often results in abject harm, all the more so for those students living with marginalized identities; our entire lives and livelihoods are placed on indefinite hold. Without internships, we may not be able to graduate, we cannot move forward with certification, and we will not be able to find work in the child life field. We are stuck, in limbo, for months, and sometimes even over a year due to when application due dates fall. I know multiple students who had to put off starting a family or buying a house because they have to try yet again for another internship cycle. Additionally, there has been an elevated mental and physical toll on students that must be addressed. During this past internship cycle alone, numerous students became so despondent they could not sleep, a student with IBS mentioned experiencing several flare ups, and more than one experienced a relapse of their anxiety and depression requiring additional medication. These experiences are not hyperbolic, and they are not uncommon.
The following is just a small sampling of how consequential the current process can feel:
The overwhelming financial burden is repeatedly pushed onto students, trapping us in a system where only those with consistent financial support can complete the process for certification. Applications for practicum and internship are a significant cost. As most hospitals explain they have too many applications to provide confirmation of receipt, it is expected students pay for tracking in addition to the cost of stamps, envelopes, paper, and printer ink. I know more than one student who has paid over $100 just to mail out applications. Given the current landscape, it is expected students will do this over and over again until they are able to secure placement.
Despite the steady increase in cost of living throughout the country, students are still expected to afford furnished housing, gas, utilities, food, potential car rentals, and other necessities for four months while working full time during internship with no income. We know marginalized students are already more likely to experience wealth inequality, thus compounding the problems surrounding a lack of diverse candidates and, ultimately, Certified Child Life Specialists. While incredibly and inequitably taxing, students who are seeking clinical experiences understand they will (a) most likely have to move and (b) that moving all but guarantees it will cost thousands upon thousands of dollars to complete an internship. We undergo the painstaking application process anyway as, for almost all of us, there is simply no other choice.
Conversations around competitiveness often feel moot as hundreds of students remain in a backlog that could take several cycles to get through (and that is if no new applicants even enter the process). Students are often told to improve their resume each cycle by simply acquiring any experience they can. The idea that students should simply continue to pad their resumes, when they already qualify for internship according to ACLP requirements, is an issue of equitable access to certification and undue burdens, not competitiveness or quality of applicants. Moreover, individuals applying to internships for the first time are not always able to compete with those who have been through multiple cycles and may have already completed multiple practicums or additional experiences. Not to mention, the turnaround time from summer to fall applications is only about four weeks and, while the turnaround from fall to the winter/spring deadline is around four months, most opportunities to apply for summer practicums or other experiences will have passed by the time internship offers are finalized. What do hospitals realistically expect students to accomplish during these time frames?
Furthermore, despite the ACLP clearly noting practicums are not required for certification, practicums have become as competitive as internships, requiring the majority of students to go through multiple rounds before being granted placement. It is expected students should now be willing to move across the country in order to obtain these entry-level experiences. Some hospitals tell students they now need to have at least two practicums on their resume while other hospitals tell students they view multiple practicums as a potential red flag, wondering if it implies they were not able to successfully complete the others. Ultimately, many students report having to “play the game” with internships, and now practicums, resulting in severe mental anguish, confusion, and burn out before they ever enter the field.
Similarly, it is important to note we are no longer operating under a system within which applying to as many hospitals as one can afford guarantees an internship. A student who applied to 21 internship sites was rejected from all 21. However, they exceed qualifications according to both the internship readiness standards the ACLP has currently outlined and the feedback provided by the hospitals to which they applied. Another student shared with me they “did everything right” and “even asked for feedback [to see where they could improve].” But, the feedback was essentially, “there were six of you in the final round and at some point we just had to pick one.” Additionally, despite knowing nothing about where else students may have been able to – or even wanted to – apply, hospitals needing to draw a line somewhere have begun recently denying qualified students based on assumptions. An anonymous, vetted Instagram post explained a selection committee “considered not offering [an internship] to a student they “…didn’t think [would] choose [their] small hospital.” Meanwhile, a different student received an email in which they found out a hospital stopped accepting out-of-state candidates altogether because they became inundated with applications and figured out-of-state students would not come if they received an offer closer to home. While I applaud these sites for their honesty, and I genuinely encourage more of it, how many other students, without knowing, have been rejected for similar assumptions rather than their ability to actually be successful interns? There may be even more barriers to certification in which students continue to bear the brunt of the harm.
To further put this into perspective, during the past round of applications, I interviewed students who had been rejected from various hospitals and contacted the hospitals about their application numbers. In two instances, the hospitals informed me that they had received “over 100” (the hospital with the highest application numbers) and “66” (the hospital with the lowest number of applications). The “over 100” hospital accepted four students, and the “66” hospital accepted one. That means those two hospitals had rejection rates of 96% and 98%. Even with possibility of duplicate applications to multiple hospitals, that is still a very difficult barrier for a student to overcome!
Continuing the Conversation Together
Please know, I want to be clear, I do not believe any one person is responsible for what this situation has become. Every child life specialist I have ever reached out to for guidance or support has been extraordinarily kind and generous with their time – including members of various ACLP committees. Still, we have a responsibility to publicly acknowledge a field consistently over saturated with overqualified candidates cannot continue on in this way. We are not operating under the same reality current Certified Child Life Specialists experienced even two years ago when the ACLP initially conducted its Internship Review and Selection Think Tank. We need to know exactly how many qualified students are still in need of a placement, we need to appreciate how hard hospitals are working to parse through applications, and we need to openly discuss the barriers, challenges, and burnout of students and child life specialists alike.
While we are all feeling the effects of the global healthcare crisis, students are shouldering the burdens in different ways. It is only by bringing all stakeholders to the table that we can move forward with new, improved, and more equitable frameworks for success in both the internship process and certification at large. I would encourage folks from all spectrums of the child life field to submit an op-ed and share their perspectives in order to help continue this process. Moreover, I would implore the ACLP Board of Directors to provide space for students to share what they are experiencing. One potential long-term solution is to create a student advisory group and/or student liaison board position. It is long past time to open lines of communication with all members – not just the Certified Child Life Specialists.
By working together, and listening to one another, I know we can, and will, get through this; I look forward to continuing these essential conversations alongside you all.