Adult Clinical Neuropsychology

Goals

The Adult Clinical Neuropsychology track is an experience in diagnostic Neuropsychology using clinical interviewing and a flexible battery approach. Interns will become competent in the administration, scoring, and interpretation of neuropsychological instruments for the purposes of assisting in differential diagnosis, assessment of treatment effectiveness and treatment planning.
Interns will become comfortable with the consultative role that neuropsychologists play when working with neurologists and neurosurgeons as well as various mental health professionals and other medical professionals.

Placement

Neuropsychology interns work within the Neuropsychology Division of the Department of Behavioral Health. Interns work directly with staff psychologists and have regular interactions with other trainees including practicum students, postdoctoral fellows, and psychiatry residents.

Patient population

The Neuropsychology Division is a large system-wide service and receives its referrals from throughout the hospital. We evaluate over 1,500 patients each year with a large volume referred from the departments of neurology and neurosurgery. We are actively involved in the Epilepsy Center and perform pre- and post-surgical evaluations on patients with intractable epilepsy and other neurological conditions including Parkinson’s disease and tumors.

The general clinic population is diverse and includes patients with stroke or other vascular disease, movement disorders, traumatic brain injury and sports-concussions, various dementing disorders, psychiatric disorders, etc. Assisting in differential diagnosis between psychiatric and neurological diseases and addressing competency-related issues is often a part of the work in neuropsychology.

Theoretical approach

The diagnostic procedures follow a flexible battery approach that is often used for clinical research.

Responsibilities

Interns will be responsible for all aspects of the inpatient/outpatient neuropsychological evaluations conducted (including interview, test administration, report writing, and providing feedback) within the course of the internship year. During the initial training period interns are oriented to the administration and scoring of the various measures used by our staff neuropsychologists. They will initially be observed on administration and have scoring checked to ensure accuracy. Afterwards interns will generally only be observed during clinical interviews. The intern will complete 2 testing days each week. Interns will also be responsible to attend both general psychology didactics and neuropsychology specific didactics as outlined below. The remaining time available is often used for administrative purposes (scoring of files, report writing, and clinical supervision).

Minor rotations

Interns in Adult Neuropsychology complete four minor rotations. Across the internship year, interns will spend approximately 4 hours per week in direct patient care delivering cognitive rehabilitation treatment. During the second half of the year, the intern will complete 3 additional minor rotations, each for one-half day for 2 months. Rotation options include normal pressure hydrocephalus clinic, general outpatient mental health, trauma surgery, ambulatory internal medicine/primary care, transplant surgery, bariatric surgery, sleep medicine, anesthesia pain, general oncology, and ENT oncology.

Supervision

Interns rotate among all adult staff neuropsychologists for supervision. Each evaluation is reviewed by the staff member in detail. Staff all take a developmental approach to supervision, making supervision more intensive at the beginning of the year, though specific approach to supervision will vary by supervisor preference. There is a minimum of 2 hours of weekly individual supervision. Interns have the opportunity for interdisciplinary experiences by working with psychiatric and other residents who rotate through the neuropsychology service as a part of their training and attending epilepsy surgical conference with staff. Interns from all tracks also participate in a one-hour, weekly group supervision with the Director of the Psychology Internship Program. Interns will rotate presenting a case paired with a question or topic for discussion for the group.

Didactics

Core neuropsychology didactics consist of a lecture series, 12-week neuroanatomy course taught by one of the staff neuropsychologists, and a weekly practical seminar for the last two-thirds of the year (case conferences, fact findings, trainee presentations). A general psychology internship didactic curriculum is also attended once weekly. Additionally, interns will be able to attend the Department of Neurology’s neuroscience/grand round lecture series and brain cutting as schedules permit.

Outcome/evaluation

Interns in Adult Neuropsychology will be evaluated in a number of ways. Primarily, outcome is evaluated on clinical progress via individual supervision. Additionally, one of the staff neuropsychologists will review progress more formally with each intern on a quarterly basis. Interns will also be responsible for a topical presentation during our practical seminar series. Interns are also required to present at our case conference and participate in fact-finding examinations, though interns are not formally evaluated regarding internship progress on these examinations as they are intended to introduce the intern to ABPP examination procedures in clinical neuropsychology. Finally, interns will participate in a final oral outcome evaluation, during which they will present a case to two adult neuropsychologists in an examination meant to model after the case presentation aspect of the ABPP oral examination in clinical neuropsychology.