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Clinical Neuropsychology Training Issues: A Students's ... Clinical Neuropsychology Training Issues: A Students's ... Presentation Transcript

  • Clinical Neuropsychology Training Issues: A Student’s Perspective By Zoe Proctor-Weber, PhD James A. Haley VA Medical Center Tampa, FL
  • Overview of Training in Neuropsychology
    • Clinical Neuropsychology is a formally recognized specialty area under the umbrella of clinical psychology.
    • In addition to training in general clinical psychology, it involves specialized training in theoretical, empirical, and practical aspects of the brain-behavior relationship.
    • Education, training, and supervision in Clinical Neuropsychology is available primarily at the postdoctoral level, although preparation begins at the doctoral level.
  • Be knowledgeable
    • Houston Conference Guidelines
      • Provides an integrated model of professional education and training in Clinical Neuropsychology:
      • General Knowledge Base and Skills
      • Doctoral, Internship and Postdoctoral Training Guidelines
      • Continuing Education
      • Professional and Scientific Activity
      • Subspecialties
      • Hannay, H. J., Crosson, B.A., Hammeke, T. A., Hamsher, K. deS., & Koffler, S. P. 1998. Proceedings: The Houston Conference on Specialty Education and Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13 (2).
  • DEFINITION OF A CLINICAL NEUROPSYCHOLOGIST (1989)
    • A professional psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The Clinical Neuropsychologist is a doctoral-level psychology provider of diagnostic and intervention services who has demonstrated competence in the application of such principles for human welfare following:
    • A. Successful completion of systematic didactic and experiential training in neuropsychology and neuroscience at a regionally accredited university.
    • B. Two or more years of appropriate supervised training applying neuropsychological services in a clinical setting. 
    • C. Licensing and certification to provide psychological services to the public by the laws of the state or province in which he or she practices.  
    • D. Review by one's peers as a test of these competencies.
    • *Attainment of the ABCN/ABPP Diplomate in Clinical Neuropsychology is the clearest evidence of competence as a Clinical Neuropsychologist, assuring that all of these criteria have been met.
    • UNDERGRADUATE FOCUS:
      • Psychology coursework and/or major (esp. abnormal, developmental, statistics).
      • Biology or behavioral medicine coursework (provides a strong foundation for graduate neuropsychology coursework)
      • Research Assistanceship and/or involvement
    PRELIMINARY STEP UNDERGRADUATE TRAINING
  • SELECTING A GRADUATE PROGRAM
    • Graduate Schools: University or Professional?
    • University programs are highly competitive (low selection ratio). Your application will be helped by excellent grades, GRE scores and some previous research experience—preferably, a published paper, if only as a co-author.
    • Professional schools are easier to get into, but they are very expensive. You will have to take out enormous student loans, or you might try to work while studying—perhaps even studying part-time. Also, many professional schools offer primarily the Psy.D. degree, reserving the Ph.D. (if they offer it at all) for a few, select students.
  • Neuropsychology Track?
    • Specialization in NP can begin at the doctoral level.
    • Often, Clinical Neuropsychology is offered as a distinct track in clinical psychology programs, designed to follow APA Div40/Houston Conference guidelines.
    • Recognized tracks make it easier to specialize (existing, easily accessible NP faculty, research labs, clinics, on/off campus practica sites, core coursework curriculum…).
    • No Track? That’s OK.
    • Important to be proactive
      • Seek out didactics, research and clinical training opportunities in the community to be competitive.
  • Predoctoral NP Specialty Preparation
    • Core Coursework in NP
      • In addition to the basic Clinical Psychology curriculum, competitive students have completed doctoral level coursework in:
        • Neuropsychology Assessment
        • Clinical Neuropsychology
        • Behavioral and Clinical neurosciences
        • Behavioral (Clinical) Neurology
        • (coursework generally includes exposure to functional neuroanatomy, neuropathology, psychopharmacology, neuroimaging, relevant test construction/research, neuropsychology assessment, case conceptualization…)
  • Predoctoral Clinical Experience
    • Practica Placement
    • Hospital (acute inpt, rehab, outpt services)
    • Mental Health Clinics (LD, ADHD, TBI, CVA, MDC)
    • Private Practice
    • Goal:
      • Exposure to a wide range of diagnoses, tests, clinical settings, age range, conceptualization style…
      • Experience conducting interviews, administering comprehensive test batteries, staffing cases, writing reports and working within a multidisciplinary treatment team.
  • Research
    • Many internship sites place a strong emphasis on research and scholarly interest and “product” (even if you intend to practice as a clinician).
      • National conference attendance and association membership
      • Journal club participation
      • Poster presentations
      • Book chapters
      • Peer reviewed publications
      • Grants
    • Tendency to prefer applicants who have successfully proposed or defended their dissertation prior to the start of internship.
  • NETWORKING
    • Be active! Be visible!
    • Former students.
    • Local psychologists in the community.
    • Psychology organizations such as APAGS, your state psychological association and APA are also important connection vehicles.
  • Find a Mentor
    • Be resourceful.
    • Identify a professor who conducts research on a subject that interests you.
    • Find a professor with whom you interact well, regardless of his or her field of research.
      • Seek a supportive relationship.
      • Take courses offered by him/her.
      • Arrange for office visits for additional discussions.
      • Offer to do some volunteer work on research.
    • Be reliable, dependable and professional.
  • SEEK SPECIAL OPPORTUNITIES
    • Don’t wait for opportunities to come to you!
    • Offer to TA graduate classes or teach undergrad classes.
    • Volunteer to work on research projects.
    • Scout out hidden training gems within your own program.
    • Bare minimum won’t cut it.
  • The Successful Intern Applicant
    • Internship sites differ in terms of focus and expectations:
    • Clinical Experience, Research, Didactics
    • Early in your graduate training learn what specific
    • internship sites expect and value in training.
    • How? Call sites you are interested in and see what
    • their successful applicants had – get specifics
    • “ an ideal candidate would have…” in terms of
    • research, clinical experience, extra-curricular
    • activities etc…
      • KNOW WHAT YOU NEED!
  • Selection Criteria for Clinical Neuropsychology Internships
    • Supervisors of 50 Clinical Neuropsych internships (Cripes 1995, 1998) were asked to rank order criteria used for selecting intern applicants.
    • Surveys
    • 40 responses (80% response rate)
    • Reflects “aspirational” criteria
    Mittenberg, W., Peterson, R. S., Cooper J. T., Strauman, S. & Essig, S. M. (2000). Selection Criteria for Clinical Neuropsychology Internships. The Clinical Neuropsychologist, 14 (1), 1-6.
  • Supervisor’s Rank Ordered Critical Items   10       GPA   9 Work Sample   8 Familiarity with Applicants Supervisor(s)   7 Clinical Experience - Psychotherapy   6 Pubs/Presentations (research competence)   5 Personal Statement (Goals/Interests)   4 Letters of Recommendation   3 Interview (Interpersonal Characteristics)   2 NP Specialization within Program   1 Clinical Experience - Assessment Rank Order        
  • Preferred NP Practica or Clinical Training Experience       25%   Cog rehab pts   30% Counseling pts   47.5% Medical rehab/health psych pts   72.5% Clinical Psych pts   77.5% Psychiatry   95% Neurology   97.5% Clinical NP pts Considered Essential or Very Important    
  • Desired Setting Experience   5 Private Practice   4 Private Rehab Facility   3 Community Hospital or Clinic   2 VA Medical Center   1 Univ Medical Center Rank Order    
  • Prior Assessment Experience   27.5%   Vocational/Functional Assessment   20% Projective   90% Objective Personality Assessment   37.5% Fixed   60% Process   80% Flexible/Functional Systems   NP Assessment Considered Essential or Very Important    
  • Educational Background   27.5%       Diss Completed   92.5% Diss Proposed   85% NP Recommendation Letters   87.5% NP Faculty/Supervisors   82.5% Div 40 Curriculum Considered Essential or Very Important    
  • Prior Research Activity   45%       APA Div40   40% NAN   47.5% INS   50% Nat Conference Presentations   42.5% Publications in Referenced Journals Considered Essential or Very Important    
  • Other Considerations for Selecting an Internship
    • Seek balanced training programs.
      • Clinical Rotations (seek variety re: populations, disorders, settings).
      • Offered Didactics (general and specialty). Quality?
      • Research opportunities (does their faculty publish?) Role of interns (collect data, analyses, write?).
      • Supervision (Individual? Group?) With whom? Seek variety.
      • Teaching (opportunities to present lectures?)
      • Other considerations:
        • How many neuropsych interns? Sharing resources?
        • Is there a postdoc program?
  • Availability vs. Opportunity
    • To good to be true?
      • Make sure the “available” opportunities listed on site brochures are actually attainable (talk to current interns!).
    • Manage/protect your time.
      • Set limits with your supervisors.
      • Acknowledge the amount of time it takes you to do complete something.
    • Set reasonable/attainable goals.
      • Make wise choices (1 peer reviewed pub vs. 3 posters).
  • KEEP AN OPEN MIND
    • Remember you won't always know what you like until you try it.
    • Graduate training is a time to grow and discover interests – use this time to round out your education.
    • General clinical training is an essential aspect of training to become a Neuropsychologist.
    • All graduate programs offer students the chance to learn how to be critical thinkers and good learners–skills that you'll be able to use no matter how the market for psychology changes.
  • Think Ahead
    • Educate yourself! Know the expected requirements for the next level of training.
    • Select an internship site that will help you become a more competitive postdoc candidate (fill in your training gaps).
      • Research
      • Clinical
      • Didactics
  • A Model Example
    • JAHVA Medical Center, Tampa, FL
      • Educates students on the requirements/qualifications for attaining competitive postdoctoral fellowships and board certification.
      • Provides ABCN Didactics to introduce and prepare trainees at the intern and postdoctoral level to successfully navigate and pass the NP Specialty boards.
    • Participation is required for Postdocs and strongly encouraged for Interns:
    • Teach neuroanatomy and neuropathology to students and staff.
    • 100 question practice NP written exams.
    • Mock oral fact-finding exams.
    • Mock oral ethics exam.
    • Work sample submission and oral defense of a NP case.
  • Resources for prospective students, interns, postdocs
    • A list of graduate training programs in Clinical Neuropsychology is maintained by Division 40 of the American Psychological Association.
    • www.div40.org
    • The list is periodically published in The Clinical Neuropsychologist , by Swets & Zeitlinger Publishers.
  • Graduate, internship and postdoctoral training programs
    • Name of institution and department
    • DOT contact information (Board certified yes/no)
    • # of available positions
    • Length of program
    • Available financial assistance
    • Info on training setting, patient demographics, research
    • Specialty training (neuropsychology, rehabilitation etc…)
    • Application procedure information
  • Resources
    • Check out websites
    • APA-40 (Division of Clinical Neuropsychology (40) of the American Psychological Association)
    • APPIC (Association of Psychology Postdoctoral and Internship Centers)
    • APPCN (Association of Postdoctoral Programs in Clinical Neuropsychology)
    • AITCN (Association for Internship Training in Clinical Neuropsychology)
    • ABCN ( American Board of Clinical Neuropsychology )
    • ABPDN (American Board of Pediatric Neuropsychology)
    • ABPP-CN (American Board of Professional Psychology - Clinical Neuropsychology)
    • NAN ( National Academy of Neuropsychology)
    • INS (International Neuropsychology Society)
    • AACN (American Academy for Clinical Neuropsychology)
    • ADECN (Association for Doctoral Education in Clinical Neuropsychology)
    • Join Listserves:
    • Div40ANST
    • WINS
    • NPSYCH
    • PEDSNPSYCH
    • POSTDOC
    • INTERN
    • APAGS
    • Attend National Conferences
    • NAN (National Academy of Neuropsychology)
    • INS (International Neuropsychology Society)
    • APA (American Psychological Association)
  • Independent Training Centers
    • Center for Applied Neuropsychology - The Center for Applied Neuropsychology (CAN) is a private, non-profit, community-based agency devoted to service, research, and training in rehabilitation psychology, neuropsychology, and vocational rehabilitation.
    • NAN distanCE - The National Academy of Neuropsychology takes the forefront in offering neuropsychology-oriented continuing education (CE) via the Internet. www.nanonline.org/
    • The Neuropsychology Center - The Neuropsychology Center offers a variety of training opportunities and experiences. These include Continuing Education (CE) seminars, clinical consultation, and ad hoc training experiences. http://www.neuropsych.com/
  • Overview of Postdoctoral Training in Clinical Neuropsychology Corwin Boake, PhD University of Texas-Houston Medical School and Memorial Hermann-TIRR, Houston, Texas [email_address]
  • Main topics
    • Houston Conference guidelines
    • What to look for in a residency
    • Nuts & bolts of application & interview
    • National match
    • Survey of 2007 match applicants
      • Goal is to complete the education and training necessary for independent practice of clinical neuropsychology (CN)
      • Residency is a REQUIRED component in specialty education in CN
      • The equivalent of 2 years of full-time education and training
      • Residency MUST occur on at least a half-time basis
      • ENTRY criteria:
        • 1. Entrance SHOULD be based upon completion an APA/CPA- accredited doctoral program.
        • 2. Residents WILL have successfully completed an APA/CPA- accredited internship which includes SOME training in CN.
    Houston Conference guidelines for postdoctoral training
      • EXIT criteria:
      • 1. Faculty includes a board-certified clinical neuropsychologist and other psychologists.
      • 2. Training at a fixed site or affiliated local sites with primarily on-site supervision.
      • 3. Access to clinical services and training in medical specialties and allied professions.
      • 4. Interactions with residents in medical and allied specialties.
      • 5. Eligibility for state or provincial licensure for independent practice.
      • 6. Eligibility for board certification by ABCN.
    Houston Conference guidelines for postdoctoral training
  • Preparing for application to postdoctoral programs
    • Doctorate in clinical/counseling/school
    • APA/CPA accreditation of doctoral program and internship
    • Neuropsychology background through practica, employment, coursework, and/or research
    • If no exposure available in doctoral program, supplement with additional supervised practicum, employment, etc.
  • Preparing for application to postdoctoral programs
    • Involvement in specialty organizations (e.g., APA Div 40, INS, NAN)
    • Need to complete dissertation by start date of residency
    • Use internship to round out general clinical competencies
    • Neuropsychology internship is not necessary and not always helpful
    • Plan applications with advisor or mentor
  • How to judge program quality
    • Meets Houston conference guidelines
    • Offers a variety of clinical experience
    • Quality supervision and fair evaluation
    • Opportunities for education and research
    • Expected clinical productivity
  • How to judge program quality
    • Evidence of staff expertise
    • Adequate resources
    • APA accreditation: potential advantage but not required at the postdoctoral level
    • Outcomes of previous residents
  • Applying to postdoctoral programs
    • Programs have different application procedures (but simpler than internship)
    • List specific goals in cover letter
    • Attend INS for interviews
    • Speak with former/current trainees
    • Apply to many programs
  • APPCN membership criteria
    • Duration of 2 years of postdoctoral training, or equivalent on at least a half-time basis
    • Activity at least 50% clinical, 10% didactics, and 10% research
    • Program director is board-certified in clinical neuropsychology by ABCN
  • National match: timeline Applicant Program Register with NMS Interviews Submit ranks Match Clearing-house mid-January 2008 2/29/08 3/10/08 Deadline
  • National match: Basic procedures
    • Computerized matching process, run by NMS on behalf of APPCN
    • All programs meeting Houston guidelines may participate
    • Fees for applicants and programs
    • Match assignments are based on applicants’ and programs’ rankings
    • Match assignments are binding
    • Clearinghouse available after match
  • National match: rules for participation
    • Program can disclose only if the applicant is competitive and will be ranked
    • Premature offers are not allowed
    • No limit on number of applications or number of ranks submitted
  • National match: N of applicants and positions
  • National match: success rates
  • National match: Relationship of outcome to N of ranks submitted mean N of ranks (2007)
  • National match survey
    • Survey of applicants in 2007 match
    • Purpose:
      • Describe match registrants
      • Assess satisfaction with the match
      • What influences match outcome
    • The overall match rate for those who responded was 62%
  • National match survey: Factors that influence match outcome
  • National match survey: Factors that influence match outcome
  • National match survey: Factors that influence match outcome
  • National match survey: Summary
    • Factors associated with match success:
      • Publications
      • Number of interviews obtained: for those with 8 or more interviews, match rate was 95%
    • 75% of non-matched applicants reported obtaining a neuropsychology fellowship
  • National match: Advantages to the applicant
    • Access to most quality programs that meet training standards for ABCN
    • Procedure is fair to applicants
    • Ability to apply to many programs using the same process
    • Minimize travel by interviewing at INS
    • Match outcome is binding
    • Clearinghouse
  • National match: important links APPCN: www.appcn.org NMS: www.natmatch.com/appcnmat/
  • Conclusions
    • Postdoctoral residency is required for new doctorates to practice in this specialty
    • Competition for residency positions
    • Preparing a competitive application
  • Questions?
  • American Board of Clinical Neuropsychology (ABCN) Celiane Rey-Casserly, PhD
  • Why Board Certification?
    • Protection of the patient is paramount!
    • During earlier periods, multiple routes to clinical practice were followed-now development of formal training opportunities
    • Even with formal training, level of training cannot be guaranteed, either by program or by student.
    • Self-designation is not acceptable. Certificates of training are no better.
    • Certification by examination by peers is the only appropriate method of assuring competence.
  • Psychology Boards Analogous to Medical Boards
    • State licensure is not appropriate for specialty regulation.
      • Problems with generic licensure abound, including:
        • Understanding of specialty criteria difficult for legislators
        • Multiple claims to competence without appropriate exam
    • Board certification is voluntary and regulated by the field.
      • Medical specialties also not regulated at state level
      • AMA directory lists “self-designated” specialists
  • Purpose of the Examination
    • The examination for the diploma is designed to assess advanced competence in the practice of clinical neuropsychology. It is intended not just as a measure of fund of knowledge, but also as a tool to determine the effectiveness of application of neuropsychological principles in the clinical setting and the promotion of the welfare of the patient. The examination is designed to provide a standard by which competence to practice Clinical Neuropsychology is judged.
    • Bieliauskas & Matthews, 1987
  • ABCN Officers and Appointees 2007-2009
    • President Michael Westerveld
    • Vice President Bernice Marcopulos
    • Secretary Karen Wills
    • Treasurer Rich Naugle
    • ABPP Representative Sandra Koffler
    • Executive Director Linas Bieliauskas
    • Exam Committee Chair Bernice Marcopulos
    • Local Arrangements Chair Chris Grote
  • ABCN BOD 2007 Debra Koltai Attix (2007-2012) Richard Naugle (2000-2009) William Barr (2003-2008) Celiane Rey-Casserly (2005-2010) James Becker (2004-2009) Brenda Spiegler (2005-2010) Julie Bobholz (2007-2012) Sara Swanson (2004-2009) Jennifer Haut (2006-2011 Fred Unverzagt (2006-2011) David Kareken (2006-2011) Michael Westerveld (2000-2009) Sandra Koffler (1997-2007) Karen Wills (2003-2009) Gregory Lee (2004-2009 Tony Wong (2007-2012) John Lucas (2005-2010) Bernice Marcopulos (2003-2008)
  • Current Status of Board Certification
    • As of June, 2007, there are 599 board certified Clinical Neuropsychologists, from 48 states, the District of Columbia, and 4 provinces.
    • Since its inception, ABCN has awarded board certification to 609 individuals.
    • In 2005, 61 took the written exam and 36 took the oral exam.
    • In 2006, 83 took the written exam and 47 took the oral.
    • So far 2007: 86 written; 20 orals
  • ABCN Written Examinations in Recent Years * * with one exam to go
  • Application and Examination 2 phases
    • Assessment of education, training, knowledge
    • 1. Application and Credentials Review
    • 2. Written Exam
    • Assessment of competence
    • 3. Practice Sample Evaluation
    • 4. Oral Exam
  • Costs
    • $125 Application Fee
    • $300 Written Examination Fee
    • $250 Work Sample Fee
    • $450 Oral Examination Fee
  • How Long Does it Take?
  • Eligibility Criteria
    • Earned doctoral degree in psychology from a regionally accredited university.
    • Membership in professional psychological organizations which have identified purposes and policies that are congruent with those of ABPP.
    • Licensed or certified at the level of independent practice.
    • Areas of training and experience:
      • Basic Neurosciences -Neuropathology
      • Clinical Neurology -Neuroanatomy
      • Psychological Assessment
      • Clinical Neuropsychological Assessment
      • Psychological Intervention
      • Psychopathology
    • Three years of experience in Clinical Neuropsychology, satisfied by:
      • 3 years of experience, one of which may be predoctoral internship with an emphasis in Clinical Neuropsychology
      • one year pre or post doctoral experience and successful completion of a postdoctoral program in Clinical Neuropsychology
    • Two years of supervision in the practice of Clinical Neuropsychology, satisfied by:
      • 2 years of postdoctoral supervision
      • 1 year of predoctoral & 1 year of postdoctoral supervision
      • completion of a postdoctoral program in Clinical Neuropsychology
  • Written Examination
    • Prepared in conjunction with the Professional Examination Service (PES)
    • Updated every 2-3 years by 30%
    • Items rated for appropriateness as well as accuracy
    • 100 multiple-choice items, covering 4 rubrics
    • Given at each of the four major neuropsychological meetings annually, INS, AACN, APA Division 40, and NAN
  • Four Rubrics for Questions from Houston Conference
    • Generic Psychology Core
    • Generic Clinical Core
    • Brain-behavior Relationships
    • Clinical Neuropsychology
  • Work Sample Submission
    • A work sample consists of two cases
    • The cases must be sufficiently different to demonstrate broad knowledge
    • Original report, summary sheet, copy of raw test protocols
    • Note: Supplementary materials NO LONGER REQUIRED!
  • Oral Examinations
      • When work samples have been accepted (not passed ) for oral examination, candidate is asked to prepare to take the next available oral examination. Examinations are currently held at Rush-Presbyterian-St. Luke’s Medical Center in Chicago in the middle of May and the middle of October each year. With two examination teams, 24 candidates can be accommodated at each exam. There are current capabilities to expand to 36 candidates per examination if necessary.
      • The examination committee of ABCN selects the examiners from a fixed cadre of examiners, selected for high quality of past exam administrations or high probability of effective examination based on training experience. The examiners represent the diversity of board certified clinical neuropsychologists, including gender, region, child/adult emphasis, and seniority.
  • Board Preparation Resources
    • The History
    • “ BRAIN” is an ABPP/CN study group that was started by a few candidates back in 2002. Formally named "BRAIN" later. Lots of info about the group has been compiled and is now available on the web, so it might be easiest to just check that out:
    • http://www.cincinnatichildrens.org/svc/alpha/n/neurobehavioral/brain/ .
  • “BRAIN”
    • BRAIN (which stands for “Be Ready for ABPP in Neuropsychology) is becoming an increasingly well organized group designed to help our colleagues obtain their ABCN certification. While it was originally started by a small group of friends (prior to AACN’s mentoring program), it has expanded to include over 125 members. The listserve consists of neuropsychologists at all stages of the ABPP process, from individuals who are still thinking about turning in their credentials to over 30 people who are now ABCN diplomates. They have designed study notes (which can be viewed at the website) and also provide supportive suggestions and guidance to candidates as they proceed through the ABPP process. They have also been able to provide a forum for individuals to develop study groups for each stage of the ABPP process, as well as provide a little bit of inspiration and positive peer pressure. They now have an official listserve (thanks to Bob Ivnik’s generosity) and website (thanks to Dean Beebe’s efforts).
  • “BRAIN”
    • New members are accepted upon referral from a member of AACN or an already existing member of BRAIN who may or may not have completed the ABPP/CN process (this person is considered the new member's "sponsor").
    • If a supervisor is not a member of AACN or Brain, they should contact someone who is.
    • The only other criterion to join BRAIN is that the new member be a licensed psychologist.
  • BRAIN (continued)
    • If an AACN or BRAIN member would like to add someone to the study group listserve,contact Michael Kirkwood ( [email_address] ) with the name,email address, and a brief narrative biosketch of the potential member.
    • After receiving this information, Dr. Kirkwood will send an email to the new member and the sponsor, which will include an introductory welcome letter and listserv registration information. Dr. Kirkwood will subsequently post the biosketches of new members to the BRAIN listserv as a means of introducing them to the group.
  • AACN Resources
    • Available at www.theaacn.org
    • AACN Study Guide for board certification: A very detailed resource regarding each step in the process.
    • AACN Mentorship Program:
      • Available to candidates who have passed the Credentials Review
      • Meant for support and consultation
      • Participation is optional, although advisable
    • Questions?