Clinical Neuropsychology Training Issues: A Student’s Perspective

1. Clinical Neuropsychology Training Issues:A Student’s Perspective By Zoe Proctor-Weber, PhD James A. Haley VA Medical Center Tampa, FL

2. 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.

3. 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).

4. 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.

5. PRELIMINARY STEP UNDERGRADUATE TRAINING • 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

6. 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.

7. 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.

8. 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…)

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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!

15. 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.

16. Supervisor’s Rank Ordered Critical Items

17. Preferred NP Practica or Clinical Training Experience

18. Desired Setting Experience

19. Prior Assessment Experience

20. Educational Background

21. Prior Research Activity

22. 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?

23. 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).

24. 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.

25. 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

26. 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.

27. 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.

28. 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.

29. 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

30. 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)

31. 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/

32. Overview of Postdoctoral Training in Clinical Neuropsychology Corwin Boake, PhD University of Texas-Houston Medical School and Memorial Hermann-TIRR, Houston, Texas corwin.boake@uth.tmc.edu

33. Main topics • Houston Conference guidelines • What to look for in a residency • Nuts & bolts of application & interview • National match • Survey of 2007 match applicants

34. Houston Conference guidelines for postdoctoral training • 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.

35. 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.

36. 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.

37. 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

38. 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

39. 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

40. 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

41. 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

42. Deadline Applicant Program Register with NMS mid-January 2008 Interviews Submit ranks 2/29/08 Clearing-house Match 3/10/08 National match: timeline

43. 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

44. 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

45. National match: N of applicants and positions

46. National match: success rates

47. National match: Relationship of outcome to N of ranks submitted mean N of ranks (2007)

48. 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%

49. National match survey: Factors that influence match outcome

50. National match survey: Factors that influence match outcome