Transcript Clinical Neuropsychology Training Issues: A Students’s

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.
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
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).

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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.
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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
Rank Order
Clinical Experience - Assessment
1
NP Specialization within Program
2
Interview (Interpersonal Characteristics)
3
Letters of Recommendation
4
Personal Statement (Goals/Interests)
5
Pubs/Presentations (research competence)
6
Clinical Experience - Psychotherapy
7
Familiarity with Applicants Supervisor(s)
8
Work Sample
9
GPA
10
Preferred NP Practica or Clinical
Training Experience
Considered Essential or Very Important
Clinical NP pts
97.5%
Neurology
95%
Psychiatry
77.5%
Clinical Psych pts
72.5%
Medical rehab/health psych
pts
47.5%
Counseling pts
30%
Cog rehab pts
25%
Desired Setting Experience
Rank Order
Univ Medical Center
1
VA Medical Center
2
Community Hospital or Clinic
3
Private Rehab Facility
4
Private Practice
5
Prior Assessment Experience
Considered Essential or Very
Important
NP Assessment
Flexible/Functional
Systems
80%
Process
60%
Fixed
37.5%
Personality Assessment
Objective
90%
Projective
20%
Vocational/Functional Assessment
27.5%
Educational Background
Considered Essential or Very
Important
Div 40 Curriculum
82.5%
NP Faculty/Supervisors
87.5%
NP Recommendation Letters
Diss Proposed
Diss Completed
85%
92.5%
27.5%
Prior Research Activity
Considered Essential or Very
Important
Publications in Referenced Journals
42.5%
Nat Conference Presentations
50%
INS
47.5%
NAN
40%
APA Div40
45%
Other Considerations for
Selecting an Internship

Seek balanced training programs.
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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


Set limits with your supervisors.
Acknowledge the amount of time it takes you
to do complete something.
 Set

your time.
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
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
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:
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Teach neuroanatomy and neuropathology to
students and staff.
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100 question practice NP written exams.
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Mock oral fact-finding exams.
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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
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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
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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 protected]
Main topics
Houston Conference guidelines
What to look for in a residency
Nuts & bolts of application &
interview
National match
Survey of 2007 match applicants
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:

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1. Entrance SHOULD be based upon completion an APA/CPAaccredited doctoral program.
2. Residents WILL have successfully completed an APA/CPAaccredited 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.
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 halftime basis
Activity at least 50% clinical, 10%
didactics, and 10% research
Program director is board-certified in
clinical neuropsychology by ABCN
National match: timeline
Deadline
mid-January
2008
Applicant
Program
Register with NMS
Interviews
2/29/08
3/10/08
Submit ranks
Match
Clearinghouse
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
120
100
2001
2002
2003
2004
2005
2006
2007
80
60
40
20
0
Applicants
Positions
National match: success rates
100
90
80
70
60
50
40
30
20
10
0
2001
2002
2003
2004
2005
2006
2007
Applicants
Positions
National match: Relationship of
outcome to N of ranks submitted
mean N of ranks (2007)
6
5
4
Matched
Unmatched
3
2
1
0
Applicants
Positions
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
Match Rate by Publications
100
80
60
40
20
0
0 to 1
2 to 4
5 or more
Number of Publications
National match survey: Factors that
influence match outcome
Match Rate by Presentations
100
80
60
40
20
0
0 to 3
4 to 9
10 or more
Number of Presentations
National match survey: Factors that
influence match outcome
Match Rate by Interviews
100
80
60
40
20
0
0 to 3
4 to 7
8 or more
Number of Interviews
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
1. Postdoctoral residency is required for
new doctorates to practice in this
specialty
2. Competition for residency positions
3. 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
 Vice President
 Secretary
 Treasurer
 ABPP Representative

Michael Westerveld
Bernice Marcopulos
Karen Wills
Rich Naugle
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
90
*
80
70
60
50
40
30
20
10
0
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
19
97
19
96
19
95
19
94
19
93
19
*
with one exam to go
Application and Examination
2 phases
Assessment of
education, training,
knowledge
Assessment of
competence
1. Application and
Credentials Review
3. Practice Sample
Evaluation
2. Written Exam
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 protected]) 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
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Available at www.theaacn.org
AACN Study Guide for board certification:
A very detailed resource regarding each
step in the process.
AACN Mentorship Program:
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Available to candidates who have passed the
Credentials Review
Meant for support and consultation
Participation is optional, although advisable
Questions?