Training and Preparation of Clinical Neuropsychology doctoral students

1. Training and Preparation of Clinical Neuropsychology doctoral students A webinar for Training Directors, Mentors, Faculty, and Students Sponsored by the Education Advisory Committee of the Society for Clinical Neuropsychology, APA Division 40 March 5, 2019

2. Presenters Pamela M. Dean, Ph.D., ABPP-CN Assistant Professor of Psychiatry & Behavioral Sciences, University of Washington School of Medicine VA Puget Sound Health Care System, Seattle, WA Emily H. Trittschuh, PhD Associate Professor of Psychiatry & Behavioral Sciences, University of Washington School of Medicine VA Puget Sound Health Care System, Geriatric Research Education & Clinical Center Seattle, WA Scott A. Sperling, Psy.D. Assistant Professor of Neurology University of Virginia Health System, Charlottesville, VA David Kaufman, Ph.D., ABPP-CN Associate Professor of Psychology, Saint Louis University Gateway Neuropsychology, St. Louis, MO

3. Overview • Taxonomy of Clinical Neuropsychology Training and History • Pathways to Clinical Training • Research Involvement • Professional Involvement • Dos and Don’ts of creating your CV

4. Taxonomy of clinical neuropsychology training and history Scott A. Sperling, PsyD.

5. Clinical Neuropsychology Training Guidelines • 1977 • INS established the Task Force on Education, Accreditation, and Credentialing in Neuropsychology • 1981 • Task force published guidelines in a newsletter • 1984 • Guidelines approved by APA, Division 40 • 1987 • Guidelines published in TCN

6. Houston Conference on Specialty Education and Training in Clinical Neuropsychology (1997) • Doctoral Level • Generic psychology and clinical core • Foundations of Neuropsychology • Internship Level • Completes general clinical training • Extends training in Neuropsychology • Postdoctoral Level • Advanced education and training in Neuropsychology

7. Houston Conference Guidelines in Neuropsychology • Specifies rigorous, extensive, and cumulative training • Flexible: Does not specify order • Requires 2 years of post doctoral training

8. Taxonomy for Education and Training in Clinical Neuropsychology • Lack of consistency in how programs described education and training opportunities • Across psychology training programs • Within recognized specialties (e.g., Clinical Neuropsychology)

9. Taxonomy for Education and Training in Clinical Neuropsychology • Professional organizations and groups have used different terms to describe training programs • APPIC: “major rotation” and “informal/minor/external rotation” • APA accreditation regulations: “areas of emphasis”

10. So What’s the Problem? • Hinders trainees’ ability to accurately evaluate and compare training programs • Leads to a poor understanding of training standards

11. Clinical Neuropsychology Taxonomy • Clinical Neuropsychology Synarchy (CNS) first charged with developing neuropsychology taxonomy • CNS Member Organizations • AACN: American Academy of Clinical Neuropsychology • ABCN: American Board of Clinical Neuropsychology • ABN: American Board of Professional Neuropsychology • ADECN: Association for Doctoral Education in Clinical Neuropsychology • AITCN: Association for Internship Training in Clinical Neuropsychology • APPCN: Association of Postdoctoral Programs in Clinical Neuropsychology • SCN: Society for Clinical Neuropsychology • NAN: National Academy of Neuropsychology

12. Clinical Neuropsychology Taxonomy • (2015) CNS formally adopted the Taxonomy for Education and Training in Clinical Neuropsychology. • (2017) Taxonomy for Education and Training in Clinical Neuropsychology: past, present, and future (Sperling et al., 2017, The Clinical Neuropsychologist)

13. Taxonomy for Education and Training in Clinical Neuropsychology • The taxonomy builds upon existing education and training guidelines • Houston Conference Guidelines • Requirements for accreditation by the APA and CPA

14. Taxonomy for Education and Training in Clinical Neuropsychology • Establishes guidelines regarding the content that needs to be covered to constitute a neuropsychology course • Provides clarity as to what constitutes a “practicum” in clinical neuropsychology

15. Taxonomy for Education and Training in Clinical Neuropsychology • Establishes hierarchical definitions of education and training opportunities within academic, clinical, and research domains • Intensity of Training • Major Area of Study • Emphasis • Experience • Exposure • Stage of Training • Doctoral • Internship • Postdoctoral • Post-licensure

20. Why it Matters • Help clinical neuropsychology programs accurately and consistently describe the content and range of training opportunities • Help programs modify their program to meet the minimum specifications required for their desired level of intensity • Increase consistency in the descriptions of training across training programs • Greater “truth in advertising”

21. The Taxonomy Does Not… • Define how programs should design their curricula or training • Eliminate flexibility or uniqueness in training • Dictate what particular training sequence is “correct” for any one student

22. Take Home Points • Level of intensity does not define the quality of a training program • Participation in a program that offers a Major Area of Study does not indicate that a student has superior training, skills, knowledge, or competencies • Doctoral programs may or may not have a neuropsychology track. Non-track programs may have a major area of study in neuropsychology that also provide quality opportunities.

23. Responsibility of Students • Do due diligence in assessing and selecting programs at each stage of training • Intensity of training • Types of experiences • Supervisors/Mentors • Quality • Fit

24. Entry-level Competencies in Clinical Neuropsychology • HCG continues to guide the PROCESS of training • Competencies define the expected OUTCOMES of training • Expected by the completion of postdoc • Career-long continuing education is needed to maintain competency

25. Entry-level Competencies in Clinical Neuropsychology • Application of a competency model to clinical neuropsychology (Rey-Casserly, Roper, and Bauer, 2012, Professional Psychology: Research and Practice) • Inter-organizational; moderated by the CNS

26. CNS Member Organizations • AACN: American Academy of Clinical Neuropsychology • ABCN: American Board of Clinical Neuropsychology • ABN: American Board of Professional Neuropsychology • ADECN: Association for Doctoral Education in Clinical Neuropsychology • AITCN: Association for Internship Training in Clinical Neuropsychology • APPCN: Association of Postdoctoral Programs in Clinical Neuropsychology • SCN: Society for Clinical Neuropsychology • NAN: National Academy of Neuropsychology

27. Pathways to a neuropsychology InternshipClinical Training Pamela M. Dean, Ph.D., ABPP-CN

28. Experiences • Clinical • Research • course work • Didactics/seminars • Professional activities. • Experiences with psychiatric and neurological populations, practicum settings, neuropsychological and psychological assessment, intervention, and research production are typically among the experiences trainees wish to consider when applying for internship. • The question is: is there better guidance for what programs are looking for to evaluate candidacy? • Ritchie, Odland, Ritchie, & Mittenberg (2012) published a survey of programs that met Div 40/Houston Conference guidelines for specialty internship training in neuropsychology. Supervising neuropsychologists from 75 programs ranked information for the importance of practicum and doctoral experiences.

29. Importance of overall criteria Ritchie, D., Odland, A.P., Ritchie, A.S., & Mittenberg, W. (2012)

30. Practicum settings Ritchie, D., Odland, A.P., Ritchie, A.S., & Mittenberg, W. (2012)

31. Patient populations Ritchie, D., Odland, A.P., Ritchie, A.S., & Mittenberg, W. (2012)

32. Graduate school background Ritchie, D., Odland, A.P., Ritchie, A.S., & Mittenberg, W. (2012)

33. Clinical Practica • Practicum experiences are generally one academic year (or 9-months in semester or quarter systems. • Experiences should include supervised training for at least 8 hours per week • At least 50% of that training includes clinical contact with patients in the provision of neuropsychological services. • Sites may include private practice, VA hospital, Medical Center, or group practice. • Experiences such as biofeedback or rehabilitation (not supervised by a neuropsychologist) may not be suitable or sufficient experiences • At least 1 Neuropsychology practicum is advised • Internship sites and faculty have different preferences for training backgrounds. • Trainees will need neuropsychology experiences, but the balance of NP to other general clinical experiences will vary.

34. Experiences Outside of Clinical Practice • Courses/Training: • Neuroanatomy Neuropsychological Assessment • Neuroscience Psychological Assessment • Clinical Neurology Psychological Intervention • Neuropathology Psychopathology • Seminars/Didactics • Universities or academic medical institutions • Online courses • NAN • Behavioral and Cognitive Neurology • Applications of Brain Imaging in Clinical Neuropsychology • Clinical Neuroanatomy • Recorded Webinars • Other opportunities • Grand Rounds • Brain Cuttings

35. Psychologist and a Neuropsychologist • General training in psychology is important to also have well rounded clinical skills • Therapy • Broad age range • Varying settings • Varying diagnostic groups • Couples/group experiences • Psychological assessment • Training experiences with patients from diverse backgrounds (i.e., urban vs rural, race, ethnicity, disability etc).

36. How to seek out clinical Experiences • Training programs may have knowledge of and relationships with community providers. • When training experiences are limited in your region, finding quality sites can be challenging. Trainees may need to consider practicum sites within 1-2 hours driving distance.

37. Nature and Involvement in Training Experience • Neuropsychology practica sites should include training in each aspect of the clinical evaluation: • Record review, clinical interview, test administration, battery interpretation and conceptualization, report writing, +/- intervention work based on report findings.

38. Clinical Supervision • Per APA guidelines, all supervision in clinical neuropsychology must be provided by persons with competencies in clinical neuropsychology. • Competence is related to the supervisors education and training in Clinical Neuropsychology including doctoral course work, predoctoral internship, and completion of a two year postdoctoral fellowship in compliance with the Houston Conference Guidelines. • *note: ABCN recognizes that supervisors who completed their training in Clinical Neuropsychology prior to 2005 may vary in these training standards. • Supervisors may or may not be board certified • The American Board of Professional Psychology, Clinical Neuropsychology (ABCN) and The American Board of Neuropsychology (ABN) are the two recognized boards.

39. Track vs Non-tract internships • A search in APPIC with “neuropsychology” as a criteria yields • 111 programs for Adult and Child • 369 Adult only • 226 Child only • This does not tell you if it is a generalist or track program • Division 40 (SCN) search yields 53 programs; however, not all programs are represented • Look to brochure for more information: • Major area of study • Emphasis • Experience • Exposure

40. Track vs Non-track Internship Programs • For non-track/generalist programs, trainees interested in pursuing neuropsychology postdoctoral fellowships will want to look for key information: • Rotations meet Div. 40/Houston Conference Guidelines • Rotation is full time • Sites have different preferences, but in general, in the end, it is more about fit and experiences gained throughout internship

41. Fit and goals vs experiences • Conversations about long-term goals (i.e., working in an academic medical center) and current experiences (i.e., group or individual practice) can help candidates evaluate their fit for internship programs of interest. • Mentors/DCT’s are encouraged to help trainees be honest with experience, vs, need, vs, goals. • Early conversations can help trainees evaluate training needs and programmatic conversations about feasibility of seeking out these experiences. • Setting up practicum experiences to match over-arching goals can help to increase the competitiveness of a candidate’s application. • Prior to applying, re-evaluate the match between experiences, sites of interest, and long-term goals. • Ex: Candidates without Academic medical or VA medical

42. If at first you don’t succeed….try try again • Neuropsychology internships are highly competitive, even for applicants with strong training backgrounds. • Review sites the student applied to vs their CV and experiences. • May need to take an extra year to increase experiences that match sites of interest. • Areas to consider focusing during that additional year: • Defend dissertation • Gain additional clinical experience to fill a gap • Publish or present research

43. Research and Scholarly work David Kaufman, Ph.D., ABPP-CN

44. Research and Scholarly Work • Research is an important component to graduate education in neuropsychology • Compared to other PhD/PsyD programs, clinical neuropsychology graduate students often have fewer publications due to increased clinical training needs • Some programs have less emphasis on research with higher clinical expectations • In these programs, trainees may need to seek out mentors who can provide additional research opportunities • There are many possibilities for publication/presentations: • Thesis/Dissertation projects • Case studies • Research projects with non-NP mentors

45. Conference Presentations • Common NP conferences: • INS (February) • Abstract deadline: August • AACN (June) • Abstract deadline: January • SCN/APA Div 40 (August) • Abstract deadline: December • NAN (October) • Abstract deadline: February • Look for non-neuropsychology conferences that may fit with research interests (i.e., developmental, behavioral, or dementia) or related disciplines (e.g., Neurology [AAN] or Psychiatry [Biological Psychiatry]). • Aim to present research findings at one conference each year in grad school. • Posters are the most common format – make sure your project’s data collection is complete • Take advantage of student-focused meetings and seminars at conferences, and don’t hesitate to network!

46. Planning for Research • Discuss with mentors in advance about expectations and your role in the project • Keep an eye out for grant funding announcements from NP-related groups (e.g., SCN Dissertation Award) • Be clear upfront about whether you will be responsible for the project (e.g., first author), or whether you will contribute in other ways • Be realistic with your time commitments • Look for projects with clearly defined end points • Recognize that some projects may not be a good fit • Size, scope, risk • Reach out to productive research mentors (even non-NP), especially if NP research is not available • Publication track record, grant funding

47. Scholarly Work • While research publications and presentations are the most meaningful forms of scholarly work, there are others that can have an impact: • Webinars, panel discussions • Interviews via local news, social media • Student interest group publications • Ad hoc peer-review (supervised) • Program evaluation and program development • Clinical databases can yield valuable research projects, but it often takes considerable time to enter and analyze data • Consider using large publicly available databases such as ADNI or the Human Connectome Project. • Partner with other students or advanced trainees • Any form of research productivity is valuable, even if it is not closely related to NP. But try to find a connection between projects so that you can tell a coherent story about your experiences.

48. Professional involvement Emily H. Trittschuh, Ph.D.

49. Get INVOLVED!!! • Many different professional societies have student volunteer opportunities • This is great for networking not only with others in the field, but also growing your support network of likeminded trainees. • Provides leadership skills • Allows students to learn administrative and programmatic aspects that underlie training • Volunteer opportunities may also be available where you are completing your doctoral training.

50. CV for Applying to Internship: Dos and Don’ts