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 knowledgeableHouston 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 ApplicantInternship sites differ in terms of focus and

expectations:

Clinical Experience, Research, Didactics

Early in your graduate training learn what specificinternship sites expect and value in training.

How? Call sites you are interested in and see whattheir 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 OrderClinical 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 85%  

Diss Proposed 92.5%  

Diss Completed       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.

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

ResourcesCheck 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:Div40ANSTWINSNPSYCHPEDSNPSYCHPOSTDOCINTERNAPAGS

Attend National ConferencesNAN (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 Schooland

Memorial Hermann-TIRR, Houston, Texas

corwin.boake@uth.tmc.edu

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 residencyUse internship to round out general clinical competenciesNeuropsychology internship is not necessary and not always helpfulPlan 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

MatchClearing-

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

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National match survey

Survey of applicants in 2007 matchPurpose: 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

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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 ABCNProcedure is fair to applicants Ability to apply to many programs using the same processMinimize travel by interviewing at INSMatch outcome is bindingClearinghouse

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 Appointees2007-2009

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 Examinationsin Recent Years

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Application and Examination2 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 ExaminationsWhen 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 (kirkwood.michael@tchden.org) 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?