Curriculum

Supervision
Training methodology includes a significant percentage of time involved in supervised delivery of clinical services in direct contact with service recipients primarily at Geisinger Medical Center, Danville, which is also referred to as the main campus. Supervision will be consistent with the training activities so as to provide an intensive, advanced experience while maintaining appropriate responsibility for the recipients of the service. Fellows will receive at a minimum, two hours of individual supervision per week. Fellows will have additional access to supervisor consultation and collaboration as needed.  Supervisory consultation and intervention will be readily available as needed in emergency situations.

Written evaluations are provided on a quarterly basis by current supervisor(s). A copy of the evaluation form is available upon request from the program director, Bradley J. Wilson, PhD, ABN. If a fellow receives an unsatisfactory evaluation indicating he/she is not performing at an expected level, the supervisor(s) will develop a specific written plan to assist that fellow to improve performance.

Rotations and settings
Rotations with different supervisors are planned for 4 to 6 months, and while most will involve a general pool of clinical referrals (i.e. across a number of diagnostic categories), an emphasis on particular clinical syndromes is anticipated with each supervisor in association with their interests and degree of involvement with inpatient consultations and other divisions within the health system, such as trauma surgery, neurology and neurosurgery. The fellow will gain experience and training with neuropsychological assessments across a range of patients, including patients with acquired brain injuries, dementia, epilepsy, motor disorders, MS, medical diseases potentially effecting cognitive function (such as cardiovascular disease, liver disease, renal disease, autoimmune disease) , psychiatric and psychological disorders. The postdoctoral fellow will also help provide inpatient consultations to specialty medical services, including trauma surgery, neurosurgery, neurology, psychiatry, medicine and cardiology. Training experiences are almost exclusively at the main campus with the one minor exception involving some outpatient activity noted below.

Outpatient psychiatry clinic

The fellow will be responsible for three neuropsychological assessments, on average, per week, including interpretation of test results and report writing. Clinical activity will also include providing feedback of test results to patients, including clinical and diagnostic impressions, identification of potential targets for intervention, and treatment recommendations. There will also be opportunity for providing evidence-based cognitive rehabilitative psychological services. Considered as part of this experience, the fellow will provide one outpatient assessment a week (over a four-to-six month period) at a northeast Geisinger facility separate from the Danville main campus.

The fellow will gain experience with:

  • Administration of neuropsychological tests
  • Interpretation of test findings integrated with clinical history
  • Report writing
  • Basis for test selection and scope of the assessment
  • Psychiatric diagnostic interviewing
  • Neurobehavioral status exams
  • Medical chart review
  • Follow-up encounters with patients and families to review test results, impressions, and recommendations; in addition to being consultative, feedback is also conceptualized as a therapeutic interventional process
  • Discussion of test results with referring physicians and other professionals
  • Opportunity to provide evidence-based cognitive rehabilitative psychological services and cognitive-behavioral therapy

The fellow will gain experience and training with neuropsychological assessments across a range of patients, including patients with acquired brain injuries, dementia, epilepsy, motor disorders, MS, medical diseases potentially effecting cognitive function (such as cardiovascular disease, liver disease, renal disease, autoimmune disease) , psychiatric and psychological disorders.

Outpatient neurology clinic
The postdoctoral fellow will be responsible for two DBS pre-surgical assessments a week. This rotation will also involve follow-up assessments with patients post-surgery. The postdoctoral fellow will also attend Neurology Deep Brain Stimulation (DBS) Team meetings.

The fellow will gain experience with:

  • Evaluation and assessment of cognitive and psychological contraindications for DBS. DBS candidates include patients with essential tremor, dystonia and Parkinson ’s disease
  • Administration and interpretation of neuropsychological testing of patients who are candidates for DBS
  • Basis for test selection and scope of the assessment
  • Role of the neuropsychologist within the DBS team
  • Pathophysiology of motor disorders and the relationship to neurobehavioral effects
  • Medical chart review
  • Report writing
  • Follow-up encounters with patients and families to review test results, impressions, and recommendations; in addition to being consultative, feedback is also conceptualized as a therapeutic interventional process
  • Discussion of test results with referring physicians and other professionals

Inpatient consultation
The postdoctoral fellow will help to provide inpatient consultations throughout the course of the entire fellowship to specialty medical services, including trauma surgery, neurosurgery, neurology, psychiatry, medicine and cardiology.

The fellow will gain experience with:

  • Approaches to neurobehavioral assessment of patients with concern for cognitive impairment in an acute setting, including review of the medical chart and understanding of variables related to cognitive prognosis, and assessments to assist with diagnosis, determination of medical decision making capacity, disposition planning and follow-up recommendations
  • Discussion of impressions and recommendations with referring physicians, physician’s assistants, social workers, and nurse case managers
  • Geisinger Medical Center is a Level One Trauma Center. The fellow will attend trauma surgery treatment team meetings and gain experience with a multidisciplinary approach to inpatient treatment of patients with TBI, including discussion of impressions and recommendations with multidisciplinary team members.

Rehabilitation hospital
This is an optional four-to-six month rotation that will have the fellow spending one day per week at the rehabilitation hospital.

The fellow will gain experience with:

  • Psychiatric diagnostic interviewing and neurobehavioral status examinations within an inpatient rehabilitation hospital setting.
  • Medical chart review
  • Medication neuropsychological side effects
  • Short-term psychotherapeutic interventions with patients experiencing acute and chronic medical problems, including patients with acquired brain injuries, motor disorders, pain disorders, and medical diseases including cardiovascular diseases, renal disease, COPD, autoimmune disease
  • Discussion of diagnostic impressions and treatment recommendations to referring physiatrists

Didactics and conferences

  • Neuropsychology seminar
  • Psychiatry Grand Rounds
  • Neurology residency didactics
  • Neuroscience Grand Rounds
  • C & L case conference
  • Required readings and literature reviews

The fellow will also have the opportunity to accompany neurology and neurosurgery attending physicians, residents, and/or physician assistants rounding with patients (for one-week periods of time) and observe neurosurgery procedures.

Activity expectations include 26 to 28 clinical service hours and three hours a week of conferences and/or didactics on average, in addition to two hours minimum of individual supervision.