Clinical neuropsychology track

The purpose of the neuropsychology track doctoral internship at Geisinger Health System is to complete training in the general practice of professional psychology and extend specialty training in the science and professional practice of clinical neuropsychology. Training is offered in accordance with prevailing standards of the field. We believe that the training experience is best suited to meet the needs of trainees who intend to pursue postdoctoral specialty training in clinical neuropsychology.

Interns can expect to experience both breadth and depth of training in the service of this goal, including exposure to a wide range of patient populations, interprofessional experiences, and didactic experiences. Training includes a significant percentage of time involved in supervised delivery of clinical services and interested interns may have the opportunity to be involved in research as available and appropriate. Interns will receive a minimum of two hours of individual supervision per week (though in our experience, interns typically receive much more supervision). Written evaluations are provided on a quarterly basis by current supervisor(s).

The training year includes a six-month major rotation and six-month minor rotation in clinical neuropsychology and thus, trainees can expect to be involved in the provision of neuropsychological services throughout the internship year. There is a concurrent year-long major rotation in rehabilitation neuropsychology with an emphasis on treatment. These experiences are complimented by a six-month minor rotation in consultation/liaison and emergency psychiatry.

During the first six-month major rotation in clinical neuropsychology, interns spend a large portion of their time in outpatient neuropsychological assessment (two full assessments per week) and the equivalent of one full day a week at Geisinger Health South Rehabilitation Hospital. During the second six-month neuropsychology minor rotation, interns continue to see one outpatient neuropsychological assessment per week, spend the equivalent of one and a half days per week at Geisinger Health South Rehabilitation Hospital, and complete a minor rotation in consultation liaison psychiatry and emergency psychiatry. These primary rotations will be supplemented by additional clinical activities as available and appropriate to interns’ training needs, including leading a cognitive wellness group, working closely with behavioral neurology at one of Geisinger’s Aging Brain and Behavioral Neurology Center clinics, inpatient neuropsychological consultation, and neuropsychological evaluations in support of Geisinger’s epilepsy and deep brain stimulation surgical programs.

Supervision emphasizes building fundamental skills in diagnostic interviewing, psychometric foundations of test interpretation, and developing knowledge of the wide range of clinical syndromes and presentations that interns can expect to encounter in clinical practice. The large catchment area of the health care system and wide referral base represent distinct strengths of training at Geisinger and contribute to a varied and stimulating training year.

Geisinger is also the site of a postdoctoral residency program recognized by the Academy of the American Board of Professional Neuropsychology, which contributes to the training community in which the intern is immersed. Didactic programming includes but is not limited to department of psychiatry grand rounds, integrated neuropsychiatry/neurology didactics, neuropsychology residency didactics, as well as the weekly didactics, case conference, and ethics seminar provided through the clinical psychology internship program, multidisciplinary tumor board conference, and aging brain consensus conference. At Geisinger, neuropsychology is well represented on several multidisciplinary treatment teams comprised of neurosurgeons, behavioral neurologists, neurologists, and neuroradiologists amongst other specialties, which allows interns to develop an appreciation of multidisciplinary collaboration within a tertiary care setting.

Clinical rotations

Clinical neuropsychology
During the six-month major and six-month minor rotations in clinical neuropsychology, the doctoral intern will gain experience with administration of neuropsychological tests, test selection, psychiatric diagnostic interviewing, interpretation of test results, and report writing under appropriate supervision. Interns will provide feedback regarding test results to patients, including diagnostic impressions, identification of potential targets for intervention, and treatment recommendations. They will also have the opportunity to carry outpatient psychotherapy patients.

Representative populations interns can expect to see include patients with traumatic brain injuries, degenerative conditions, stroke, epilepsy, movement disorders, multiple sclerosis, medical diseases affecting cognitive function (e.g., cardiovascular disease, liver disease, renal disease, autoimmune disease), psychiatric, and neuropsychiatric disorders. In addition to more traditional models of test interpretation, interns will learn a system of psychometrically based interpretation that we believe contributes to making more objective clinical and diagnostic determinations.

Geisinger Health South Physical Medicine and Rehabilitation
Over the course of a year-long major rotation, interns will be involved in the practice of rehabilitation neuropsychology at Geisinger Health South Rehabilitation Hospital with an emphasis on treatment. Interns will conduct psychiatric diagnostic interviews, neurobehavioral status examinations, and brief neuropsychological assessments. They will also provide short-term psychotherapeutic interventions to patients experiencing acute and chronic medical problems, such as those with traumatic brain injuries, stroke, pain disorders, or medical diseases (e.g., cardiovascular disease, orthopedic injuries, renal disease, COPD, or autoimmune disease).

The intern can expect to further develop skills in medical chart review, consultation to a multidisciplinary treatment team involving physiatrists, and appreciation of medication side effects that may be contributing to patient presentation. This experience allows interns to gain an appreciation of patient presentations at a more acute phase of injury/illness.

Consultation liaison psychiatry and emergency psychiatry
Interns will complete a six-month minor rotation in consultation liaison psychiatry and emergency psychiatry during the second half of the year, supervised by members of the psychiatry service. Interns can expect to develop a greater appreciation of medical culture and mental health treatment throughout the spectrum of care. The psychiatry consultation and liaison rotation will take place over the course of three months and involves rounding throughout the medical center as a member of a team comprised of a psychiatrist, medical residents, and the psychology intern. Representative patients include those presenting with delirium, acute suicidal ideation, and behavioral management problems among other issues.

During the other three months that comprise the emergency psychiatry rotation, interns will complete clinical assessments of individuals presenting to the emergency department with psychiatric concerns and will conduct risk assessments.

Additional experiences
In our experience, interns have access to far more training experiences than they can realistically take advantage of during the training year. Past trainees have been able to observe brain cuttings, Wada procedures, deep brain stimulation surgical procedures, and intrasurgical brain mapping during tumor resection. There may also be opportunities to be involved in teaching medical students and bariatric surgery evaluations. There is ongoing research within the division of neuropsychology that interested interns will have the opportunity to participate in as their interest and training circumstances allow.