Clinical neuropsychology track
The purpose of the neuropsychology track doctoral internship at Geisinger 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 Division 40 Houston Conference Guidelines and guidelines promulgated by the American Psychological Association (APA) for internship training in clinical psychology. We believe that the training experience within the clinical neuropsychology track is best suited to meet the needs of trainees who intend to pursue postdoctoral specialty training in clinical neuropsychology. Accordingly, preference is given to those who intend a future career as a neuropsychologist. The internship program focuses on work with adults and is thus unlikely to meet the needs of trainees who wish to pursue a career in pediatric neuropsychology. Interns can expect to experience both breadth and depth of training during their time at Geisinger, including exposure to a wide range of patient populations, interprofessional experiences, didactic opportunities and involvement in research. Training includes a significant percentage of time involved in supervised delivery of clinical services and interested interns will have the opportunity to be involved in research as available and appropriate (this is not a requirement at the internship level). Geisinger is home to a Clinical Neuropsychology Postdoctoral Residency Program that is a member of the Academy of the American Board of Professional Neuropsychology. Previous interns have chosen to stay at Geisinger for postdoctoral training, which we believe is a testament to the quality of the training we offer.
Northeast and central region tracks
For the 2020 – 2021 training year, we are pleased to announce that we will now have three full-time internship positions. Two of these positions are in the central region and are based out of Geisinger Medical Center (Danville, Pa.). One position is based in the northeast region, out of the Memory and Cognition Clinic site near Geisinger Wyoming Valley Medical Center (Wilkes-Barre, Pa.). The main differences between these tracks are in supervision and minor rotations. Interns in the central region will have two primary outpatient neuropsychological supervisors (Drs. Fulton and Stewart) and will engage in the behavioral medicine minor rotation (though opportunities for some rotation at the cancer center may be possible for interested interns). Outpatient neuropsychological activities of interns in the northeast will be supervised by Dr. McKnight and the northeast intern will engage in the Henry Cancer Center minor rotation (some exposure to other Danville-based training experiences, such as Geisinger Encompass Health may be possible for interested interns). Given the substantial similarities between these tracks, we encourage applicants interested in one track to apply to both the northeast and central practice sites.
Supervision and setting
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. Supervision follows a developmental model. Early on in a given rotation, there are opportunities to observe supervisors conducting clinical interviews, feedback sessions and other relevant clinical activities. Trainees then assume an increasing level of independence throughout the rotation as befits their level of skill, with the expectation that they function relatively autonomously with appropriate supervision by the end of the training experience. The Division of Neuropsychology is comprised of six full-time neuropsychologists. Drs. Stewart and Fulton are primary outpatient supervisors for the central region and Dr. McKnight is the primary outpatient supervisor in the northeast. Interns are also supervised by members of the adult clinical psychology faculty during their behavioral medicine/Henry Cancer Center rotations. This gives trainees the advantage of experiencing multiple different perspectives toward patient care and multiple supervisory styles. Interns will receive a minimum of two hours of individual supervision per week from a licensed psychologist (though in our experience, interns typically receive much more supervision) in addition to two hours of group or other supervision, which may be in the form of case conferences and fact findings. They are also subject to a minimum of four live evaluations of assessment and treatment activities per quarter.
Neuropsychologists at Geisinger practice evidence-based neuropsychology, including working within the framework of a psychometric model that makes use of base rates of low scores whenever clinically appropriate. This allows interns to learn a flexible and portable interpretive system, grounded in psychometric theory, with a known rate of false-positive errors. We believe this system contributes to more precise and empirically based clinical decision making. Another unique feature of training at Geisinger is the large catchment area of the healthcare system and wide referral base, which contributes to a varied and stimulating population of referrals. Typical populations served include individuals presenting with memory loss and dementia, brain tumor/CNS cancer, moderate to severe traumatic brain injury, mild traumatic brain injury, stroke, autoimmune conditions and psychiatric comorbidities in addition to neurosurgical populations. In our experience, there is a high number of patients with complex conditions and/or less common conditions (i.e., atypical or rare dementia syndromes, complex medical comorbidities, genetic conditions and multifaceted psychiatrically complex cases), who are often referred for care at Geisinger due to the resources and expertise available at our healthcare system.
Didactic programming includes but is not limited to Department of Psychiatry grand rounds, neuropsychology residency didactics, Memory and Cognition Consensus Conference, as well as the weekly didactics, case conference and Ethics Seminar provided through the Clinical Psychology Internship Program. At Geisinger, neuropsychology is well represented on several multidisciplinary treatment teams comprised of neurosurgeons, behavioral neurologists, neuro-oncologists and neuroradiologists amongst other specialties, which allows interns to develop an appreciation for multidisciplinary collaboration within a tertiary and quaternary care setting.
The training year includes a six-month major rotation in outpatient clinical neuropsychology (approximately two outpatient evaluations per week) and a six-month major rotation in Memory and Cognition Clinic (two days a week). These experiences are complemented by minor rotations in outpatient clinical neuropsychology (approximately one outpatient evaluation per week) and in behavioral medicine, either with a general behavioral medicine population (central region) or with cancer patients (northeast region). Thus, each intern completes two major and two minor rotations. Interns complete their major rotation in Memory and Cognition Clinic and a minor rotation in outpatient neuropsychology concurrently. The other half of the year, interns complete their major rotation in outpatient clinical neuropsychology and their minor rotation in behavioral medicine. Interns are thus heavily involved in neuropsychological evaluation and treatment activities for the entire training year. Other training opportunities such as working at Encompass Health, Geisinger’s affiliated rehabilitation hospital (Danville, Pa.) and involvement in the inpatient consultation service may be available to interested trainees. Additionally, Dr. Fulton runs an ongoing cognitive wellness group for individuals with subjective memory complaints and mild cognitive impairment that interns have had the opportunity to facilitate in the past. These experiences will be supplemented by additional clinical activities as available and appropriate to interns’ training needs including teaching activities, didactics and clinical research. A sample training sequence is presented below:
|July to January||January to July|
|Memory and cognition major rotation||Outpatient neuropsychology major rotation|
|Outpatient neuropsychology minor rotation||
Behavioral medicine minor rotation
Outpatient clinical neuropsychology (central and northeast regions)
During their six-month major and six-month minor rotations in outpatient clinical neuropsychology, the doctoral intern will be responsible for outpatient neuropsychological evaluations under appropriate supervision. The intern will gain experience with administration of neuropsychological tests, test selection, neurobehavioral status examination, interpretation of test results and report writing. Interns conduct all parts of the evaluation themselves, under appropriate supervision, including a clinical interview, testing and eventually feedback to the patient. 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 the system of psychometrically based interpretation that we employ when appropriate at Geisinger, which we believe contributes to more objective clinical decision making and test interpretation.
Memory and Cognition Clinic (central and northeast regions)
Interns will spend six months (two days per week) working in Geisinger’s Memory and Cognition program. For interns in the central region, we anticipate that this will involve rotating one day a week at our Bloomsburg clinic site (a 20-minute drive from Danville) and one day a week at our Wilkes-Barre clinic site. For interns in the northeast, both clinic days will be at our Wilkes-Barre clinic site. This is a multidisciplinary experience where interns will work closely with and will have the opportunity to observe one of our behavioral neurologists. The program is designed as a model system of dementia care that provides a “one stop shop” for individuals presenting with memory loss and dementia. During this rotation, interns can expect to encounter a broad range of dementia syndromes. They will gain exposure to the integration of structural neuroimaging and other biomarkers (e.g., CSF biomarkers for Alzheimer’s disease, SPECT-DaT scan, metabolic PET imaging) with neuropsychological test data in the service of diagnostic clarification. They will learn how to work in the faster pace of a medical clinic setting, which entails conducting a clinical interview, administering and scoring tests, providing feedback to the referring physician, and developing a treatment plan the same day of the MDC appointment. Interns will be present during the diagnostic consensus conference that takes place between their supervisor and a behavioral neurologist, which contributes to skill building in effective multidisciplinary communication and to understanding the medical approach to diagnosis and treatment of dementia.
Behavioral medicine (central region)
Interns in the central region will complete a six-month minor rotation (approximately one half-day of patients per week) in behavioral medicine within the outpatient Department of Psychiatry. They will conduct psychiatric diagnostic evaluations and provide psychotherapeutic treatment services to individuals presenting with a range of psychiatric conditions including depression, anxiety, difficulties adjusting to chronic illness and somatic symptom disorders. While the intern can expect to work with a general psychiatric outpatient population, attempts are made to provide the intern with a case load that is representative of the types of issues they can expect to work with therapeutically in neuropsychological practice, including individuals with cognitive complaints, cognitive impairments and/or comorbid medical conditions. Supervision emphasizes empirically supported treatment models such as cognitive behavioral therapy, acceptance and commitment therapy, motivational interviewing and other targeted treatments.
Henry Cancer Center (northeast region)
Interns in the northeast will complete a six-month minor rotation (approximately one half-day of patients per week) providing psychotherapeutic services to cancer patients at the Henry Cancer Center. This training experience is ideally suited to individuals with a particular interest in working with this population. Interns will have the opportunity to provide outpatient and consultative services to patients and will participate in a multidisciplinary clinic for newly diagnosed cancers as part of the integrated care team. The intern can expect to be exposed to individuals at varying stages of illness, including those with terminal illness and those who have survived treatment. Supervision emphasizes empirically supported treatment models such as cognitive behavioral therapy, acceptance and commitment therapy, motivational interviewing and other targeted treatments.
Neuropsychology offers an inpatient consultation service at Geisinger Medical Center and Geisinger Bloomsburg Hospital. While not a core training experience for interns, the interested intern may be able to shadow and/or participate in these consultations. Consultations come from the emergency department and various medical floors of the hospital and typically involve concerns about a patient’s ability to make medical decisions. Geriatric individuals presenting with varying severities of delirium and dementia make up the bulk of referrals. This training experience provides an excellent opportunity for interns to hone their skills in medical chart review, to gain an appreciation for how general medical status contributes to cognitive functioning, to see patients with relatively acute presentations, and to gain exposure to medical culture within an inpatient hospital setting.
Geisinger Encompass Health rehabilitation neuropsychology
Interested interns will have the opportunity to gain exposure to rehabilitation neuropsychology at Encompass Health, Geisinger’s affiliated rehabilitation hospital. This setting emphasizes rapid evaluation and treatment of the various psychological and neuropsychological issues affecting patients recovering from acute illness or injury. Interns will conduct psychiatric diagnostic evaluations, neurobehavioral status examinations and brief neuropsychological assessments while serving as consultants to the multidisciplinary rehabilitation treatment team. 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). They may have the opportunity to accompany their supervisor to multidisciplinary team meetings involving physiatry, occupational therapy, physical therapy and other allied health professions. The intern can expect to further develop skills in medical chart review, consultation to a multidisciplinary treatment team 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.
In our experience, interns have access to far more training experiences than they can realistically take advantage of during the training year. There are numerous didactics and grand rounds within neurosciences and Geisinger’s other institutes that interested interns will be able to attend. Previous interns have had the opportunity to observe Wada procedures, deep brain stimulation surgical implantation and brain cuttings. There may also be opportunities to be involved in teaching medical students. Dr. Stewart has an active research program and previous interns have been able to participate in writing manuscripts for publication and in creating posters to be presented at national conferences.