Program overview

Geisinger’s Clinical Neuropsychology Fellowship program is intensive and immersive, starting from the first day you join our team.

Our neuropsychology faculty supervise you from a developmental approach. At the beginning of a new clinical rotation, you’ll meet with the primary supervisor to discuss expectations, including an assessment of your skills. This will help you identify your strengths, areas for growth and training goals.

As you progress through the program, you’ll be presented with more complex training opportunities — and more autonomy — with the goal of sharpening your evaluation skills.

You’ll also participate in tiered supervision with predoctoral interns and practicum students, so you gain supervisory skills. Your main goal should be to provide residents with an array of patients from differing backgrounds and clinical conditions to prepare them for independent practice.

Over the course of your two years, you’ll have four six-month clinical rotations. Each rotation will include a combination of a general outpatient neuropsychology assignment and ancillary clinical experience. You’ll work with the training director and rotation supervisors to establish objectives, required activities and caseload guidelines.

You’ll have at least two hours of individual supervision each week with primary supervisors, along with hours with supervisors in the ancillary rotations. Supervisors use techniques like direct observation, role modeling and review of evaluation protocols and reports. You’ll receive ongoing feedback about your performance in weekly meetings and a formal performance evaluation every three months.

Clinical neuropsychology training

1. General outpatient neuropsychology evaluations: Each location across the Geisinger system where neuropsychology training occurs provides outpatient neuropsychological evaluations. You’ll work with a primary outpatient supervisor to develop outpatient neuropsychological evaluation skills, completing two to three evaluations per week. Referrals come from a variety of primary and specialty care services. You’ll have the opportunity to evaluate patients with myriad neurological, psychiatric and medical conditions including Alzheimer’s disease, cerebrovascular disease/dementia, traumatic brain injury, substance-induced neurocognitive disorders, toxic/metabolic encephalopathy, seizure disorders, severe mental illness, Parkinson’s disease, ADHD and HIV.

You’ll solidify your competence in test selection, administration, scoring, interpretation and report writing. You’ll also provide feedback to patients and families regarding evaluation findings, impressions and recommendations. This is an excellent opportunity for you to develop confidence when providing difficult feedback and to help patients, families and referring professionals understand how a neuropsychological evaluation can inform treatment plans and help people function in day-to-day life.

Overall, you’ll gain experience in:

• Administration of neuropsychological tests
• Interpretation of test findings integrated with clinical history
• Report writing
• Basis for test selection and scope of the assessment
• Diagnostic interviewing
• Neurobehavioral status exams
• Medical chart review
• Follow-up encounters with patients and families to review test results, impressions and recommendations
• Discussion of test results with referring physicians and other professionals
• Provision of evidence-based cognitive rehabilitative psychological services and cognitive-behavioral therapy

Subspecialty outpatient neuropsychology evaluations: You may also have opportunities to participate in specialty outpatient neuropsychology evaluations, namely pre- and post-surgical evaluation for seizure disorders (e.g., resections) and movement disorders (e.g., deep brain stimulation/DBS). Specific to these types of evaluations, you’ll 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
• Pathophysiology of motor disorders and the relationship to neurobehavioral effects
• Administration and interpretation of neuropsychological testing of epilepsy patients who are candidates for neurosurgical intervention (e.g., resection)
• Exposure to WADA testing
• Role of the neuropsychologist within the DBS and epilepsy teams; residents will have the opportunity to participate in the movement disorder/epilepsy interdisciplinary team meetings to present test results and impressions

2. Memory and Cognition Program: You’ll have the chance to work in Geisinger’s multidisciplinary Memory and Cognition Program, where you’ll work closely with one of the behavioral neurologists. The program is designed as a “one stop shop” for patients with memory loss and dementia. You can expect to encounter a broad range of dementia syndromes and 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. You’ll learn to work in a fast-paced clinical setting, conducting a clinical interview, administering and scoring neurocognitive tests, providing feedback to the referring physician and developing a treatment plan on the same day of the MDC appointment. You’ll participate in the diagnostic consensus conference between the supervisor and a behavioral neurologist, building your skills in multidisciplinary communication and gaining a deeper understanding of the medical approach to the diagnosis and treatment of dementia.

3. Geisinger Encompass Health Rehabilitation Hospital: Develop your rehabilitation neuropsychology skills at Encompass Health, Geisinger’s affiliated rehabilitation hospital. This setting emphasizes rapid evaluation and treatment of psychological and neuropsychological issues affecting patients recovering from acute illness or injury. You’ll conduct evaluations, neurobehavioral status examinations and brief neuropsychological assessments while serving as a consultant to the multidisciplinary rehabilitation treatment team. You’ll also provide short-term psychotherapeutic interventions to patients with acute and chronic medical problems, such as those with traumatic brain injuries, stroke, pain disorders or medical diseases (e.g., cardiovascular disease, orthopaedic injuries, renal disease, COPD or autoimmune disease). And you’ll accompany the supervisor to multidisciplinary team meetings involving physiatry, occupational therapy, physical therapy and other allied health professions. You can expect to develop skills in medical chart review and consultation with a multidisciplinary treatment team, plus an appreciation of medication side effects that may contribute to patient presentation. This will give you a greater understanding of clinical presentations at a more acute phase of injury and illness.

4. Multidisciplinary Post-Intensive Care Unit Clinic: Take advantage of the opportunity to participate in a multidisciplinary post-ICU clinic. In this clinic, post-ICU patients are evaluated on regular intervals by a multidisciplinary team composed of critical care medicine, health psychology, neuropsychology and case management. Patients are followed on semi-regular intervals based on need. Your role in this clinic is to provide brief cognitive screenings to help track patients’ cognition over time and to facilitate appropriate outpatient referrals. Additionally, you’ll provide education to patients and the team about the nature of cognitive recovery/sequalae following severe medical illness. 

5. General medical inpatient consultation and consultation/liaison (C/L) psychiatry: Neuropsychology offers a limited inpatient consultation service at Geisinger Medical Center. The C/L psychiatry has a designated psychiatric provider for consults each day of the week. While not a core training experience, interested residents will be able to shadow and/or participate in these consultations (with either a neuropsychology attending or a psychiatric provider). Consultations come from the emergency department and various medical floors of the hospital. Consults typically involve concerns about a patient’s ability to make medical decisions for various reasons (e.g., dementia, delirium, psychiatric illness, intellectual disability). This training provides an excellent opportunity for you 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 in an inpatient hospital setting.

Didactics

You’ll engage in numerous didactic opportunities throughout the two training years, including:

1. Neuropsychology Seminar: This weekly seminar is a mixture of didactic presentations by faculty on topics that will help you prepare for the clinical neuropsychology board exam, journal club, resident presentations and fact-finding exercises.
2. Joint Neuropsychology and Behavioral Neurology Case Conference/Group Supervision: Each week a neuropsychology trainee presents a neuropsychology case to the rest of the neuropsychology group and two behavioral neurologists. The group integrates clinical history, neuropsychological test findings, neurologic exam, neuroimaging and lab results to render the most likely diagnosis.
3. Psychiatry Grand Rounds: This weekly didactic meeting includes all members in the department of psychiatry. Presentations are given by both internal and external speakers. Topics cover a broad range of issues in mental health, including in the areas of psychiatry, clinical psychology and social work.
4. Neurology Grand Rounds: This weekly didactic meeting includes all members in the department of neurology. Presentations are given by both internal and external speakers. Topics cover a broad range of issues in neurology.
5. Brain cuttings: Geisinger staff pathologists offer brain-cutting sessions to neuropsychology trainees on an as-available basis.

You can also attend other didactics, seminars and/or trainings offered at Geisinger.

Competency areas assessed

Upon graduation from the program, you’ll demonstrate advanced competency in:

1. Neuropsychological assessment
2. Therapeutic feedback of neuropsychological evaluation impressions 
3. Interdisciplinary consultation
4. Multidisciplinary team treatment planning
5. Professional, ethical and legal issues 
6. Cultural and individual diversity
7. Scholarly inquiry
8. Supervision and teaching

Scholarly activity

Geisinger has a strong tradition of research and innovation, and you’ll be expected to engage in scholarly activity. Past residents have participated in applied clinical research, program development and the preparation of conference presentations. The goal is to develop manuscripts worthy of publication.

You’ll also play a teaching role, including presenting at the Neuropsychology Seminar, teaching interns in Geisinger’s American Psychological Association-approved clinical internship program (if interns are recruited for the training cycle) and presenting at Division of Psychiatry grand rounds, if you’re interested.