The Neuropsychology Track offers broad-based training for interns with specific prior graduate training in neuropsychology (though interns with no neuropsychology experience can complete any of the rotations within the track). Interns who match in the Neuropsychology Track will meet the didactic and experiential training requirements recommended by APA Division 40, including six months of specific neuropsychology experiences with multiple associated rotation-specific seminars and rounds.
The Neuropsychology Clinic provides neuropsychological evaluation services throughout the VAMC. Referrals come from a variety of inpatient and outpatient services, including mental health, neurology, primary care, physical medicine and rehabilitation, geriatric medicine, infectious diseases clinic, and others. Adults with a range of diagnoses are seen for assessment, including traumatic brain injury, cerebrovascular illness, seizure disorders, dementias, other neurodegenerative and neurological diseases, chronic substance abuse, learning disorders, and attention-deficit/hyperactivity disorder.
All interns in the neuropsychology clinic conduct outpatient neuropsychological evaluations. A hypothesis-testing approach is utilized, in which each evaluation is tailored to the specific needs of the patient and referral source. Emphasis is placed on (1) interpretation and integration of historical, observational, and qualitative information, as well as quantitative test data; and (2) development of specific, concrete treatment recommendations to maximize the benefit to each patient. Training is adapted to the needs of individual interns, so the rotation can provide valuable learning experiences for those planning a career in neuropsychology and those with little or no prior experience in the field. Interns attend the monthly neuropsychology seminar series, a forum for clinical case conferences, research presentations, and other topics of interest in an informal setting. Numerous research opportunities are available in the neuropsychology clinic. The Charleston Consortium is a member of the Association for Internship Training in Clinical Neuropsychology.
In addition to outpatient evaluations, a variety of other experiences are available on this rotation:
A weekly, interdisciplinary clinic for evaluation of older adult is led by a team composed of staff and trainees from neurology, psychiatry, and neuropsychology. Patients seen in this clinic include those with Alzheimer’s disease, vascular dementia, frontotemporal dementia, mild cognitive impairment, late-life depression, and other conditions. In addition to performing brief evaluations, interns in this clinic attend monthly, interdisciplinary team meetings in which the neurological, neuropsychological, and neuroimaging data are reviewed, consensus diagnoses are assigned, and recommendations are formulated. Interns also gain experience in providing feedback of examination results to patients and their families in an interdisciplinary setting.
Neuropsychological consult services are provided to inpatients on the psychiatry, neurology, and general medicine wards. Evaluations are frequently sought by inpatient treatment teams to provide differential diagnosis of psychiatric and cognitive disorders, to assist in determination of capacity and disposition planning, and to provide treatment recommendations to maximize post-discharge outcomes. Interns gain experience conducting brief clinical interviews with these patients, designing and administering brief test batteries targeting specific referral questions, providing results and recommendations to inpatient treatment teams in a consultative capacity, and writing concise, integrative reports.
To our knowledge, the Ralph H. Johnson VAMC is the first major medical center in the United States to conduct comprehensive clinical neuropsychological evaluations and feedback sessions via telemedicine. Through this program, veterans followed in outpatient clinics about 100 miles away from Charleston are able to avoid costs and safety concerns associated with travel. Pencil-and-paper materials are provided on-site by staff, and visual images for testing are presented digitally. To date, numerous evaluations of dementia, stroke, TBI, ADHD, MS, and Parkinson’s disease, among other conditions, have been successfully performed. Veterans report great satisfaction with evaluations provided by telemedicine; rates of adequate effort, psychometric test properties, and cognitive diagnoses are equivalent to those of the in-person hospital clinic. Interns are offered the opportunity to observe and/or conduct evaluations in this clinic.
After completing the VAMC Neuropsychology Clinic rotation, interns will be able to:
Ralph H. Johnson VA Medical Center
Housed in the Department of Neurology, this rotation is designed to help the intern develop clinical neuropsychological and psychopathology assessment skills useful in the practice of clinical neuropsychology in the medical center. This rotation provides interns with adult and pediatric experiences in medical neuropsychology, including experience with:
Interns receive training in report writing and consulting with interdisciplinary patient care teams. Clinics served include a memory disorder clinic (Alzheimer and related dementia), movement disorder clinic (focusing on pre-post neurosurgical implantation of STM DBS), epilepsy movement disorder clinic (focusing on NES and pre-post neurosurgical treatment of seizures), and general neurological clinics (forensic, head injury, organ transplantation, multiple sclerosis, CNS tumors, etc.). Some pediatric experiences may be available in the areas of epilepsy and neuro-oncology.
The primary training sites for this rotation include our outpatient clinic, the neurology service of MUSC’s outpatient hospital, and to a lesser extent, the inpatient neurology service. The training focus is medical psychology and often includes the multidisciplinary model of patient care. Educational opportunities include abundant patient contact with extensive daily individual case supervision using the medical model case teaching approach, weekly neurophysiology and neuron-radiology conferences, and monthly neuropsychology seminars. Opportunities exist to watch neurological exams, Wada studies, and/or neurosurgical procedure(s) on patients being followed by this service to gain a multidisciplinary perspective. Numerous research opportunities are available and active participation by interns is strongly encouraged.
After completing rotation, psychology interns will be able to:
Medical University of South Carolina Department of Neurology
Interns on this rotation will participate in three primary clinical experiences:
All veterans of recent military operations (e.g, OIF, OEF) are screened for a variety of behavioral health problems on their initial visit to the VAMC. Those who screen positive for possible TBI are referred for “second level” evaluation in the TBI Clinic. Patients there are examined by one of two staff physiatrists, who consult neuropsychology whenever further evaluation is needed (e.g., cognitive complaints, evidence of cognitive impairment, psychiatric symptoms, complex differential diagnosis), or whenever patients request it (e.g., for second opinions about their condition). After consulting with the physiatrist, the neuropsychologist/intern may conduct a diagnostic interview to help delineate TBI severity and possible sequelae, and to differentiate the effects of possible TBI from those of other conditions (e.g., mood or anxiety problems, substance use). Immediate feedback and psychoeducation are an integral component of these interviews, and referrals for needed services are provided.
Skills-based cognitive remediation groups, based on the evidence-supported CogSMART model are provided to groups of veterans with memory difficulties and other cognitive complaints arising from TBI, severe mental illness, and other conditions. Interns will begin by co-leading rehabilitation intervention groups, and will progress until they are leading groups relatively independently. Opportunities are also available for interested interns to provide highly individualized cognitive rehabilitation and/or psychotherapy to neurologically impaired patients.
Interns participate in all aspects of neuropsychological evaluations of outpatients with histories of TBI, and with other conditions that can affect cognition. A hypothesis-testing approach is utilized, in which each evaluation is tailored to the specific needs of the patient and referral source. Emphasis is placed on the efficient collection, analysis, and synthesis of clinical data to generate conclusions and recommendations.
After completing this rotation, interns will be able to:
Ralph H. Johnson VA Medical Center