Nashville Campus

 

Setting and Population Served:  The Nashville Campus is a state of the art, general medical and surgical hospital closely affiliated, for training purposes, with Vanderbilt University Medical Center.  The campus recently completed an extensive 43 million dollar clinical addition and renovation project that expanded facilities to meet the increased demand for outpatient services.  The renovation included the upgrading and modernization of the older areas of the campus, the purchase of state-of-the-art equipment, and the construction of a parking garage with a covered walkway into the hospital.  The campus supports training programs in a wide range of health care professions, including the various medical and surgical specialties, nursing, dentistry, pharmacy, and social work, as well as psychology.  Teaching and clinical training are recognized priorities throughout the hospital.  Supervision of interns is provided by four full time psychologists who have a diversity of clinical orientations and interests.  The campus serves as a national organ transplant center and has recently received, in conjunction with Meharry Medical School, the Alvin C. York Campus in Murfreesboro, and Vanderbilt, a major Geriatric Research, Education and Clinical Center (GRECC) grant.  An internship at the Nashville Campus will involve interns in substantive working relationships with professionals from a variety of health-care disciplines. 

The VA population is predominantly male, with an increasing number of women seen as the gender composition of the armed services has changed.  More women are seen as outpatients than inpatients, and as a result of certain special programs, it is likely that each intern will have the opportunity to see a fair number of women as outpatients.  In terms of ethnicity, the population is predominantly Caucasian, with a significant percentage of African-Americans, smaller numbers of Hispanics, and some Asian-Americans and Native Americans.  The age range varies from late adolescence across the entire life span.  There is also a wide range of psychopathology, covering almost the entire range of DSM-IV adult mental disorders.  The population includes an increasing number of recently discharged veterans from the current conflict in the Middle East, and special programs area being developed to facilitate their care. Some patients will be seen primarily in connection with severe physical illness.  Most VA patients come from the lower end of the socioeconomic spectrum, but there are many exceptions to this general rule.

Rotations:  All Nashville primary placement interns will complete four, three-month rotations.  Three of the rotations are located at the Nashville Campus and will be completed by all three interns.  The fourth rotation will be located at the Alvin C. York Campus in Murfreesboro and will be one of the three rotations named below.  See the description of the Alvin C. York Campus for a more complete description of the rotations located there.

Rotations at the Alvin C. York Campus:

Possibilities:

An intern’s Alvin C. York campus rotation will be selected after match day based on intern input and a review of the intern’s training experience, needs, and interests.

The three three-month rotations to be performed at the Nashville campus are described below.  Each Nashville intern will perform all three of these rotations. 

Pain Clinic/PTSD Group Rotation: Nashville Campus

Supervisor:  Dr. Daniel Kearns

It is considered unlikely that this rotation will undergo significant change in the next year. 

Activity and Setting:  The Nashville Campus Pain clinic is an anesthesiology-based pain center utilizing a multidisciplinary approach to pain management.  The clinic staff provides a wide range of treatment modalities to the veteran population including nerve blocks, steroid injections, pharmacotherapy, muscle stimulation, biofeedback, behaviorally focused therapy, and a pain management psychoeducational group.  The clinic also serves as a training site for Anesthesiology residents from Vanderbilt University Medical Center.  The treatment team coordinates the efforts of Anesthesiology, Psychology, and Nursing. 

Intern Duties and Roles:  During the three-month rotation, the intern is responsible for assessing patients new to the clinic, conducting biofeedback, facilitating the pain management group, and participating in biweekly multidisciplinary treatment team meetings.  Initial assessments involve a structured clinical interview and administration of brief assessment instruments (Beck Depression Inventory-II).  More thorough assessments are occasionally conducted to determine patient appropriateness for implantable spinal cord stimulators and may include the Millon Behavioral Medicine Diagnostic (MBMD), McGill-Melzack Pain Questionnaire, and SF 36.  Assessments focus on the impact of mental health problems on medical treatment, substance abuse issues, and assessment of behavioral intervention needs.  The intern will provide feedback to anesthesiology regarding the current psychological status of their patients.   The intern will also be responsible for conducting one seminar for the members of the team during the course of the rotation.  Active participation in a multidisciplinary treatment team is viewed as integral to the progression from intern to skilled and autonomous clinical professional, able to effectively disseminate useful clinical data to professionals from a variety of health care disciplines.  Supervision will include two hours scheduled supervision per week and informal supervision throughout the course of the rotation.  Outside of the Pain Clinic the intern on this rotation will co-lead a weekly therapy group for Vietnam Veterans with combat-related psychological trauma.  This experience will be supervised by Dr. Jonathan May.

Research:  There is ample opportunity for research in this area, but there are no current research projects underway in the Pain Clinic.

Organ Transplant Rotation:  Nashville Campus

Supervisor:  Dr. Saundra A. Saporiti

Dr. Norman Stephenson, the Nashville Campus' long term transplant psychologist, recently retired. Dr. Saundra Saporiti has been hired into the position, and will begin in late September of 2006. It is expected that Dr. Saporiti will put her personal stamp on the structure of the rotation, but the rotation will certainly continue and the training content of the rotation will remain substantially as described below.

Activity and Setting:  The psychologist on the liver, heart, stem cell, kidney, and lung transplantation services is an integral part of the transplant teams at this regional academic transplant center, doing psychological evaluations of potential transplant candidates as well as of support persons and living organ donors.  These evaluations involve cognitive and memory assessment, personality assessment utilizing objective tests, a diagnostic interview and a collateral interview.  The psychologist formulates specific recommendations regarding suitability for transplantation, and possible interventions or behavioral markers which should be met before the candidate is listed.  Follow-up in regard to the patient’s progress in meeting intervention goals is an ongoing part of the evaluation.  Results of the evaluation are presented in an interdisciplinary team conference involving psychologists, hepatologists, cardiologists, transplant surgeons, nurses, and social workers.  Candidacy for transplant is decided at this meeting.  In addition to evaluation, psychological interventions are provided for local transplant applicants. 

Intern Duties and Roles:  The intern and the staff psychologist attend all team meetings together and are jointly involved in all aspects of the rotation.  A goal of this rotation is the objective assessment of the risk of noncompliance, including relapse to smoking and substances of abuse, presence of dysfunctional family systems, presence of symptoms of depression, anxiety or PTSD, and cognitive impairment, any of which might be a barrier to successful transplantation.  The intern must learn to communicate and report to non-mental health medical personnel clearly, orally and in writing, and to work closely with medical center staff from a variety of disciplines.  In addition, opportunities may exist for the intern to supervise pre-doctoral practicum students on the transplant rotation. 

Research:  While there is no ongoing research project on this rotation, there is great potential for research if the intern is interested in initiating a project.

Inpatient Rehabilitation/Health Psychology Consultation and Assessment

Supervisor:   Dr. Michele Panucci

A wide variety of training experiences are included in this rotation.  The experiences are described below.   

2G-Intermediate Care Unit:  2G-IM is a 10-bed inpatient unit housing veterans in need of short-term medical care and treatment (2-3 weeks) while undergoing rehabilitation following surgery.  The intern is responsible for participating in weekly multidisciplinary discharge planning meetings and medical rounds with physicians, nurses, pharmacists, physical therapists, occupational therapists, social workers and dietary consultants. Consultation requests include: cognitive testing/screening to assess limitations and determine functional status, diagnostic clarification (e.g., depression vs. dementia), and short-term treatment for anxiety and adjustment disorders.  Neuropsychological assessment may occur in some select cases. The intern is responsible for providing the medical team with information that is critical to appropriate placement of the veteran following discharge.  Interns will also follow some patients for brief, supportive therapy while they are in the hospital.       

Smoking Cessation Program:  The intern will conduct two group sessions weekly, an Introduction to the Quit Process Group and a Relapse/Coping Group.  The first group involves the provision of basic information about the process of quitting and the evaluation of patients for appropriateness for Nicotine Replacement and/or Zyban therapy.  The second group focuses on identification of triggers, coping skills and stress management techniques.  The smoking cessation program also involves performing assessments of hospitalized patients directed to quit smoking and follow up with outpatient consult requests to assess veterans for participation in the smoking cessation group.  Occasionally, individual sessions with patients unable to attend group will also be conducted.  Written handouts and modules for the Smoking Cessation program will be developed.  Assistance and support will be provided to hospital employees who wish to quit smoking.  Interns co-facilitate groups at the start of the rotation and then act as main facilitators later in the rotation.

Compensation and Pension (C&P) Evaluations:  This involves the interview of a veteran making a claim for a service-connected psychiatric disability.  The evaluation includes obtaining a comprehensive history connecting the veteran’s identified symptoms to his/her military experience.  Many of the claims are for combat-related PTSD or PTSD secondary to sexual trauma occurring during military service, although a wide variety of diagnostic entities are seen during the C&P process.  Some C&P evaluations involve formal psychological testing.  Once the interview, record review, and testing are completed, the intern will prepare a draft of the written report of the evaluation.

Korean War/WW II Group:  This is a twice-monthly group comprised of veterans from one or both wars.  Some of the participants are ex-POW’s.  Interns act as co-facilitator with at least one or two experiences as sole facilitator of the group.

 

The assessment required on all rotations at the Nashville campus will involve both cognitive and personality assessment.  Dr. Kimberly Marshman, now stationed part time at the York Campus, should be moving to the Nashville Campus full time in the fall of 2006, and will be available to provide neuropsychological assessment supervision to interns in Nashville on an as needed basis.  All three interns with primary placements at the Nashville Campus carry an outpatient psychotherapy caseload and perform four rotations, three in Nashville, one in Murfreesboro, as described above.  The staff is flexible within the constraints imposed by service delivery requirements and the structure of the system in allowing interns to pursue more specialized individual training interests.

Constraints on Secondary Placement Selection:  The training experience at the Nashville Campus is diverse and covers the various kinds of experiences interns are expected to receive; therefore, few constraints are placed on interns’ secondary placement choices except that interns must select a placement outside of either VA facility.  Secondary placement experiences available at the Nashville VA for interns with primary placements elsewhere include psychotherapy (individual and group), assessment (personality and cognitive), pain clinic, geriatric psychology, and experiences with the transplant teams.

Positions:  3

Salary:  $22,898

Starting Date:  June 25, 2007

Ending Date:  June 20, 2008           

Contact:

Jonathan E. May, Ph.D.

(615) 327-4751, Ext. 5132     

Faculty:

Thomas W. Hagood, Ph.D.; University of Southern Mississippi. Interests: Posttraumatic Stress Disorder, Substance Abuse, Pain Management.

Daniel F. Kearns, Psy.D.; Florida Institute of Technology.  Interests:  Behavioral Medicine, Group and Individual Psychotherapy, Psychological Aspects of Chronic Pain Management. 

 

Kimberly C. Marshman, Ph.D.; Florida State University. Postdoc; Memphis VA and St. Jude's Children's Research Hospital/Lebonheur Children's Hospital. Interests: Neuropsychological Assessment and Consultation, Behavioral Medicine, Geropsychology, Clinical Research.

Jonathan E. May, Ph.D.; Vanderbilt University.  Consortium Director and TVHS Training Director.  Interests:  Individual and Group Psychotherapy, Treatment of Sexual Dysfunction, Treatment of Combat-Related Posttraumatic Stress Disorder.

Kenneth Morel, MS; University of Utah, Chicago Medical School, Finch University of Health Sciences.  Psychology Technician.  Interests: Psychological Assessment, Response Bias.   

Michele M. Panucci, Ph.D.; University of Wisconsin, Madison.  Interests:  Psychotherapy, Treatment of Female Veterans, Personality Assessment, Posttraumatic Stress Disorder, Attachment, Health Psychology Issues, e.g. weight management and smoking cessation..

Saundra A. Saporiti, Psy.D.; Nova Southeastern University. Interests: Behavioral Medicine, Women's Mental Health, Trauma, Psychological Aspects of Organ Transplantation, Personality Assessment.

revised 9-2006

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