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VA Tennessee Valley Healthcare System Rotations in Neuropsychology
There are two
Neuropsychology training rotations offered, one at the
Nashville Campus supervised by Dr. Marshman, and one
at the York Campus supervised by Dr. Denning. As
two different neuropsychologists run and supervise the
different rotations, there will be some differences in
the training experiences. They are
described separately below. One intern per year
will be enrolled in the Neuropsychology Track,
in which the first 6 months of training will be in
Neuropsychology (one 3-month rotation with Dr.
Marshman and one 3-month rotation with Dr.
Denning). The Neuropsychology Track Intern will
also choose one rotation from the Mental Health
emphasis area and one rotation from the Behavioral
Medicine emphasis area. Other interns will have
the opportunity to take one, but not both of the
neuropsychology rotations. The neuropsychology
track meets APA Division 40 standards for pre-doctoral
internship training. Recent neuropsychology interns
have successfully obtained competitive 2-year
post-doctoral fellowships in neuropsychology at sites
including the Chicago Medical School, University of
Kansas Medical School, and the Memphis VA. Nashville Neuropsychology
Rotation Location: Nashville
Campus Supervisors: Dr.
Kim Marshman Setting: The
neuropsychological assessment rotation provides an
opportunity to learn about brain-behavior
relationships, the field of neuropsychology, various
methods of assessment, and the functioning of a
neuropsychology service within a medical center
setting. Neuropsychology is a consultative
service that receives referrals from various sources
including neurology, neurosurgery, psychiatry, primary
care, and other specialty clinics/services (e.g.,
transplant). The service primarily provides
differential diagnostic assessment and recommendations
for treatment, with most patients being seen on an
outpatient basis. Typical cases involve the
assessment of cortical and subcortical dysfunction
associated with various medical conditions, illnesses,
and injuries, including degenerative dementias (e.g.,
Lewy-body, Alzheimer’s, frontotemporal), multiple
sclerosis, cerebrovascular diseases/CVAs, epilepsy,
traumatic brain injury, “normal aging” memory
complaints, and pseudodementia. Due to the nature of
the VA population, many evaluations also include the
assessment of psychiatric disorders, such as Major
Depression and Post-Traumatic Stress Disorder, and
their impact on cognitive performance. Because
changes in mood and personality may occur in certain
neurological conditions, personality assessment (e.g.,
PAI, MMPI-2) may also play an important role in a
neuropsychological assessment. Since the majority
of our patients have comorbid medical conditions
(e.g., diabetes, hypertension, sleep apnea, COPD),
interns have the opportunity to learn about the impact
of non-neurological conditions and medications on
cognitive functioning. What Interns Will Do: The
neuropsychological assessment format employs a
modified "flexible battery" approach, with typical
tests including the WASI, CVLT-II, RBANS, FTT, COWAT,
WCST and portions of the WMS and WAIS, among
others. Interns are expected to conduct one to
two supervised assessments per week, depending upon
their level of experience and training
needs. Interns will learn how to conduct a
neuropsychological clinical interview, administer and
score commonly-used neuropsychological tests,
interpret the results, develop useful recommendations,
write a comprehensive but relatively brief
neuropsychological report, and provide feedback to
patients, families, and other medical
staff. Through the clinical cases and outside
readings, interns will have the opportunity to learn
functional neuroanatomy to integrate into the report
and recommendations. Depending upon scheduling
and availability, interns may attend Neurology Rounds
at Vanderbilt and other didactics. Supervision
includes 1-2 hours of scheduled individual time, as
well as ad hoc supervision. Supervision is also
provided via written feedback on each of the intern’s
neuropsychological reports. Because the services
provided by neuropsychology are often communicated to
the referral source solely in writing, interns will be
expected to have, or be willing to develop, accurate
written communication skills during the rotation. The
overall goal of this rotation is to help the intern
gain a broad understanding of brain-behavior
relationships that will enhance his or her general
clinical skills and, for those who are interested in
pursuing post-doctoral neuropsychological training, to
provide a firm foundation for the post-doctoral
residency. Murfreesboro/York Neuropsychology Rotation Location: Murfreesboro/York Campus Supervisor: John Denning, Ph.D. Setting: The Neuropsychology Rotation is an outpatient consultation service that receives referrals primarily from Primary Care, Psychiatry, Psychology, and Neurology. The clinic provides exposure to a variety of patient populations ranging in age from the mid 20's to the upper 80's. Patients often have multiple medical conditions (e.g., high blood pressure, diabetes, sleep apnea, TBI, stroke, heart attack, etc.) and frequent co-morbid psychiatric diagnoses (Depression, PTSD, Substance Abuse, Personality Disorder). In younger populations, frequent diagnostic questions focus on the possible cognitive effects of TBI, PTSD, ADHD, and differential diagnosis to assist with treatment planning. Throughout the rotation, interns will gain exposure to patients with a variety of medical, psychiatric, and motivational factors that may influence cognitive test performance. In order to provide the most accurate assessment of neuropsychological functioning and provide the most appropriate recommendations, assessment of test validity is an extremely important aspect of this rotation. As a consequence, interns will learn to administer, score, and interpret multiple freestanding and embedded symptom validity measures within the context of every evaluation. What Interns Will Do: The intern will be responsible for 1-2 full neuropsychological assessments per week which includes record review, interview with the patient and family members, test administration (3 hours), scoring, report writing (typically 5-6 pages), and feedback of results/recommendations. The typical test battery is a flexible grouping of measures but is rather fixed with only small modifications due to patient age or motor/sensory limitations. Tests include: WAIS-III/WAIS-IV (selected subtests), CVLT-II, BVMT-R, COWAT, WCST, Trails, BNT, Stroop, BTA, ACT, FTT, TOMM, MSVT, and MENT. Supervision is at structured times during the week, informally whenever needed, and before, during, and after an evaluation. All tests are computer scored using an integrated scoring program and summary sheet that allows for simultaneous computation of standard scores based on multiple sources of normative data (e.g., Heaton, MetaNorms, MOANS/MOAANS, test manuals, etc.). Ample readings and up-to-date research findings relevant to clinical cases as well as a broad range of neuropsychology-related topics are also provided. (Optional) Research Opportunities Available: There are currently three IRB–approved research studies in progress that an intern may wish to become involved with during the internship year (archival data collected from ongoing database of patients). Additional research studies may be proposed by the intern and carried out during the course of the year. 1) Predicting the malingering of cognitive deficits - involves comparing the accuracy of 2 measures from TOMM trial 1 (total score and total number of errors on the first 10 items) to a compilation of 8 embedded measures in predicting passing or failing the MSVT 2) Characterizing the pattern of cognitive deficits in those with mTBI/PTSD after controlling for invalid test performance - describes the pattern of cognitive performance of those diagnosed with mTBI/PTSD based on whether they passed or failed various validity measures (MSVT, TOMM trial 1) 3) Assessing the construct validity of the modified WCST (Nelson version, 48 cards) in an elderly sample - provides additional data on the usefulness/efficiency of this (very) short version of the WCST and how well it measures aspects of executive functioning Nashville
9-6-11/Murfreesboro 9-29-10 |