Clinical Neuropsychology Post-Doctoral Fellowship Curriculum 

Fellows will meet criteria of the Wisconsin State Statute to be eligible for licensure of having a minimum of two (2) hours of supervision per week of fellowship training. This will amount to at least 100 hours of supervision time upon completion of the 1-year fellowship. 

Fellows will be offered an average of 2 hours of didactic training per week (though some weeks may be more or less) for a total of at least 100 hours of didactic and continuing education participation upon the completion of fellowship. Within this area, fellows are required to complete a minimum of the following:

• Weekly Friday Didactics: Fellows are required to attend a minimum of 80% of the weekly Friday didactic offerings over the course of their training year. These are scheduled from 1:00 to 3:00 p.m.
• Ethics: Fellows are strongly encouraged, but not formally required, to use one half of a meeting time day to attend the once-annual Ethics conference presented on-site.
• Case Presentation: Fellows will be required to complete two formal case presentations by the completion of their fellowship.
• Scholarly Activity: Fellows will be required to present on research related to at least two different clinical cases.

Fellows receive two hours of formal, scheduled, face-to-face or virtual individual supervision by doctoral-level licensed psychologists, with the intent of supervising psychological services rendered directly by the fellow. Fellows attend one hour per week of Professional Development Seminar, as well as one hour per week of regularly scheduled Didactic Training, which may be virtual or in-person. Additional continuing education opportunities are offered throughout the year as available to the hospital staff. 

Our program has a vast array of training resources. First, our training program is directed and managed by the hospital's department of Medical Education. The program is assigned a Fellowship Program Administrator who is the go-to person for fellows regarding attending interviews, accepting an offer, relocating, onboarding, housing, insurance, and benefits. The Program Administrator will also assist fellows with documentation required for licensure, should this be requested.

The fellow has four actively practicing licensed doctoral-level Psychologist supervisors who are on-site 5 days/45 hours per week with the exception of illness, vacation days, and holidays. Supervisors are credentialed within the hospital system, are independently practicing, and have clearance for patient care in the inpatient and outpatient settings. Supervising Psychologists have offices located next to the fellow's office and are available to the fellow by page, email, phone and/or Teams (instant message) at all times during office hours.

The fellow has access to the DSM-5, testing kits and manuals, as well as online scoring systems (e.g., Q-Global and Q-Interactive) within the department and/or their office. They are supplied with business cards and office supplies. They also are assigned a secretary to assist with any clerical needs and are assigned a Patient Liaison to assist with patient scheduling, check-in, and general management of their schedules.

The fellow is provided with a $1000 allowance to assist with purchasing any continuing education-related materials, which may include books, EPPP study materials, journal subscriptions, professional memberships, and/or licensing fees. The fellow also has access to the hospital's journal subscriptions, both in print in the Medical Library and online using the hospital's intranet for any research needs.

Gundersen is a physician-led, not for profit regional healthcare system located in La Crosse, WI. Our system includes multi-specialty group medical practices, a teaching hospital with 325 beds, regional clinics, behavioral health services, vision services, pharmacy, and air and group ambulance with a Level II Trauma and Emergency Center. The organization employs approximately 6,000 people including 500 physicians. Gundersen has been named for many awards including the designation of being among America’s 50 Best Hospitals by Healthgrades, placing it in the 1% of hospitals nationwide. It has also been recognized for environmental efforts, becoming the first energy-independent hospital in the country in 2014.

Fellows will begin their training shadowing supervisors providing care across withing the department of Neurosciences. They will be able to shadow intake appointments, consults, therapy sessions and multidisciplinary clinics. After shadowing, fellows will progress to providing care alongside their supervisors. During this training progression, supervisors will be providing additional feedback, recommendations and care as well as assessing the fellow’s readiness for more independence. As the fellow meets training objectives level, the fellow will be provided more autonomy and begin to provide more care with less supervision. Degrees of autonomy will continue to progress throughout the fellowship as the fellow improves skills to meet additional training objectives. Even with increased autonomy, supervising psychologists will continue to oversee all care of the fellow as well as be present for a portion of many appointments.

The Neuropsychology Fellow will work under the supervision of licensed Clinical Neuropsychology and Rehabilitation Psychologists primarily in the Department of Neuroscience. Training in the two primary rotations will occur sequentially throughout the year-long fellowship. The first six months will be engaged in outpatient Adult Neuropsychology assessment and consultation. The second six months will be focused on outpatient Pediatric Neuropsychology assessment and consultation.  If the fellow opts to stay for a second year, the fellow will have additional optional rotations in Inpatient/Ouptatient Rehabilitation, Pain Management or be able to delve more deeply into either Adult or Pediatric Neuropsychology.  The Fellow will receive 2 hours of individual supervision per week, 1 hour of didactics, and 1 hour of professional development each week.

The Outpatient Adult Neuropsychology Rotation will consist of neuropsychological assessments and consultations for Primary Care, Neurology, Physical Medicine and Rehabilitation, and Neurosurgery. This rotation will also include the opportunity for involvement in presurgical evaluation for DBS procedures. This rotation will take place within Gundersen Neuroscience department which includes specialities of Adult Neurology, Neurosurgery, Movement Disoroders Clinic, Stroke Clinic, TBI Clinic, Physcial Medicine and Rehabilitation, and Speech Pathology. The fellow will have access to computer, electronic medical records, dictation software, and secretarial support. The fellow will initially be required to engage in testing directly with patients to ensure familiarty with a variety of test instruments. The Neuropsychology Department has three psychometricians who will be a resource for the fellow once the fellow has demonstrated proficiency with test administration.

The Outpatient Pediatric Neuropsychology rotation will consist of neuropsychological assessments and consultations for Primary Care, Neurology, Physical Medicine and Rehabilitation, and other pediatric specialties (e.g., Oncology, Genetics). Patients typically range between 5 years old to 25 years old. This rotation will also include evaluations with older adolescents to assist with the transition to adulthood to determine the level of support needed for complex decision making (e.g., medical Power of Attorney, full adult guardianship, etc.,).  This rotation will take place within Gundersen Neuroscience Department which includes specialties of Pediatric Neurology, Pediatric Physical Medicine and Rehabilitation, and Pediatric Speech Pathology. The fellow will have access to a computer, electronic medical records, dictation software, and secretarial support. The fellow will initially be required to engage in testing directly with patients to ensure familiarity with a variety of test instruments. The Neuropsychology department has three psychometricians who will be a resource for the fellow once the fellow has demonstrated proficiency with test administration.

The Rehabilitation Psychology rotation (optional for the second year) includes neuropsychological and psychological evaluation, treatment and consultation within a 20-bed, acute rehabilitation unit servicing the full spectrum of rehabilitation populations across the adult lifespan. The primary population served consists of individuals with stroke, followed closely by those with traumatic brain injury (TBI). The remainder of the patient populations served includes those with debility, chronic and significant medical illnesses that compromise physical and/or cognitive functioning, limb amputation and spinal cord injury. The fellow will work closely with the rehabilitation team including two physiatrists, multiple mid-level staff (physician assistants and nurse practitioners), rehabilitation nursing staff, a rehabilitation psychologist, speech therapists, occupational therapists, physical therapists, recreation therapists, social workers, nutritionists, and a chaplain.

The fellow will have ample opportunity to work closely with these allied health providers as part of a strong, collegial and well-integrated interdisciplinary team. The fellow will also have the opportunity to be a part of the Spinal Cord Injury service line, where the Rehabilitation Psychology service follows all patients with traumatic spinal cord injury across the continuum of care, often intervening in the Critical Care Unit/ICU as well as the Neuroscience Unit prior to admission to the Rehabilitation Unit. There will also be opportunities for the fellow to see clinic patients for routine follow-up from acute rehabilitation.

Fellows are evaluated quarterly using the Psychology Fellow Competency Assessment Form by each of their supervisors. A deficiency is identified if a Fellow receives a rating of 2 or below on any competency in the 2nd quarter or later on the MedHub evaluation form. A rating of 2 or below would initiate a due process evaluation. It is expected that a fellow will reach a rating of at least 3 by the end of their fellowship training year.

Evaluation

• Due process
• Grievance 

*This is a required rotation

Faculty: Raymond List, PhD

Time Commitment (number of hours/week): 40 hours per week. 

Goal of Rotation: To develop proficiency in clarification of referral question, comprehensive record review, clinical interview, and neurobehavioral observation. Based on that information, the fellow will demonstrate proficiency in the selection of an appropriate test battery, based on knowledge of psychometrics, aspect of cognitive skills being assessed, and purpose of the assessment. The fellow will also be able to demonstrate proficiency in the interpretation of the assessment results in the context of the referral question, relevant functional neuroanatomy, medical history, as well as cultural and socioeconomic factors of the patient. The fellow will develop proficiency crafting a comprehensive report detailing relevant background history and concerns, test results, and interpretation as well as recommendations for additional medical intervention and assessment, behavioral and cognitive interventions, and methods for improving or at least maintaining daily functioning. The fellow will demonstrate proficiency in communicating results verbally in manner understandable to the patient and family as well as providing feedback and direction to health care providers from a variety of backgrounds.

Description of Patient Population: Primarily adult (18-90+) with very occasional opportunity for assessment with older adolescents (16+). Clinical issues are wide ranging and include general attention and memory concerns, TBI, Stroke, Dementia, Movement Disorders, Multiple Sclerosis, and Epilepsy. There may be occasional opportunity for involvement with presurgical evaluation for DBS procedures.

Setting: Outpatient Neuropsychology Assessment Clinic

Opportunities for Program Development: Limited; The fellow may have the opportunity to participate in the development or modification of patient care procedures/models of care for outpatient neuropsychology.

Current projects: Opportunity for refinement of service delivery and operation of the Neuropsychology service always exists.  

Opportunities for Research: No projects currently, but opportunities exist for interested fellows.

Objectives: 

1. Independently conduct comprehensive Neuropsychological assessment consisting of: comprehensive record review; clinical intake interview incorporating psychosocial history, medical and neurobehavioral history, relevant medical test findings, collateral information, level of current functioning; selection, administration, and scoring of neuropsychological tests appropriate to the referral question and cultural context.
2. Independently create a comprehensive written report incorporating referral question, relevant history, relevant medical data, interpretation of test results in relation to purpose of assessment and cultural context of the patient, and recommendations for addressing and treating any mood/coping dysfunction, neurocognitive limitations, as well as interventions that can sustain and even improve daily functioning.
3. Independently communicate, both verbally and in writing, results and recommendations to patient and family in a way that best answers their concerns, as well as providing clear guidance for methods to address the limitations and strengths found in the assessment.
4. Independently consult with a wide range of health care providers to clarify the requested purpose of assessment, provide guidance as to how to utilize results of assessment to maximize patient’s compliance with medical treatment, address concerns about occupational and educational functioning, provide recommendations for potential needs for support to maintain functioning in the community, and provide input regarding the patient’s decision-making capacity.

*This is a required rotation

Faculty: Dana M. McCall, PhD

Time Commitment (number of hours/week): 40 hours per week

Goal of Rotation: To develop proficiency in clarification of referral question, comprehensive record review, clinical interview, and neurobehavioral observation with a pediatric population. Based on that information, the fellow will demonstrate proficiency in the selection of an appropriate test battery, based on knowledge of psychometrics, aspect of cognitive skills being assessed, and purpose of the assessment. The fellow will also be able to demonstrate proficiency in the interpretation of the assessment results in the context of the referral question, neurodevelopmental history, medical history, current developmental stage, and cultural and socioeconomic factors of the family. The fellow will develop proficiency crafting a comprehensive report detailing relevant developmental history, current concerns, test results, interpretation, and recommendations for additional interventions and strategies for further development in areas of concern. The fellow will demonstrate proficiency in communicating results verbally in a manner understandable to the caregivers as well as explaining strengths and areas for growth to the patient at a developmentally appropriate level. The fellow will also demonstrate proficiency in providing feedback and direction to health care providers from a variety of backgrounds.

Description of Patient Population: Primary pre-school to high school (ages 5-18) with additional opportunity for assessment with young adults (18-30). Clinical issues are wide ranging and include general attention and learning/developmental concerns, TBI, Epilepsy, genetic conditions, and cancer. 

Setting: Outpatient Neuropsychology Assessment Clinic

Opportunities for Program Development: Limited; The fellow may have the opportunity to participate in the development or modification of patient care procedures/models of care for outpatient neuropsychology.
If yes, current projects: Opportunity for refinement of service delivery and operation of the Neuropsychology service always exists.

Opportunities for Research: No projects currently, but opportunities exist for interested fellows.

Objectives:

1. Independently conduct comprehensive Pediatric Neuropsychological assessment consisting of: comprehensive record review; clinical intake interview incorporating developmental history, relevant medical history including medical test findings, psychosocial history, and level of current functioning; selection, administration, and scoring of neuropsychological tests appropriate to the referral question, developmental stage, and cultural context.
2. Independently create a comprehensive written report incorporating referral question, relevant history, relevant medical data, interpretation of test results in relation to purpose of assessment and cultural context of the patient, and recommendations for additional interventions and strategies for further development in areas of concern, addressing and treating any mood/behavior dysfunction, and academic accommodations.
3. Independently communicate, both verbally and in writing, results and recommendations to caregivers, as well as the patient themselves when appropriate, in a way that best answers the concerns, as well as providing clear guidance for methods to address the limitations and strengths found in the assessment.
4. Independently consult with a wide range of health care providers to clarify the requested purpose of assessment, address concerns about educational functioning, and provide recommendations for continued growth and development. There will also be evaluations that require the Fellow to independently provide input regarding the patient’s decision-making capacity.