Psychology Post-Doctoral Fellowship Program

Pediatric Psychology Postdoctoral fellows gain clinical experience under the supervision of licensed clinical psychologists working across the hospital setting. Fellows receive opportunities to gain additional experience providing outpatient therapy in person and via telehealth, outpatient IQ/Achievement and ADHD testing services, inpatient consultation and liaison; working on multidisciplinary treatment teams; and conducting crisis evaluation and group therapy services (via telehealth). Services provided are short-term and evidenced-based. There also is potential for research collaboration and teaching opportunities, and fellows have regularly scheduled supervision and didactic seminars, which are currently being offered virtually. Opportunities to attend virtual hospital Grand Rounds and virtual Continuing Education conferences also are available. Career development opportunities, including licensure support, is provided.

Fellows are based on Gundersen's main campus in La Crosse, Wis., and have an office located in Outpatient Behavioral Health, where they see virtual and in-person outpatient and testing patients. Work-from-home options may be available during the second half of the fellowship as independence increases and fellows demonstrate competence in a variety of care areas. Fellows also interact with staff and patients in Gundersen’s Pediatric Unit, Pediatric Intensive Care Unit and Neonatal Intensive Care Unit through our consultation and liaison service. Fellows participate on multidisciplinary teams in Pediatric Specialties and Pediatric Neurology, including Pediatric Allergy; Pediatric Gastroenterology; Pediatric Endocrinology; Pediatric Cardiology; and Pediatric Hematology/Oncology. Formal participation in the Cystic Fibrosis Clinic and Pediatric Headache Clinic also is possible. Fellows regularly collaborate with Gundersen pediatricians—a significant referral source.

Fellows also receive at least two hours per week of individual supervision through a combination of in-person and virtual supervision. Fellows attend a weekly didactic and weekly professional development seminar (both of which are currently virtual) and have access to other recurring training activities, such as the Gundersen Expert Lecture Series (GELS) and other virtual on-campus trainings as offered.

Vision: To train excellent, early-career pediatric psychologists

Mission: To train culturally-competent fellows, who will graduate from their fellowship experience with the clinical and professional background necessary to be highly competitive for the position of their choosing

Aims of Fellowship:

Function independently as a psychologist in a medical center and outpatient practice setting, providing evidence-based psychological assessment and treatment to children with a variety of medical and psychological conditions;

Complete supervised training requirements necessary to obtain state licensure to practice psychology (the fellowship meets licensure requirements for licensure in the state of Wisconsin)

Competencies of Fellowship:

Competence in clinical care that recognizes the mutuality and interaction of science and practice

Competence in the interdisciplinary and biopsychosocial model of healthcare delivery

Competence in clinical care that is effective, sensitive and respectful for persons of diverse backgrounds

Competence in ethical and professional issues

(Adopted from: Palermo, Janicke, McQuaid, Mullins, Robins & Wu, 2014; Piazza-Waggoner, Karazsia, Hommel & Modi, 2015)

Competency 1: Competence in clinical care that recognizes the mutuality and interaction of science and practice

Learning Elements

• Fellows promptly and competently complete diagnostic assessment in an accurate and timely manner, while also prioritizing rapport development with the family/patient.
• Fellows are able to systematically and efficaciously conceptualize and formulate goals about how to treat a wide range of psychological conditions affecting children, adolescents, and their families.
  • Fellows autonomously write well-organized psychological documentation on children and youth seen in a medical setting, which clearly answers the referral concerns and provides the multidisciplinary team with appropriate diagnostic input and directions/recommendations for interventions.
  • Fellows implement interventions that are well-timed, effective and consistent with empirically-supported treatments.
  • Fellows complete consultations that are well-timed, effective, consistent with empirically-supported treatment, and address the medical team needs.

Competency 2: Competence in the interdisciplinary and biopsychosocial model of health care delivery

Learning Elements

• Fellows independently interact with professionals and colleagues from other disciplines and can integrate their information with the information provided by other professionals.
• Fellows are knowledgeable about the interaction between biological and psychosocial variables influencing the clinical presentation and are able to accurately assess psychosocial aspects of clinical cases.

Competency 3: Competence in clinical care that is effective, sensitive and respectful for persons of diverse backgrounds

Learning Elements

• Fellows are aware of the patient's worldview and how it impacts conceptualization of assessment and treatment with culturally-diverse children, adolescents and their families.
• Fellows are aware of their own biases and how these impact work with children, adolescents and families from diverse backgrounds so as to provide culturally-sensitive services.

Competency 4: Competence in ethical and professional issues

Learning Elements

• Fellows demonstrate good knowledge of the following and are able to apply principles consistently, seeking consultation as appropriate using:
  • Ethical Principles of Psychologist and Code of Conduct established by the American Psychological Association
  • Wisconsin Psychology Law
  • Fellows demonstrate use of positive coping strategies to manage personal and professional stressors to maintain high standards of professional functioning.
  • Fellows effectively prioritize and accomplish tasks in a timely fashion.
  • Fellows demonstrate professionalism in relationships with colleagues and staff and are adherent to department policies, including clinical and administrative responsibilities.

Activities to meet the fourth area of competency—competence in ethical and professional issues—allow fellows to read and understand the Principle Code of Ethics for Psychologists. Fellows are provided two or more hours of individual supervision, during which supervisors address any ethical/professional challenges or concerns that arise during practice. Additionally, fellows participate in one hour of professional development training per week, which is organized by licensed psychologists. Fellows also attend didactics presented by a member of the Gundersen Ethics Review Board and Legal Department to increase awareness of frequent hospital-based challenges and familiarize themselves with these departments and resources. Fellows attend ethics trainings during their year, as well as have ample opportunities to shadow their supervisors.

Fellows in the Adult Health and Rehabilitation Psychology program begin their training shadowing supervisors who provide care across the hospital system. They shadow in-person and virtual intake appointments, consults, therapy sessions and multidisciplinary clinics. Additionally, they shadow other providers in multidisciplinary clinics to get better oriented with the clinics’ flow and the roles of participants. After shadowing, fellows move to providing care alongside their supervisors. During this training progression, supervisors provide additional feedback, recommendations and care, as well as assess fellows’ readiness for more independence. Once supervisors feel fellows are progressing at an expected level, fellows are given more autonomy and begin to provide additional care with less supervision. Degrees of autonomy continue to grow throughout the fellowship as fellows improve skills and as supervisors feel is appropriate. Even with increased autonomy, supervising psychologists continue to oversee all care that fellows provide and be present for a portion of many appointments.

Fellows are based on Gundersen's main campus in La Crosse, Wis., and have an office located in Outpatient Behavioral Health, where they see virtual and in-person outpatient and testing patients. Work-from-home options may be available during the second half of the fellowship as independence increases and fellows demonstrate competence in a variety of care areas.

Fellows work under the supervision of licensed, board-certified clinical health and rehabilitation psychologists primarily in Behavioral Medicine (outpatient) and Physical Medicine and Rehabilitation. Fellows also receive at least two hours per week of individual supervision through a combination of in-person and virtual supervision.

Rotations in the above departments occur concurrently throughout the year-long fellowship, which has an option to be extended to a second year depending on the fellow's training goals and performance during the first year. Each week fellows receive two hours of individual supervision, one hour of didactics and one hour of professional development. Fellows attend a weekly didactic and weekly professional development seminar, both of which are currently virtual, and have access to other recurring training activities, such as the Gundersen Expert Lecture Series, and other virtual on-campus trainings as offered.

The Health Psychology Rotation includes opportunities to conduct psychological evaluations, personality testing, crisis evaluations and individual and group therapy services, with many referrals coming from specialty medical clinics. Collaboration with multi-disciplinary medical teams is also expected. Fellows have opportunities for evaluation and treatment of patients in the following areas: weight management (bariatric surgery, medical/behavioral weight management), eating disorders, pain management, audiology/tinnitus, insomnia and general mental health conditions that may be occurring in the context of adjusting to or experiencing a chronic medical condition.

The Rehabilitation Psychology Rotation 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.

The remainder of the patient populations served include those with debility, chronic and significant medical illnesses that compromise physical and/or cognitive functioning, limb amputation and spinal cord injury. Fellows 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. Fellows have ample opportunity to work closely with these allied providers as part of a strong, collegial and well-integrated interdisciplinary team. They also have an 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 Critical Care/ICU and Neurosciences prior to Rehabilitation admission. There also are chances for fellows to see clinic patients in person or virtually for routine follow-up from acute rehabilitation and for outpatient neuropsychological evaluation.

The amount of in-person versus virtual visits is subject to change in the setting of the evolving public health emergency related to COVID-19. Fellows are required to follow institutional guidelines for providing care to inpatients and outpatients and are expected to comply with the use of recommended personal protective equipment.

Vision: To develop competent early-career clinical psychologists by providing advanced training in health and rehabilitation psychology, which includes the provision of psychological assessment and intervention to medical populations, as well as consultation to interdisciplinary medical teams

Mission: To train fellows who will graduate from their fellowship experience with the clinical and professional foundation necessary to practice high quality, evidence-based care and attain the psychologist position of their choosing

Aims of Fellowship:

Function independently as a psychologist in a medical center and/or outpatient practice setting, providing evidence-based psychological assessment and treatment to adults across the lifespan who have various medical and psychological conditions

Complete supervised training requirements necessary to obtain state licensure to practice psychology (the fellowship meets licensure requirements for licensure in the state of Wisconsin)

Competency Learning Elements

Adapted from the following:

• Training Competencies from the Society for Health Psychology
• American Board of Professional Psychology. 2018. American Board of Rehabilitation Psychology, Certification Guidelines and Procedures, Candidate's Manual. Retrieved from https://www.abpp.org/BlankSite/media/Rehabilitation-Psychology-Documents/Candidate-manual-september-10-2018.pdf.
• American Psychological Association, Commission on Accreditation. 2015. Standards of Accreditation for Health Service Psychology. Retrieved from https://www.apa.org/ed/accreditation/about/policies/standards-of-accreditation.pdf

Competency 1
Integration of Science and Practice

Description: The integration of scientific literature and evidence-based theory and research into clinical practice. This includes fellows' ability to utilize knowledge of the existing literature in approaching assessment, conceptualization and intervention.

Learning Elements:

• Fellows critically evaluate and apply relevant literature to inform the approach to assessment and intervention with patients and families.
• Fellows utilize relevant literature to conceptualize assessment findings and formulate an approach to intervention or management that is tailored to the unique needs of the patient.
• Fellows provide consultation to interdisciplinary care teams that is based on relevant scientific findings related to the patient presenting concerns.
• Fellows demonstrate knowledge of psychometric properties, strengths, and limitations of psychological and neuropsychological measures administered as part of a patient's care, and are able to demonstrate sound interpretation of such measures in light of a patient's presenting concerns and functional capabilities.

Competency 2
Individual and Cultural Diversity

Description: The recognition and understanding of how one's own cultural background impacts clinical practice, while also striving for multicultural competence across various aspects of cultural diversity, including disability

Learning Elements:

• Fellows demonstrate awareness of how his or her own cultural background and worldview influences interactions with patients.
• Fellows demonstrate awareness of how a patient's cultural background and worldview influence his or her beliefs about health and wellness as well as interaction with the healthcare system
• Fellows are knowledgeable about the interaction between biological and psychosocial variables influencing the clinical presentation and are able to accurately assess psychosocial aspects of clinical cases.
• Fellows demonstrate sound interpretation of psychological and neuropsychological measures in accordance with a patient's cultural background.
• Fellows demonstrate awareness and knowledge of disability and age as other facets of diversity and are able to address these factors in his or her interactions with patients.

Competency 3
Ethical and Legal Foundations

Description: The awareness of standards of professional conduct, ethics and law, as well as how these impact clinical practice of psychologists within a medical setting.

Learning Elements:

• Fellows demonstrate knowledge of applicable laws and ethical standards (APA Ethics Code) pertaining to the broader practice of psychology as well as the specific practice of psychology in the medical setting.
• Fellows demonstrate knowledge of HIPAA and institutional policies protecting the privacy and confidentiality of patients.
• Fellows demonstrate knowledge of Wisconsin Statutes governing the practice of psychology.

Competency 4
Assessment

Description: The appropriate selection, administration, modification (where indicated) and interpretation of standardized tests, behavioral observations, and/or clinical interviews based on the needs of the patient and upon which recommendations are made and communicated to optimize patient outcomes

Learning Elements:

• Fellows assess adjustment to illness/disability in patients.
• Fellows assess adjustment to illness/disability in family members.
• Fellows assess the extent and nature of disability and preserved abilities/strengths.
• Fellows evaluate educational and vocational capacities where indicated.
• Fellows assess mood and personality functioning to inform interventions.
• Fellows evaluate cognitive functioning.
• Fellows evaluate decision-making capacity.
• Fellows assess for substance use disorders.
• Fellows assess pain and associated psychological factors.
• Fellows evaluate psychological strengths and risk factors of individuals seeking surgery and make appropriate recommendations to interdisciplinary teams regarding candidacy for surgery.
• Fellows assess social and behavioral functioning in patients with neurologic conditions.
• Fellows assess concerns related to sexual functioning in individuals with disabilities.

Competency 5
Intervention

Description: The selection of appropriate treatment modalities for the needs of the patient, and conducts said interventions with skill, sensitivity, and use of a relevant knowledge base to optimize patient outcomes

Learning Elements

• Fellows can appropriately select and utilize empirically-supported interventions across a wide range of presenting psychological concerns including depression, anxiety, mood disorders, and acute and chronic stress.
• Fellows can utilize empirically-supported behavioral interventions for medical conditions including pain, obesity, insomnia, cancer tinnitus and other acute or chronic illnesses.
• Fellows can utilize empirically-supported interventions as related to adjustment to disability/illness and prevention of chronic illness.
• Fellows can utilize empirically-supported family/couples therapeutic interventions as related to disability/illness and the prevention of chronic illness.
• Fellows guide and implement behavioral management interventions for individuals with neurologic/cognitive impairments.
• Fellows utilize assessment of concerns related to sexual functioning in individuals with disabilities to guide intervention.

Competency 6
Consultation

Description: The effective consultation with other professionals appropriate to the needs of the patient, in ways that will promote efficiency of care and transdisciplinary collaboration

Learning Elements:

• Fellows consult with interdisciplinary team members to improve behavioral functioning of patients to optimize participation in rehabilitation efforts.
• Fellows provide consultation to interdisciplinary teams regarding psychological and behavioral interventions for shared patients.
• Fellows provide consultation regarding cognitive functioning and modification of rehabilitation efforts in light of this.
• Fellows engage the interdisciplinary team in vocational/educational planning for individuals with neurologic illness.
• Fellows consult with members of the interdisciplinary team regarding findings on assessment of personality and mood as they impact participation in care and adherence to recommendations.

Competency 7
Professional Values, Attitudes and Behaviors

Description: The sensitivity to the welfare, rights, and dignity of others as a priority in clinical practice This also involves the capacity to empathetically relate to clients/patients and others, including members of the interdisciplinary care teams, in ways that enhance the effectiveness of services provided.

Learning Elements:

• Fellows respect and attend to the welfare of patients, their rights, and dignity across clinical work.
• Fellows demonstrate the ability to assess a patient's capacity across multiple domains and advocates for patients' autonomy in accordance with their capabilities.
• Fellows demonstrate good boundaries with patients and staff.
• Fellows demonstrate the ability to collaborate effectively with other disciplines to the benefit of the patient.
• Fellows are receptive to feedback and suggestions from supervisors and other professional colleagues.

Integration of Science and Practice: Fellows are provided with a reading list at the beginning of the fellowship year, which highlights relevant books and peer-reviewed journal articles that provide the scientific foundations of the assessment, intervention, consultation, ethical and diversity issues they will encounter while on fellowship. During individual supervision and through didactics and professional development presentations, fellows are given information on and asked to describe the scientific basis for their approach to patient care. In-vivo and virtual supervision provide fellows with an opportunity to be evaluated on their application of the scientific base.

Individual and Cultural Diversity: Fellows gain skills in this area through readings provided at the outset of fellowship; face-to-face assessment and intervention with diverse patient populations; and supervision, where this topic is routinely explored when staffing new and ongoing patients. Didactics and professional development topics devoted to diversity also are included in the fellowship year.

Legal and Ethical Foundations: Fellows gain skills in this area through readings provided at the outset of fellowship and through supervision, where this topic is routinely explored when staffing new and ongoing patients. Didactics and professional development topics devoted to legal and ethical foundations are also included in the fellowship year. Fellows develop and deepen their knowledge of and commitment to consumer protection primarily through work in the Rehabilitation and Neuropsychology clinics, where patient populations include individuals with neurological impairments that could impact decision-making capacity. Shadowing the primary supervisor, Bryan Kolberg, PsyD, ABPP, and working closely with the multidisciplinary teams enrich fellows’ understanding in this area.

Assessment: While working with the Bariatric Clinic, Dig DEEP Clinic, Eating Disorders Program and Outpatient Behavioral Health, fellows have opportunities to conduct intake assessments for patients with weight management difficulties, chronic pain, eating disorders and/or co-occurring medical and mental health difficulties. Assessments generally involve a clinical interview and administration of self-report, objective questionnaires (e.g., PHQ-9 to assess depression). While working within the rehabilitation psychology rotation, fellows complete intake assessments and/or neuropsychological test batteries to evaluate cognitive, emotional and behavioral comorbidities that may impact rehabilitation. Fellows receive direct and indirect supervision in person and virtually regarding their assessment work throughout the fellowship year.

Intervention: While working with the Bariatric Clinic, Dig DEEP Clinic, Eating Disorders Program, and Outpatient Behavioral Health, fellows have opportunities to conduct brief, empirically supported therapy interventions for patients with a variety of co-occurring medical and mental health conditions. Visits are done virtually via telehealth, as well as in person when appropriate. Similarly, within the rehabilitation psychology rotation, fellows have opportunities to provide brief rehabilitation intervention to aid patients in their transition to discharge/return home. Fellows receive direct and indirect supervision in person and virtually regarding their intervention work throughout the fellowship year.

Consultation: Fellows have opportunities to develop consultation skills by shadowing their supervisors during interactions with multidisciplinary teams. Fellows transition to taking on more independence with consultation to other providers and receive feedback in supervision.

Professional Values, Attitudes, and Behaviors: Fellows collaborate closely with their supervisors and multidisciplinary teams throughout the Hospital. They learn citizenship and strategies for communication with medical providers through shadowing and direct and indirect supervision, which is completed in-person and virtually.