Michael E. DeBakey VA Medical Center - Houston, Texas

Clinical Neuropsychology Fellowship

Overview

A primary goal of the Michael E DeBakey VAMC (MEDVAMC) Postdoctoral Fellowship in Clinical Neuropsychology is to provide advanced training in the specialty of clinical neuropsychology that prepares Fellows for independent practice in settings where the psychologist provides neuropsychological assessment, treatment recommendations and interventions for patients with various medical, psychiatric, and neurological conditions. It is also our goal that graduates of this Fellowship pursue board certification in clinical neuropsychology through the American Board of Professional Psychology. These goals are accomplished through the Fellow’s active participation in 2 major clinical neuropsychology rotations under the supervision of board certified neuropsychologists (1 year general neurology neuropsychology in the Neurology Care Line, 1 year rehabilitation neuropsychology in the Physical Medicine and Rehabilitation Care Line); minor clinical neuropsychology rotations through the Mental Health Care Line; relevant placements in locations such as the Parkinson’s Disease Research, Education & Clinical Center and Spinal Cord Injury Unit; neuropsychology didactic and research experiences; and advanced psychotherapy training. This program emphasizes sound clinical practice informed by an understanding of empirical support/extant literature, knowledge of various theoretical models, and application of critical thought. This approach is fully consistent with the VA commitment to provide psychology training in evidence based practices. This program is a member of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), is designed to be consistent with recommendations of the Houston Conference for Training in Clinical Neuropsychology, and is designed to meet the post-doctoral requirements for board certification in Clinical Neuropsychology (American Board of Professional Psychology/American Board of Clinical Neuropsychology). This Fellowship is not currently APA accredited but is in the process of seeking accreditation. An APA site visit is scheduled for September, 2011.

Training Model and Program Philosophy

The Postdoctoral Fellowship in Clinical Neuropsychology is based on a scientist-practitioner model of training. Fellows are expected to engage in clinical and didactic training and remain actively involved in research across the training term. We view research and scholarly activities as informing and directing clinical practice, and clinical practice, in turn, guiding research questions and activities. As per APPCN guidelines, Clinical Neuropsychology Fellows will have a minimum of 4 hours per week dedicated to clinical research activity and 4 hours per week dedicated to educational activities. We view the vital inter-dependence of science and practice in clinical psychology as a core principle upon which the training system is structured. 

Program Organization

The Clinical Neuropsychology Fellowship is one of several postdoctoral training programs administered by the Psychology Training Program which is part of the larger Psychology Practice at the MEDVAMC. Although there are some overlapping training opportunities, the Clinical Neuropsychology Fellowship is programmatically distinct from the APA accredited Traditional Practice Fellowship. The Clinical Neuropsychology Fellowship is headed by a Neuropsychology Fellowship Director (Director: Robert Collins, Ph.D., ABPP-CN) who apprises Psychology Training Committee of relevant Neuropsychology Fellowship activities. Within the Neuropsychology Fellowship, Fellows each select a neuropsychology preceptor from core neuropsychology faculty who provide weekly individualized supervision and mentorship as Fellows advance through the program. 

Clinical Neuropsychology Objectives 

Clinical Neuropsychology Fellows receive training of sufficient breadth to ensure advanced competency as a professional psychologist and also receive training of sufficient depth and focus to ensure the technical expertise and proficiency necessary to the specialty of clinical neuropsychology. In order to meet this balance, Clinical Neuropsychology Fellows have training objectives that can be considered both general and specific. First, Postdoctoral Fellows in Clinical Neuropsychology are expected to meet general training objectives which were selected based on our own philosophy, national guidelines including the general guiding principles of postdoctoral training as listed in the Guidelines and Principles for Accreditation of Programs in Professional Psychology, and the Houston Conference Guidelines (e.g., section VII: Skills). Additionally, neuropsychology specific training objectives such as functional neuroanatomy, neurological disorders (etiology, pathology, course, treatment), impact of non-neurological disorders on the CNS, neuroimaging, psychopharmacology, specialized neuropsychological assessment techniques, neuropsychology research and design, professional issues in neuropsychology, and practical limitations of neuropsychology are required as part of the Clinical Neuropsychology Fellowship. These neuropsychology specific training objectives are largely drawn from the Houston Conference Guidelines (e.g., sections VI: knowledge base; VII: skills; X: residency education), as well as neuropsychology knowledge and skill that we implement through practice at MEDVAMC, and are woven into the Fellow's Training Plan.   

Fellows are expected to demonstrate proficiency across the following eight training objectives: 1) advanced skill in neuropsychological assessment, 2) advanced skill in interventions, 3) scholarly inquiry, 4) advanced knowledge of brain-behavior relationships, 5) administrative and organizational activities; 6) consultation, program evaluation, supervision, and teaching; 7) professional issues and conduct; and 8) cultural and individual diversity issues.

Mechanisms of Neuropsychology Skill and knowledge Development

To ensure that Clinical Neuropsychology Fellows receive training of sufficient breadth, depth, and focus, Fellows are immersed in clinical neuropsychology training for a two year period.  The development of advanced skill and knowledge will primarily occur through four mechanisms and these will ultimately be woven into an Individualized Fellow Training Plan:

1. Supervised Clinical Neuropsychology Experience: Fellows will receive daily supervised contact with patients during their clinical rotations. As a general framework, each week of the Fellowship will be approximately divided into 80% clinical service and 20% research and scholarly activity.  There are two major rotations (neurology neuropsychology with Dr. Collins and rehabilitation with Dr. Pastorek), each occurring at approximately 16 to 20 hours per week during separate years of the Fellowship. There are mandatory minor neuropsychology rotations in the Mental Health Care line occurring under the supervision of Drs. Cohen, Booth, and Miller with allotted training periods to be determined during the development of the Fellows' IFTP. As per APPCN guidelines, Fellows will spend at least 4 hours per week in research activity and 4 hours per week in didactics. Psychotherapy activities, research involvement, professional activities to include supervision and teaching, ethics and diversity experiences will also be integrated into the IFTP according to the Fellow’s prior experiences, current interests, and determined needs. 

2. Neuropsychology Didactics:  Fellows will be required to attend neuropsychology and postdoctoral Fellowship seminars/didactics which meet throughout the year. It is expected that Fellows will spend, on average, at least 4 hours weekly involved in these educational activities. Available seminars include:

Central Nervous System 1 and 2, Baylor College of Medicine (required for Fellows not having already met Houston Conference Guidelines for Foundations of Brain-Behavior relationships): Fellows requiring this training foundation will attend the Central Nervous System (CNS) classes at Baylor College of Medicine. This coursework covers CNS neuroanatomy, the neurological examination, and multiple CNS disease prototypes, and foundations of neuroimaging techniques.  Both class lectures and laboratory work are required. Class lectures are recorded and enrolled Fellows have access to these lectures through the internet.

Weekly Neuropsychology Seminar/Case Conference (required for first and second year Fellows): Covers foundations of neuropsychology, including functional neuroanatomy, neuropathology, and assessment. Fellows will organize this course, which covers the presentation of foundational topics in neuropsychology (functional neuroanatomy, relevant cognitive domains, psychometric issues) and will be assigned specific foundational topics as related to their training needs. In addition, Neuropsychology staff, and outside neuropsychologists, will direct a review of current literature as applied to clinical case presentations to further foster evidence based practice. The purpose of the seminars is to address topics related to the Houston Conference Guidelines for foundation of practice of Clinical Neuropsychology and will, in part, be integrated into a Fellow's IFTP.    

Weekly Post-doctoral Fellowship Seminar (required for first year and optional for second year Fellows unless new material is being presented): Fellows will attend weekly seminars covering a wide range of advanced issues in psychology presented by various staff to the all MEDVAMC psychology post-doctoral Fellows (e.g., Serious Mental Illness, Trauma, and Neuropsychology). 

MEDVAMC Neurology Lecture Series (encouraged for first and second year Fellows): Clinical Neuropsychology Fellows are encouraged to attend this weekly seminar for neurology medical students and residents (currently Friday afternoons, three times per month). Issues in neurology to include epilepsy, stroke, neurodegenerative disorders, and psychiatric issues are covered by MEDVAMC neurology staff.

Monthly Post-doctoral Diversity Seminar (required for first year and optional for second year Fellows unless new material is being presented): Fellows will attend monthly seminars covering a wide range of advanced diversity issues in psychology presented by staff from the diversity sub-committee of the Training Committee to all MEDVAMC post-doctoral Fellows (e.g., Serious Mental Illness, Trauma, and Neuropsychology). Fellows will also make a presentation at this seminar.

Neuroimaging Rounds and Brain Cuttings (encouraged when available): These didactic opportunities are periodically available across the year and Fellows are encouraged to attend. The neuroimaging rounds cover special topics in neuroimaging and related neurological disorders and are presented through the department of radiology at MEDVAMC. Brain cuttings are presented through the Pathology department at MEDVAMC. A weekly neuro-radiology case review is conducted on Thursdays by a neuroradiologist at MEDVAMC (Fellows can request a review of a current case).

Baylor College of Medicine Neurology Education Series (optional for first and second year Fellows): This is a series of neurology topics presented at Baylor College of Medicine across various days. Fellows are forwarded the education bulletin which lists topics ranging from developmental neurological disorders to specific journal club meetings.

Psychiatry, Neurology, and Cognitive Neuroscience Grand Rounds/Presentations (optional for first and second year Fellows): Special topics in psychiatry and neurology are presented through Baylor College of Medicine. Neuropsychology Fellows are encouraged to attend annual cognitive neuroscience seminars offered through Rice University.

Clinical Neuroscience Consortium (optional for first and second year Fellows): Monthly meeting of Care Lines within the hospital and from Baylor College of Medicine to discuss neuroscience related topics, research, and the application of these in a VA setting.

Professional Societies: (Strongly encouraged for first and second year Fellows):  Fellows are encouraged to participate in professional societies both on the local and national level. The Houston Neuropsychological Society (HNS) is an active group of neuropsychologists who meet every two months for an hour long didactic. Annually, this group also provides a daylong seminar from a recognized leader in the field (past presenters include Muriel Lezak, George Prigatano, and Edith Kaplan). Fellows can attend the monthly and annual presentations at no cost and for a small fee can join HNS. Fellows are also encouraged to attend and present at national conferences, such as the International Neuropsychological Society or the National Academy of Neuropsychology both to make research presentations as well as to attend didactics.

Exposure to Interdisciplinary Services within the Hospital (emphasized for first and second year Fellows): Fellows will be encouraged to observe the clinical activities of professionals from other disciplines (approximately 1-2 days) that are also directly involved in patient care in both neurology and rehabilitation. An emphasis with be that Fellows shadow neurologists at the cognitive clinic as well as a social worker but other opportunities include meeting with speech language therapists, OT, PT, and psychiatry, etc.

3. Neuropsychology Research: Fellows will be expected to engage in research and scholarly activities throughout the duration of the Fellowship. A host of supervisors for research are available both at the MEDVAMC and BCM, and preceptors will help their Fellows identify a research supervisor. There is an expectation that Fellows produce one publication quality research project during each major rotation (e.g., two for completion of the Fellowship training). We believe that placing an emphasis on research will allow Fellows to further develop an understanding of research methodologies and will allow them to pursue their specialized interests within neuropsychology. Such skills will also allow the Fellow to critically evaluate research, therapies, etc., thus producing a psychologist grounded in evidenced based practice. Fellows can receive up to 8 hours of protected time, weekly, for research activity, depending on the other training needs of the Fellow.

4. Supervision: Fellows will receive no less than two hours of individual supervision weekly and have no fewer than two supervisors during any training year. Fellows will receive, at a minimum, 1 hour or direct supervision from each supervisor weekly and will additionally meet with their preceptor for 1 hour of direct supervision.  Additional supervision, in both individual and group format will occur as a function of the Fellows IFTP and training needs. Clinical Neuropsychology Fellows have access to the Diversity Fellow Mentorship program (administered through Psychology Training) and at the start of the Fellowship will have the opportunity to receive mentorship from a staff member of similar racial/ethnic background.  This mentorship, which would occur in addition to regularly scheduled preceptor supervision, is aimed at career development and professional issues across a Fellow's training experience at MEDVAMC. We believe this is a unique opportunity among neuropsychology fellowship programs.

Fellows receive feedback about their performance as part on ongoing, weekly supervision and are formally evaluated with regard to each of the eight competencies and follow through on their training plan at set time points (e.g., preceptor and rotation evaluations every 6 months, etc.). Additionally, 1) Fellows will each complete 4 advanced neuropsychology foundation lectures at neuropsychology case conference and 2) will complete therapy and neuropsychological assessment competency demonstrations which will be evaluated by staff. Midway through training, Fellows will complete a mock ABPP neuropsychology written examination and towards the end of training Fellows will complete a mock ABPP oral examinations (materials provided through APPCN).

Fellows can review all methods by which competency will be assessed in the MEDVAMC training manual. This training manual is presented to Fellows upon acceptance in to the Fellowship and contains detailed information regarding Evaluation and Grievance procedures to include: 1) frequency and process of evaluation for both neuropsychology residents and faculty members 2) procedures to advise and assist residents who are not performing at an expected level of competence 3) methods and frequency with which residents participate in evaluating the training program 4) program and institutional grievance procedures and 5) Fellowship exit criteria.

Training Sites

Neurology Care Line (NCL)

Dr. Robert Collins

The Neurology Care Line (NCL) has 20 inpatient beds and, annually, approximately 3,600 unique Veterans are seen in both inpatient and outpatient contexts. The inpatient unit sees a wide variety of patients in acute and post-acute care for dementia, stroke, brain tumor, traumatic brain injury, anoxia/hypoxia, etc. There are a wide range of neurology outpatient clinics, including cognitive disorders, stroke, epilepsy, and movement disorders. The NCL neuropsychology service receives consults solely though the NCL inpatient and outpatient clinics. The neuropsychology service primarily offers neuropsychological assessments as essential services but to a lesser extent individual therapy services are provided. Annually, the neuropsychology service receives approximately 200 outpatient consultations. The NCL has an active epilepsy surgery program, to include dedicated beds for long term epilepsy monitoring. Dr. Collins has direct involvement with the MEDVAMC epilepsy surgery program and inpatients on the long term monitoring unit are screened by the neuropsychology service (approximately 150 patients annually).

The primary clinical activities occurring during the major rotation in the NCL will include outpatient and inpatient neuropsychological assessments in typically older patients with various types of cognitive and behavioral dysfunction.  Patient populations include adults with neurodegenerative diseases (Alzheimer’s, vascular, frontolobar, Lewy body, etc.), stroke, epilepsy, and neuropsychiatric disorders with evaluations bearing directly on disease diagnosis, treatment planning, and functional independence.  Fellows will also assist in pre- and post-surgical evaluation of epilepsy patients, Wada's evaluation, and presentation at surgery planning meetings.   There are ample research opportunities with Dr. Collins and/or other NCL staff available during this rotation.

Rehabilitation Care Line (RCL)

Drs. Nicholas Pastorek and Brian Miller 

The Rehabilitation Care Line contains the Polytrauma Network Site, the focus of which is on the assessment and treatment of Veterans with traumatic brain injury and other physical and psychiatric comorbidities. Veterans seen through the Polytrauma Network most commonly have a history of mild to moderate traumatic brain injury, although Veterans with severe traumatic brain injury are also followed through this center for long term care. There is also an inpatient rehabilitation unit that provides services to Veterans recovering from a wide variety of neurological insults including stroke, brain tumor, traumatic brain injury and anoxia/hypoxia. Dementia and delirium processes are occasionally seen in the population as well. Approximately 15 full evaluations are completed per month along with a number of briefer evaluations and individual and group therapy sessions. Approximately 190 outpatient and inpatient consultations are completed annually.

The primary clinical activities will include outpatient and inpatient neuropsychological assessment and intervention with Veterans with traumatic brain injury who served in Operation Enduring Freedom / Operation Iraqi Freedom / Operation New Dawn (OEF/OIF/OND). As a member of the multidisciplinary polytrauma team, Fellows will provide services including assessment of cognitive and academic functioning, individual psychotherapy and cognitive rehabilitation services, and family education and support. The Fellow will utilize innovative evidenced based practices to maximize independence and quality of life of these Veterans by assisting in the management of symptoms common in this population, including chronic pain, insomnia, and cognitive problems. In addition to providing services to the OEF/OIF/OND Veterans with a history of brain injury, the Fellow will have the opportunity to provide assessment and intervention to Veterans on the inpatient rehabilitation unit with impaired cognitive functioning secondary to a host of factors, such as stroke, anoxic brain injury, and brain tumors.

Mental Health Care Line (MHCL)/ Community Integration Program Clinical Neuropsychology Rotation (MH CASE)

Drs. Andrea Cohen, Jane Booth, and Brian Miller

The MH CIP program takes consultative referrals from the Mental Health Care Line and other hospital care lines excluding Rehabilitation and Neurology.  Annually, the three neuropsychologists assigned to this program complete approximately 500 outpatient consultations and 470 inpatient consultations.  The median age of Veterans seen was 62 years. Most Veterans were diagnosed with a dementia process but a higher percentage had psychiatric etiology or influence of symptoms as compared to the Neurology Care Line group. 

The primary clinical activities occurring during this rotation will include outpatient and inpatient neuropsychological assessments in Veterans of varying ages and with various types of cognitive and behavioral dysfunction. Patient populations include adults with neurodegenerative diseases (Alzheimer’s, vascular, frontolobar, Lewy body, etc.), stroke, epilepsy, and neuropsychiatric disorders with evaluations bearing directly on disease diagnosis, treatment planning, and functional independence. Fellows will work with Drs. Cohen, Miller, and Booth during their training term, with the allotment of time to be determined during formulation of the IFTP.

The Parkinson’s Disease Research, Education & Clinical Center (PADRECC)

Dr. Michele York
 
The PADRECC is also housed within the NCL.  Annually, the PADRECC treats 601 unique patients through its four outpatient clinics for a total of 1145 visits.  Diagnoses of patients treated included Parkinson’s Disease, atypical parkinsonism, dystonia, essential tremor and torticollis. The Houston PADRECC is participating in a landmark study of deep brain stimulators in treating advanced Parkinson’s Disease. Dr. Michelle York is a clinical neuropsychologist who works part time at the PADRECC and Fellows will have an option of working with her during their training term.

Psychotherapy Rotations 

During the course of neuropsychology training, Fellows will complete a minor psychotherapy rotation(s). As there is a large psychology training staff at MEDVAMC there are multiple opportunities for Fellows to gain experience in individual and group psychotherapy with a variety of patient populations.  Recommended therapy rotations include geropsychology under the supervision of Dr. Waldman, Spinal Cord Injury under the supervision of Drs. Ames, and Behavioral Medicine with Dr. Cully. Descriptions of these rotations, as well as other psychotherapy training opportunities can be found on the MEDVAMC webpage: http://www.houston.va.gov/psych_fellowship.asp 

Additional Information for Applicants

The Clinical Neuropsychology Fellowship occurs across 2 years, and Fellows are expected to work full-time, accruing 2080 hours per year. Fellows receive a stipend of $47,693 for the first year and $50,197 for the second year. Benefits include 13 days of annual leave, 13 days of sick leave, 10 paid federal holidays, and eligibility for health insurance. Fellows also may receive up to seven days of authorized absence for professional conferences and approved educational activities. All Fellows are appointed at the Instructor level in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Office space with computers and statistical software (SPSS) are provided by NCL and RCL and access to an extensive online library of electronic journals and references is available.

Application Process for Two-Year Fellowship in Neuropsychology

By the start of our program, applicants must have completed all requirements of an APA-accredited doctoral program in psychology and a one-year APA-accredited internship.  The program will actively recruit applicants who are interested in pursuing a VA career as a clinical neuropsychologist. We will accept applications for the 2012-2014 Fellowship class in the fall of 2011. As per APPCN guidelines, we will be available to interview at the winter conference of the International Neuropsychological Society and we will participate and adhere to all pertinent rules of the APPCN match. We will offer optional group interviews onsite in December 2011 and January 2012. For applicants wishing to interview onsite, an early application submission is recommended (early December). The MEDVAMC is an equal opportunity employer, and the Clinical Neuropsychology Fellowship has a strong interest in recruiting persons from diverse backgrounds. Applicants with a disability who require accommodations for the application process or interview are encouraged to contact the Neuropsychology Fellowship Director to discuss their needs. 

Please refer to the application procedure below and interested individuals should feel free to contact Dr. Collins directly if there are questions about the Clinical Neuropsychology Fellowship (Robert.Collins3@va.gov; 713-794-8939):

Dr. Robert Collins, ABPP-CN
Clinical Neuropsychology Fellowship Director
Neurology Care Line (127)
Michael E DeBakey VA Medical Center
2002 Holcombe
Houston, Texas 77030

Core Faculty/Supervisors

The following is a list of the core faculty who are actively are involved in the training of Clinical Neuropsychology Postdoctoral Fellows. 

Jane Booth, Ph.D, ABPP - CN: Community Integration Program (CIP) – Neuropsychology

Andrea Cohen, Ph.D.:  Community Integration Program (CIP) – Neuropsychology

Robert L Collins, Ph.D., ABPP- CN: Neurology Care Line (NCL) – Neuropsychology; Director of the Clinical Neuropsychology Postdoctoral Fellowship

Brain Miller, Ph.D.: Community Integration Program (CIP)/Polytrauma Network Site –  Neuropsychology

Nicholas J Pastorek, Ph.D., ABPP- CN:  Rehabilitation Care Line (RCL) and Polytrauma Network Site – Neuropsychology

Michele K York, Ph.D.: Parkinson’s Disease Research, Education and Clinical Center  (PADRECC), Neurology Care Line (NCL) – Neuropsychology

This Fellowship is not currently APA accredited but is in the process of seeking accreditation. An APA site visit is scheduled for September, 2011. Questions regarding our accreditation status through the APA can be directed to:

Program Consultation and Accreditation
American Psychological Association
750 First Street NE
Washington, DC 20002-4242

(202) 336-5979