Sample Letters of Recommendation of a Non Profit Clinical Neuropsychology Training Issues A Student’s Perspective By

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					Clinical Neuropsychology
     Training Issues:
 A Student’s Perspective
    Zoe Proctor-Weber, PhD
    James A. Haley VA Medical Center
              Tampa, FL
         Overview of Training in
   Clinical Neuropsychology is a formally recognized
    specialty area under the umbrella of clinical

   In addition to training in general clinical
    psychology, it involves specialized training in
    theoretical, empirical, and practical aspects of the
    brain-behavior relationship.

   Education, training, and supervision in Clinical
    Neuropsychology is available primarily at the
    postdoctoral level, although preparation begins at
    the doctoral level.
          Be knowledgeable
    Houston Conference Guidelines
    Provides an integrated model of professional
    education and training in Clinical

   General Knowledge Base and Skills
   Doctoral, Internship and Postdoctoral Training
   Continuing Education
   Professional and Scientific Activity
   Subspecialties
           Hannay, H. J., Crosson, B.A., Hammeke, T. A., Hamsher, K. deS., & Koffler, S. P. 1998.
           Proceedings: The Houston Conference on Specialty Education and Training in Clinical
           Neuropsychology. Archives of Clinical Neuropsychology, 13(2).
   A professional psychologist who applies principles of assessment and
    intervention based upon the scientific study of human behavior as it relates to
    normal and abnormal functioning of the central nervous system. The Clinical
    Neuropsychologist is a doctoral-level psychology provider of diagnostic and
    intervention services who has demonstrated competence in the application of
    such principles for human welfare following:

   A. Successful completion of systematic didactic and experiential training in
    neuropsychology and neuroscience at a regionally accredited university.

   B. Two or more years of appropriate supervised training applying
    neuropsychological services in a clinical setting.

   C. Licensing and certification to provide psychological services to the public by the
    laws of the state or province in which he or she practices.

   D. Review by one's peers as a test of these competencies.

          *Attainment of the ABCN/ABPP Diplomate in Clinical Neuropsychology is the
          clearest evidence of competence as a Clinical Neuropsychologist, assuring that all
          of these criteria have been met.

 •Psychology coursework and/or major (esp. abnormal,
 developmental, statistics).

 •Biology or behavioral medicine coursework (provides a
 strong foundation for graduate neuropsychology coursework)

 •Research Assistanceship and/or involvement
      Graduate Schools: University or Professional?

   University programs are highly competitive (low selection
    ratio). Your application will be helped by excellent grades, GRE
    scores and some previous research experience—preferably, a
    published paper, if only as a co-author.

   Professional schools are easier to get into, but they are very
    expensive. You will have to take out enormous student loans,
    or you might try to work while studying—perhaps even
    studying part-time. Also, many professional schools offer
    primarily the Psy.D. degree, reserving the Ph.D. (if they offer it
    at all) for a few, select students.
       Neuropsychology Track?
Specialization   in NP can begin at the doctoral level.

Often,  Clinical Neuropsychology is offered as a distinct
track in clinical psychology programs, designed to follow
APA Div40/Houston Conference guidelines.

Recognized   tracks make it easier to specialize (existing,
easily accessible NP faculty, research labs, clinics, on/off
campus practica sites, core coursework curriculum…).

No Track? That’s OK.
Important to be proactive
   Seek out didactics, research and clinical training
   opportunities in the community to be competitive.
             Predoctoral NP Specialty
   Core Coursework in NP

       In addition to the basic Clinical Psychology curriculum,
        competitive students have completed doctoral level
        coursework in:

         •   Neuropsychology Assessment
         •   Clinical Neuropsychology
         •   Behavioral and Clinical neurosciences
         •   Behavioral (Clinical) Neurology

             (coursework generally includes exposure to functional
             neuroanatomy, neuropathology, psychopharmacology,
             neuroimaging, relevant test construction/research,
             neuropsychology assessment, case conceptualization…)
    Predoctoral Clinical Experience
Practica Placement

   Hospital (acute inpt, rehab, outpt services)
   Mental Health Clinics (LD, ADHD, TBI, CVA, MDC)
   Private Practice

     Exposure to a wide range of diagnoses, tests, clinical

      settings, age range, conceptualization style…
     Experience conducting interviews, administering

      comprehensive test batteries, staffing cases, writing
      reports and working within a multidisciplinary
      treatment team.
   Many internship sites place a strong emphasis on
    research and scholarly interest and “product” (even if
    you intend to practice as a clinician).
       National conference attendance and association membership
       Journal club participation
       Poster presentations
       Book chapters
       Peer reviewed publications
       Grants

   Tendency to prefer applicants who have successfully
    proposed or defended their dissertation prior to the start
    of internship.
 Be   active! Be visible!

 Former  students.
 Local psychologists in the community.
 Psychology organizations such as
  APAGS, your state psychological
  association and APA are also important
  connection vehicles.
                 Find a Mentor
 Be resourceful.
 Identify a professor who conducts research
  on a subject that interests you.
 Find a professor with whom you interact
  well, regardless of his or her field of
       Seek a supportive relationship.
       Take courses offered by him/her.
       Arrange for office visits for additional
       Offer to do some volunteer work on research.

   Be reliable, dependable and professional.
 Don’t wait for opportunities to come to you!
 Offer to TA graduate classes or teach
  undergrad classes.
 Volunteer to work on research projects.
 Scout out hidden training gems within your
  own program.
 Bare minimum won’t cut it.
  The Successful Intern Applicant
Internship sites differ in terms of focus and

           Clinical Experience, Research, Didactics

Early in your graduate training learn what specific
internship sites expect and value in training.

  How?      Call sites you are interested in and see what
            their successful applicants had – get specifics
            “an ideal candidate would have…” in terms of
            research, clinical experience, extra-curricular
            activities etc…

                  KNOW WHAT YOU NEED!
  Selection Criteria for Clinical
  Neuropsychology Internships
 Supervisors of 50 Clinical Neuropsych
 internships (Cripes 1995, 1998) were
 asked to rank order criteria used for
 selecting intern applicants.

 Surveys
 40responses (80% response rate)
 Reflects “aspirational” criteria
            Mittenberg, W., Peterson, R. S., Cooper J. T., Strauman, S. & Essig,
            S. M. (2000). Selection Criteria for Clinical Neuropsychology
            Internships. The Clinical Neuropsychologist, 14(1), 1-6.
      Supervisor’s Rank Ordered
            Critical Items
                                            Rank Order
Clinical Experience - Assessment                 1
NP Specialization within Program                 2
Interview (Interpersonal Characteristics)        3
Letters of Recommendation                        4
Personal Statement (Goals/Interests)             5
Pubs/Presentations (research competence)         6
Clinical Experience - Psychotherapy              7
Familiarity with Applicants Supervisor(s)        8
Work Sample                                      9
GPA                                             10
 Preferred NP Practica or Clinical
       Training Experience
                             Considered Essential or Very Important

Clinical NP pts                        97.5%

            Neurology                    95%

           Psychiatry                  77.5%

Clinical Psych pts                     72.5%
Medical rehab/health psych
pts                                    47.5%

Counseling pts                           30%
Cog rehab pts                            25%
   Desired Setting Experience
                               Rank Order

Univ Medical Center                     1

VA Medical Center                       2

Community Hospital or Clinic            3

Private Rehab Facility                  4

Private Practice                        5
Prior Assessment Experience
                               Considered Essential or Very

NP Assessment
                  Systems                             80%

                  Process                             60%

                     Fixed                          37.5%

Personality Assessment

Objective                                             90%

Projective                                            20%
Vocational/Functional Assessment                    27.5%
     Educational Background
                         Considered Essential or Very

Div 40 Curriculum                             82.5%

NP Faculty/Supervisors                        87.5%

NP Recommendation Letters                       85%

Diss Proposed                                 92.5%
Diss Completed                                27.5%
        Prior Research Activity

                                      Considered Essential or Very

Publications in Referenced Journals                42.5%

Nat Conference Presentations                       50%

                    INS                            47.5%

                   NAN                             40%

              APA Div40                            45%
          Other Considerations for
           Selecting an Internship
   Seek balanced training programs.

       Clinical Rotations (seek variety re: populations,
        disorders, settings).
       Offered Didactics (general and specialty). Quality?
       Research opportunities (does their faculty publish?)
        Role of interns (collect data, analyses, write?).
       Supervision (Individual? Group?) With whom? Seek
       Teaching (opportunities to present lectures?)
       Other considerations:
         • How many neuropsych interns? Sharing resources?
         • Is there a postdoc program?
  Availability vs. Opportunity
 To   good to be true?
     Make sure the “available” opportunities listed
      on site brochures are actually attainable (talk
      to current interns!).
 Manage/protect      your time.
     Set limits with your supervisors.
     Acknowledge the amount of time it takes you
      to do complete something.
 Set   reasonable/attainable goals.
     Make wise choices (1 peer reviewed pub vs. 3
   Remember you won't always know what you like until
    you try it.

   Graduate training is a time to grow and discover
    interests – use this time to round out your education.

   General clinical training is an essential aspect of training
    to become a Neuropsychologist.

   All graduate programs offer students the chance to learn
    how to be critical thinkers and good learners–skills that
    you'll be able to use no matter how the market for
    psychology changes.
                  Think Ahead
 Educateyourself! Know the expected
 requirements for the next level of training.

       an internship site that will help you
 Select
 become a more competitive postdoc
 candidate (fill in your training gaps).
     Research
     Clinical
     Didactics
           A Model Example
 JAHVA    Medical Center, Tampa, FL
    Educates students on the
     requirements/qualifications for attaining
     competitive postdoctoral fellowships and
     board certification.

    Provides ABCN Didactics to introduce and
     prepare trainees at the intern and
     postdoctoral level to successfully navigate
     and pass the NP Specialty boards.
    Participation is required for Postdocs and
    strongly encouraged for Interns:

   Teach neuroanatomy and neuropathology to
    students and staff.

   100 question practice NP written exams.

   Mock oral fact-finding exams.

   Mock oral ethics exam.

   Work sample submission and oral defense of a NP
     Resources for prospective
     students, interns, postdocs
A list of graduate training programs in
 Clinical Neuropsychology is maintained by
 Division 40 of the American Psychological

 The list is periodically published in The
 Clinical Neuropsychologist, by Swets &
 Zeitlinger Publishers.
       Graduate, internship and
    postdoctoral training programs
 Name of institution and department
 DOT contact information (Board certified yes/no)
 # of available positions
 Length of program
 Available financial assistance
 Info on training setting, patient demographics,
 Specialty training (neuropsychology,
  rehabilitation etc…)
 Application procedure information
Check out websites
   APA-40 (Division of Clinical Neuropsychology (40) of the American Psychological
   APPIC (Association of Psychology Postdoctoral and Internship Centers)
   APPCN (Association of Postdoctoral Programs in Clinical Neuropsychology)
   AITCN (Association for Internship Training in Clinical Neuropsychology)
   ABCN (American Board of Clinical Neuropsychology )
   ABPDN (American Board of Pediatric Neuropsychology)
   ABPP-CN (American Board of Professional Psychology - Clinical Neuropsychology)
   NAN (National Academy of Neuropsychology)
   INS (International Neuropsychology Society)
   AACN (American Academy for Clinical Neuropsychology)
   ADECN (Association for Doctoral Education in Clinical Neuropsychology)

Join Listserves:

Attend National Conferences
    NAN (National Academy of Neuropsychology)
    INS (International Neuropsychology Society)
    APA (American Psychological Association)
Independent Training Centers
   Center for Applied Neuropsychology - The Center for Applied
    Neuropsychology (CAN) is a private, non-profit, community-based
    agency devoted to service, research, and training in rehabilitation
    psychology, neuropsychology, and vocational rehabilitation.
   NAN distanCE - The National Academy of Neuropsychology takes
    the forefront in offering neuropsychology-oriented continuing
    education (CE) via the Internet.
   The Neuropsychology Center - The Neuropsychology Center
    offers a variety of training opportunities and experiences. These
    include Continuing Education (CE) seminars, clinical consultation,
    and ad hoc training experiences.
Overview of Postdoctoral Training
  in Clinical Neuropsychology

         Corwin Boake, PhD
     University of Texas-Houston Medical School
     Memorial Hermann-TIRR, Houston, Texas
Main topics

Houston Conference guidelines
What to look for in a residency
Nuts & bolts of application &
National match
Survey of 2007 match applicants
  Houston Conference guidelines for
  postdoctoral training
 Goal is to complete the education and training necessary
  for independent practice of clinical neuropsychology (CN)
 Residency is a REQUIRED component in specialty
  education in CN
 The equivalent of 2 years of full-time education and
 Residency MUST occur on at least a half-time basis
 ENTRY criteria:
     1. Entrance SHOULD be based upon completion an APA/CPA-
      accredited doctoral program.
     2. Residents WILL have successfully completed an APA/CPA-
      accredited internship which includes SOME training in CN.
 Houston Conference guidelines for
 postdoctoral training
 EXIT criteria:
 1. Faculty includes a board-certified clinical
     neuropsychologist and other psychologists.
 2. Training at a fixed site or affiliated local sites with
     primarily on-site supervision.
 3. Access to clinical services and training in medical
     specialties and allied professions.
 4. Interactions with residents in medical and allied
 5. Eligibility for state or provincial licensure for
     independent practice.
 6. Eligibility for board certification by ABCN.
Preparing for application to
postdoctoral programs
Doctorate in clinical/counseling/school
APA/CPA accreditation of doctoral
program and internship
Neuropsychology background through
practica, employment, coursework, and/or
If no exposure available in doctoral
program, supplement with additional
supervised practicum, employment, etc.
Preparing for application to
postdoctoral programs
Involvement in specialty organizations (e.g.,
APA Div 40, INS, NAN)
Need to complete dissertation by start date of
Use internship to round out general clinical
Neuropsychology internship is not necessary
and not always helpful
Plan applications with advisor or mentor
How to judge program quality

Meets Houston conference guidelines

Offers a variety of clinical experience

Quality supervision and fair evaluation

Opportunities for education and research

Expected clinical productivity
How to judge program quality

Evidence of staff expertise

Adequate resources

APA accreditation: potential advantage but
not required at the postdoctoral level

Outcomes of previous residents
Applying to postdoctoral programs

Programs have different application
procedures (but simpler than
List specific goals in cover letter
Attend INS for interviews
Speak with former/current trainees
Apply to many programs
APPCN membership criteria

Duration of 2 years of postdoctoral
training, or equivalent on at least a half-
time basis
Activity at least 50% clinical, 10%
didactics, and 10% research
Program director is board-certified in
clinical neuropsychology by ABCN
   National match: timeline

  Deadline    Applicant   Program

              Register with NMS


 2/29/08        Submit ranks

 3/10/08            Match            house
National match: Basic procedures

Computerized matching process, run by NMS on
behalf of APPCN
All programs meeting Houston guidelines may
Fees for applicants and programs
Match assignments are based on applicants’ and
programs’ rankings
Match assignments are binding
Clearinghouse available after match
National match: rules for participation

Program can disclose only if the applicant
is competitive and will be ranked

Premature offers are not allowed

No limit on number of applications or
number of ranks submitted
 National match:
 N of applicants and positions


60                               2003
40                               2005
      Applicants     Positions
 National match: success rates

 70                              2001
 60                              2002
 50                              2003
 40                              2004
 30                              2005
 20                              2006
 10                              2007
      Applicants    Positions
National match: Relationship of
outcome to N of ranks submitted
        mean N of ranks (2007)



3                                Matched
    Applicants     Positions
National match survey

Survey of applicants in 2007 match
   Describe match registrants
   Assess satisfaction with the match
   What influences match outcome
The overall match rate for those who
responded was 62%
National match survey: Factors that
influence match outcome

         Match Rate by Publications
        0 to 1       2 to 4      5 or more
             Number of Publications
National match survey: Factors that
influence match outcome

         Match Rate by Presentations

         0 to 3       4 to 9    10 or more
             Number of Presentations
National match survey: Factors that
influence match outcome

          Match Rate by Interviews

        0 to 3          4 to 7     8 or more
                 Number of Interviews
National match survey: Summary

Factors associated with match success:
   Publications
   Number of interviews obtained: for those with
    8 or more interviews, match rate was 95%

75% of non-matched applicants reported
obtaining a neuropsychology fellowship
National match:
Advantages to the applicant
Access to most quality programs that meet
training standards for ABCN
Procedure is fair to applicants
Ability to apply to many programs using
the same process
Minimize travel by interviewing at INS
Match outcome is binding
National match: important links


1. Postdoctoral residency is required for
   new doctorates to practice in this

2. Competition for residency positions

3. Preparing a competitive application
   American Board of
Clinical Neuropsychology

    Celiane Rey-Casserly, PhD
          Why Board Certification?
   Protection of the patient is paramount!
   During earlier periods, multiple routes to
    clinical practice were followed-now
    development of formal training opportunities
   Even with formal training, level of training
    cannot be guaranteed, either by program or by
   Self-designation is not acceptable. Certificates
    of training are no better.
   Certification by examination by peers is the
    only appropriate method of assuring
        Psychology Boards Analogous to
                Medical Boards
   State licensure is not appropriate for specialty
       Problems with generic licensure abound, including:
         Understanding of specialty criteria difficult for
         Multiple claims to competence without
          appropriate exam
   Board certification is voluntary and regulated
    by the field.
       Medical specialties also not regulated at state level
       AMA directory lists “self-designated” specialists
   Purpose of the Examination
The examination for the diploma is designed to assess
 advanced competence in the practice of clinical
 neuropsychology. It is intended not just as a
 measure of fund of knowledge, but also as a tool to
 determine the effectiveness of application of
 neuropsychological principles in the clinical setting
 and the promotion of the welfare of the patient.
 The examination is designed to provide a standard
 by which competence to practice Clinical
 Neuropsychology is judged.
                Bieliauskas & Matthews, 1987
ABCN Officers and Appointees
 President               Michael Westerveld
 Vice President          Bernice Marcopulos
 Secretary               Karen Wills
 Treasurer               Rich Naugle
 ABPP Representative     Sandra Koffler

 Executive Director       Linas Bieliauskas
 Exam Committee Chair     Bernice Marcopulos
 Local Arrangements Chair Chris Grote
              ABCN BOD 2007
Debra Koltai Attix (2007-2012) Richard Naugle (2000-2009)
William Barr (2003-2008)    Celiane Rey-Casserly (2005-2010)
 James Becker (2004-2009)     Brenda Spiegler (2005-2010)
Julie Bobholz (2007-2012)     Sara Swanson (2004-2009)
Jennifer Haut (2006-2011      Fred Unverzagt (2006-2011)
David Kareken (2006-2011)     Michael Westerveld (2000-2009)
Sandra Koffler (1997-2007)    Karen Wills (2003-2009)
Gregory Lee (2004-2009       Tony Wong (2007-2012)
John Lucas (2005-2010)
Bernice Marcopulos (2003-2008)
Current Status of Board Certification
   As of June, 2007, there are 599 board
    certified Clinical Neuropsychologists,
    from 48 states, the District of Columbia,
    and 4 provinces.
   Since its inception, ABCN has awarded
    board certification to 609 individuals.
   In 2005, 61 took the written exam and 36
    took the oral exam.
   In 2006, 83 took the written exam and 47
    took the oral.
   So far 2007: 86 written; 20 orals
                   ABCN Written Examinations
                        in Recent Years





























                                                                    *   with one exam to go
     Application and Examination
               2 phases
     Assessment of           Assessment of
   education, training,        competence

1. Application and        3. Practice Sample
  Credentials Review       Evaluation

2. Written Exam           4. Oral Exam

   $125 Application Fee

   $300 Written Examination Fee

   $250 Work Sample Fee

   $450 Oral Examination Fee
How Long Does it Take?
                 Eligibility Criteria
   Earned doctoral degree in psychology from a regionally
    accredited university.
   Membership in professional psychological organizations
    which have identified purposes and policies that are
    congruent with those of ABPP.
   Licensed or certified at the level of independent
   Areas of training and experience:
        Basic Neurosciences       -Neuropathology
        Clinical Neurology        -Neuroanatomy
        Psychological Assessment
        Clinical Neuropsychological Assessment
        Psychological Intervention
        Psychopathology
Three years of experience in Clinical
 Neuropsychology, satisfied by:
   3 years of experience, one of which may be predoctoral
    internship with an emphasis in Clinical Neuropsychology
   one year pre or post doctoral experience and successful
    completion of a postdoctoral program in Clinical

Two years of supervision in the practice of Clinical
 Neuropsychology, satisfied by:
   2 years of postdoctoral supervision
   1 year of predoctoral & 1 year of postdoctoral supervision
   completion of a postdoctoral program in Clinical
        Written Examination
 Prepared in conjunction with the Professional
  Examination Service (PES)
 Updated every 2-3 years by 30%
 Items rated for appropriateness as well as
 100 multiple-choice items, covering 4 rubrics
 Given at each of the four major
  neuropsychological meetings annually, INS,
  AACN, APA Division 40, and NAN
Four Rubrics for Questions
from Houston Conference
 Generic  Psychology Core
 Generic Clinical Core

 Brain-behavior Relationships

 Clinical Neuropsychology
     Work Sample Submission
A  work sample consists of two cases
 The cases must be sufficiently different
  to demonstrate broad knowledge
 Original report, summary sheet, copy of
  raw test protocols

Note: Supplementary materials NO
         Oral Examinations
When work samples have been accepted (not passed) for
 oral examination, candidate is asked to prepare to take
 the next available oral examination. Examinations are
 currently held at Rush-Presbyterian-St. Luke’s Medical
 Center in Chicago in the middle of May and the middle
 of October each year. With two examination teams, 24
 candidates can be accommodated at each exam. There
 are current capabilities to expand to 36 candidates per
 examination if necessary.
The examination committee of ABCN selects the
 examiners from a fixed cadre of examiners, selected for
 high quality of past exam administrations or high
 probability of effective examination based on training
 experience. The examiners represent the diversity of
 board certified clinical neuropsychologists, including
 gender, region, child/adult emphasis, and seniority.
 Board Preparation Resources
The History

“BRAIN” is an ABPP/CN study group that was
  started by a few candidates back in 2002.
  Formally named "BRAIN" later. Lots of info
  about the group has been compiled and is now
  available on the web, so it might be easiest to
  just check that out:
BRAIN (which stands for “Be Ready for ABPP in
  Neuropsychology) is becoming an increasingly well
  organized group designed to help our colleagues obtain
  their ABCN certification. While it was originally started by
  a small group of friends (prior to AACN’s mentoring
  program), it has expanded to include over 125 members.
  The listserve consists of neuropsychologists at all stages of
  the ABPP process, from individuals who are still thinking
  about turning in their credentials to over 30 people who
  are now ABCN diplomates. They have designed study notes
  (which can be viewed at the website) and also provide
  supportive suggestions and guidance to candidates as they
  proceed through the ABPP process. They have also been
  able to provide a forum for individuals to develop study
  groups for each stage of the ABPP process, as well as
  provide a little bit of inspiration and positive peer
  pressure. They now have an official listserve (thanks to
  Bob Ivnik’s generosity) and website (thanks to Dean
  Beebe’s efforts).
 New   members are accepted upon referral
  from a member of AACN or an already
  existing member of BRAIN who may or
  may not have completed the ABPP/CN
  process (this person is considered the new
  member's "sponsor").
 If a supervisor is not a member of AACN or
  Brain, they should contact someone who
 The only other criterion to join BRAIN is
  that the new member be a licensed
             BRAIN (continued)
If an AACN or BRAIN member would like to add someone to
   the study group listserve,contact Michael Kirkwood
   ( with the name,email
   address, and a brief narrative biosketch of the potential
After receiving this information, Dr. Kirkwood will send an
   email to the new member and the sponsor, which will
   include an introductory welcome letter and listserv
   registration information. Dr. Kirkwood will subsequently
   post the biosketches of new members to the BRAIN
   listserv as a means of introducing them to the group.
                  AACN Resources
   Available at
   AACN Study Guide for board certification:
    A very detailed resource regarding each
    step in the process.
   AACN Mentorship Program:
       Available to candidates who have passed the
        Credentials Review
       Meant for support and consultation
       Participation is optional, although advisable

Description: Sample Letters of Recommendation of a Non-Profit document sample