[The role of the neuropsychologist in Parkinson's disease]

Psychologists specializing in neuropsychology, more commonly known as neuropsychologists, play an important role in the care of cognitive, behavioral and emotional aspects of patients with Parkinson's disease. They are also involved in research and public education on the disease.

Competencies unique to clinical neuropsychology: A consensus statement of educators, practitioners, and professional leaders in Australia

Objective: To delineate the unique role of clinical neuropsychologists in contemporary Australian clinical practice and present a comprehensive consensus-based set of clinical neuropsychology competencies to guide and standardize the training of clinical neuropsychologists. Method: Twenty-four national representatives of the clinical neuropsychology profession (71% female, M = 20.1, SD = 8.1 years clinical practice), including tertiary-level educators, senior practitioners and members of the executive committee of the peak national neuropsychology body, formed the Australian Neuropsychology Alliance of Training and Practice Leaders (ANATPL). Informed by a review of existing international competency frameworks and Australian Indigenous psychology education frameworks, a provisional set of competencies for clinical neuropsychology training and practice were developed, followed by 11 rounds of feedback and revisions. Results: The final set of clinical neuropsychology competencies achieved full consensus and falls into three broad categories: generic foundational (i.e. general professional psychology competencies applied to clinical neuropsychology); specific functional (i.e. specific to clinical neuropsychology areas of practice) competencies relevant to all career stages; and functional competencies relevant to advanced career stages. Competencies span a number of knowledge and skill-based domains including neuropsychological models and syndromes, neuropsychological assessment, neuropsychological intervention, consultation, teaching/supervision and management/administration. Conclusion: The competencies reflect recent advances in the field of clinical neuropsychology, including expanded intervention competencies, culturally-informed neuropsychological practice and use of emerging technologies. They will be available as a resource to guide curriculum development for clinical training, as well as providing a useful framework for professional practice and advocacy more broadly within the discipline of clinical neuropsychology.

H - 62 Current State of the Practice of Clinical Neuropsychology in Bolivia

OBJECTIVE

The present study aimed to determine the current state of the practice of clinical neuropsychology in Bolivia.

METHOD

This is a descriptive and cross-sectional study. The sample consisted of 72 professionals working in the field of neuropsychology in Bolivia. The information was collected through an online questionnaire that included 70 questions about the participants' professional training, professional practice, research, teaching, and perceived barriers to the profession's development, among other factors.

RESULTS

Approximately 76% of participants reported receiving postgraduate neuropsychology training. Their training was rated as very good (34.8%) and good (23.9%). Conversely, their clinical supervision was rated very good (24.3%) and good (33.3%). The participants indicated that their professional practice is conducted mainly in private settings (72.2%). Also, they mentioned that the most assessed disorders were learning disabilities (93.5%), intellectual disabilities (90%), and ADHD (87.5%). Similarly, the more frequent conditions rehabilitated were learning disabilities (23.6%), ADHD (20%), and depression (20.85%). Only 41.5% of the participants reported conducting research. A smaller proportion of professionals (31.5%) taught neuropsychology courses.

CONCLUSIONS

Neuropsychology is a relatively new field of work in Bolivia. For this reason, the participants considered that to enhance the quality of this specialty in Bolivia, new graduate programs in neuropsychology must be developed, more standardized tests validated, and more job positions created, especially in public institutions. Additionally, a professional organization that regulates the standards of this field needs to be established.

B - 40 Mending the Trainee-to-Workforce Pipeline: Recruitment and Retention Strategies on Black Trainee Enrollment and Matriculation within Neuropsychology Programs

OBJECTIVE

This study intended to understand how Black trainees view the use and effectiveness of recruitment and retention strategies used by clinical psychology programs with a emphasis in neuropsychology.

METHOD

This pilot study included participants (N = 14) who were current trainees or early career neuropsychologists who identified as Black/African American. A computer-based survey was used to collect demographic, student, and early career neuropsychologist data wherein participants completed a 7-point Likert scale to rate the effectiveness of their program's use of 10 recruitment strategies and nine retention strategies. The strategies are based on research conducted by Rogers and Molina (2006) regarding recruitment and retention of students of color in clinical psychology graduate programs. Participants were contacted through APA listservs, particularly Division 40 and Division 45, within the American Academy of Clinical Neuropsychology, and the Society for Black Neuropsychology.

RESULTS

Results were descriptive due to a lack of power and were often variable. Over half indicated that their programs do not use recruitment materials geared toward minoritized applicants, and their programs did not use marketing materials designed to attract Black trainees. Regarding the effect that the presence of minoritized faculty mentors and their support of research in diversity-related issues have on retention, 28.6% of respondents reported that they are extremely effective retention strategies.

CONCLUSIONS

As the U.S. continues to grow increasingly diverse, neuropsychology must be ready to meet this shift. The overwhelming majority of active neuropsychologists identify as Caucasian (Sweet et al., 2021). There is a responsibility to actively work toward the mending of the trainee-to-workforce pipeline.

B - 27 Philadelphia Neuropsychology Society's Equity Forum: Efforts to Address Local Level Needs for Equity in Neuropsychology

OBJECTIVE

While there are growing national advocacy efforts to advance equity in neuropsychology, fewer initiatives exist at local and regional levels. The Philadelphia Neuropsychology Society's (PNS) Equity Forum was created to provide diversity, equity, and inclusion (DEI)-related support, advocacy, and resources to local trainees, professionals, and communities. We describe the Forum's efforts to promote policies, educate, and offer support at a local level.

METHOD

We conducted an archival review of activities of the PNS Equity Forum from January 2021 to April 2023, including a PNS needs assessment survey (NAS), the southeastern PA Regional Community Health Needs Assessment (rCHNA), electronic correspondence, and website traffic.

RESULTS

Results identified the need to increase access to resources for 1) culturally responsive research, 2) bilingual providers, 3) low-cost care, and 4) brain health education for the local public. In response, the Forum implemented the following initiatives: monthly ce seminars and journal club, quarterly newsletter, and a resource repository for culturally, linguistically, and socioeconomically diverse communities in the Philadelphia region. The Forum provided DEI-related education to monthly PNS speakers and created safe discussion spaces after national tragedies. The PNS Forum website page saw a 114% increase in views, the list of bilingual and culturally-aware providers received 25% more views, and the quarterly newsletter saw a 100% increase in views in the last month.

CONCLUSIONS

Neuropsychologists can serve as social change agents in local and regional neuropsychology organizations, and create transformational spaces for accessible, equitable, and sustainable neuropsychology practices and training environments.

Characteristics of and Professional Issues Experienced by Early Career Neuropsychologists in the United States - Findings from a Survey Study

OBJECTIVE

Multiple transitions occur during the early career stage of a psychologist, perhaps to a higher extent and with more potent ramifications than subsequent career stages. However, limited information exists on the various expectations, concerns, and challenges experienced by early career psychologists (ECPs) broadly, and more specifically in clinical neuropsychology. Therefore, the Society for Clinical Neuropsychology (SCN)/Division 40's Early Career Neuropsychologist Committee developed a Needs Assessment Survey with the primary goal of identifying various training and professional development issues encountered by ECPs in clinical neuropsychology.

METHOD

A comprehensive survey was distributed electronically via listserv announcements and SCN communication tools (Newsletters and Neuroblasts). Data collection occurred from 29 May, 2020 to 02 August, 2020. The total sample comprised of 89 respondents (85% aged 31-40 years; 83% female; 82% Caucasian, followed by 18% Asian; 3% of Hispanic ethnicity).

RESULTS

Majority of the respondents graduated from APA-accredited doctoral programs and from postdoctoral programs that adhered to Houston Conference Guidelines. About 7% took >2 years to complete their residency and about 10%-15% of ECPs expressed clear dissatisfaction with at least some aspect of their residency training. Becoming board certified in neuropsychology was the highest ranked career goal for ECPs in neuropsychology (45%), whereas 72% indicated difficulty understanding billing and insurance-related issues as the most frequently encountered professional challenge. About 57% of ECPs were concerned about maintaining work/life balance.

CONCLUSIONS

Specific ways to aid and strengthen trainees and ECPs' professional needs are discussed with a focus on activities that can be undertaken at individual-, department-, profession-, and higher legislative-specific levels.

IMPACT STATEMENT

Question: Using survey data, this study aimed to characterize early career psychologists (ECPs) training history and their current work settings, identify their needs, and understand their perspectives about challenges and expectations. Findings: Results reveal that the workforce comprising of ECPs is getting increasingly diverse, and their needs are typically focused on obtaining board certification. ECPs identified areas for improvement in their training, such as increasing their knowledge of billing and insurance, and expressed concerns about maintaining work/life balance. Importance: The Minnesota 2022 Update Conference seems like a promising platform for addressing several of the needs identified by the survey and providing updated guidelines for ECPs. Next Steps: Based on the findings, general guidelines have been proposed for state and local level organizations along with call for action to higher-level legislation.

Curatorship applications: The role of neuropsychology

This article highlights ethical issues that may arise in the relationship between curatorship applications and neuropsychology. In South Africa (SA), curatorship applications for the elderly diagnosed with dementia require substantiation from two medical professionals, one of whom should be a practising psychiatrist deemed competent to provide this. Concurrently, there is often a request for a psychologist to conduct a neuropsychological assessment and to produce a relevant report. The process may result in ethical issues at various stages of the assessment. The balance between protecting the patient's rights v. freedom of autonomy becomes a central issue. Psychiatrists and psychologists are cautioned to adhere to best practices throughout the assessment, maintaining a critical and reflective stance. The limitations of cognitive assessment as a predictor of functionality should be considered. Furthermore, neuropsychological training in SA differs across institutions, resulting in variable practitioner competency. 'Competency' itself is an ambiguous legal term that may be interpreted variably. This article outlines the definitions and requirements of the curatorship process, as well as the role and limitations of neuropsychology, with emphasis on the ethical dilemmas that may arise.

A Survey of Doctoral Internships Offering Clinical Neuropsychology Training: Updated Expectations for Competitive Applicants

OBJECTIVE

The specialty of clinical neuropsychology has experienced significant professional growth and increasing standardization of educational and training guidelines over the past 20 years. Previous literature demonstrated the importance of routine distribution of selection criteria used by training directors and supervising neuropsychologists for competitive applicants aiming to specialize in neuropsychology during internship. This study examined supervisors' updated expectations for competitive applicants from a more diverse sample of doctoral internship programs offering neuropsychological training. These data also provide cross-sectional and longitudinal comparisons to help trainees tailor their graduate training experiences.

METHOD

The sample included training directors and/or supervising neuropsychologists from 80 internship programs (73.4% of submitted surveys). Spearman correlations, analyses of variance, and chi-square tests of independence were conducted for cross-sectional and longitudinal comparisons.

RESULTS

Clinical experience in assessment and the personal interview were consistently the two most prioritized criteria across all groups, whereas prioritization of the additional criteria was variable based on the program's characteristics. Internship programs generally preferred practica experience at university-affiliated medical centers, Veterans Affairs medical centers, and private/community-based hospitals. University-affiliated medical centers and internships offering ≥50% neuropsychology training showed similar preferences for applicants with a depth and breadth of graduate school experience in neuropsychology. Longitudinally, the applicant expectations for programs offering ≥50% neuropsychology training remained largely unchanged between 2000 and 2020.

CONCLUSIONS

This study updated expectations for competitive applicants from a diverse sample of neuropsychology training programs, underscored the importance of fit between trainee and program, and demonstrated consistency over time for trainees seeking neuropsychology training during internship.

Action-Observation in Fine Motor Learning Applying Neuropsychology Principles to Enhance Academic Teaching in the Field of Rheumatology A Pilot Study

BACKGROUND

The subject of fine motor acquisition among adults has been wellstudied in the fields of neurorehabilitation and neuropsychology. Action-based observation among subjects of varying skill sets has been shown to be an effective means of acquiring a new fine motor skill. This study applied these principals to assist postgraduate students in acquiring a new fine motor skill.

METHODS

This survey-based study measured postgraduate students'self-rated comfort with motorskill acquisition. Postgraduate students of varying skillswith ultrasonography attended a hands-on conference introducing a novel skill. A survey assessing their self-rated skill acquisition on a Likert scale was administered immediately following the conference and again at 6 months.

RESULTS

All of the postgraduate students said that they agreed or strongly agreed that they could identify the anatomic structures using the techniques discussed immediately following the conference. All of the postgraduate students reported that observing someone else learn a new scanning technique helped them learn the technique. At 6-month follow-up, three out of four respondents continued to either agree or strongly agree with those statements.

CONCLUSION

This study provides a basis for further research on the efficacy of action-based observation techniquesfor fine motorlearning,suggesting that the technique is efficacious and well received among a small population of adult learners. This could have implications for the introduction of fine motortechniquesin academic medicine. It may be beneficial to cohort postgraduate students of varying skill levels during training, as opposed to stratifying them by postgraduate training year.

[Prefrontal clinical symptoms in daily living: screening assessment by means of the short Prefrontal Symptoms Inventory (PSI-20)]

INTRODUCTION

Estimation of daily symptoms of frontal dysfunction is considered to be essential in order to endow neuro-psychological assessments with ecological validity. The questionnaires available today were constructed to estimate executive problems in daily life in populations with neurological damage. There is a need for instruments focused on measuring these behaviours in the general population or in clinical populations with mild or moderate impairment.

AIM

To examine the factorial validity and to find evidence of concurrent validity of the short version of the Prefrontal Symptoms Inventory.

SUBJECTS AND METHODS

Three samples were obtained: the first, from the Internet (n = 504); the second, in a non-clinical population by means of paper and pencil (n = 1,257); and the third, from patients being treated for substance addiction (n = 602). A factorial analysis without restraints was used on the first sample and the results were submitted to confirmatory factorial analysis on the other two samples.

RESULTS

The three-factor structure that was found was confirmed with excellent indicators of fit in the other two samples. Evidence of concurrent validity was found with quality of life and mental health tests.

CONCLUSIONS

We propose a short questionnaire for detecting failures of a prefrontal origin in daily living, which improves on the psychometric qualities of similar tests, but is oriented towards severe neurological pathologies. The structural stability of the test ensures it can be used in the general population, for the early detection of cognitive impairment, and in clinical populations with mild or moderate deterioration. A set of criteria are proposed for use in interpreting the results.

Designing pedagogy incorporating executive function

The National Academy of Neuropsychology defines clinical neuropsychology as "a sub-field of psychology concerned with the applied science of brain-behavior relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and/or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders" (National Academy of Neuropsychology, 2011 ). Pediatric neuropsychologists have long been concerned about another area of functionality, making their recommendations educationally relevant. This article describes accommodated metacognitive instruction, a pedagogy based on cognitive neuropsychological principles of learning and used to instruct college faculty on a methodology for teaching in all-inclusive environments.

Essential Books and Journals in Clinical Neuropsychology: An Australian Perspective

To assist in the identification of key professional resources for neuropsychologists, 214 Australian clinical neuropsychologists were asked to identify "essential" reference materials. Fifty members of the Australian College of Clinical Neuropsychologists returned useable surveys. Forty-three respondents provided information about which clinical neuropsychology books and journals they considered essential and why. Results showed 15 books, including 3 Australian books, and 31 journals were included in the essential reading list of at least 10% of this sample. Compared to similar previous surveys (predominantly conducted overseas and mostly over 10 years ago), the results of this survey suggest that, Australian neuropsychologists have similar views about the top ranking books and journals in clinical neuropsychology as their overseas counterparts. An exception to this general trend may be the status of reference books containing norms, which appear to be growing in perceived importance. Importantly, the results of this survey may be used to help practitioners identify key professional resources in the area of clinical neuropsychology.

Grasping at ontological straws: overcoming reductionism in the Advaita Vedānta-Neuroscience dialogue

Contemporary neuropsychology reveals that the parietal lobe contains neurons that are specifically attuned to the act of grasping and this act may be fundamental to the establishment of the phenomenal boundaries between subject and object. Furthermore, alterations to this process, such as the hypoactivation of this region during meditation or the hyperactivation associated with schizophrenia, may eliminate or confuse, respectively, the phenomenal boundaries between subject and object. Traversing disciplines, the Advaita Vedānta school of Hinduism traces some of its key terms for subject and object to the verbal root grah, to grasp. The subject is literally the grasper. Furthermore, the practice of asparśa yoga, the yoga of no-touch, is aimed at stopping, hypoactivating, the grasping process in order to transcend all subject-object boundaries. This paper will argue that while we have not uncovered an identity of thought, we have uncovered a confluence of ideas between these two disciplines. We will see that this confluence of ideas has not pitted the believer against the critic-not forced us into the great reductionism debate that has dominated so much of the interchange between religious studies and the sciences. This case study will illuminate some of the methodological ways around this reductionism battle and also the boundaries of both disciplines for the intellectual benefit of each.

Identifying areas for curricular program improvement based on perceptions of skills, competencies, and performance

OBJECTIVE

Educational program evaluation and program improvement are processes that can be enhanced by involving multiple stakeholders and measurement tools. The purpose of this study was to compare faculty and resident physician perceptions of both teaching quality and resident competence for 13 core psychiatric skills and the six Accreditation Council for Graduate Medical Education general competencies. Additionally, resident performance as assessed by portfolios was descriptively examined relative to these perceptions of skills and competencies. Using this combination of data, the authors propose a useful approach for identifying areas for improvement within a medical residency's program curriculum.

METHODS

Ten teaching faculty members (100%) and 18 residents (82%) within a psychiatry department completed parallel surveys. Trained raters scored resident-completed portfolio entries. Nonparametric and descriptive analyses were used to compare the various data sources.

RESULTS

In general, faculty and residents showed congruence in their perceptions about resident performance. They agreed on the quality of teaching skills and general competencies. General competency scores from the portfolios were congruent with this perspective. However, there were mismatches in perceptions and performance on portfolios for some areas. Of the 13 core psychiatric skills examined, only one area, neuropsychiatry, was rated below average by both faculty and residents, while the median portfolio performance score was below competent for four skills, including neuropsychiatry. Faculty rated resident competence significantly higher than residents rated themselves for biopsychosocial formulation and medical psychiatry.

CONCLUSION

This study describes and highlights the usefulness of a multidimensional approach that includes resident and faculty perspectives and externally rated performance measures to assist in identifying potential target areas for curriculum improvement.

Neurobiological formulations: integrating clinical and biological psychiatry

OBJECTIVE

The authors describe a pilot program allowing psychiatric residents to participate in neurobiological evaluations of patients with Axis I disorders. The program aimed to familiarize residents with available tools for assessing cognitive and neuroanatomical abnormalities in psychiatric patients and to foster greater interest among residents in correlating psychiatric symptoms with abnormalities in neural structures and pathways.

METHODS

Residents meet weekly with a faculty mentor to plan and construct a neurobiological formulation. Residents review the salient literature on the Axis I condition present in a patient of their choosing. The patient undergoes neuroanatomical, physiological, and cognitive testing relevant to his disorder. The resident then integrates the findings from this testing with the patient's clinical presentation. Using a questionnaire, the authors obtain feedback from residents based on residents' experiences with this didactic program.

RESULTS

Residents felt they obtained a greater appreciation and understanding of the relevance of neuroanatomical and neurophysiological abnormalities and testing in clinical psychiatry. The project was well received and residents rated it highly for its educational value.

CONCLUSION

Neurobiological formulations offer a new educational method to foster knowledge and interest among psychiatric residents about the importance of neuroscience in clinical practice.

A quest for antipsychotic drug actions in the brain: Personal experiences from 50 years of neuropsychiatric research at Karolinska Institutet

The exploration of physiological and molecular actions of psychoactive drugs in the brain represents a fundamental approach to the understanding of emerging psychological phenomena. The author gives a personal account of his medical training and research career at Karolinska Institutet over the past 50 years. The paper aims at illustrating how a broad medical education and the integration of basic and clinical neuroscience research is a fruitful ground for the development of new methods and knowledge in this complicated field. Important aspects for an optimal research environment are recruitment of well-educated students, a high intellectual identity of teachers and active researchers, international input and collaboration in addition to good physical resources. In depth exploration of specific signaling pathways as well as an integrative analysis of genes, molecules and systems using multivariate modeling, and bioinformatics, brain mechanisms behind mental phenomena may be understood at a basic level and will ultimately be used for the alleviation and treatment of mental disorders.

Dyslexia, learning, and pedagogical neuroscience

The explosion in neuroscientific knowledge has profound implications for education, and we advocate the establishment of the new discipline of 'pedagogical neuroscience' designed to combine psychological, medical, and educational perspectives. We propose that specific learning disabilities provide the crucible in which the discipline may be forged, illustrating the scope by consideration of developmental dyslexia. Current approaches have failed to establish consensus on fundamental issues such as theoretical causes, diagnostic methods, and treatment strategies. We argue that these difficulties arise from diagnosis via behavioural or cognitive symptoms, even though they may arise from diverse causes. Rather than an inconvenience, variability of secondary symptoms within and across learning disabilities can inform both diagnosis and treatment. We illustrate how brain-based theories lead to radical restructuring of diagnostic methods and propose that there is an urgent need to develop genetic and brain-based diagnostic methods designed to lead to individually-appropriate remediation and treatment methods.

Effect of a structured course involving goal management training in older adults: A randomised controlled trial

OBJECTIVE

The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints.

METHODS

A randomised controlled design was used involving 69 community dwelling individuals aged 55 years and older. Both objective and subjective measures were included to assess executive functioning. General linear model with repeated measures analysis of variance was used to examine the intervention effects.

RESULTS

After the intervention, the participants in the intervention group were significantly less annoyed by their cognitive failures, were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group.

CONCLUSION

These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning.

PRACTICE IMPLICATIONS

Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable, the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults.

The TCN/AACN 2005 “Salary Survey”: Professional Practices, Beliefs, and Incomes of U.S. Neuropsychologists

Doctoral-level members of Division 40 (Clinical Neuropsychology) of the American Psychological Association and other neuropsychologists were invited to participate in a web-based survey in early 2005. Response rate was estimated to be between 28.5 and 31.3%. The range of years postdoctorate was 1-51. Demonstrating the substantial proportional change in gender taking place in the field, 7 of 10 postdoctoral residents were women. Whereas the median age of APA members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists is 47 and has essentially remained unchanged since 1994, indicating substantial entrance of young psychologists into the field. Use of testing assistants remains commonplace. The "flexible battery" approach has increased in popularity and predominates, whereas endorsement of the "standardized battery" approach continues to decline. More than 90% of respondents are engaged in full-time or full-time plus part-time employment. Incomes from 2004 vary considerably by years of clinical practice, work setting, amount of forensic practice, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, at least at the higher income levels. Job satisfaction of neuropsychologists in general is higher than reported for other U.S. jobs. Fewer than one in five respondents is considering changing job position and very few individuals are considering leaving neuropsychology or psychology for a different field. More than 8 of 10 respondents experienced an income increase in the last five years, whereas fewer than 1 in 10 experienced a decrease. While higher than reported by other types of psychologists, neuropsychology incomes have lagged behind inflation when compared to 1992 data. Numerous breakdowns related to income and professional activities are provided.

Core curriculum for training in behavioral neurology and neuropsychiatry

Recognizing the fundamental congruence between behavioral neurology and neuropsychiatry, the Joint Committee on Subspecialty Certification of the American Neuropsychiatric Association (ANPA) and the Society for Behavioral and Cognitive Neurology (SBCN) assert that these historically separate but parallel disciplines can be merged into a single subspecialty area of medicine: Behavioral Neurology & Neuropsychiatry. The authors first describe the historical background for the development of this medical subspecialty. Second, the goals and objectives for training in Behavioral Neurology & Neuropsychiatry are outlined. Finally, a core curriculum for fellowship training in Behavioral Neurology & Neuropsychiatry developed by SBCN and the ANPA is presented.

Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.

Racial and ethnic diversity among trainees and professionals in psychology and neuropsychology: needs, trends, and challenges

The United States is rapidly becoming a more racially and ethnically diverse nation, bringing the challenge of ensuring that health care specialties, including neuropsychology, are representative of and competent to serve the needs of this population. Initiatives have been undertaken to increase minority representation in training for psychology and neuropsychology. However, tracking progress requires reliable race/ethnicity data collection and reporting. On the 2002 American Psychological Association (APA) Directory Survey (APA Research Office, 2002), up to 42% of the APA membership and up to 25% of the Division 40 membership did not specify race/ethnicity status. Within Division 40, data for members who did report race/ethnicity suggest that representation of Hispanic, Asian, Black/African American, and Native American members lags substantially behind that of White members. Improved methods for collecting information on race/ethnicity are needed to meet diversity objectives.

The Houston Conference revisited

This paper presents a review and critique of the Houston Conference on Specialty Education and Training in Clinical Neuropsychology, together with an informal summary of opinions of a number of neuropsychologists. Issues regarding the role of the Clinical Neuropsychology Synarchy (CNS) and the applicability of the conference policies are offered. Several deficiencies and limitations of the policy statement are discussed. An informal survey of neuropsychologists interested in the Houston Conference indicates rather different opinions concerning the training and education of neuropsychologists. It is our contention that the results of the Houston Conference can only be considered controversial at best and that there is still much diversity of opinion in the field regarding the proper training of neuropsychologists. We hope to stimulate further discussion and greater involvement of the profession before final criteria for education and training are developed and adopted.

[Problem-based learning in medical education. Integrated "Nervous System and Behavior" course at the Munich Ludwig Maximilian University]

The new curriculum for medical licensure in Germany focuses on interdisciplinary and problem-based learning. In recent years, first experiences with this learning model were gathered in several German medical schools conducting courses supplementing the traditional curriculum. This article describes the course "Nervous system and behavior" at Ludwig Maximilian University in Munich. This course was established in cooperation with Harvard University in Boston, USA (The Munich-Harvard Alliance) together with three other clinical courses and has run every semester since the winter of 1999. As this course integrates neuroscience disciplines with special emphasis on neurology and psychiatry, it may serve as a role model for the implementation of these subjects in a new curriculum. This article introduces the reader to its structure and elements as well as feedback from students.

A Status Report On the Practice of Forensic Neuropsychology

The practice of forensic neuropsychology has experienced tremendous growth over the past two decades, becoming perhaps the most rapidly expanding area of practice within the field of clinical neuropsychology. Indeed, there have been many important advancements in the field that have helped to position neuropsychologists as instrumental participants within the forensic arena. Yet, there is currently no consensus in our field regarding what constitutes competency in forensic neuropsychology and also no specific guidelines or standards of practice to inform neuropsychologists about how to operate in the forensic arena. There are even fewer safeguards to protect the public from questionable methods of practice. This article provides a status report on the practice of forensic neuropsychology. It employs a framework emphasized by Otto and Heilbrun (2002) in their assessment of the field of forensic psychology. Emphasis is directed toward identifying recent advances in the field and documenting some of the inherent flaws and weaknesses in forensic practice to help advance the practice of forensic neuropsychology toward a more established specialty area.

Internet resources for psychiatry and neuropsychiatry

Some of the most useful internet resources relevant to psychiatry and neuropsychiatry are summarised. Web sites recommended for professionals and patients are detailed, including where to find evidence based psychiatry, psychiatry news, and professional organisations. Some thoughts on "cyberchondria" and the opportunities that the internet offers for illness transmission are also considered.

Survey of graduates of programs affiliated with the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN)

A survey addressing training experiences and current professional practices was sent to 219 persons who had completed a 2-year postdoctoral residency in clinical neuropsychology through a program that was affiliated with the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). A total of 108 usable replies were received, yielding a response rate of 49%. More than 80% of the respondents considered completion of a 2-year postdoctoral residency to be an essential component of the training as a clinical neuropsychologist, and more than 50% indicated that their residency had yielded at least one publication in a peer-reviewed journal. They identified individual supervision as the most helpful during their postdoctoral training, and tended to remain very active in the field of clinical neuropsychology. It is concluded that APPCN-affiliated programs are largely successful in preparing residents for independent practice as clinical neuropsychologists but that there are opportunities for further didactical improvement in the area of billing and reimbursement, as well as preparation for board certification in Clinical Neuropsychology through the American Board of Professional Psychology.

Educational neuroimaging: a proposed neuropsychological application of near-infrared spectroscopy (nIRS)

OBJECTIVE

To provide a description of an emerging neuroimaging methodology, near-infrared spectroscopy (nIRS), and a potential educational application of the unique aspects of this technology.

SUMMARY

nIRS is documented for its potential as a personal, portable, brain imaging system that may prove useful for cerebral monitoring in applied settings such as home, school, and work. The basis of nIRS brain imaging is reviewed, with summary descriptions of optical and neurovascular issues as well as a brief comparison to other brain imaging methodologies. Recent developments in nIRS technology are discussed, including ongoing validation efforts and potential applications for neuropsychologists. We describe one potential application of nIRS (i.e., educational neuroimaging) as an illustration of the use of nIRS technology and the potential expansion of the neuropsychologist's role in the educational setting.

CONCLUSION

nIRS holds the potential of opening new clinical questions and opportunities for neuropsychologists, and may provide a low-cost means of repeatable, neurovascular monitoring in nonmedical settings.

An essay on the Houston Conference policy statement: static yet incomplete or a work in progress?

Ardila (Neuropsychol. Rev. 12: 3, 2002) criticizes the Policy Statement from the Houston Conference on Specialty Education and Training in Clinical Neuropsychology (Hannay et al., Arch. Clin. Neuropsychol. 13: 157-250, 1998) as possessing deficiencies in the training of clinical neuropsychologists in three fundamental knowledge areas: the history of the discipline, neuropsychological syndromes, and neuropsychological theory. These problems are seen here as a result of a more pervasive problem associated with the Houston Conference training model's emphasis on technical skill over science and the attempt to micromanage the training of the clinical neuropsychologist at the administrative level.

Houston Conference: need for more fundamental knowledge in neuropsychology

Two training models in neuropsychology have been recently proposed (Guidelines of the INS-Division 40 Task Force on Education, Accreditation, and Credentialing, Clin. Neuropsychol. 1: 29-34, 1987; Hannay, H. J. et al., Anh. Clin. Neuropsychol. 13: 157-250,1998). When comparing both educational models, similarities but also differences are found. According to the Houston Conference model--but not to the former model--neuropsychology represents a specialty of psychology. In the Houston Conference training model, applied knowledge is overtly emphasized, whereas fundamental or basic knowledge in neuropsychology appears weak. The proposed program does not seem to provide sufficient emphasis and background knowledge in (1) History of neuropsychology, (2) Neuropsychological syndromes, and (3) Neuropsychology theory.

National survey of clinical neuropsychology postdoctoral fellows

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.

Ethical considerations for peer review in forensic neuropsychology

The role of an expert is to assist the trier of fact in weighing evidence and reaching conclusions. Critical evaluation of opposing experts is an integral part of this process. In more recent times, cross-examination has given way to critical evaluation of opposing experts outside of the courtroom, a tactic we refer to as peer review in this paper. Though neuropsychologists frequently review the work of their colleagues, we are concerned here primarily with commentary that is at best misleading, and occasionally malicious, unethical, and unprofessional. Despite a growing trend to use experts as peer reviewers in the medicolegal arena, expectations concerning ethical and professional conduct of neuropsychologists have been absent. Enforcement of appropriate conduct is further complicated by the ambiguity of existing ethical standards and state statutes, and their limited applicability to all neuropsychologists who provide forensic services. This article provides an overview of ethical and professional issues pertaining to forensic peer review and concludes with recommendations for appropriate professional conduct.

Association of postdoctoral programs in clinical neuropsychology: update and new directions

This paper provides an update on the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), which was formed in 1992. The paper summarizes the historical background of APPCN, reports on contemporary influences on APPCN and its role in postdoctoral education and training in neuropsychology, and provides an update on APPCN's most recent initiatives. The paper includes a list of current members in APPCN and explains how other postdoctoral residency programs in clinical neuropsychology may apply for membership.

Through the looking glass: Where is the thought? A reply to Rodriguez-Menendez

In reply to my presidential address, Rodriguez-Menendez questions my comments about poorer performance on the national licensing exam by graduates of Psy.D. programs and professional schools than by Boulder-model Ph.D. programs. He goes on to confirm that their scores are indeed significantly lower, but suggests this is not important. Apart from this apparent confirmation, the remainder of his assertions that Psy.D. programs indeed provide good scientific training appear to be contraindicated by both the model and the performance of graduates of those programs. Finally, the need for standards is again asserted, with a reiteration of the need to ask who benefits from attacks on upholding standards: the patient and profession or the one who is doing the attacking.

American Board of Clinical Neuropsychology special presentation: The American Board of Clinical Neuropsychology (ABCN), 2000 update

This paper updates neuropsychologists on the process of obtaining board certification in clinical neuropsychology through the American Board of Clinical Neuropsychology (ABCN), a specialty board operating under the auspices of the American Board of Professional Psychology (ABPP). At this time, the ABPP and ABCN have certified 406 clinical neuropsychologists, which makes it the largest board-certification organization in clinical neuropsychology. This article details the advantages of board certification through the ABCN and the four steps which must be passed in order to obtain board certification. These steps are: credential review, written examination, work sample, and oral examination.

Ten-year follow-up survey of clinical neuropsychologists: part I. Practices and beliefs

A 21-item questionnaire previously used to survey practices and beliefs of clinical neuropsychologists (Sweet & Moberg, 1990; Sweet, Moberg, & Westergaard, 1996) was mailed in February 1999 to all ABPP Diplomates in clinical neuropsychology and a larger sample of randomly selected non-ABPP members of Division 40 (Clinical Neuropsychology) of the American Psychological Association. Results were compared with data previously collected in 1989 and 1994. Across 10 years there have been some persistent differences between neuropsychologists based on board certification status. These differences include degree of involvement in neuropsychological practice and forensic practice, involvement in research and teaching, frequency of subscribing to or regularly reading a variety of relevant journals, employment settings, use of assistants, and use of projective assessment. There are also a number of areas of shared belief and common practice. These important areas of agreement are unrelated to board certification status and are interpreted as signs of cohesiveness and maturity in the continuing evolution of the subspecialty. Shared beliefs and common practices include: appropriate field of training, type of degree, assessment philosophy, most types of information to be gathered in evaluations, and time spent per assessment. In general, the use of assistants is correlated significantly with the number of evaluations performed per month. Although sometimes viewed as exclusively providing assessment, the majority of neuropsychologists are also involved in treating patients with brain dysfunction. Survey data appear useful in characterizing and monitoring professional status and trends of clinical neuropsychology.

Selection criteria for clinical neuropsychology internships

Criteria used in the evaluation and selection of applicants for clinical neuropsychology internships were identified by a survey of the programs listed in The Clinical Neuropsychologist. Neuropsychologists from 40 programs replied to the survey, yielding an 80% response rate. Clinical experience in neuropsychological assessment, specialization in clinical neuropsychology during graduate training, personal interview, and letters of recommendation were reported to be the most salient selection criteria. Practica that provide experience with flexible batteries at university-affiliated medical centers and doctoral curricula that follow INS/APA Division 40 guidelines, with teaching and supervision provided by neuropsychologists were preferred prerequisites to internship. Selection criteria reflect a vertically integrated model of education and training in accordance with the Houston Conference model.