The Practice of Clinical Neuropsychology: Viability, Utility, Future Directions?

[Pragma]

Even with pretty darn neuro-intensive grad school and internship training, the amount I learned via formal postdoc was significant.

I try to explain this to students considering this specialty and others all the time. Postdoc is really where the rubber meets the road in specialty training. You can have solid training up to that point, but during those two years that's where you develop the automaticity and competency that is needed for independent practice. Exposure to patients is a big part of it, but you also really need the didactics, quality supervision, and opportunities to work with other medical professionals to learn more about a variety of conditions.

I try to imagine myself practicing "neuropsychology" without that experience, and it would be scary. We need to get rid of the charlatans out there.

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[WisNeuro]

Agreed, I came from a fairly heavy neuro background in grad school (worked in a neuroscience lab with eeg and fMRI, 1.5 years 2 days a week neuro prac at top site), did a half-time neuro internship, and will still say that I was nowhere near ready for practice in Neuropsychology until the end of my postdoc. Absolutely crucial.

 

[Therapist4Chnge]

I had a pretty solid assessment background in grad school and spent probably 50% of my time doing neuro-related work on internship (with close mentorship) and fellowship was still at an entirely different level. The pure volume of cases and variety of presentations were two of the biggest differences on fellowship. I had no idea how much I didn't know coming out of internship until I started on fellowship and got dumped into the deep end of the pool.

 

[Pragma]

In addition to volume of cases and variety of presentations, I'd say the opportunities for more extensive neuroanatomy training (e.g, brain cutting) and procedures (e.g WADA, awake craniotomy) stood out. The variety of different consults across a whole medical center also provides necessary perspective. Moreover, the interactions with physicians and other health professionals helped to define scope of practice.

But hey, who's to say someone who gave a few RBANS on externship can't do neuropsychological testing?

 

[Therapist4Chnge]

Didactic training really helps inform on the applied clinical work. During my fellowship years we had 2hr of formal didactic lectures per wk (1hr Peds, 1hr Adult), extensive neuroanatomy training (w. wkly wet lab), and then weekly neurology didactics for two years. Add in optional weekly didactics and case presentations by a variety of departments and the breadth of exposure was pretty awesome.

Of course, I could probably just take some classes online and get the same experience.

The above is why I value formal fellowships over informal or private practice fellowships.

 

[AcronymAllergy]

Agreed with all of the above. The neuroanatomy coursework was something I placed a premium on in my postdoc "hunt," and even though I'd had some of it before, the intensity (i.e., med school classes) was new, and being able to build on that prior exposure and knowledge is really what helped it all to sink in.

Same goes with pretty much everything else, which is why the "where the rubber meets the road" comment is so accurate. It's not that you're seeing things you haven't seen while on postdoc (although some of that happens as well), it's that you're appreciating things you haven't appreciated before, and at a level of depth and understanding that reflects the advanced nature of the training.

 

[PsychePsych1]

Hey everybody, I'm a first-time poster here. I'm honestly not sure if I will have any sort of longevity on this website (on this account), as I didn't really intend to post anything. So, with all of that in mind: I apologize if this is an inappropriate time to try and revive an old thread.

Lately, I have had a real developing interest in the field of neuropsychology, and this website has been an absolute boon in regards to deciding if neuropsychology is what I want to pursue for a career or not. As I have been reading up on the subject and its field (and its respective content on this website) -- this thread really stood out to me (as somebody who is trying to determine if this field is right or not for me [the job itself definitely is, but, the aforementioned reasons in previous posts have made me question if it is a plausible career to pursue]), so I figured that others in the same boat would benefit from a continued discourse on the thread topic (and for those interested/previously engaged here, perhaps an avenue to blow off some stream and/or evaluate the contemporary state of neuropsychology).

On an unrelated note: I apologize if this is a dumb question/notion, but, on the topic of the 'future of neuropsychology', it seems like a lot of worry is with regard to other professionals invading in on neuropsychological assessments. My question is, as I am trying to better understand neuropsychology and its respective subculture, can neuropsychologists play a role that goes further than just assessments (e.g., ameliorate the workload of neurologists by quarterbacking some of their responsibilities, like helping patients and their families make social/behavioral adjustments after a patient receives a Multiple Sclerosis diagnosis)? I apologize if that doesn't make any logical/coherent sense -- I'm just trying to further the discourse here because this thread was awesome.

 

[WisNeuro]

On an unrelated note: I apologize if this is a dumb question/notion, but, on the topic of the 'future of neuropsychology', it seems like a lot of worry is with regard to other professionals invading in on neuropsychological assessments. My question is, as I am trying to better understand neuropsychology and its respective subculture, can neuropsychologists play a role that goes further than just assessments (e.g., ameliorate the workload of neurologists by quarterbacking some of their responsibilities, like helping patients and their families make social/behavioral adjustments after a patient receives a Multiple Sclerosis diagnosis)? I apologize if that doesn't make any logical/coherent sense -- I'm just trying to further the discourse here because this thread was awesome.

The assessment piece is only a small part of our overall role. We already are involved in things such as " helping patients and their families make social/behavioral adjustments after a patient receives a Multiple Sclerosis diagnosis." Or other things like helping patients/families understand a diagnosis of dementia, the need for things like advanced directives, consideration of skilled nursing care, being part of a treatment team deciding if someone is a good candidate for DBS placement, helping with intraoperative brain mapping for resection surgery in epilepsy, assessing cognitive change and/or offering therapeutic interventions in neurooncology patients, and on and on. Testing is the least of what we do.