Am I being unrealistic in my (neuro) internship dreams?

[abcdeltaforce]

[deleted to protect my anonymity during internship apps!]

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[msc545]

It will depend a lot on your school - which one is it? PsyD is not helpful here.

 

[PsyDuck90]

Are any of your former supervisors boarded in neuro and know the folks at any of these sites? Do you have any veteran experience? A lot of the VA sites like to see experience at a VA (although not necessarily a deal breaker). Also, it depends on the VA. Are we talking some of the flagship VAs like Houston, Tampa, etc. or some of the smaller VAs that still have a neuro track?

I would make sure to have a mix of reach sites like UCLA and Emory but also some sites that get fewer apps. Look at the breakdowns of accepted students in the APPIC stats. Do they outright say no PsyDs or maybe just have never accepted a single PsyD in all the reported years? I wouldn’t stack your list with those. I would also maybe add some rehab sites on the list as that is a lesser talked about specialty that still deals with a lot of similar populations.

If you are committed to a neuro track internship, I would also prepare for the possibility that you may need to stay an extra year. Based on your experience, it looks like you’ll have one year of a neuro practicum and only a couple of months at a second. I’m a neuro postdoc and was involved with the internship process this past cycle and we had a lot of applicants who had multiple neuro practicums and strong letters from boarded neuropsychs.

 

[abcdeltaforce]

It will depend a lot on your school - which one is it? PsyD is not helpful here.

Yes, this is my main concern. I prefer not to post my specific school but it is one that has large cohorts and offers relatively few research opportunities

 

[abcdeltaforce]

Are any of your former supervisors boarded in neuro and know the folks at any of these sites? Do you have any veteran experience? A lot of the VA sites like to see experience at a VA (although not necessarily a deal breaker). Also, it depends on the VA. Are we talking some of the flagship VAs like Houston, Tampa, etc. or some of the smaller VAs that still have a neuro track?

I would make sure to have a mix of reach sites like UCLA and Emory but also some sites that get fewer apps. Look at the breakdowns of accepted students in the APPIC stats. Do they outright say no PsyDs or maybe just have never accepted a single PsyD in all the reported years? I wouldn’t stack your list with those. I would also maybe add some rehab sites on the list as that is a lesser talked about specialty that still deals with a lot of similar populations.

If you are committed to a neuro track internship, I would also prepare for the possibility that you may need to stay an extra year. Based on your experience, it looks like you’ll have one year of a neuro practicum and only a couple of months at a second. I’m a neuro postdoc and was involved with the internship process this past cycle and we had a lot of applicants who had multiple neuro practicums and strong letters from boarded neuropsychs.

Thank you for the thoughtful response. My supervisors at my current site are not boarded in neuro, despite most of them being board eligible (some are preparing their documentation currently for board certification). However, we have had PsyD students from my program accepted into neuro tracks at various VAs around the country even without neuro experience, so I think you're correct in that it will depend which ones I apply to! My top choice VA currently is the neuro track at Tennessee Valley. I think you've offered great advice, and being from a rural area I plan to include many rural sites on my list to have better chances in the case that my reach sites find my application lacking.

As for the additional year... that would be a tough pill to swallow as my program is unfunded. But I suppose I should consider it. If I were to take an extra year, what would you recommend adding to my CV over the year to make me a more competitive applicant at neuro sites?
Thank you again 🙂

 

[PsyDuck90]

Ideally you wouldn’t have to, but if you are very set on neuro, an extra year is a path some take. Usually the focus is on getting more neuro experience and neuro focused pubs/posters. And making sure your dissertation is defended or close to it.

Looking at what sites have historically accepted students from your program is also a very good idea. If they liked those trainees, they will often really consider other students from the same program. If they didn’t like those trainees, then they may be more hesitant about students from that program.

Also, make sure your cover letters are very clear with why you are a good fit for their particular site. Highlight the experiences you are interested in and how the experiences you’ve had will help you succeed in those rotations and how those rotations and the internship will help you with your future career goals. Generic cover letters won’t do you any favors.

Edited for typo.

 

[abcdeltaforce]

Ideally you wouldn’t have to, but if you are very set on neuro, an extra year is a path some take. Usually the focus is on getting more neuro experience and neuro focused pubs/posters. And making sure your dissertation is defended or close to it.

Looking at what sites have historically accepted students from your program is also a very good idea. If they liked those trainees, they will often really consider other students from the same program. If they didn’t like those trainees, then they may be more hesitant about students from that program.

Also, make sure your cover letters are very clear with why you are a good fit for their particular site. Highlight the experiences you are interested in and how the experiences you’ve had will help you succeed in those rotations and how those rotations and the interaction will help you with your further career goals. Generic cover letters won’t do you any favors.

Great tips, thanks so much! I recognize there's a lot to do but you've helped a lot!

 

[psych.meout]

Yeah, it sucks to potentially have to take another year, but your hand might be forced regardless if you don't match because you don't have enough neuro experience. You currently have as much neuro experience as I had when I applied for internship and I'm not even in neuro. You don't really get to count the hours you're going to accrue between internship app deadlines and interviews, so you might get screened out from various sites for not having enough neuro hours compared to your competition.

 

[abcdeltaforce]

Yeah, it sucks to potentially have to take another year, but your hand might be forced regardless if you don't match because you don't have enough neuro experience. You currently have as much neuro experience as I had when I applied for internship and I'm not even in neuro. You don't really get to count the hours you're going to accrue between internship app deadlines and interviews, so you might get screened out from various sites for not having enough neuro hours compared to your competition.

This is very true, and exactly why I made this post! I have some fellow students telling me it's all more than enough but I needed an unbiased opinion from people who don't know me. Thank you!!

 

[WisNeuro]

I'd look at this in a longer sense, beyond internship. Presumably, you want a career as a neuropsychologist. If so, you need to be thinking more about postdoc, with internship as a stepping stone. Your assessment hours are low and research experience/productivity also low. If you opt for an internship site that is not really neuro, but maybe has a small rotation, you're setting yourself up for a tough go getting a legitimate postdoc. If an extra year can help you get more neuro assessment experience, and possibly more research productivity in neuro areas, that'd be huge. Try not to paint yourself into a corner where you're considering private practice "postdocs." I don't know anyone who's done one that was happy with it, or that I'd consider a competent provider.

 

[summerbabe]

Agree with considering an additional year in school if that's possible since you probably won't have stellar hours, research, board certified recs from folks well connected in the field and possible program bias & the long game is board certification, which could be disrupted with a bad internship.

And while I'm not a neuro person, I've noticed an unofficial 'feeder' system in neuro at different VAs that I've been involved with strong neuro training. They often recruited or preferenced a set of grad programs/VA practicums and then fed their grads to certain postdocs since these folks respect the competency of their neuropsych colleagues (e.g., if they were trained by Dr. X at the Memphis VA, they are almost certainly solid vs. I have no idea who Dr. Z at random private practice is).

Regardless, your best shot might be landing at a place like the Central Iowa VA, which is in a less desirable location and doesn't have a formal neuro track but has boarded NPs on staff (last I checked), an opportunity to get lots of hours & reports during internship and a record of sending graduates into formal NP postdocs and eventual board certification. Good luck!

 

[Therapist4Chnge]

Regardless, your best shot might be landing at a place like the Central Iowa VA, which is in a less desirable location and doesn't have a formal neuro track but has boarded NPs on staff (last I checked), an opportunity to get lots of hours & reports during internship and a record of sending graduates into formal NP postdocs and eventual board certification. Good luck!

Considering less geographically preferred places is a good option, especially if they have one or more boarded neuropsychs on staff. I ended up ranking a few midwestern VAs ahead of a number of "name" places bc I honestly thought the fit was better and my mentor advised me to strongly consider fit over name. I ended up matching at my top midwest VA choice and worked with a fabulous mentor. Lineage matters in Neuropsych (& also rehab psych), so being able to work under boarded supervisors can be helpful.

 

[cara susanna]

I matched at a VA in a pretty desirable location with zero VA experience, but I wasn't neuro and had good research credentials (I later learned that the latter is why they ranked me higher)

 

[abcdeltaforce]

I matched at a VA in a pretty desirable location with zero VA experience, but I wasn't neuro and had good research credentials (I later learned that the latter is why they ranked me higher)

Considering less geographically preferred places is a good option, especially if they have one or more boarded neuropsychs on staff. I ended up ranking a few midwestern VAs ahead of a number of "name" places bc I honestly thought the fit was better and my mentor advised me to strongly consider fit over name. I ended up matching at my top midwest VA choice and worked with a fabulous mentor. Lineage matters in Neuropsych (& also rehab psych), so being able to work under boarded supervisors can be helpful.

Agree with considering an additional year in school if that's possible since you probably won't have stellar hours, research, board certified recs from folks well connected in the field and possible program bias & the long game is board certification, which could be disrupted with a bad internship.

And while I'm not a neuro person, I've noticed an unofficial 'feeder' system in neuro at different VAs that I've been involved with strong neuro training. They often recruited or preferenced a set of grad programs/VA practicums and then fed their grads to certain postdocs since these folks respect the competency of their neuropsych colleagues (e.g., if they were trained by Dr. X at the Memphis VA, they are almost certainly solid vs. I have no idea who Dr. Z at random private practice is).

Regardless, your best shot might be landing at a place like the Central Iowa VA, which is in a less desirable location and doesn't have a formal neuro track but has boarded NPs on staff (last I checked), an opportunity to get lots of hours & reports during internship and a record of sending graduates into formal NP postdocs and eventual board certification. Good luck!

I'd look at this in a longer sense, beyond internship. Presumably, you want a career as a neuropsychologist. If so, you need to be thinking more about postdoc, with internship as a stepping stone. Your assessment hours are low and research experience/productivity also low. If you opt for an internship site that is not really neuro, but maybe has a small rotation, you're setting yourself up for a tough go getting a legitimate postdoc. If an extra year can help you get more neuro assessment experience, and possibly more research productivity in neuro areas, that'd be huge. Try not to paint yourself into a corner where you're considering private practice "postdocs." I don't know anyone who's done one that was happy with it, or that I'd consider a competent provider.

I will definitely consider an extra year as a viable option - specifically because a neuro postdoc is the goal. I met with my supervisors today to discuss this and they think I can match for sure as long as I have a broad range of reach sites and rural/less desirable sites 🙂 I'm going to meet with another supervisor tomorrow for another perspective.

However, on the bright side I reviewed my hours with my primary supervisors today (because people were saying they were low and I feel like I've been killing myself this year) and found out I have been grossly miscalculating my hours based on poor advice from fellow students rather than my site supervisors. They reviewed my hours with me, and I actually have 550 assessment hours so far this year - which makes WAY more sense as I have completed over 40 comprehensive reports this year alone, among other activities without reports. So - there may be hope but I definitely appreciate all of the realistic and unbiased advice. Can't wait to update y'all next February! 🙂

 

[WisNeuro]

I will definitely consider an extra year as a viable option - specifically because a neuro postdoc is the goal. I met with my supervisors today to discuss this and they think I can match for sure as long as I have a broad range of reach sites and rural/less desirable sites 🙂 I'm going to meet with another supervisor tomorrow for another perspective.

However, on the bright side I reviewed my hours with my primary supervisors today (because people were saying they were low and I feel like I've been killing myself this year) and found out I have been grossly miscalculating my hours based on poor advice from fellow students rather than my site supervisors. They reviewed my hours with me, and I actually have 550 assessment hours so far this year - which makes WAY more sense as I have completed over 40 comprehensive reports this year alone, among other activities without reports. So - there may be hope but I definitely appreciate all of the realistic and unbiased advice. Can't wait to update y'all next February! 🙂

How did you not count double your face to face hours? What exactly are they saying is counted here?>

 

[psych.meout]

How did you not count double your face to face hours? What exactly are they saying is counted here?>

And based on their first post, that means that they have over 1000 total F2F hours in just 2 practica, which is a substantial outlier. I imagine they're going to get lots of questions from faculty during interviews about the quality and rigor of these hours.

Maybe they're trying to count their hours from being a psychometrist? That's going to be suspect for many reasons, most importantly that psychometrists aren't doing the same work as grad students in practica.

 

[WisNeuro]

And based on their first post, that means that they have over 1000 total F2F hours in just 2 practica, which is a substantial outlier. I imagine they're going to get lots of questions from faculty during interviews about the quality and rigor of these hours.

Maybe they're trying to count their hours from being a psychometrist? That's going to be suspect for many reasons, most importantly that psychometrists aren't doing the same work as grad students in practica.

Not sure what the specific rules are now, but we weren't supposed to count paid hours as F2F hours on AAPI applications, but we could note it elsewhere.

 

[psych.meout]

Not sure what the specific rules are now, but we weren't supposed to count paid hours as F2F hours on AAPI applications, but we could note it elsewhere.

You can count paid hours, but it has to be of the same quality as other, unpaid practica, e.g., be focused on training students to be psychologists (not just as workhorses doing grunt work, like only administering and scoring measures), have sufficient supervision, etc.

 

[RxPsych]

How did you not count double your face to face hours? What exactly are they saying is counted here?>

I was going to mention this as being a little suspicious, particularly given the practicum placements OP mentioned, and wondering whether the supervisors are just padding their hours which definitely does happen.

 

[WisNeuro]

I was going to mention this as being a little suspicious, particularly given the practicum placements OP mentioned, and wondering whether the supervisors are just padding their hours which definitely does happen.

Well then, OP better be prepared to answer questions about hours on interviews.

 

[summerbabe]

To the OP:
DO NOT pad hours!

I think you could really benefit from getting advice from outside your program, such as from APPIC reps themselves (Greg K himself would probably Zoom you to go over dos and donts for hours).

As somebody who reviews apps every year, it’s usually super obvious when people’s hours or reports are suspicious. And thinking an applicant’s ethics might be fast and loose is a terrible first impression.

And depending on the competitiveness of your site, that might be an auto disqualifier (my VA site isn’t quite that competitive but discrepancies like this are very much noted in our TDs notes for every applicant and likely discussed during the TD interview).

 

[PsyDuck90]

Yes, I’m curious how your assessment hours for this year total 550 hours for 40ish reports, without counting report writing time (which, if I remember T2T correctly, falls under support hours?). Even if we divided it by 50 reports, that would be 10 hours of assessment hours per report. How long are these batteries?

 

[psych.meout]

Yes, I’m curious how your assessment hours for this year total 550 hours for 40ish reports, without counting report writing time (which, if I remember T2T correctly, falls under support hours?). Even if we divided it by 50 reports, that would be 10 hours of assessment hours per report. How long are these batteries?

Well, it could be that that OP didn't write the reports for all the hours in which they saw patients. I know some of my neuropsych peers will often be with a post doc or intern and will alternate between who writes the reports, because the prac students tend to take longer, require more editing and feedback, etc. and it wouldn't be practical to have them write every report and get them back to patients in a timely manner.

Still, there's something weird with how OP suddenly found 300 extra assessment hours after talking to their supervisors. Not saying that the supervisors are doing anything intentionally wrong or misleading, but rather that they may just not know how APPIC currently characterizes different kinds of hours and may be unintentionally having OP count certain activities as direct hours when they should be support.

Even then, I'm wondering about the quality of their hours, including adequate supervision, and if they should even count as training towards internship vs. just a psychometrist job. For example, I just finished internship and we had to get a bare minimum of 500 direct hours and that required getting at least 4 hours of supervision per week. I can't imagine that OP is getting anything close to that, especially if some of these hours are from a paid psychometrist position, and prac students also need a higher ration of supervision to clinical hours compared to interns because they have less knowledge and experience.

Thus, even beyond just quantitatively having enough hours to apply for internship, I'd also be concerned about the quality of those hours and whether OP is ready to go to internship, particularly for a neuro one with only one neuro practicum. That's not a lot of breadth and depth of experience in this specialty area. Seems like a recipe for getting in over one's head.

 

[psycho1391]

Considering less geographically preferred places is a good option, especially if they have one or more boarded neuropsychs on staff. I ended up ranking a few midwestern VAs ahead of a number of "name" places bc I honestly thought the fit was better and my mentor advised me to strongly consider fit over name. I ended up matching at my top midwest VA choice and worked with a fabulous mentor. Lineage matters in Neuropsych (& also rehab psych), so being able to work under boarded supervisors can be helpful.

You could consider the Illiana VAMC in Danville Illinois. They have a neuropsych placement and are not super competitive. Great and supportive training staff. No research though.

 

[WisNeuro]

You could consider the Illiana VAMC in Danville Illinois. They have a neuropsych placement and are not super competitive. Great and supportive training staff. No research though.

As this is an area of weakness in their current application, I would suggest against this route as it would put them even further behind for an adequate neuro postdoc.

 

[abcdeltaforce]

[deleted site specific info to maintain anonymity during apps]

5) We are not allowed to count report writing as direct hours. These would go in support.

6) I'm not sure about other schools, but my school does not allow psychometrician hours to be logged in T2T. We can add it to our CV as far as I know and mention it on interviews, but they have been very clear that work hours are not to count because they would be unable to vet their authenticity/quality. Because of this, I really minimized my time at this job so it is not a significant number of hours comparatively anyway.

7) I have only had two total weeks off from this site this year, and ~550 hours (533.25 if you need exact numbers) is ~12.5 face to face client hours per week over the course of 46 weeks (which is about how long I've been here). I KNOW I have been doing more than that on many weeks because of the (volunteer) screening events, endless clients, and consistent schedule. I truly believe my hours are accurate as I have worked my butt off this year.

SO - now that I have written out this entire book explaining it all, I hope that quells anyone's concerns. Yes, it's a lot, and may seem insane. I am prepared to defend it in interviews, and I know I will be getting great LOR from my supervisors (both school and site) to back me up as a hard worker. Yes, my hair began falling out from stress, lack of sleep, and poor self-care. This is my flaw as a clinician, student, and employee, and I know that. BUT I have stepped back over these final few weeks in the summer to recoup from the burnout and try to recover before my next site (which is much more standardized at 2 comprehensive testing clients per week, nothing extra). So all in all, I'll probably only have 10-15 more hours F2F this year and then the rest will be tying up loose ends and catching up on reports. I feel like I'm sharing a lot but I don't want to leave anything up for suspicion here as I really value this community.

Again, I apologize for the delay and definitely see why my hours jump sparked concern. I need to be mindful that I can't just post and forget next time. Sorry friends and thanks for all the tips! Just to mitigate my new anxiety about looking like a padder, I will likely still end up reaching out to APPIC to see if there's a way I can "double" verify my hours or something. Sigh. Thank you and please let me know if you have further questions or concerns 🙂

 

[AcronymAllergy]

I don't think 12.5 face-to-face client assessment hours per week seems outrageous; that probably comes out to 2-3 testing patients/week. I honestly don't remember how many assessment clients/patients I would typically see per week in grad school, but it was probably around 2 or 3, particularly in later years when course load was low.

I also don't think anyone is going to bat an eye at a 6-8 page report. Out in the "real world," many clinicians would consider even that too long. But in grad school, it's not at all unusual. 90-minute feedback sessions are probably also more than the typical clinician provides, but in a training context, again, probably won't cause anyone to think twice.

It sounds like you have viable explanations for everything, so I imagine it'll be fine. 500 face-to-face hours is typically the minimum that internship sites will want trainees to have in a year, so if you're clearing that in a practicum placement, you may just have interviewers ask about it.

 

[psych.meout]

@WisNeuro @PsyDuck90 @psych.meout @psycho1391 @summerbabe

Hello everyone sorry I was MIA - I posted and forgot about this not realizing how wild that may have sounded. Your concerns are reasonable and I feel a little silly for not explaining it and having my character come into question. Let me start by first saying my site is unique and you will see why...

So to clear things up (I'm sorry I don't know how to tag everyone without replying to everyone so I'm hoping you all just check this) -

1) I have only been using Time 2 Track (no other hours verification) and was trusting the numbers it was giving me. I hadn't really gotten to know the system beyond the basics of how to enter activities. When my supervisors and I reviewed my hours, they questioned why I had so many support hours (as that can often be a result of padding).

***I should also note that when I started T2T at this site, we knew the batteries were going to be largely the same and didn't want to have to enter in the battery/individual assessments each time, so my classmate created a "recurring" battery on my T2T account for me. Not sure if anyone has done this as well so I'll explain it: Basically they scheduled an activity for MTWTh and F repeating every day from 2027-2028, with all the assessments and tests in our standard battery. That way, my T2T basically had unconfirmed activities planned every day for a year (a year that is outside my program dates so it wouldn't print them in my final review - but we can also just delete unused ones), so when I went to add an activity from a client, I would just go to the corresponding date in 2027/2028, edit that pre-existing activity to match the new (actual) date that the client was seen, and it would prevent me from having to enter in every test for every client I saw. Here's the link my friend said they used: Log Assessments. It's been a lifesaver so highly recommend! Now...

We (two of my sups and myself) went to look at why my support hours were outrageous, it turns out that the recurring battery had been set to "Psychological Assessment Scoring/Interpretation" instead of "Neuropsychological Assessment", because my classmate had entered it wrong and I wasn't up to date on submitting my T2T hours to my sup until recently so I hadn't noticed (it was easier to describe fellow students as providing me with faulty info than writing this novella about why they entered in an activity on my T2T and I was too daft to notice but I understand the confusion so here we are). So once my supervisors and I sifted through the clients I had actually seen for full neuro testing (using billing, not guesses) and edited the activity type, all of my hours over the past year were counted in the correct area (so obviously my support hours also went down VERY significantly). Our batteries involve 2 2-hour intakes, and then usually around 4-8 hours of testing (it can be split into more than one session of course and often goes longer/add additional appointments if we find anything we need to delve further into etc.). I'm not always present for the intake sessions as the postdocs normally conduct those with the psychologists, but for all of my reports I did the actual testing.

2) Some of you were curious about the total amount of testing hours. So, not all of my hours are comprehensive neuro clients (remember, my original 250 before fixing the mistake?). My site does regular free memory screening events at least twice a month in the community and it's not abnormal to have 8-9 straight hours of screening (which yes, includes brief testing measures) from each event. Additionally, most of the clients who are recommended to get a comprehensive eval at these events come to see us, so the waitlist is never ending. We get tons of community referrals too. I have never had to wait or beg for testing patients, I've had to ask for fewer because I don't have time to breathe or eat. Us prac students will often do the testing for the interns/postdocs if needed as well (they write the report), so that's another face to face opportunity with no report-writing.

3) THEN we also do at LEAST 90 minute feedback sessions with clients following comprehensive evals (which counts for assessment hours in T2T!). We sit and go over the entire report and recommendations, and it can often take longer than 90 minutes depending on the case/client. Our reports generally come out to around 6-8 pages single space (obviously can get much longer based on complexity) with a scoresheet at the end, not sure if that matters to the crew here, but I didn't write 40 separate 50-page reports (lol). If this makes the report crappy to classic neuro people then so be it but that's what we do and the neurologists/PCP like our format because they find what they need quickly. I can't change that and I still think mine are very good and will hold up when I submit them for internship.

4) My current site has six different licensed psychologists, 2-4 interns, 2-4 postdocs, and three locations, and I am a prac student for all of them (rotating days). So I have multiple clients per week from each location. Again, not all of the clients I see are comprehensive. I will often be asked to assess therapy clients for other clinicians briefly with an RBANS and a few psych measures/exec functioning tests for progress monitoring etc. and won't be asked to write a report for these assessments. I am also invited to sit-in on intakes with new prospective neuro clients if I have a free period, which often involves a brief MoCA/MMSE, or RBANS, and a few psych measures alongside standard interviewing. We also get asked regularly to administer a brief battery to primary care patients when needed (my site is combined medical, behavioral, dental, and specialist healthcare but not a hospital). We ALSO have a senior center attached to one of the sites that we provide services to.

5) We are not allowed to count report writing as direct hours. These would go in support.

6) I'm not sure about other schools, but my school does not allow psychometrician hours to be logged in T2T. We can add it to our CV as far as I know and mention it on interviews, but they have been very clear that work hours are not to count because they would be unable to vet their authenticity/quality. Because of this, I really minimized my time at this job so it is not a significant number of hours comparatively anyway.

7) I have only had two total weeks off from this site this year, and ~550 hours (533.25 if you need exact numbers) is ~12.5 face to face client hours per week over the course of 46 weeks (which is about how long I've been here). I KNOW I have been doing more than that on many weeks because of the (volunteer) screening events, endless clients, and consistent schedule. I truly believe my hours are accurate as I have worked my butt off this year.

SO - now that I have written out this entire book explaining it all, I hope that quells anyone's concerns. Yes, it's a lot, and may seem insane. I am prepared to defend it in interviews, and I know I will be getting great LOR from my supervisors (both school and site) to back me up as a hard worker. Yes, my hair began falling out from stress, lack of sleep, and poor self-care. This is my flaw as a clinician, student, and employee, and I know that. BUT I have stepped back over these final few weeks in the summer to recoup from the burnout and try to recover before my next site (which is much more standardized at 2 comprehensive testing clients per week, nothing extra). So all in all, I'll probably only have 10-15 more hours F2F this year and then the rest will be tying up loose ends and catching up on reports. I feel like I'm sharing a lot but I don't want to leave anything up for suspicion here as I really value this community.

Again, I apologize for the delay and definitely see why my hours jump sparked concern. I need to be mindful that I can't just post and forget next time. Sorry friends and thanks for all the tips! Just to mitigate my new anxiety about looking like a padder, I will likely still end up reaching out to APPIC to see if there's a way I can "double" verify my hours or something. Sigh. Thank you and please let me know if you have further questions or concerns 🙂

By any chance, is this a private institution/practice?

 

[WisNeuro]

What are these 8 hour evaluations for?

 

[psych.meout]

What are these 8 hour evaluations for?

And what are there "2 2-hour intakes"?

 

[WisNeuro]

And what are there "2 2-hour intakes"?

If I'm doing an IME that has TBI and PTSD as a question, I can see that. Those need pretty comprehensive history taking. I'm having a hard time seeing that for pretty much any actual clinical case a neuropsychologist might see, though.

 

[psych.meout]

If I'm doing an IME that has TBI and PTSD as a question, I can see that. Those need pretty comprehensive history taking. I'm having a hard time seeing that for pretty much any actual clinical case a neuropsychologist might see, though.

Yes, I can see that being part of forensic cases (e.g., the forensic cases I was involved in at my neuropsych prac) but this seems like these are clinical cases and that this is their SOP, not the exception for unusually complex cases (e.g., cases that are ostensibly clinical, but it turns out that there is a forensic component that the patient did not previously disclose).

 

[WisNeuro]

Yes, I can see that being part of forensic cases (e.g., the forensic cases I was involved in at my neuropsych prac) but this seems like these are clinical cases and that this is their SOP, not the exception for unusually complex cases (e.g., cases that are ostensibly clinical, but it turns out that there is a forensic component that the patient did not previously disclose).

I specifically ask about current or pending litigation or WC issues and document that clearly, especially in cases where there is a head injury. Usually curtails such as people may have the wherewithal to worry about lying about something that will be easily discoverable in their medical record. If they are in current litigation, I will encourage them to speak with counsel about the distinction between clinical evaluations and IMEs, wherein in if the former is not helpful to their case, it is easily discoverable by opposing counsel. That takes care of about 90% of those referrals.

 

[psych.meout]

I specifically ask about current or pending litigation or WC issues and document that clearly, especially in cases where there is a head injury. Usually curtails such as people may have the wherewithal to worry about lying about something that will be easily discoverable in their medical record. If they are in current litigation, I will encourage them to speak with counsel about the distinction between clinical evaluations and IMEs, wherein in if the former is not helpful to their case, it is easily discoverable by opposing counsel. That takes care of about 90% of those referrals.

I did my neuro prac at a very large AMC. We always asked about these things when it came to sitting down with the patient and their families for the intakes, but I don't know if the intake people screwed up the couple of times it happened. I did other pracs at the same institution and the providers and supervisors were all great but admin and support were always meh.

 

[jdawg2017]

Aside from my in-house practicum, which was basically an ADHD/LD clinic, I never spent more than maybe 4 hours of testing time on a general memory referral case. The longest batteries I’ve ever done outside of the LD/ADHD world are for epilepsy pre-surgical patients, which are sometimes 6-8 hours.

This might be a side point, but I’m curious if people think some clinical experiences do excessive testing because of the “arms race” for internship hours. The incremental validity from doing so much testing is likely minimal, and in the real world you’re not typically doing batteries that are that long…

Also, the longest feedbacks I’ve done are an hour, and most trend toward about 30 mins since I’m basically repeating what’s already in the report and answering questions. I’m curious why feedbacks are 90 minutes minimum…

 

[psych.meout]

Aside from my in-house practicum, which was basically an ADHD/LD clinic, I never spent more than maybe 4 hours of testing time on a general memory referral case. The longest batteries I’ve ever done outside of the LD/ADHD world are for epilepsy pre-surgical patients, which are sometimes 6-8 hours.

This might be a side point, but I’m curious if people think some clinical experiences do excessive testing because of the “arms race” for internship hours. The incremental validity from doing so much testing is likely minimal, and in the real world you’re not typically doing batteries that are that long…

Also, the longest feedbacks I’ve done are an hour, and most trend toward about 30 mins since I’m basically repeating what’s already in the report and answering questions. I’m curious why feedbacks are 90 minutes minimum…

It's probably less about internship hours than it is about money, though if they're billing insurance, I'm wondering what codes they're using and how often they're getting rejected.

 

[abcdeltaforce]

By any chance, is this a private institution/practice?

I believe they're currently classified as a research institution/nonprofit (I'm not involved in this aspect), but as far as my T2T it's just labeled as an outpatient medical center. The medical/dental/behavioral/etc. are all run under the same people (business? LLC? 501c? Idk the nitty gritty), so it's not, like, private practitioners separately renting out spaces. It's one cohesive institution that offers comprehensive care. Not really sure how they roll otherwise (like billing codes etc.) but I know they take both insurance and private pay clients if that helps your question? I have also seen them waive costs for patients whose insurance does not pay or who are unable to afford to pay out of pocket. I don't own a business, I don't know how this works. But they have an entire billing department dedicated to figuring that stuff out.

What are these 8 hour evaluations for?

this is not something I ever thought was abnormal (don't forget this is my only neuro experience so far outside of my testing job which is essentially purely ADHD/LD testing) but I have found that it really does end up taking the whole time. Two four hour testing sessions, sometimes split into more frequent shorter sessions if the patient suffers from extensive fatigue (MS/TBI/etc.). Some of my patients are older adults with memory/aphasic concerns and comorbid psych/functional concerns, but I have had my fair share of complex non-older adult cases with trauma, MVA/TBI, multiple comorbid and chronic medical conditions (including things like chronically unmanaged HIV, neurosyphilis, severe OCD/hoarding, progressive degenerative diseases like MS/ALS, wernicke-korsakoff, chronic polysubstance use, comprehensive referred evaluations following acute encephalopathy/coma/neurosurgery etc). Some of these will include the boston aphasia system/other language tests, WAIS or other FSIQ, the full WMS-IV, attention/WM/EF measures, WJ achievement AND cognitive, etc and then all the psych/emotional/personality measures which we have them complete in office. So it gets long, but if anything I never leave an eval thinking "dang, I wish we had done a ____ measure to check ____" because we are encouraged to add tests as long as we can demonstrate their usefulness to the conceptualization and the supervisor must approve it before administration. Yes, not every case takes 8 hours exactly. Some are simpler and end up taking 3-4, but some end up taking 10 or 12 over the course of many sessions, even though it doesn't happen all the time. Evals to assess therapy clients for progress monitoring are much shorter also.

And what are there "2 2-hour intakes"?

With many cases, we often find that the four hour (total) intake gets us enough information. Even then we often conduct collateral interviews (which doesn't have an activity label in T2T), records requests and reviews, observations, etc when permitted by the patients. We do offer pre-surgical evaluations (bariatric, cosmetic, epilepsy) but I have not done any of these.

I specifically ask about current or pending litigation or WC issues and document that clearly, especially in cases where there is a head injury. Usually curtails such as people may have the wherewithal to worry about lying about something that will be easily discoverable in their medical record. If they are in current litigation, I will encourage them to speak with counsel about the distinction between clinical evaluations and IMEs, wherein in if the former is not helpful to their case, it is easily discoverable by opposing counsel. That takes care of about 90% of those referrals.

We do not take forensic cases at my site. The most "forensic-like" case I have done is a referral from an immigration evaluation to see if the person could forego the written citizenship exam due to LD/BIF (so basically doing FSIQ w/ achievement and effort measures w/ my supervisor in the room), and for this I did not write the report.

Aside from my in-house practicum, which was basically an ADHD/LD clinic, I never spent more than maybe 4 hours of testing time on a general memory referral case. The longest batteries I’ve ever done outside of the LD/ADHD world are for epilepsy pre-surgical patients, which are sometimes 6-8 hours.

This might be a side point, but I’m curious if people think some clinical experiences do excessive testing because of the “arms race” for internship hours. The incremental validity from doing so much testing is likely minimal, and in the real world you’re not typically doing batteries that are that long…

Also, the longest feedbacks I’ve done are an hour, and most trend toward about 30 mins since I’m basically repeating what’s already in the report and answering questions. I’m curious why feedbacks are 90 minutes minimum…

We review the entire report with the clients to ensure the information is accurate and then discuss what interpretations of scores mean, and review recommendations. With the client cases I have had, I have seen that the 90 minutes allows the patient to have all of their questions answered without feeling rushed, stop in the middle of the report and explain what things mean, and leaves the patient feeling as though they got what they paid for. Many of my clients also bring their family members because many of the report recommendations include recs for family members/caregivers/spouse etc., so they ask their questions too. I truly have yet to have an unsatisfied client, even when we're delivering life-changing bad news (though I'm not claiming this could never happen). I think people want to feel cared for and even though it's not my decision, I see the value in 90 minute feedbacks and my clients have every option to leave early. However, I think the fastest one we've ever had was about an hour and it was a review of their condition that they had been dealing with for 15+ years so they didn't have a lot of questions, they mostly were curious as to why certain aspects of their condition affect certain aspects of their cognition, and what they can expect in the future/where to go for further info.

My supervisors love to teach so I have had at least one of all of the cases listed above, among the classic things like various dementias, strokes/vascular events, and ADHD/LD/ASD. The site truly takes everything, and I think I've gotten to see some amazing and rare cases. Maybe I'm naive, but after being here I feel like I see an incredibly well-run interdisciplinary practice that makes patients feel cared for and gives back to the community with volunteer and pro-bono services. Please remember, it's not really up to me how much time I spend with the patients. At the end of the day, they are my supervisor's patients and they make the final call since I'm a student. But I don't doubt their competence as clinicians, ever, and the I have received extremely positive feedback from my patients about our evals, myself, and my supervisors.

 

[abcdeltaforce]

I don't think 12.5 face-to-face client assessment hours per week seems outrageous; that probably comes out to 2-3 testing patients/week. I honestly don't remember how many assessment clients/patients I would typically see per week in grad school, but it was probably around 2 or 3, particularly in later years when course load was low.

I also don't think anyone is going to bat an eye at a 6-8 page report. Out in the "real world," many clinicians would consider even that too long. But in grad school, it's not at all unusual. 90-minute feedback sessions are probably also more than the typical clinician provides, but in a training context, again, probably won't cause anyone to think twice.

It sounds like you have viable explanations for everything, so I imagine it'll be fine. 500 face-to-face hours is typically the minimum that internship sites will want trainees to have in a year, so if you're clearing that in a practicum placement, you may just have interviewers ask about it.

Also, yes, I had very few classes this past year as I stacked my classes up in the prior two summers to try to have as much time as possible at prac this year.

 

[abcdeltaforce]

Also, I think I may have confused some people - but I won't be able to work as a contracted psychometrician at my current site until I'm finished being a practicum student there. This was just mentioned in the first post to emphasize that I will have another testing job come august.

 

[AcronymAllergy]

My neuropsych evals in grad school were frequently ~6-8 hours and included a variety of things I'd likely never give in my current clinical practice, including the full WAIS and full WMS, full Halstead-Reitan, various PVTs, and PAI or MMPI. In this case, it was almost entirely for training purposes to get students experience with those measures in their entirety; the evals were not insurance-based and I believe were paid at a flat rate, so my advisor borderline lost money doing them just on the protocol forms alone. The reports were also longer than anything I would write nowadays, again for training purposes (e.g., describing and explaining performances in every domain and on every test). Feedback in grad school was typically an hour, as it is now, but my focus during that time has definitely shifted away from the test scores themselves. However, if it were a psychoed (which I don't do currently), I could see why focusing on specific test scores would be more appropriate.

In my case, it took me doing lots of these evals to see why: A) all that testing isn't usually necessary, and B) which measures were typically more vs. less helpful (I'm looking at you, Seashore Rhythm Test).

All that being said, if this is your only neuropsych practicum, the more you're able to branch out beyond this, the better. The good news is that depending on where you go for internship, the clinical workload may not be too much higher.

 

[psych.meout]

I believe they're currently classified as a research institution/nonprofit (I'm not involved in this aspect), but as far as my T2T it's just labeled as an outpatient medical center. The medical/dental/behavioral/etc. are all run under the same people (business? LLC? 501c? Idk the nitty gritty), so it's not, like, private practitioners separately renting out spaces. It's one cohesive institution that offers comprehensive care. Not really sure how they roll otherwise (like billing codes etc.) but I know they take both insurance and private pay clients if that helps your question? I have also seen them waive costs for patients whose insurance does not pay or who are unable to afford to pay out of pocket. I don't own a business, I don't know how this works. But they have an entire billing department dedicated to figuring that stuff out.


this is not something I ever thought was abnormal (don't forget this is my only neuro experience so far outside of my testing job which is essentially purely ADHD/LD testing) but I have found that it really does end up taking the whole time. Two four hour testing sessions, sometimes split into more frequent shorter sessions if the patient suffers from extensive fatigue (MS/TBI/etc.). Some of my patients are older adults with memory/aphasic concerns and comorbid psych/functional concerns, but I have had my fair share of complex non-older adult cases with trauma, MVA/TBI, multiple comorbid and chronic medical conditions (including things like chronically unmanaged HIV, neurosyphilis, severe OCD/hoarding, progressive degenerative diseases like MS/ALS, wernicke-korsakoff, chronic polysubstance use, comprehensive referred evaluations following acute encephalopathy/coma/neurosurgery etc). Some of these will include the boston aphasia system/other language tests, WAIS or other FSIQ, the full WMS-IV, attention/WM/EF measures, WJ achievement AND cognitive, etc and then all the psych/emotional/personality measures which we have them complete in office. So it gets long, but if anything I never leave an eval thinking "dang, I wish we had done a ____ measure to check ____" because we are encouraged to add tests as long as we can demonstrate their usefulness to the conceptualization and the supervisor must approve it before administration. Yes, not every case takes 8 hours exactly. Some are simpler and end up taking 3-4, but some end up taking 10 or 12 over the course of many sessions, even though it doesn't happen all the time. Evals to assess therapy clients for progress monitoring are much shorter also.


With many cases, we often find that the four hour (total) intake gets us enough information. Even then we often conduct collateral interviews (which doesn't have an activity label in T2T), records requests and reviews, observations, etc when permitted by the patients. We do offer pre-surgical evaluations (bariatric, cosmetic, epilepsy) but I have not done any of these.


We do not take forensic cases at my site. The most "forensic-like" case I have done is a referral from an immigration evaluation to see if the person could forego the written citizenship exam due to LD/BIF (so basically doing FSIQ w/ achievement and effort measures w/ my supervisor in the room), and for this I did not write the report.


We review the entire report with the clients to ensure the information is accurate and then discuss what interpretations of scores mean, and review recommendations. With the client cases I have had, I have seen that the 90 minutes allows the patient to have all of their questions answered without feeling rushed, stop in the middle of the report and explain what things mean, and leaves the patient feeling as though they got what they paid for. Many of my clients also bring their family members because many of the report recommendations include recs for family members/caregivers/spouse etc., so they ask their questions too. I truly have yet to have an unsatisfied client, even when we're delivering life-changing bad news (though I'm not claiming this could never happen). I think people want to feel cared for and even though it's not my decision, I see the value in 90 minute feedbacks and my clients have every option to leave early. However, I think the fastest one we've ever had was about an hour and it was a review of their condition that they had been dealing with for 15+ years so they didn't have a lot of questions, they mostly were curious as to why certain aspects of their condition affect certain aspects of their cognition, and what they can expect in the future/where to go for further info.

My supervisors love to teach so I have had at least one of all of the cases listed above, among the classic things like various dementias, strokes/vascular events, and ADHD/LD/ASD. The site truly takes everything, and I think I've gotten to see some amazing and rare cases. Maybe I'm naive, but after being here I feel like I see an incredibly well-run interdisciplinary practice that makes patients feel cared for and gives back to the community with volunteer and pro-bono services. Please remember, it's not really up to me how much time I spend with the patients. At the end of the day, they are my supervisor's patients and they make the final call since I'm a student. But I don't doubt their competence as clinicians, ever, and the I have received extremely positive feedback from my patients about our evals, myself, and my supervisors.

The more information you provide about this site, the more questions and concerns I have and the more I want to encourage you to take another year before internship getting experience at a different neuropsych site.

 

[PsyDuck90]

It looks like you’re getting a lot of exposure to a variety of tests, which is great from a training perspective. However, this is absolutely not the norm for neuropsych practice. I honestly can’t fathom what I could possibly ask in 4 hours of an intake that is important to know for the purposes of the evaluation, not including the collateral information or record review. A good chunk of that information is likely extraneous. Being able to key into what is important and what is irrelevant is a clinical skill, and also a necessity as most sites will not give you such a crazy amount of time for an intake. At the VA, the typically neuro testing slot is 180 minutes, which includes intake and testing. My internship supervisors really stressed helping me get my hour long interview down to 45 minutes for standard memory disorders patients over the course of my training with them, and I have found that incredibly valuable having transitioned to post-doc. Also, putting someone with MS through that much testing is….a choice I suppose. For example, the MACFIMS, which is a relatively standard battery for MS, is 90 minutes long because of the extensive fatigue.

While you want to make sure your battery is comprehensive, there is also a detriment to over testing. First of all, you’re just statistically likely to get some false positive in terms of performance below expectations on at least something. And you’re also exposing the person to unnecessary testing. And the compensation/billing piece sounds a little sketch cuz I can’t imagine insurance typically approving that number of codes, as that is way outside the norm for a neuropsych battery.

I have absolutely added tests here and there while doing an evaluation because I picked up on something either in the interview or during the evaluation, and my supervisors encourage that. But we also aren’t throwing the kitchen sink at every patient.

OP, learn as much as you can from this training site, but please be aware this is not a model you will likely encounter elsewhere, especially if you go on to train at an AMC or VA. There, the skill is often sharpening your efficiency by doing a thorough chart review, gathering all other necessary information during the intake/collateral interview, and selecting a battery of tests that will help you test your initial conceptualization and hypotheses.

 

[szymk1sm]

While I agree with what other posters have said, it does seem like the OP is getting exposure to a wide range of neurological / neuropsychiatric / neurodegenerative conditions as a practicum student at this site. OP is involved in chart review, testing, report writing, and feedback - all things that a practicum student should be getting experience with. They have no control over billing or how their supervisor(s) set up their practice. As long as OP is meeting the minimal or required number of assessment and therapy hours (and their dissertation is at whatever point their program deems as acceptable), then they should consider applying for internship (under the guidance of their DCT, supervisors, etc.).

These are all "learning points" that one can include in their internship statements as areas they want to grow or develop efficiency / proficiency in (e.g., I have a wide range of experiences at this prac site - including different neurocognitive presentations, extensive neuropsychological batteries, report writing, and feedback sessions. For internship, I want to become more efficient in my neuropsychological practice to prepare me for a postdoctoral fellowship that follows Div 40 / Houston guidelines and will make me board eligible. For example, decreasing my interviews to 1-hour, developing flexible batteries that last 1-2 hours depending on patient complaint to test my initial conceptualization and hypotheses, and writing reports that are digestible to both the referring provider and the patient). I also cannot emphasize enough how important it is to be open to feedback and doing things in a "different way than what you were taught" on internship and post-doc.

Remember - there are multiple pathways to becoming a neuropsychologist. Some of us were fortunate enough to get practicum placements at sites that train you for real-word academic / VA neuropsychology practice. Other sites still hold on to the old-school developmental model of longer testing / longer reports - which still provides useful learning opportunities. More practicum experience is not always better (at least this was the advice I was given in graduate school - and I went to a "top tier" neuropsychology program) and OP is not expected to have it all figured out by the time they are applying for internship.

OP may find it beneficial to review some of the webinars that are already out there on preparing for neuropsychology internships. These slides are older but still have good information: https://scn40.org/wp-content/uploads/anst-eac-aitcn_internship_webinar_final.pdf

 

[psych.meout]

While I agree with what other posters have said, it does seem like the OP is getting exposure to a wide range of neurological / neuropsychiatric / neurodegenerative conditions as a practicum student at this site. OP is involved in chart review, testing, report writing, and feedback - all things that a practicum student should be getting experience with. They have no control over billing or how their supervisor(s) set up their practice. As long as OP is meeting the minimal or required number of assessment and therapy hours (and their dissertation is at whatever point their program deems as acceptable), then they should consider applying for internship (under the guidance of their DCT, supervisors, etc.).

These are all "learning points" that one can include in their internship statements as areas they want to grow or develop efficiency / proficiency in (e.g., I have a wide range of experiences at this prac site - including different neurocognitive presentations, extensive neuropsychological batteries, report writing, and feedback sessions. For internship, I want to become more efficient in my neuropsychological practice to prepare me for a postdoctoral fellowship that follows Div 40 / Houston guidelines and will make me board eligible. For example, decreasing my interviews to 1-hour, developing flexible batteries that last 1-2 hours depending on patient complaint to test my initial conceptualization and hypotheses, and writing reports that are digestible to both the referring provider and the patient). I also cannot emphasize enough how important it is to be open to feedback and doing things in a "different way than what you were taught" on internship and post-doc.

Remember - there are multiple pathways to becoming a neuropsychologist. Some of us were fortunate enough to get practicum placements at sites that train you for real-word academic / VA neuropsychology practice. Other sites still hold on to the old-school developmental model of longer testing / longer reports - which still provides useful learning opportunities. More practicum experience is not always better (at least this was the advice I was given in graduate school - and I went to a "top tier" neuropsychology program) and OP is not expected to have it all figured out by the time they are applying for internship.

OP may find it beneficial to review some of the webinars that are already out there on preparing for neuropsychology internships. These slides are older but still have good information: https://scn40.org/wp-content/uploads/anst-eac-aitcn_internship_webinar_final.pdf

I'm not saying that OP received no benefit from this site or that this site is doing everything wrong, e.g., it seems like they are getting good experience writing more practical reports, they're getting to work with multiple supervisors. What I'm getting at is that there are definitely some questionable practices here that no one (e.g., OP's grad program or peers) are clued in on and OP seems to have really bought into how they are doing things there without really understanding or questioning what, how, and why the site is doing things like this. More importantly for this specific topic of internship, this training model of 4-hour interviews and 8-12 hours of testing for clinical cases is so far to other extreme on the spectrum that I'm wondering how prepared OP will be for internship, especially one doing neuro at an AMC or VAMC. Sure, they aren't expected to be at the entry level practice level for neuro or even a first year post doc, but it's pretty huge adjustment from your only experience being 4-hour interviews to getting 60-90 minutes max. Increasing efficiency and speed and thinking on your feet in one domain is difficult enough at that level, but it seems like OP would have a significant learning curve across domains, which would make internship significantly harder.

TL;DR: I think OP has had too much depth in terms of this site as their only neuro experience and it's such an outlier training model that they would be better prepared for internship interviews and internship year in general with another neuro practicum that has a different model and gives them different experiences.

 

[abcdeltaforce]

I understand everyone’s concerns and after hearing what you all have said I am certainly critically evaluating the pros and cons of this site. However, I’ve already spent the year here, and I would say it was an overwhelmingly positive learning and training experience. As I’ve said, it’s a very unique site and while some may see that as a bad thing, I think it’s been a fantastic learning experience.
My next site is a much more “typical” site - insurance only, 30-45 minute intakes and 3 hour max testing sessions, memory/aphasia patients only, two patients per week. So I will be getting exposed to doing things more efficiently and up to par with what is typically seen in the neuro field.

I also will tell you all that every one of the prac students in the last few years that went through my current site and ranked neuro sites matched into a Neuro track/focused internship - including people in recent years who have matched into UCLA’s internship program (hence why I started looking into it). It is incredibly rare for people from my school to take an extra year ($), so most, if not all, of these former students had two practicum years and an upcoming third placement when they applied, just as I will. I know many prior students who are now at legit neuro post docs, and they went through this site. Obviously there are other aspects to an application but thus far it doesn’t seem like the site itself has prevented anyone from a successful neuro trajectory.

At the end of the day, I recognize the uniqueness and the possible pitfalls of the site, and I appreciate everyone bringing them to my attention so I could consider them. Do I personally see the benefits of why they do things the way they do? Yes, I do. And that doesn’t make me oblivious - if you had satisfied patients and families, a great work environment, well-paid clinicians with great interdisciplinary relationships, and the opportunity to work with diverse clientele why would you feel as though something is not right? Not saying that I can’t get those things anywhere else, but I also don’t feel like doing things differently always means that it’s inherently wrong or nefarious. Everyone is always going to have opinions and preferences, and I look forward to learning more through additional experiences about other ways neuropsychology works in practice.

All I can do is be honest on my application and in my interviews and continue to be open to learning new things and new ways of doing things. I am in no way set in stone about the ways of doing things thus far, and I recognize that everyone I learn from will be looking for something different. I am excited to continue to learn and grateful to have experienced such a diverse array of cases this year. I will be sure the update everyone throughout the process of apps/interviews/etc. so everyone can know what questions I’m being asked!