Typically, the interns spend 40 hours per week involved in individual evaluations and interventions, individual and group supervision and didactics, and completing documentation requirements (e.g., writing of neuropsychological reports). Upon successful completion of the training year, interns will have completed 2000 hours of supervised clinical experience that can be applied towards licensure. Under supervision, interns engage in a wide variety of neuropsychological and psychological assessments and interventions appropriate to the role and function of a neuropsychologist.
Training Experiences
Consultation Service: Interns will provide consultations on patients hospitalized at the Lancaster Rehabilitation Hospital. Students will be trained to review hospital records, read and interpret relevant neuroimaging studies, evaluate patients, and provide feedback to the consulting physician, nursing staff, and ancillary health professionals.
Bedside/Inpatient Psychometric Testing: Interns will learn to administer, score, and interpret neuropsychological/psychological tests given to hospitalized patients. Often this testing is of the screening variety, which allows for determining post-injury baselines or assessments of patients suspected of having a dementia or delirium. Occasionally, a comprehensive neuropsychological test battery is necessary but usually this type of assessment is performed on an outpatient basis. Bedside testing is typically in the form of an MMSE or MOCA, BDI, BAI or similar instruments.
Outpatient Neuropsychological and Psychological Evaluations: Interns will be introduced to the administration, scoring, and interpretation of the Wechsler assessment tools, Neuropsychological Assessment Battery (NAB), RBANS, various memory scales, intelligence tests, etc. Students will participate in case presentations using the neuropsychological test data and are expected to develop a basic understanding of neuropsychological test data and clinical underpinnings. Interns will also learn to evaluate patients suspected of having a dementia using a dementia test battery. It is expected that interns will participate in evaluating patients at our Alzheimer’s and Memory Care (AMC) Program, interfacing with neurologists, geriatricians, nurse practitioners, physician assistants, nurses, and social workers in determining a diagnosis and treatment plan for their patients.
A comprehensive concussion program was established in 2009, for purposes of evaluating individuals with suspected head injuries to contribute to a multidisciplinary approach of care. Involvement in our concussion clinic equips interns with practical skills in managing and understanding nuanced complexities of concussion cases.
Interns will perform pre-surgical neuropsychological evaluations of patients being considered for deep brain stimulator placement for treatment of Parkinson’s or essential tremor as well as ventriculoperitoneal shunt placement for treatment of normal pressure hydrocephalus. A portion of NPH evaluations occur in an inpatient setting at our downtown hospital two hours following lumbar puncture. By engaging in these evaluations, interns will gain valuable insights into the intersection of neuropsychology and neurosurgery.
Interns will also perform psychological evaluations of patients participating in the bariatric weight loss surgery program and those being considered for implantation of morphine pumps or spinal cord stimulators. Using information from clinical interview and psychological tests, these evaluations are requested to determine current behavioral, cognitive, emotional functioning and the patient’s current life situation that might be of significance in fostering or inhibiting optimal outcomes.
Inpatient Psychotherapy: Students will provide psychotherapy services to medical inpatients at Lancaster Rehabilitation Hospital (LRH). Usually, this is in the form of group psychotherapy for stroke and TBI patients through provision of a cognitive-behavioral/psycho-educational approach for purposes of aiding patients adjust to and cope with their condition. Additionally, there are opportunities to provide individual psychotherapy to patients at LRH, generally those with neurologic conditions.
Outpatient Psychotherapy: Students will assist in providing psychotherapy services and psychoeducation through our Mindfulness Based Stress Reduction for Insomnia group, which occurs biannually as an 8-week course. This group is generally offered to patients with chronic and/or treatment-resistant insomnia, as identified by our team. Interns are expected to lead portions of this group alongside a neuropsychologist and/or one of our licensed clinical social workers or counselors.
While not a primary focus of our program, interns are given opportunities to see some patients for individual psychotherapy on an outpatient basis. Patients seen for psychotherapy may include individuals following head injury or stroke or those dealing with adjustment issues related to a medical or neurological condition. Our service does not accept referrals for patients with the need for intensive, long-term psychotherapy or patients with the primary problem being related to a specific personality disorder (other than that caused by cerebral pathology).
Psychoeducational Talks: Interns will provide educational talks to community organizations, and present at hospital based in-services and grand rounds as requested by their supervisors. These talks/presentations will often cover frequently seen medical/psychiatric conditions that affect patients and their families throughout Lancaster County. Some examples of talks given by past interns include: Cerebellar Cognitive Affective Syndrome, Traumatic Brain Injury - “the Silent Epidemic,” Birth Order Traits – Genetic or Environmental, Depression in the Elderly, Post-Partum Depression, Coping with Chronic Disease for Caregivers and Stroke Survivors, The Dementias and Care Giving, and Normal vs. Pathological Memory Loss.
Clinical Supervision: Clinical supervision is the primary training modality for development of professional expertise. Intensive clinical supervision is provided in both the inpatient and outpatient settings. Supervision by licensed psychologists is ongoing with a minimum of four hours of face-to-face and group supervision per week. When the Intern is providing inpatient consultation service, he or she will meet daily with the supervising psychologist for face-to-face and group case conferencing supervision. This will involve a review of cases being seen for follow-up and a review of each new patient the intern evaluates that day. Interns are provided with 2 hours of supervision per week with their primary supervisor, and an additional 2 hours of group supervision.
Orientation: Hospital based orientation is provided by health system staff, and the departmental orientation is provided by the Director of Training, Dr. Purzycki.
Didactics
Interns are required to participate in regularly scheduled didactic training seminars at the internship site. The intern must log an average of two (2) hours of didactic training per week. There will be ample opportunities to meet this requirement. Each week, the clinical staff leads seminars on relevant clinical topics. A two hour weekly time slot is set aside in the schedule for inter department didactics. A list of recent topics is included below:
- Two Day Lancaster General Health Employee Orientation
- Epic and M Modal Voice Recognition Software Training
- Orientation to Internship Program and Services
- Neuropsychology Specific Didactics
-
Assessment Training
- Introduction to fMRI
- Supervision in Neuropsychology
- Alzheimer’s disease
- Vascular dementia
- Lewy body disease
- Frontotemporal dementia
- Parkinson’s Disease
- Normal Pressure Hydrocephalus
- Post-Doctoral Fellowship Application Process
- Pain Evaluations and Spinal Cord Stimulator Surgery
- Medical Marijuana
- Pre-Bariatric Surgery Evaluations
- Movement Disorders
- Spinal Cord Stimulator Trial Surgery
- Ethics in Psychology Parts 1-3
- Concussion Parts 1-3
- Multiple Sclerosis
- Limbic-Predominant Age-Related TDP-43 Encephalopathy
- Neuroimaging in Stroke
- Intro to EMG
- Neuro-Oncology Parts 1-2
- COVID-19
- Evaluating Neuropsychological Test Data (Halstead Reitan Battery) Parts 1-2
- Occupational Therapy and Concussion
- Lumbar Punctures
- Advanced fMRI Parts 1-3
- Capacity Evaluations
- Biofeedback
- Deep Brain Stimulation
- Rethinking Stress
- Neuroanatomy: Learning and Memory Networks
- LGBTQ+ Care
- Executive Functioning, Part 1-2
- Visuospatial Abilities, Parts 1-2
- Vagus Nerve Stimulation
- How Do I Know if My Patient Declined? Improved?
- Neuropsychological Rehabilitation
- Essentials of Neuropsychology Business
- Financial Success as a Health Care