Get to know us: We will be at the Training Director Meet-Up Session on Friday November 6, 2024 at the NAN (National Academy of Neuropsychology) conference in Los Angeles, CA. We are hosting a pre-application Open House on teams on Wednesday 12 November from 4:30 pm - 6:00 pm, central time. Email Karin.McCoy@va.gov for the teams link.
STVHCS offers a two-year APA-accredited postdoctoral fellowship in Clinical Neuropsychology and recruits two fellows each year. The goal of the Clinical Neuropsychology Fellowship Program is to prepare fellows for employment as neuropsychologists and board certification through the American Board of Professional Psychology (ABPP). Our program provides training consistent with the Houston Conference Guidelines (Hannay, 1998) and is a member program of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN; www.appcn.org). Our program is supportive of the Minnesota Update Conference principles and looks forward to the publication of the follow-up documents suggesting best ways to implement the newly published competencies.
Fellows learn a variety of neuropsychological assessment, intervention, and research techniques within a VA hospital and design their training to meet individual needs and career goals. Additional training opportunities are available at our sister institution, UT Health San Antonio, which is connected to the VA hospital via a sky bridge, and Brooke Army Medical Center (BAMC), which is approximately 15 miles away. Most graduates of our fellowship program obtain employment in VA Neuropsychology Service positions or academic medical centers.
STVHCS has APA-accredited Clinical Psychology fellowship and internship programs. Thus, there are fourteen fellows in total – four in neuropsychology and ten in the clinical psychology fellowship program. The internship program has seven interns.
Clinical Training Experiences in Year 1: During Year 1, Fellows are expected to engage in outpatient and inpatient experiences, across the general clinic and polytrauma. Below are the settings available:
1. Neuropsychology Outpatient Consult Service (NOCS): The Consult Service is an outpatient clinic which receives a wide array of referrals from neurology, primary care, mental health, social work, and other medical specialty clinics to assist with differential diagnosis and treatment planning. The most common referral reasons are stroke, neurodegenerative/dementing disorders, neurological conditions (e.g., Parkinson’s disease, epilepsy, multiple sclerosis), non-acute brain injury, medical/metabolic comorbidities (e.g., hepatic/renal failure, sleep apnea, HIV/AIDS), psychiatric disturbance, learning disorders, capacity, and presurgical candidacy evaluation. While rotating in this clinic, the first-year fellows will be expected to have two full days of outpatient evaluations; additionally, fellows will co-facilitate a weekly group. One provider in this clinic conducts Spanish-language neuropsychological evaluations; fellows have an opportunity to participate if fluent in Spanish. Note that fellows may have the opportunity to work in the outpatient neuropsychology in Kerrville, Texas, which is a rural area about 60 miles north of San Antonio.
2. Polytrauma Outpatient Neuropsychology Service (PONS): Outpatient polytrauma provides neuropsychological assessment for individuals who have integrated into the community and are being followed for long-term sequelae of moderately-severe traumatic brain injuries. The newest PMR service, stroke rehabilitation, may also request neuropsychological assessments through PONS.
3. Polytrauma Rehabilitation Center (PRC): The San Antonio PRC is the newest of five VA Polytrauma hospitals. The 12-bed inpatient unit is focused on the rehabilitation of veterans and active-duty service members, most often admitted for post-acute treatment of acquired brain injuries (e.g., moderate-severe traumatic brain injury (TBI), emerging consciousness, stroke, hypoxia/anoxia) and orthopedic injuries. During the PRC rotation, fellows will work as an active member of an interdisciplinary treatment team which includes physicians, speech pathologists, occupational therapists, physical therapists, optometrists, psychologists (individual and family), social workers, chaplains, nurses, and recreational therapists.
4. Polytrauma Transitional Rehabilitation Program (PTRP): PTRP is a residential rehabilitation program for active-duty service members and military veterans who have sustained injuries to multiple systems. TBI is the most common injury, with most program participants having sustained orthopedic trauma, amputation(s), spinal cord injury, and/or burn injuries in addition. Many were exposed to traumatic combat experiences and have psychological disorders related to war experiences or injury-related events. Primary transitional program goals are to aid participants' a) return to community living with maximum independence, and b) return to productive community roles, with an emphasis on work or formal education programs. Fellows are involved in evaluation and treatment. Initially, they help the team identify and conceptualize the nature of cognitive, emotional, personality, and psychosocial issues that affect the individual's progress in continuing rehabilitation, adjustment to injury, and quality of life issues. Fellows work closely with the treatment team to address emotional issues, implement environmental or behavioral interventions to assist with management of behavioral sequelae of injury, and build patients' knowledge of deficits and skills for managing cognitive symptoms of brain injury.
5. Inpatient Neuropsychology. Fellows have an opportunity to work with the inpatient neurology and internal medicine teams through assessments of inpatients. The questions might be differential diagnosis, with delirium an important consideration, or capacity assessment, especially related to discharge planning. Patients are referred from any floor or unit at the main hospital, Audie L Murphy Medical Center.
Year 2: During Year 2, fellows develop a more individualized training plan based on the following required and optional clinical experiences:
1. Neuropsychology Consult Service (required): Second-year fellows have at least one day assigned for outpatient evaluations per week. Additional clinical duties include (1) responding to inpatient neuropsychology consultation requests for patients admitted to medicine or psychiatry units, (2) co-facilitating a cognitive stimulation group for veterans diagnosed with dementia, and (3) providing individual cognitive rehabilitation to 2-3 patients at a time. One of the neuropsychologists in this clinic conducts Spanish-language assessments; if fluent in Spanish, fellows have an opportunity to participate.
2. Neurology Consultation/Liaison (required): Second-year fellows will spend one month rounding with the inpatient neurology team. During this month, outpatient responsibilities will be waived (e.g., outpatient neuropsychological assessments) to allow sufficient time each day to round with the neurology residents and attending neurologist.
3. Brooke Army Medical Center (required): Second-year fellows will spend two days per week at BAMC for two months, during which time they will provide outpatient evaluations for active duty and retired military personnel. These evaluations may include forensic/disability evaluations for the medical boarding process for active-duty service members. This experience is an immersion in active-duty culture; fellows will learn about military structure and culture. Additionally, ethical and professional issues regarding confidentiality for forensic/medical board examinations and command reporting will be relevant.
4. Additional Clinical Experiences (optional):
At the VA: (a) Neuroseizure Clinic; (b) movement disorders clinic (c) Sleep Medicine Clinic; (d) Polytrauma Neuropsychology (PRC, PONS, or PTRP); (e) Clinical Psychology training experiences (primary care, spinal cord, transplant evaluations, palliative care, trauma, substance use disorders, geropsychology, psychosocial rehabilitation for serious mental illness, rural mental health, etc.).
At UT Health San Antonio: Comprehensive Epilepsy Service.
• Second-year fellows provide tiered neuropsychology case supervision to neuropsychology practicum students.
Information on training competencies, didactics, administrative and research expectations, training staff, and training facilities available on the website.