Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, Arizona
Structure of the Postdoctoral Residency Program
Barrow’s Postdoctoral Residency Program in Clinical Neuropsychology is a two-year program requiring clinical teaching and research activities typically requiring a 50-hour work week.
Residents in clinical neuropsychology are involved in direct patient care in several settings that may include:
- Inpatient Neurorehabilitation Unit
- Center for Transitional Neurorehabilitation
- Epilepsy Monitoring Unit
- Outpatient Neuropsychological Consultation Service
- Inpatient Neuropsychological Consultation Service
- Children’s Center for Neuropsychological Rehabilitation
In addition, Barrow offers a growing number of clinic services within the hospital, including those pertaining to Movement Disorders, Normal Pressure Hydrocephalus, and Hypothalamic Hamartoma. The Section of Clinical Neuropsychology also participates in a number of ongoing clinical research trials.
The residency application deadline is February 1, 2010
Rotations
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Outpatient Neuropsychological Consultation Service
Most patients on the Outpatient Neuropsychological Consultation Service are referred by neurologists and neurosurgeons. Both adults and children are seen. A wide variety of neurologic conditions are seen including, but not limited to, traumatic brain injury, cerebrovascular accident, dementing illnesses, multiple sclerosis, tumor, epilepsy, movement disorders, normal pressure hydrocephalus, aneurysms, and those undergoing presurgical evaluation for procedures such as deep brain stimulation. The Section of Clinical Neuropsychology is also involved in various clinical research drug and outcome studies.
Inpatient Neurorehabilitation
The 52-bed CARF-accredited inpatient neurorehabilitation unit at St. Joseph’s Hospital and Medical Center includes spinal cord injury, brain injury, stroke, brain tumor, and pediatrics. Residents spend a major rotation evaluating and treating patients with a variety of CNS injuries and illnesses.
Epilepsy Monitoring Unit (EMU)
The EMU is a 15-20 bed unit devoted to 24-hour continuous EEG monitoring of patients with seizure disorders. Residents participate in evaluating pediatric and adult patients undergoing monitoring for differential diagnosis or presurgical evaluations. We perform approximately one Wada (intracarotid amytal procedure) per week. Residents have the opportunity to administer the Wada. Weekly interdisciplinary meetings with neurology, neurosurgery, and neuroradiology provide residents the opportunities to interact closely with members of the Comprehensive Epilepsy Program and to present neuropsychological findings. This rotation also includes monthly meetings in neurophysiology conferences and epilepsy research.
Acute Inpatient Consultation Service
This is not a stand-alone rotation; rather it is a general neuropsychology service provided in the hospital across a variety of inpatient departments including medical, cardiac, pediatric, and neuroscience ICUs. Short evaluations to assist with differential diagnosis or transfer/discharge planning, including those that may go to inpatient rehabilitation, are the main goal of these consultations.
Center for Transitional Neurorehabilitation (CTN)
CTN offers intensive, day-long treatment for older adolescents and adults with brain injuries. The program features a holistic approach for the treatment of cognitive, language, physical, emotional, neuropsychological, and vocational needs. CTN focuses on independence in the home and community and on productivity when patients return to work or school. Family members receive emotional support and learn about the patient's strengths and limitations and how to assist the patient in functioning in the home.
CTN offers four rehabilitation-oriented programs:
- Home Independence Program
- Work Re-Entry Program
- School Re-Entry Program
- Transitional Program
Neuropsychology residents serve as part of the treatment team along with speech and language pathology, physical therapy, occupational therapy, vocational counseling, and recreational therapy. Responsibilities include providing individual and group psychotherapy, cognitive remediation training, and participation in the program milieu.
Children’s Center for Neuropsychological Rehabilitatio (CCNR)
The CCNR is a new service developed within the Department of Clinical Neuropsychology. The CCNR is designed as an outpatient comprehensive assessment and treatment program for children and adolescents with known or suspected brain disorders.
Services within the CCNR are being designed to improve children’s academic, emotional, behavioral, and social functioning, as well as reducing the distress of parents and teachers related to management of the child.
Planned services to be provided through the CCNR include:
- Neuropsychological assessment
- Cognitive rehabilitation
- School tutoring
- Friendship (social skills) training
- Individual and family psychotherapy/behavior modification
- Summer day treatment program
Neuropsychology residents will serve as part of a treatment team in assisting with the provision of clinical services. Responsibilities will include neuropsychological assessment, as well as providing treatment services to patients and their families.
Conditions the CCNR treats include:
- Acquired Brain Injury (e.g. traumatic brain injury, stroke, encephalitis)
- Medical conditions known to affect brain functioning (e.g. epilepsy, cancers and treatment, brain tumor, premature birth)
- Neurogenetic conditions (e.g. tuberous sclerosis, neurofibromatosis, Turner’s syndrome)
Tracks
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Barrow offers two tracks of training within the Postdoctoral Residency Program in Clinical Neuropsychology:
- General Clinical Neuropsychology
- Neurorehabilitation with a specialty in Neuropsychological Rehabilitation
Track 1: General Clinical Neuropsychology
Individuals who seek training in general clinical neuropsychology obtain extensive clinical supervision in the neuropsychological evaluation of a wide range of patients at different age ranges. This track includes supervised training in appropriate record review, clinical interviewing, administration of neuropsychological tests, and report writing. Residents also receive training in providing feedback to the patient regarding their findings in a manner that is clinically sensitive and helpful to patients and their families.
Within the context of this track, individuals typically spend the majority of their training time on the Inpatient Neurorehabilitation Unit, the Epilepsy Monitoring Unit, and the Outpatient Neuropsychological Consultation Service. For interested individuals, a pediatric neuropsychology rotation is anticipated to be available through the CCNR. A key component to training programs is supervision by multiple clinical neuropsychologists who have varying degrees of experience with different patient populations. The goal is to expose the resident to a wide variety of neurological and neurosurgical disorders and to familiarize them with the most meaningful way of assessing these patients. In doing so, the resident learns to convert that assessment information into practical healthcare decisions for the patient. This track also requires extensive training in communicating with physicians in a manner that clarifies our neuropsychological understanding of the patient.
As a part of this training program, residents may receive supervision in individual psychotherapy and cognitive retraining for selected patients. Residents in this track are given opportunities to participate in a wide variety of clinical research projects, including those that involve functional MRI.
Track 2: Neurorehabilitation with a specialty in Neuropsychological Rehabilitation
The second track of training focuses on neurorehabilitation with a specialty in neuropsychological rehabilitation. Individuals who seek this training path frequently plan a career in the field of brain injury rehabilitation. They receive extensive training in the assessment of cognitive and personality disorders of brain-dysfunctional patients who are in acute and post-acute rehabilitation programs. Their primary focus is on learning methods of neuropsychological rehabilitation intervention to help patients become independent and return to a productive lifestyle.
This track helps train clinical neuropsychologists to work within the context of an interdisciplinary team and to develop a positive working alliance with family members as well as the patient. Individuals who seek this track receive extensive training at the Center for Transitional Neurorehabilitation (CTN) and the Inpatient Neurorehabilitation Unit. They also obtain some experience in cases of differential diagnosis either through the Outpatient Consultation Service or the Epilepsy Monitoring Unit. For interested individuals, a pediatric rehabilitation rotation is anticipated to be available through the CCNR. In addition, residents participate in research projects related to neurorehabilitation.
Training Objectives
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It is imperative that the trainee’s experience demonstrate that they can carry out the necessary assessment activities in order to qualify for various clinical neuropsychology job positions. Core to the work of clinical neuropsychology is the ability to conduct neuropsychological assessments of a wide variety of patients (e.g., those with TBI, CVA, epilepsy, dementia, Parkinson’s disease, multiple sclerosis, malignant and non-malignant brain tumors). Successful completion of either track offered at Barrow would meet this training objective.
Psychologists who finish residency programs typically seek state licensure and hospital privileges. Those agencies request from the Director of the Postdoctoral Residency Program a statement about whether or not the individual is competent to carry out various services in order to obtain privileges.
Didactics
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All residents participate in four major teaching activities within the Section of Clinical Neuropsychology.
- Residents’ Seminar
- Neuropsychology/Neuroimaging Seminar
- General Neurology and Neurosurgical Grand Rounds Conference
- Clinical Seminar (bi-weekly, similar to a journal club, but includes presentation of individual cases and topics of interest to all neuropsychologists within the Section of Clinical Neuropsychology)
Residents also have the opportunity to meet with one of the boarded (ABPP) staff members on a monthly basis for Fact Finding Seminar in preparation for pursuing board certification. Other available teaching conferences will be negotiated with each resident (e.g., EMU Conference, Neurophysiology Conference, Brain Cutting, Neurovascular Conference, Tumor Board).
Research
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Each resident is expected to produce one scholarly paper or poster for each year of his or her residency. The paper may be either theoretical or empirical, depending on the background and interest of the resident. All residents will have an opportunity to observe neurosurgery, participate in case conferences, and test selected patients before and after neurosurgery. Clinical teaching and research activities of the resident will typically require a 50-hour work week.
In addition to these clinical work settings, residents can participate in a variety of research neuroimaging activities within the Neuropsychology/Neuroimaging Laboratory. Many of the attending faculty are involved in ongoing research projects and are open to student involvement in those projects. Opportunities for the development of other research projects are also present. Previous residents have submitted grant proposals and presented at national conferences related to their work within the residency program.
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