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section of the document. Some sentiment that the term behavioral was
broad enough to subsume the cognitive and affective descriptors was expressed.
The wording "Neuropsychological interventions" was substituted for "Psychological
interventions for behavioral change."
Finally, a proposal to add the word neuropsychological before each
heading under the skills section was put before the assembly. It was stated
that this addition would be redundant because the whole document was about
neuropsychology, and the proposal was defeated.
The assembly then voted on the entire section 11 as amended, and approved
it. The plenary session adjourned for the evening.
III. HOW SHOULD EDUCATION AND TRAINING IN THE SPECIALTY OF
CLINICAL NEUROPSYCHOLOGY BE ACCOMPLISHED?
A. CAN ALL EDUCATION AND TRAINING IN CLINICAL NEUROPSYCHOLOGY BE ACCOMPLISHED
AT A SINGLE LEVEL?
CHARGE TO THE DELEGATES
H. Julia Hannay, Sandra Koffler, and Thomas A. Hammeke
This question was introduced by noting that it consisted of two parts.
Part A asked whether all of the training can be done at a single level?
In order to answer that question delegates would have to decide what aspects
of the education and training outlined in answering Question II could he
accomplished realistically at each level. Two of the breakout, groups were
to emphasize either doctoral, internship, or postdoctoral education and
training in their deliberations. Groups Two (Rourke) and Three (Fennell)
were asked to emphasize doctoral training. Groups Four (Marcotte) and Five
(Boll) were asked to emphasize internship training, and Groups One (Berent)
and Six (van Gorp) were asked to emphasize residency training,
Introductory comments about doctoral training noted that when many
of the delegates were interested in becoming clinical neuropsychologists,
the primary route for doing so was a postdoctoral fellowship. Now there
are quite a few doctoral programs around the country that are offering
education and training in clinical neuropsychology at the doctoral level.
There used to be several freestanding doctoral programs that gave a PhD
in clinical neuropsychology. The programs at the University of Victoria
and the University of Houston were examples of this. The University of
Victoria built a clinical program around their neuropsychology program,
which is now an APA-approved clinical program. The University of Houston
still has a few more students to graduate from the clinical neuropsychology
program. Four years ago the clinical and clinical neuropsychology programs
merged so that there is now a clinical neuropsychology track in the APA-approved
clinical program. This is the model for doctoral training in clinical neuropsychology
that is being used in many places. Queens College at CUNY has a clinical
neuropsychology track but it is in a neuropsychology program rather than
a clinical program. It does, however, have a link to the clinical program
for general clinical training. Other doctoral training sites have only
a concentration and not a track and naturally fewer departmental resources
for neuropsychology than programs that have a clinical neuropsychology
track,
There were many issues to be considered at the doctoral level. For
instance, did the delegates think that there should be freestanding clinical
neuropsychology programs in the future and, if so, what should such programs
include? Did the delegates think that instead all doctoral level training
should go on only in a clinical neuropsychological track in a clinical
program or could it take place in other types of programs and, if so, what
should those programs include." In considering these and other issues,
delegates were reminded to look back the Reports of the INS-Division 40
Task Force on Education, Accreditation, and Credentialing (1987), the Guidelines
for the knowledge base and skills that were outlined the previous day in
answer to Question II and the unpublished survey data that involved doctoral
programs (Hannay, 1996).
It was noted that the internship in accordance with the guidelines
of the Committee of Accreditation (American Psychological Association,
1996a), should provide opportunities for carrying out major professional
functions in greater depth, breadth, and frequency than in practicum training.
Internship training is primarily experiential in nature and is augmented
by mentoring, didactic experiences and role modeling. It is unlikely that
APA-accredited internships will have sufficient opportunities for acquiring
specialized competency, given the extensive knowledge and skill requirements
listed in the INS-Division 40 Guidelines (Reports of the INS-Division 40
Task Force on Education, Accreditation, and Credentialing, 1987). Several
other issues needed to be considered. What should be the exit criteria
for a neuropsychology internship ? Should the internship be added to residency
training? Would this allow for adequate generic training in that the residency
to follow would provide neuropsychology specialty training? At a recent
meeting of the Association for Internship Training, in Clinical Neuropsychology
(AITCN), it was recommended that the internship remain flexible to meet
individual needs of the intern. How could this be accomplished? Returns
from a recent questionnaire sent out to the members of this association
indicated that most neuropsychology internship placements require prior
training in neuropsychology. How should the internship thus fit into the
sequence of neuropsychology training?
Introductory comments on issues at the residency level highlighted
use of the term residency as opposed to the term postdoctoral fellowship
used historically in psychology. The Ann Arbor Conference on postdoctoral
education and training (Belar et al., 1993) had used the term residency
for several reasons. These included an alignment of our discipline with
that of other professional disciplines in use of the term residency to
connote education and training of a broad set of professional knowledge
and skills in the practice of a broad range of client populations. In contrast
the term, fellowship, has been used to connote more narrowly focused areas
of research or practice either by emphasizing specific settings, techniques,
or patient populations (e.g., a fellowship in EEG or in a surgical epilepsy
program). Shifting to a residency may potentially mean that psychology
residents will be given the same benefit packages afforded to residents
in our sister specialties in medicine.
Considerable strides in development of residency training programs
in clinical neuropsychology in recent years were noted and attributed to
the groundwork laid by the guidelines in the Reports of the INS-Division
40 Task Force on Education, Accreditation, and Credentialing (1987) that
were subsequently refined by the Association of Postdoctoral Programs in
Clinical Neuropsychology (APPCN) (Hammeke, 1993). These guidelines state
that the goal of residency training is to produce graduates with sufficient
knowledge and skills to practice independently in the profession and at
a level commensurate with board certification standards.
Controversy has arisen at the residency level in defining the qualifications
of the program director, the desired length of the program, and the allocation
of time for the resident during the residency. Using guidelines from the
Reports of the INS-Division 40 Task Force on Education, Accreditation,
and Credentialing (1987) as a foundation, APPCN member organizations agreed
that board certification of the training director is an important criteria
in order to foster achievement of the exit criteria for training. As did
the guidelines, APPCN members endorsed a two year training program, but
permitted a one year program for students who have considerable education
and training in the specialty prior to their residency, providing
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