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.
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.
Inpatient Psychotherapy: Students will provide psychotherapy services to medical inpatients at Lancaster Rehabilitation Hospital. Usually, this is in the form of aiding the patient in adjusting to an acute, chronic, and/or unexpected medical problem; continuing treatment for an ongoing psychiatric problem, e.g. anxiety or depression; and assisting the family in understanding and coping with the patient’s medical problem. Inpatients typically respond best to a cognitive-behavioral/psycho-educational approach and it is this model that the intern is most often expected to practice. The interns will also provide group psychotherapy to stroke patients and their families.
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 Halstead-Reitan Neuropsychological Test Battery (HRB), 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 Program, to interface with neurologists, geriatricians, nurses, and social workers in determining a diagnosis and treatment plan for their patients.
A comprehensive concussion program was established in 2009, with special focus on student athletes, providing pre-play and post-concussion neuropsychological evaluation to offer guidance on return to play and academics and to minimize protracted recovery and morbidity following concussive injuries.
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.
Outpatient Psychotherapy: While not a primary focus of our program, interns are given opportunities to see some patients for psychotherapy. 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. Interns will also see patients with a variety of pain-related issues though the hospital’s Fibromyalgia Program, which is located at our Health Campus. 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.
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.
Inter Department Didactics
- Two Day Lancaster General Health Employee Orientation
- Epic and Dragon Voice Recognition Software Training
- Orientation to Internship Program and Services
- Neuropsychology Specific Didactics
- The Mental Status Examination
- Introduction to the Halstead Reitan Battery - Part I
- Introduction to the Halstead Reitan Battery - Part II
- Evaluating Concussion
- The Neurological Examination
- Normal Pressure Hydrocephalus
- Neuropsychological Case Studies
- Unusual Neurological Cases
- Multiple Sclerosis
- Memory and Transient Global Amnesia
- The Neuropsychology of Aging
- Epilepsy – Part I
- Epilepsy – Part II
- Epilepsy – Part III
General Psychology and Health Psychology Didactics
- Conducting Bariatric Surgery Psychological Evaluations
- Conducting Fibromyalgia Psychological Evaluations
- Physiology of Stress
- Adult Attention Deficit Hyperactivity Disorder
- Mindfulness Based Treatment of Insomnia
- Managing the Agitated Patient
- Manualized Treatment of Binge Eating Disorder
- Models of Supervision
- Effective Supervision
- Preparing for the EPPP
- Diversity – Module I
- Diversity – Module II
- Diversity – Module III
- Diversity – Module IV
Additional Didactic and Training Opportunities
- Monthly Stroke Rounds at Lancaster General Health
- Trauma Conferences at Lancaster General Health
- Full Day Neuroscience Conference
- Brain Cutting
- Introduction to Neuroimaging
- CPR Training and Certification