Clinical Neuropsychology Fellowship Tracks
There are two primary fellowship tracks available, an adult fellowship track that has two sub-tracks, and a pediatric fellowship track. Both fellowship tracks provide the opportunity to work with a wide array of patient populations and considerable resources within which the fellow can advance his or her specific interests while gaining a broad spectrum of experience. Supervised direct service delivery responsibilities include interviewing, test administration, report writing, consultation with various departments and medical personnel, and provision of feedback to patients, families, and referral sources.
Sub-Tracks and Rotation Sites
The adult fellowship has two sub-tracks, each involving two primary rotation sites. Applicants may apply to either or both sub-tracks, indicating order or preference. Fellows may chose to remain in their track for their second fellowship year, switch to the other track, or spend their second year full time at DHMC.
- Sub-Track 1 (DHMC-NHH): The Neuropsychology Service at Dartmouth-Hitchcock Medical Center in Lebanon, and the Neuropsychology Laboratory at New Hampshire Hospital in Concord.
- Sub-Track 2 (DHMC-Hanover Psychiatry): The Neuropsychology Service at Dartmouth-Hitchcock Medical Center in Lebanon, and the Neuropsychology Service at Hanover Psychiatry in Hanover.
Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon NH: The Neuropsychology Service at DHMC serves as the primary training site for all fellows. Outpatients make up the bulk of referrals, though inpatients are occasionally seen. Referrals come from a wide variety of sources including the clinical services of Neurology, Neurosurgery, Psychiatry, and Internal Medicine, as well as other medical units at DHMC. Referrals also come from sources in the regional communities including school systems, health care providers, community mental health centers, and medical-legal practices. Fellows also gain experience with the intracarotid sodium amobarbital evaluation (Wada Test) for presurgical planning.
Second year fellows rotate for six months in the Healthy Aging and Brain Care (HABC) clinic, a collaborative service involving neuropsychology, geropsychiatry and neurology. They conduct brief cognitive assessments, may sit in on patient interviews with the physicians, and provide feedback to the multidisciplinary team. Second year fellows also have the opportunity to participate in the Dartmouth Interdisciplinary Developmental Disability Clinic (DIDD) involving psychiatry, neurology, internal medicine, occupational therapy and neuropsychology, in the evaluation of adults with developmental disability and/or autism with challenging behaviors.
New Hampshire Hospital (NHH) in Concord NH: NHH is the state's primary psychiatric inpatient facility, and is a teaching hospital staffed by Dartmouth Psychiatry faculty. As such, it represents a unique example of public sector-academic liaison. The Neuropsychology Laboratory is housed in the Acute Psychiatric Services facility. Neuropsychological consultation is provided for patients from admissions and longer-term units, including Adult Psychiatry and Geriatric units.
Hanover Psychiatry in Hanover NH: Hanover Psychiatry is a psychiatric and psychological practice of the Department of Psychiatry at Dartmouth. The Neuropsychology Service at Hanover Psychiatry offers comprehensive (neuropsychological, personality, psychodiagnostic) evaluations for individuals with a wide range of clinical issues. A unique aspect of this service is its highly collaborative nature, with some clients evaluated by the neuropsychology team, clinical psychologist and/or psychiatrist, and a joint report produced. Fellows attend weekly staff meetings that address issues related to working in a clinical practice, as well as discuss clinical cases and scientific topics.
The typical caseload of adult fellows is 2-3 cases per week, depending on the sub-track. All fellows, regardless of sub-track, provide consultation to referral sources, feedback with patients and families, and where appropriate, participate in intervention planning and monitoring as part of their duties. Furthermore, adult fellows, mainly in their second year, take turns participating in the intracarotid sodium amobarbital procedure (Wada tests) with a faculty member, although allowance is made for fellows who have greater or lesser interest in the procedure and population (mainly epilepsy). Clinical cases are typically seen from Monday to Thursday, while required didactics take place on Fridays.
Adult DHMC-NHH sub-track fellows’ typical neuropsychological evaluation caseload includes three cases per week:
- Year 1: 1 case at NHH; 1 case at DHMC without psychometry support; 1 case at DHMC with psychometrist support
- Year 2: 1 case or clinic at DHMC without psychometry support; 2 cases at DHMC with psychometrist support
Adult DHMC-Hanover Psychiatry sub-track fellows’ typical weekly neuropsychological evaluation caseload in both years involves 2 cases without psychometrist support, the majority of cases being seen at DHMC and a smaller subset at Hanover Psychiatry. Opportunities to work with psychometrists are also available, though to a much more limited extent than for DHMC-NHH sub-track fellows. Fellows in this track can also have opportunities to participate in the HABC clinic and Wada tests if interested.
The pediatric neuropsychology postdoctoral fellowship program at Dartmouth involves numerous activities designed to provide a well-rounded learning experience. In addition to the DHMC clinical outpatient service that evaluates children with neurological, metabolic, developmental and learning problems, we participate in 4 interdisciplinary clinics with developmental pediatrics, neurology, and psychiatry:
- Autism and Communications Disorders Clinic (ACDC) evaluating children ages 0-5 years old: answering referral questions pertaining to development, speech-language disorders, and ASD.
- Neuropsychological and Developmental Psychiatric Clinic (NDPC) for children and adolescents with complex medical presentations ages 6-17: answering referral questions for children with complex medical histories, cognitive and academic struggles, and mental health comorbidities.
- Autism Spectrum Disorders diagnostic clinic: answering referral questions focused on the diagnosis of ASD, utilizing ADOS-2 and standardized developmental interviewing.
- Interdisciplinary Developmental Disabilities Clinic (IDD): in this unique clinic, the patient, their family, and their entire community-based team are present for evaluation, assessment, and the creation of treatment recommendations from a multi-disciplinary team of providers.
Sports neuropsychology is also a major element of the training experience. Fellows are engaged in extensive participation within a school-based concussion management intervention program. There are also many consultation opportunities, including work with concussion management programs at regional high schools, middle schools, and colleges. Work within the hospital’s sports concussion program is also available.
Participation in intracarotid sodium amobarbital (WADA) procedures and epilepsy surgery planning conferences are also available.
Rotation at New Hampshire Hospital’s Anna Philbrook Center (Concord, NH) provides neuropsychological testing and team-based consultation experiences within an inpatient psychiatric population. Pediatric fellows also evaluate adults to round out their experience.
The typical caseload of pediatric fellows is 2-3 cases per week, depending on their mix of clinical activities. Effort is made to keep caseload equivalent across years, although it may vary slightly. All fellows provide consultation to referral sources, feedback with patients and families, and where appropriate, participate in intervention planning and monitoring as part of their duties. The mix of activities is somewhat flexible and can be tailored to fellows’ interest when possible. Dedicated writing days are provided across both years of training. Clinical cases are typically seen from Monday to Thursday, while required didactics take place on Fridays. Below are reference samples, but may vary:
- Year 1: 1 case at NHH; 1 case at DHMC (interdisciplinary clinic); 1 case at DHMC (outpatient evaluation)
- Year 2: 2 cases at DHMC (outpatient evaluations); 1 case at DHMC (interdisciplinary clinic)