Clinical Neuropsychology Fellowship Tracks
There are two primary fellowship tracks available, an adult fellowship track 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.
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 such as Neurology, Neurosurgery, Psychiatry, Pediatrics, 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, and community mental health centers.
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. The pediatric fellows see patients in the Anna Philbrook Center (APC), which is also located within the main building.
The adult fellowship has two sub-tracks, each involving two primary rotation sites. Applicants may apply to either or both sub-tracks, indicating order of preference. In consultation with faculty, 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.
- DHMC: Second year fellows have the opportunity to participate in specialty clinics. In the Cognition in Older Adults (COA) clinic, Huntington’s disease (HD) Clinic, and the Cancer clinic, they conduct brief cognitive assessments, may sit in on patient interviews with the physicians, and provide feedback to the multidisciplinary team. Second year fellows participate in the Dartmouth Interdisciplinary Developmental Disability Clinic (DIDD) that involves clinicians from psychiatry, neurology, internal medicine, occupational therapy, and neuropsychology in the evaluation of adults with developmental disability and/or autism with challenging behaviors.
- Hanover Psychiatry in Hanover NH: Hanover Psychiatry is a psychiatric and psychological practice of the Department of Psychiatry at Dartmouth. The Neuropsychology Service offers comprehensive (neuropsychological, personality, psychodiagnostic) evaluations for individuals 16 years of age and older having a wide range of clinical issues. A unique aspect of this service is its highly collaborative nature, with some clients evaluated by the neuropsychology clinical psychology and/or psychiatry, and a joint report produced. Fellows attend weekly staff meetings pertaining to issues related to working in a clinical practice, discuss clinical cases, and scientific topics.
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), and other multidisciplinary clinics. Required didactics take place on Fridays.
Adult DHMC-NHH sub-track fellows’ typical neuropsychological evaluation caseload includes 3-4 cases per week (a combination of full and short evaluations), with psychometrist support for some cases.
Adult DHMC-Hanover Psychiatry sub-track fellows’ typical neuropsychological evaluation caseload includes 2 cases per week without psychometrist support, and occasional short evaluations at DHMC (e.g., COA Clinic). Opportunities to work with psychometrists are available, though to a much more limited extent than for DHMC-NHH sub-track fellows.
The typical caseload of second year adult fellows who are full-time at DHMC includes 3-4 cases per week (a combination of full and short evaluations), with psychometrist support for some cases.
The pediatric neuropsychology postdoctoral fellowship program at Dartmouth involves numerous activities designed to provide a well-rounded training and learning experience. In addition to the DHMC clinical outpatient service that evaluates children with various 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 Psychiatry 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 part of this experience.
While mostly conducted with the adult population, pediatric fellows are provided the opportunity to participate in WADA procedures. As part of their training in epilepsy, attendance at the weekly surgical planning conferences is also available.
A rotation at NHH is also part of the learning experience, where the fellow provides neuropsychological assessment and team-based consultation experiences within an inpatient psychiatric population.
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 the fellow’s 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.