Board Certification in Clinical Neuropsychology: A Guide to Becoming ABPP ABCN Certified Without Sacrificing Your Sanity (Oxford Workshop Series)

BOARD CERTIFICATION IN CLINICAL NEUROPSYCHOLOGY

OXFORD WORKSHOP SERIES: AMERICAN ACADEMY OF CLINICAL NEUROPSYCHOLOGY

Series Editors Greg J. Lamberty, Editor-in-Chief Ida Sue Baron Richard Kaplan Sandra Koffler Jerry Sweet

Volumes in the Series Ethical Decision Making in Clinical Neuropsychology Shane S. Bush Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment Michael A. McCrea Understanding Somatization in the Practice of Clinical Neuropsychology Greg J. Lamberty Board Certification in Clinical Neuropsychology: A Guide to Becoming ABPP/ABCN Certified Without Sacrificing Your Sanity Kira Armstrong, Dean W. Beebe, Robin C. Hilsabeck, and Michael W. Kirkwood

BOARD CERTIFICATION IN CLINICAL NEUROPSYCHOLOGY A Guide to Becoming ABPP/ABCN Certified Without Sacrificing Your Sanity Kira Armstrong, PhD, ABPP/CN Dean W. Beebe, PhD, ABPP/CN Robin C. Hilsabeck, PhD, ABPP/CN Michael W. Kirkwood, PhD, ABPP/CN

■■■ OXFORD WORKSHOP SERIES

1 2008

3 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam

Copyright © 2008 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Board certification in clinical neuropsychology : how to become board certified without sacrificing your sanity / Kira Armstrong . . . [et al.]. p. cm. — (Oxford workshop series) Includes bibliographical references and index. ISBN 978-0-19-534134-8 1. Clinical neuropsychology—Certification—Study guides. I. Armstrong, Kira. RC386.6.N48S74 2008 616.80076—dc22 2008005895

Note: The book presents the views and opinions of the individual authors and does not necessarily represent the policies and opinions of the American Board of Clinical Neuropsychology.

1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper

We dedicate this book to our mentors, students, and colleagues in BRAIN, whose experiences and wisdom form the backbone of this book. We also thank our families and friends who have supported us in our personal and professional journeys.

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Prologue

The American Psychological Association (APA) has 148,000 members, but only 3,000 psychologists are active and board certified through the American Board of Professional Psychology (ABPP). This amounts to roughly 2% of active psychologists having attained specialty board certification. In contrast, 694,438 physicians in the United States hold board certification through one of the 24-member boards of the American Board of Medical Specialties (ABMS). There are 13 specialty boards that are members of ABPP, one of them being the American Board of Clinical Neuropsychology (ABCN). As of early 2008, there were 625 active board-certified specialists in clinical neuropsychology as compared to the membership of the Division of Clinical Neuropsychology (Division 40) of APA of roughly 4,000 members. This amounts to roughly 16% of those practicing clinical neuropsychology, a somewhat better proportion than the estimated percentage of practicing psychologists overall. Nevertheless, this is far below the desired goal of ABCN to have every eligible practicing clinical neuropsychologist board certified. In discussing the benefits or lack thereof for specialty board certification in clinical neuropsychology with colleagues and students, it has continually been my experience that there is a significant lack of understanding of the rationale, policies, and procedures requisite to obtaining specialty board certification. For one thing, these policies and procedures have changed significantly over time since the founding of ABPP in 1947 and ABCN in 1981. Change is to be expected as an examination process such as that for specialty certification is a living undertaking, continually being adapted to the needs of patients and those of the profession. Nevertheless, when outmoded notions about what board certification means and how it is conducted persist, students and independent professionals often feel estranged from a process that no longer functions in the manner for which misconceptions may be held. For example, ABPP used to have a requirement that practicing psychologists had to be five years beyond the attainment of their doctorate to apply for board certification. Although this requirement was dropped around 1985, it is amazing how many individuals still hold that this requirement remains.

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The best way to address the possibility of persistent incorrect notions or misconceptions is to make the contemporary examination process for board certification as clear, transparent, and user friendly as possible. In the Board Certification in Clinical Neuropsychology, Drs. Armstrong, Beebe, Hilsabeck, and Kirkwood have done exactly that. The authors are all recently board certified in clinical neuropsychology and belonged to a group called “Be ready for ABPP in Neuropsychology (BRAIN)” as candidates. BRAIN became, and remains, a national resource and study group for candidates for board certification in clinical neuropsychology. Based on their experiences, with questions, uncertainties, misconceptions, rumors, and ambiguities, the authors have put together this book to move candidates beyond common pitfalls and unnecessary distractions in preparing for board examination. Starting with something as simple as decoding commonly used acronyms, the authors lay out the benefits of becoming board certified, the most important of which is quality assurance of services to the public, and attempt to address popular myths and misconceptions about the process. It guides the reader through all necessary steps, beginning with how to complete the application, how to prepare one’s credentials for review, how to get ready for the written examination (including how to secure readily available resources for review), how to prepare the practice sample and how to get ready for the oral exam. As already mentioned, the authors have been through this process themselves and they share their group experience and first-hand knowledge about what steps are the most beneficial and what activities provide distraction or lead to misstep along the way. I commend this fine volume to the reader’s attention and trust it will provide the support and assistance to make candidacy for board certification in clinical neuropsychology as rewarding an experience as possible and to render the process user friendly and fluid. We all continue to aspire to the goal of having most, if not all, qualified practitioners of clinical neuropsychology achieve ABPP/ABCN board certification. Linas A. Bieliauskas Executive Director American Board of Clinical Neuropsychology Ann Arbor, Michigan

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Prologue

Preface This book reflects as much a process as it does a product. In fact, many of the ideas presented can be traced to 2002, when about a dozen friends decided to pursue board certification in clinical neuropsychology through the American Board of Professional Psychology (ABPP). They had heard rumors, some of which persist to this day, about how difficult and time consuming the route to board certification was. So, they decided to approach the task the same way they made it through graduate school—by joining forces and dividing the work into smaller, more manageable parts. In the process, they learned that becoming board certified, though no picnic, was not nearly as painful as they had been led to believe. They began spreading the word and inviting friends and colleagues to freely use and add to the resources that the group had developed. Over time, this peer support group grew impressively larger, and eventually developed its own website and email listserve. You may now know this group as “BRAIN” (which stands for Be Ready for ABPP in Neuropsychology). BRAIN’s increasing membership made it clear that well-trained, boardeligible neuropsychologists still sought resources to help them through the certification process. BRAIN eventually became a standing committee of the American Academy of Clinical Neuropsychology (AACN), so that the efforts of both groups could be combined. At around the same time that BRAIN was growing and gaining more recognition, AACN and Oxford University Press were developing the AACN Workshop Series. Consequently, we (the authors of this book) were asked to draw upon our experiences as part of the current leadership of BRAIN to write this “how to” book. The hope was that by doing so we would create a book that could be used by readers such as you (or your trainees) as a guide to effectively and efficiently achieve board certification in clinical neuropsychology through ABPP (without, of course, sacrificing your sanity!). We cannot take full credit for the material in this book. In the truest sense, the content stems from a collective wisdom that has developed every time a peer, colleague, or trainee asked a question or contributed an idea toward making the preparation process easier or more efficient. The many

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members of BRAIN have contributed most significantly to the tips and preparation strategies you will read here. We do not have room to thank them all individually, but we do want to gratefully acknowledge their input and express our sincere appreciation for their ongoing devotion, collegiality, optimism, and generosity in sharing ideas and volunteering their time to help qualified neuropsychologists become board certified. If you have additional study tips or ideas for improving this book, we invite you to contact us. We cannot guarantee that we will be able to incorporate every recommendation into future revisions, but we assure you that your ideas will be considered carefully. As you will read, we fervently believe in the importance of ABPP certification in clinical neuropsychology and are convinced that, by sharing the accumulated wisdom of successful candidates, we will move toward our goal of having all qualified clinical neuropsychologists become boarded. We welcome your input and hope that you find this book useful in your own pursuit of board certification. We believe your work will be well worth the effort!

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Preface

Contents

Chapter 1

Introduction The Whos, the Whys, and (Some of) the Whats

Chapter 2

The Written Application and Credential Review Taking the Plunge 27

Chapter 3

The Written Examination Less Painful Than You Think

Chapter 4 Chapter 5 Chapter 6

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The Practice Sample Showcasing Your Clinical Talents The Oral Examination One More Hurdle to Go

References Index

67

87

Staying Motivated Surviving Bumps in the Road Epilogue

3

123

131 133

135

About the Authors

139

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BOARD CERTIFICATION IN CLINICAL NEUROPSYCHOLOGY

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1 ■■■ Introduction The Whos, the Whys, and (Some of) the Whats

Welcome! We are so glad you decided to take this step toward board certification in clinical neuropsychology or, if you are a supervisor, toward preparing your trainees to take that step. This book has been written for you. It provides support and down-to-earth advice for practicing neuropsychologists who are pursuing board certification via the American Board of Clinical Neuropsychology (ABCN), a specialty board of the American Board of Professional Psychology (ABPP). It also provides neuropsychology supervisors and their trainees with information that will give a “leg up” on the preparation process. We (the authors) share the belief that the discipline of clinical neuropsychology and the consumers of neuropsychological services are best served by the board certification of qualified clinicians. We also know that qualified clinicians, like you, lead busy lives and need practical information and advice if you are to become board certified. Consequently, we take a decidedly pragmatic tone in this book. Who are we and, more pointedly, why should you trust our advice? The reasons are several. First, each of us completed ABPP/ABCN certification only a few years before writing this book, so the preparation process and the up-to-date procedures are still fresh in our minds. Second, collectively we represent the full developmental spectrum of clinical neuropsychological practice, from pediatric to geriatric. Third, each of us is experienced in mentoring individual trainees and peers through the board certification

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process. Fourth, our involvement in Be Ready for ABPP In Neuropsychology (BRAIN), a board-preparation support network that we will tell you more about later, has given us unique insight into successful and unsuccessful preparation strategies. Finally, through personal and professional connections (mixed with a healthy dose of impetuousness and gall) we have been able get the “inside scoop” on important aspects of the process. In this introductory chapter, we will describe the multiple potential benefits of board certification, followed by straight talk on some myths and misinformation you may have encountered about ABPP/ABCN and the certification process. Our goal is to help you to appraise realistically how board certification fits into your life and career plans. In this chapter you will also find important resources that you can (and should) access to make this process easier. Finally, we will introduce the rest of the book, which provides step-by-step advice regarding the practical aspects of getting board certified through ABPP/ABCN. Before moving on, you should take a moment to look over Box 1.1. Within the first pages of this chapter, we have already managed to throw three acronyms at you: ABCN, ABPP, and BRAIN. Box 1.1 will help you sort through these and the rest of the “alphabet soup” of acronyms and organizations within neuropsychology—the “who’s who”—that you will encounter as you pursue board certification.

Why Bother? The Benefits of Board Certification Now that you know who’s who, it’s time to get to the “why” of the matter. Simply stated, ABPP/ABCN board certification benefits the practitioner, the profession, and the public. Box 1.2 summarizes some of these benefits. We cannot guarantee that you will personally benefit from board certification. We have no crystal ball, and the benefits you might receive once you become certified will vary depending on your situation. Given our unpredictable career paths, some of the benefits from board certification may not be apparent for years. That being said, in our experience, every neuropsychologist who has achieved ABPP/ABCN certification can point to multiple personal benefits.

Benefits to the Practitioner On a basic level, getting boarded could boost your income or job security. The most recent neuropsychology salary survey (Sweet et al., 2006) showed that ABPP/ABCN-certified neuropsychologists on average earn one-third

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Board Certification in Clinical Neuropsychology

BOX 1.1 Alphabet Soup: Making Sense of the Acronyms APA

American Psychological Association. Founded in 1892, this is the dominant professional membership and advocacy organization in professional psychology. As a membership organization, APA has relatively minimal standards for entry, and consequently cannot be considered a strong credentialing body.

ABPP

American Board of Professional Psychology. Created in 1947 with the support of the APA, ABPP is the most highly respected credentialing board in professional psychology. It is composed of a unitary governing body and 13 affiliated specialty boards linked to subdisciplines such as clinical psychology, clinical health psychology, forensic psychology, rehabilitation psychology and, of course, clinical neuropsychology.

ABCN

American Board of Clinical Neuropsychology. Created in 1981, ABCN is the ABPP specialty board responsible for developing and implementing the assessment procedures that are specific to ABPP certification in clinical neuropsychology. Becoming board certified in clinical neuropsychology involves passing the general requirements of ABPP and the specific requirements of ABCN. Because these requirements are melded together, we will often refer to ABPP/ABCN together. Note that the shared responsibilities of ABPP and ABCN can lead to somewhat confusing credentialing labels; you will find that board-certified individuals denote this credential in different ways, including ABPP/ CN, ABPP-CN, or ABPP/ABCN. These acronyms all mean the same thing: board certified in clinical neuropsychology by the ABCN and ABPP. (continued)

BOX 1.1 Alphabet Soup: Making Sense of the Acronyms (Continued) AACN

American Academy of Clinical Neuropsychology. Established in 1996, this is a membership organization composed primarily of individuals who have been board certified by ABPP/ABCN. Non-ABPP/ABCN-certified individuals also can apply to become “affiliate” members; affiliates cannot vote but enjoy many of the same benefits as voting members. AACN is not the same as ABCN. In fact, ABCN and AACN are legally separate because there is a potential conflict of interest when the same body that is involved in credentialing is also involved in professional advocacy. ABCN handles the specialty credentialing. AACN focuses on advocacy and education, including a yearly convention that is open to all neuropsychologists (not just those who are board certified). If you are interested in the history of ABCN and AACN, see Yeates and Bieliauskas (2004).

APPCN

Association of Postdoctoral Programs in Clinical Neuropsychology. Created in 1992, this is a federation of postdoctoral residency/fellowship programs that share a common mission: “to foster the development of advanced postdoctoral education and training programs in clinical neuropsychology and to establish standards for residency programs in clinical neuropsychology that lead to the development

of competency in this area of specialty practice.” All APPCN programs are led by an ABPP/ ABCN-certified clinical neuropsychologist and are intended to prepare trainees to pursue ABPP/ ABCN certification. Although you do not need to have an APPCN fellowship to pursue ABPP/ABCN certification, it is good to know that they are designed to prepare you for the process. APPCN uses a computerized trainee match program that also integrates many non-APPCN training programs. ABPN

American Board of Professional Neuropsychology and American Board of Pediatric Neuropsychology. Neither ABPN nor ABPdN is part of ABPP. In a different context, ABPN is also the acronym for the American Board of Psychiatry and Neurology, a specialty board in the American Board of Medical Specialties. There is no affiliation between the medical version of ABPN and the neuropsychology version of ABPN (or ABPdN or ABCN, for that matter).

ABPdN

American Board of Pediatric Neuropsychology. An independent neuropsychology board that is not affiliated with ABCN or ABPP.

BRAIN

Be Ready for ABPP in Neuropsychology. This is a free peer support organization founded in the early 2000s with the goal of helping qualified clinical neuropsychologists achieve ABPP/ABCN certification. Three of us are founding members of BRAIN and all four held leadership positions in the organization at the time we wrote this book.

BOX 1.2 Some Benefits of Board Certification Benefits to the Practitioner • Better pay and job satisfaction • Job security • Streamlined credentialing • Preserved credentialing • License and practice mobility • Prestige within profession • Credibility in eyes of colleagues and referral sources • Renewed emphasis on learning

Benefits to the Profession • Set standards for competence • Uniform training models for competence • Increased breadth and depth of knowledge base of practitioners • Preserved self-regulation Benefits to the Public • Reduced confusion • Quality assurance

more and are significantly more satisfied with their income and job than those who are not ABPP/ABCN certified. Obviously, income and job satisfaction are dependent on a lot of factors, but board certification is one of the best single predictors of both (Sweet et al., 2006). Furthermore, some institutions specifically link bonuses and promotions to board certification. Others require board certification or its timely pursuit as a condition of employment. It appears that, if anything, more institutions are moving in that direction, so board certification may one day be critical for your job and salary, especially if you are relatively young in the profession. Perhaps you have considered changing positions. ABPP/ABCN certification may help here too, by streamlining the credentialing process at state licensing boards, insurance companies, and professional practice networks. Indeed, with increasingly restrictive criteria being used to join and maintain membership on some insurance panels, board certification can help you to stand out. In addition, if you are considering a private practice, it is worth knowing that some malpractice insurance policies offer discounts to ABPP-certified psychologists.

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Board Certification in Clinical Neuropsychology

ABPP/ABCN certification is intended to be a marker of competence in the specialty area of clinical neuropsychology. In a field like neuropsychology, where there is insufficient regulation of training and competence, board certification is an important means of identifying yourself as competent based on having been examined using objective, rigorously defined methods. This may lead to increased referrals from clinicians, families, and lawyers who have come to trust board certification procedures, as well as increased credibility in both clinical and legal proceedings. On a personal level, if you harbor deep dark doubts about a self-perceived shortcoming in your background (e.g., you did not get into the “right” graduate school, internship, or postdoc), becoming ABPP/ABCN certified makes an unambiguous statement that your knowledge and skill set in clinical neuropsychology can stand tall next to some of the best in the field. If you are involved in a training program, being board certified can help you attract excellent candidates as well. Sure, there are celebrities in neuropsychology who will attract great trainees even if they are not board certified. However, odds are that, marvelous as you are, you have not quite reached celebrity status . . . yet. For you (like us) ABPP/ABCN certification is important because savvy trainees seek out positions that are supervised by board-certified neuropsychologists. Why? Consider the potential impact of your board certification status on them. The value of your name on a student’s vita or letter of recommendation is often based on your reputation. Unless you are a celebrity in the field, your students may be applying to jobs and placements where the reviewers have never heard of you. When faced with tough decisions about evenly matched applicants, reviewers look at the quality of former supervisors and recommenders. If you are an “unknown” without board certification, your name may carry less weight than it may if you are ABPP/ABCN certified. If you work at a hospital or receive referrals from physicians, you can bet that most of your medical colleagues already assume that you are board certified. After all, they had to undergo their own stringent board certification procedures. In this context, the fact that you are not board certified may look odd. At the very least, you may have some explaining to do. Be honest in your explanation—there is a rigorous board process in clinical neuropsychology that is widely recognized and respected, even if you have not yet pursued it. Sure, board certification has not penetrated psychology as much as it has medicine, but clinical neuropsychology boarding has been around for only 25 years, compared to over a century for medical boarding.

The Whos, the Whys, and (Some of) the Whats

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Given its rapid expansion, we predict that board certification in clinical neuropsychology will become the expected standard, as it has in the medical subspecialties, within the span of your career. Finally, in the process of becoming ABPP/ABCN certified, you will learn a tremendous amount. Time limitations and practicality have no doubt dictated that you focus on specific clinical populations in your training and clinical work. Even the broad exposure that you received as a trainee is prone to “getting stale” in areas you do not use regularly. In preparing for board certification, you will be surprised by the things that you did not know or that you mistakenly thought you knew. More sobering are the things you will realize you probably should have known all along because they are directly relevant to your daily work. This is the value of continuing education. Pursuing board certification allows you to prioritize continuing education in a way that is otherwise very difficult to do. Without a doubt, you will end the process with more depth and breadth of knowledge than when you started. Moreover, though it is hardly worth mentioning, you will get several hours of American Psychological Association (APA)-approved CE credit when you are done with the process, which is helpful when it is time to renew your license or hospital privileges.

Benefits to the Profession and the Public With rare exception (e.g., in the State of Louisiana), the term “neuropsychologist” has little legal protection. Almost any practicing psychologist can call him or herself a neuropsychologist, and in some jurisdictions, even masterslevel clinicians might legally do so. Anyone who has been in the field long enough has encountered reports from self-proclaimed “neuropsychologists” who clearly lack the training and clinical acumen to work competently in this specialized area. Ethics codes and legal mandates generally prohibit practicing outside of one’s area of competence, but an uninformed clinician is not in a position to “know what he or she does not know.” In addition, in all but the most egregious cases, it is extremely difficult to prove that a clinician has practiced outside of his or her boundaries of competence. In the absence of a clear standard for specialty competence, the reputation of the profession is sullied whenever the title “clinical neuropsychologist” is paired with poor quality work. The profession is also vulnerable to definitions from the outside (e.g., state bureaucrats) or from those whose allegiances are more with their own financial security than with the good of the public. An important way the profession can prevent this kind of

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Board Certification in Clinical Neuropsychology

counterproductive meddling is by establishing and promoting objective, high standards for specialty competence and a rigorous means of demonstrating this competence via board certification. The profession also benefits when there is some uniformity in its training models and when its members strive for a comprehensive knowledge base. At the time we wrote this book, the Houston Conference guidelines for training (Hannay et al., 1998) comprised the single most widely recognized and respected training model in clinical neuropsychology. ABCN is the only neuropsychology certifying organization that has explicitly endorsed the Houston Conference guidelines for training. Further, because clinicians who pursue board certification typically undertake extensive continuing education, the process builds the field’s overall breadth and depth of knowledge. When you pursue board certification, you also join ABCN and ABPP in their mission to protect public welfare. Aside from board certification, John Q. Public has no way to distinguish a legitimate specialist from a questionable character. We have all been in a similar situation when we needed a plumber, auto mechanic or other service professional, but the stakes are much higher here. Neuropsychologists assist with key decisions about people’s lives—the appropriate care of an elderly parent, the proper educational setting for a brain-injured child, and so on—that have significant and lasting effects. An inadequately trained or skilled clinician poses a real risk of not only being ineffective, but also actually hurting people. Objectively verifiable board certification protects the public by designating individuals who have passed rigorous criteria for specialized competency (anyone can look up providers at the public ABCN and ABPP web sites). Further, it reduces public confusion by defining who we are as a profession, what our background is, and what we do. In short, board certification is good for the profession and good for the public. By extension, when you, the competent neuropsychologist, pursue and achieve ABPP/ABCN certification, you will strengthen the profession as a whole and promote public welfare. Indeed, we believe that the profession and public will be in the best position when, as with medical boards, board certification becomes the accepted standard in clinical neuropsychology.

Myths, Distortions, and Plain Nonsense Now that we have laid out the benefits of board certification, let us address some of the potential deterrents. There is a lot of misinformation floating around that we hope to set straight. Here’s what’s what.

The Whos, the Whys, and (Some of) the Whats

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Myth 1: Nobody is board certified, so you don’t need to bother. It is true that the discipline of psychology has been later than the discipline of medicine to adopt board certification as the expected clinical credential needed to practice. However, ABPP certification has been growing rapidly. Moreover, the number of new certifications in the specialty of clinical neuropsychology recently has either exceeded any other ABPP specialty, or been a close second to the clinical psychology specialty, which has been recognized longer and has a much larger potential applicant pool (Sweet, 2008). Unless you plan to practice in a remote setting, many of your colleagues in town (or your competitor!) are likely to become ABPP/ABCN certified soon, if they are not already. Myth 2: Board certification amounts to little more than a popularity contest. Don’t confuse ABPP/ABCN certification with membership in a “vanity board” or with “fellow” status in some professional societies. “Vanity boards” have no meaningful standards for entry, and may even grow from groups of friends nominating each other. Vanity boards have no positive role in protecting the profession or public, and can in fact harm both. Fellow status in a society is a legitimate professional honor, granted to people by virtue of their reputations and past accomplishments, which for some academic psychologists does not concern clinical practice at all. Nevertheless, obtaining fellow status often involves peer nominations and a vote by society members or board of directors. In contrast, ABPP/ABCN certification involves a wellstructured and objective four-step progression, which is outlined in Box 1.3. Each of these steps will be discussed in considerable detail in their respective chapters. For now, it is important to know that there are these four steps, and that they are based upon what you know, not who you know or your prior accomplishments (see also Myth 4). Myth 3: All board certifications in clinical neuropsychology are alike. This has probably been the most contentious topic facing the subdiscipline for the past couple of decades. As of the time we wrote this book, there were three boarding systems that provided credentials in clinical neuropsychology: ABCN, American Board of Professional Neuropsychology (ABPN) and the newest comer, American Board of Pediatric Neuropsychology (ABPdN). Of these, only ABCN is affiliated with ABPP. There are no rules prohibiting anyone from becoming certified by more than one neuropsychology board. However, all four of us are board certified solely through ABPP/ABCN. Here are some of our reasons. First, we believe that ABPP/ABCN certification is more desirable than certification through independent organizations. As

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Board Certification in Clinical Neuropsychology

BOX 1.3 Steps of the ABPP/ABCN Certification Process Four basic steps: 1. Initial application and credential review. You will submit application materials that allow ABPP and ABCN to review your background, training, licensure, and ethics history (if any). The goal is to screen out people who are unlikely to pass later steps. 2. Written examination. You will need to pass a 100-item multiple-choice exam covering topics relevant to the practice of clinical neuropsychology. 3. Practice sample review. You will submit two neuropsychological evaluations that you have conducted, including de-identified test protocols, data sheets, and reports. This will be reviewed by 3 to 4 boarded neuropsychologists and rated as “acceptable” or “unacceptable.” 4. Oral examination. You will undergo an oral examination broken into three 1-hour segments: defense of practice samples, ethics/professional issues, and “fact-finding” (a simulated evaluation process designed to look at your clinical process and formulations). Other important information about the process: There is a (liberal) time limit. Once you pass the initial application and credential review, you have up to 7 years to finish the remaining three steps. You can move on to the next step only after you pass the earlier one. For example, you cannot have your practice samples reviewed until you pass the written examination. After the initial application and credential review, you have up to three chances to pass each step. For example, you can take the written exam up to three times if needed. Even if you stumble on all three attempts at a given step, you can restart the process after the 7-year period has elapsed. ●

●

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The Whos, the Whys, and (Some of) the Whats

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one of 13 specialty boards within ABPP, ABCN is recognized and endorsed by the largest, oldest, and most respected board certification organization in professional psychology. Although the APA has not endorsed any specific specialty board, ABPP is an outgrowth of the APA. Moreover, ABPP was modeled after the American Board of Medical Specialties (ABMS), which is the dominant umbrella board for medical subspecialties. The steps in the ABCN certification process closely parallel those of the medical specialty boards, with similar pass rates as well (McSweeny et al., 2004). Second, ABCN is the largest and most influential clinical neuropsychology board. When we wrote this book, ABCN was at least twice the size of other credentialing bodies in neuropsychology and also growing at a faster rate. It had certified over 600 clinical neuropsychologists by the first half of 2007, which is more than twice the number that had been certified less than a decade earlier. Furthermore, although ABCN focuses exclusively on the board certification process, its sister organization, the American Academy of Clinical Neuropsychology (AACN), is energetically involved in advocacy and education, including a successful yearly convention that is open to all. Many recognized leaders in the field of clinical neuropsychology (e.g., authors of major neuropsychology texts, those holding elected office in neuropsychology organizations) are ABCN certified. Third, ABPP and ABCN have taken exceptional care to ensure the most ethical credentialing process possible. Some examples of this will be listed in our response to the next myth. For now, it is worth noting that even the separation of ABCN (which sets and maintains board certification standards) and AACN (which is a membership organization that charges dues and has educational and advocacy missions) is intentional. Although the point can be subtle, there is a potential conflict of interest when the same organization that awards board certification is also involved in professional advocacy. Myth 4: ABCN is an “old boys’ network.” One of the most widely perpetuated myths is the belief that you have to be part of an “in” crowd to become ABPP/ABCN certified. We cannot assure you enough that this is false. In fact, great pains have been taken to ensure a fair assessment, regardless of “who you know.” For example, of the four steps in the assessment process, two (the written examination and practice sample review) are scored completely “blind” to the candidate’s name, background, or affiliation. There cannot be such blinding in the initial application and credential review but, as you will see in Chapter 2, this step is almost a “gimme” for anyone with a reasonable background in clinical neuropsychology. In

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Board Certification in Clinical Neuropsychology

addition, as described in Chapter 5, though it is impractical to “blind” the face-to-face oral evaluation, there are well-defined procedures for avoiding bias and conflict of interest during that step. There are plenty of opportunities for you to appeal decisions or provide feedback on the process. In fact, you can appeal an unfavorable decision at any step. Moreover, your feedback will be solicited at all steps beyond the initial application. For example, after the oral examination, you will get a chance to anonymously rate the performance of your examiners and to make suggestions for improvement of the examiners and the process. Don’t worry; the examiners don’t get your feedback until after they have finalized their ratings, so you need not fear negative repercussions. As will be described in Chapter 4, ABCN has developed an automatic appeal process for the practice samples that allows you to have an additional review if your sample is not accepted. This helps ensure that you have not fallen victim to an overly critical review. Finally, for the written examination, there is an ongoing reappraisal of the accuracy, writing, and psychometric quality of individual items by practicing neuropsychologists and by an independent test-development service (Professional Evaluation Service; the same folks who run the national Examination for Professional Practice in Psychology or EPPP). If only everything in life was as self-consciously fair as the ABCN process! Oh, and for those who think the “boys” part of “old boys’ network” is still applicable, it may surprise you to know that about half of ABPP/ABCNcertified individuals are women (Sweet et al., 2006). Myth 5: Not passing a step in the ABCN process means you are incompetent or unqualified to practice neuropsychology, let alone become board certified. This myth may have roots in the insecurity of individual applicants, but unfortunately it has been fertilized by misleading statements by some professionals, even in print (Rohling et al., 2003). ABPP/ABCN’s central assertion that board-certified practitioners are competent clinical neuropsychologists is not a statement about anyone who is not board certified. ABCN and ABPP draw no conclusions about those who have not been board certified, for two very good reasons. First, it is understood that many practicing clinical neuropsychologists have not yet attempted to become board certified. Second, as you no doubt know from your own clinical work, a single test performance is the product of many factors, only some of which are of primary interest. For example, with the ABPP/ABCN oral examination, you can imagine that anxiety or unfamiliarity with test procedures might

The Whos, the Whys, and (Some of) the Whats

15

play important roles. As a result, competent clinicians may get tripped up at some step in the ABCN process (McSweeny et al., 2004). That said, not passing a stage of the process can feel pretty disheartening. Clinical neuropsychology is part of who you are, your identity. It’s probably right after your name on your business card, your reports, and the wall outside your door. It is natural for you to pose hard questions if you—who may not have been an academic superstar but who has always at least passed (for crying out loud)—get feedback that you did not pass a step in the ABCN process. If this happens to you, Chapter 6 can help get you through. In the meantime, realize that no one else is questioning your competence, least of all ABCN or ABPP. In fact, ABCN and ABPP will not release the names of candidates until they have passed all four steps of the process and have consequently become board certified. Moreover, when you take the written and oral examinations, which are semi-public because you will see other applicants, you will be required to sign a statement of confidentiality. That statement prohibits revealing the identity of your fellow test-takers, in addition to specific information about test content. So, in terms of public embarrassment, no one else should know that you even attempted a given step in the process unless you have told them, let alone how well you did. Myth 6: Getting tripped up on one step will be held against you later. As noted in Box 1.3, after you pass the initial credential review you are allowed three tries at each step in the process before you are required to start over completely. If you stumble on one of the steps, we strongly recommend that you try again. The number of times that you attempt any given step is never revealed to the examiners. Once you pass a step, you pass the step, regardless of how many times you have attempted it. The flip side, of course, is that there are no bonus points for doing really well on any given step. The only exception, we suppose, are your practice samples. Since onethird of the oral examination involves discussing your practice samples, that part might be easier if your practice samples excel. Even so, the oral examiners will have no idea if the practice samples they see are your first submission or your third. Myth 7: Only academic neuropsychologists are board certified. Why would a strictly academic neuropsychologist waste their time and money? Board certification in clinical neuropsychology is a clinical credential, not an academic one. The primary benefits to the individual (e.g., insurance credentialing, practice portability) are in the clinical realm. The ABCN web site even notes that board certification may particularly benefit private

16

Board Certification in Clinical Neuropsychology

practitioners who cannot rely upon an institutional affiliation as evidence that they are competent. Given this, it is no surprise that the vast majority of individuals who have been ABCN certified hail from applied settings: private practices, clinics, or hospitals (Sweet et al., 2006). Myth 8: The assessment process is out of touch with clinical practice. ABCN is run by clinicians, for clinicians. Sure, there is a written examination, but many of the examinees that we know have repeatedly commented on how applied most of the questions are. Other clinical board certification processes, including some medical subspecialty boards, include a similar written examination. Beyond the written exam, other aspects of the ABPP/ABCN process are designed to clearly evaluate the breadth and depth of your clinical skills. For example, your practice samples are real cases from your clinical practice. The three parts of the oral examination relate to your practice sample, your ability to elicit clinical information and formulate a clinical case, and your understanding of ethical and professional practice principles as they apply to clinical work. Myth 9: ABCN is biased against pediatric and child clinical neuropsychologists. Nearly half the number of ABPP/ABCN-certified clinicians work either exclusively with children or with both adults and children (Sweet et al., 2006). Furthermore, three of the four authors of this book do clinical work almost entirely with children. To be fair, clinicians who work exclusively with children do face some unique challenges in their preparation for boards. For example, because brain-behavior relationships are less likely to yield “classic” syndromes in children than in adults, pediatric and child clinical neuropsychologists often spend much more of their professional time considering developmental, functional, and contextual issues. The minutia of neuroanatomy knowledge, especially for those who deal primarily with neurodevelopmental conditions, can slowly fade due to disuse. Consequently, child-oriented clinicians may need to focus their ABCN preparations a bit more on functional neuroanatomy, and yes, they will need to learn about dementing processes that may not directly relate to their daily clinical work. However, we agree with ABCN’s assertion that a sophisticated understanding of how the brain underlies thought, emotion, and behavior is a key feature that distinguishes all neuropsychologists (child- and adultoriented alike) from non-neuropsychologists. Each of the ABPP/ABCN examination procedures has also been designed to minimize child versus adult biases. For example, specialized training in pediatric neuropsychology is just as relevant as training in adult

The Whos, the Whys, and (Some of) the Whats

17

neuropsychology in the initial credential review. The written examination balances items that are exclusively relevant to adult practice (e.g., dementias) with those that are primarily relevant to working with children (e.g., neurodevelopmental conditions). Practice sample reviewers are matched according to the age range of the cases; pediatric cases are reviewed by pediatric neuropsychologists, adult cases by adult neuropsychologists. In the oral examination, you will have a choice of “fact-finding” cases to work on: child or adult. Myth 10: You need to be in the field for a long time to get board certified—or conversely—Board certification is only for new graduates. These kinds of polarizing statements are both false and unproductive. It is true that, in the past, applicants needed to have been in the field for a few years before they would be considered. That is no longer the case; aside from requiring state licensure and adequate postdoctoral training (more on that in Chapter 2), there is no practice length requirement for ABPP/ABCN certification. In fact, we can think of advantages and disadvantages both for new and more “mature” (you’re not old) clinicians. For example, new graduates will tend to have a fresher academic knowledge, but may not yet have a natural flow in their clinical interviews and case conceptualizations. Mature clinicians on the other hand will have a sophisticated clinical acumen, but may need to refresh their knowledge in areas that are not part of their routine clinical practice. Myth 11: The failure rate is too high. We are not going to lie: You will find parts of the process challenging. However, with adequate training and preparation you will find the process entirely feasible, especially with help from this book. Furthermore, the pass rates are reasonable. For example, as you will read in the coming chapters, the application and credential review step has an initial pass rate well over 90%. It is true that each of the other steps may be more difficult and as a result the pass rate is lower. However it is also important to realize that not everyone who completes a formal training program has the same background and it may take more than one try to pass subsequent steps. The intent of the written exam, practice sample, and oral exam is to ensure that qualified individuals whose credentials are accepted actually possess the knowledge required for competent practice and can demonstrate their ability to apply that knowledge to actual cases. ABCN considers this important because, as McSweeny et al. (2004) observed, it is very difficult to revoke board certification once it has been awarded. Consequently, the potential for damage to the profession and the

18

Board Certification in Clinical Neuropsychology

public of awarding board certification to a non-deserving individual is difficult to reverse. For much the same reason, the medical subspecialties have similar pass rates for each step in their assessment processes. Of course, the cost of having a difficult test threshold is that some qualified individuals will not pass every step on their first attempt. The ABPP/ ABCN process is designed to help those qualified individuals if they are persistent. Yes, there is a possibility that you may have to repeat one or more steps. But as we have already noted, you can attempt a given step up to three times. Furthermore, we will give you resources in this book to increase your odds of passing on the first time. We will also give you strategies to help you try again should the need arise (e.g., the “6 Rs to Recovering Your ABPP/ABCN Groove” in Chapter 6). Persistence can pay off, and we strongly encourage people to persevere if they are tripped up by any part of the process. But, like the medical specialty boards, passing is not guaranteed, for the sake of public safety. Myth 12: It takes too darned long! We suppose this depends on how you define “too darned long.” As noted in Box 1.3, you have up to 7 years to complete the process once you have passed the initial credential review. However, you do not need anywhere near that long to do so. As the top portion of Figure 1.1 shows, in theory you could get through it all in less than 1½ years, only a year of which is “on the clock” (the figure includes the initial application and credential review process, which does not count against the 7-year time limit). Of course, the process usually is not that quick, for reasons within the evaluation process (e.g., having to wait for one of the two oral examinations each year) and outside of it (e.g., change in job or personal situation). The bottom portion of Figure 1.1 shows one of many possible alternative timelines. Remember, once you achieve ABPP/ ABCN certification, no one else knows or cares how long it took you to do it or how many bumps you experienced on the road. You’re board certified, and that’s that.

Help! (Accessing the Available Resources) You need not do this alone. There are many resources to help you in addition to this book, and we will point you in the right direction. Nonetheless, pursuing ABPP/ABCN certification is not like the EPPP, for which there are slick preparatory systems you can buy. The reason is simple: Whereas every year hundreds of people take the EPPP as they pursue licensure in psychology, only a few dozen begin the APPP/ABCN certification process. More test-

The Whos, the Whys, and (Some of) the Whats

19

Year 1 J

F M A M

J

J

Year 2 A S O N D

J

F M A M

J

J

A

S O N D

J

J

A S

Application Prep, Review Written Exam Prep and Scoring Work Sample Prep and Review Oral Exam Prep and Review

J

F M A M

J

J

A

S O N D

J

F M A M

O N D

Application Prep, Review Written Exam (did not pass first time around, then retook at next cycle) Work Sample Prep and Review Oral Exam Prep and Review FIGURE 1.1 Two of the many possible timelines for completing the ABPP/ABCN certification process. The top shows a “quickest case” scenario. The bottom shows the path of someone who retook the written exam. Applicants have up to 7 years to fi nish once their initial credential review is approved.

takers mean greater potential profit for study materials publishers, which is good motivation to put out more abundant (fee-based) resources for the EPPP. Fortunately, profit isn’t everything, and there are folks who have put together some very important resources for you to consider. This book is one resource. The others are ABPP, ABCN, AACN, and BRAIN. Box 1.4 summarizes what you should look for from each of these organizations, and how to access them (as of the time we wrote this book).

How to Use This Book The certification process can be overwhelming if you try to take it in all at once. That is why we have organized this book in a step-by-step fashion. Chapters 2 to 5 each cover a distinct step in the process. Within each chapter, you will find ●

●

20

a description of the task you will face and what is being assessed the actions you should take to prepare

Board Certification in Clinical Neuropsychology

BOX 1.4 Major Resources You Should Access ABPP (American Board of Professional Psychology) What they provide: An overview of ABPP and what board certification means to psychology and to the public A summary description of the ABPP and ABCN requirements An access point to ABCN Important forms you will need at each step of the ABPP/ ABCN certification process; if you go to the web site, be sure to bookmark the “forms” link ●

●

● ●

How to access them: Via web: www.abpp.org Via e-mail: offi[email protected] Via phone: 1-800-255-7792 or 1-912-234-5477 Via fax: 1-912-234-5120 Brick-and-mortar address: 300 Drayton Street, 3rd Floor, Savannah, GA 31401 ● ● ● ● ●

ABCN (American Board of Clinical Neuropsychology) What they provide: A description of ABCN and what board certification means to clinical neuropsychology and to the public A detailed description of the ABCN requirements An overview of the examination process A listing of examination dates and deadlines Answers to “frequently asked questions” and Links to the application materials at the ABPP site and study materials at the AACN site ●

● ● ● ● ●

How to access them: Via web: www.theabcn.org Via e-mail: [email protected] (Note: e-mail will go directly to Linas Bieliauskas, Ph.D., ABPP/CN, the executive director of ABCN and executive secretary of the AACN) ● ●

(continued)

The Whos, the Whys, and (Some of) the Whats

21

BOX 1.4 Major Resources You Should Access (Continued) ● ● ●

Via phone: 1-734-936-8269 Via fax: 734-936-9761 Brick-and-mortar address: Department of Psychiatry (F6248, MCHC-6), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109

AACN (American Academy of Clinical Neuropsychology) What they provide: A description of the AACN and its mission, Information on relevant educational programs Links to ABPP and ABCN Information on a mentorship program that can connect you with an ABPP/ABCN-certified individual who helps you through the process after your initial application is approved An excellent study guide that you should read in full. Yes, you should read the AACN study guide cover to cover. We consider our book to be a complement to that study guide, not a replacement. Also, the AACN study guide is free on the AACN web site, so you have nothing to lose AACN-sponsored seminars on the ABPP/ABCN certification process at the major neuropsychology conferences, including the conferences of the AACN, the International Neuropsychological Society (INS), and the National Academy of Neuropsychology (NAN) ● ● ● ●

●

●

How to access them: Via web: www.theaacn.org E-mail, phone, fax, and brick-and-mortar information are the same as ABCN. ● ●

BRAIN (Be Ready for ABPP In Neuropsychology) What they provide: A description of BRAIN and its mission ●

(continued)

22

Board Certification in Clinical Neuropsychology

●

● ●

Information on a listserve-based peer support network of neuropsychologists who are in or have recently completed the ABPP/ABCN certification process Advice on how to approach each step of the certification process Study outlines, flash cards, sample tests, and sample study schedules, and for listserve members, coordinated study and support groups leading up to each major administration of the ABPP/ABCN written and oral examinations. BRAIN is driven by the voluntary efforts of its members, as coordinated by a leadership group (all unpaid). You should expect to find energetic, supportive, and pragmatic folks on the BRAIN listserve (which you should join—it’s free!). You should also expect a number of freely available study materials at the web site. You should not expect these materials to be extremely polished. BRAIN is an elaborate study support network—like a group of friends sharing notes—not a commercial producer of study materials

How to access them: Via web: www.cincinnatichildrens.org/svc/alpha/n/neurobehavioral/ brain. You can also link to the BRAIN site via the AACN web site. There is no centralized BRAIN office, so there is no specific e-mail, phone, fax, or brick-and-mortar way to contact the organization. However, relevant e-mail addresses for specific individuals (e.g., listserve membership coordinator, web site monitor) are listed on the web site and, once you are on the listserve, you will be able to communicate readily with the whole network of (as of mid-2007) over 200 members.

●

●

● ●

a sneak peek at what is going on “behind the scenes” at ABPP or ABCN an estimate of how much time it will take to prepare and complete the step straight talk on additional myths potentially helpful resources

Each chapter also includes a section for trainees and supervisors. We think that preparation for board certification can and should start even before you

The Whos, the Whys, and (Some of) the Whats

23

finish your training. The “Supervisors and Trainees” section of each chapter provides tips on how to structure a training program to optimize the chances for success in the ABPP/ABCN certification process. The final chapter of the book describes the special circumstance of getting tripped up at some stage of the process. As we have already noted, there is a possibility that you will need to attempt a stage more than once. If this happens, it is likely to raise some tough feelings and decisions that warrant a dedicated chapter. We hope you will not need it and that this book will help you to avoid this experience, but it is there if the need arises. There is one important point that might disappoint some readers: This book does not provide detailed study outlines or other neuropsychological content. This is an intentional choice that was made for several reasons. First, the field is constantly evolving, limiting the “shelf life” of these kinds of study materials. Second, study outlines are already available for free on the BRAIN web site. The BRAIN materials are not perfect, but they have been good enough for dozens of clinical neuropsychologists to become board certified, including the four of us. In fact, over the past few years, about 50% to 75% of each cohort completing the ABPP/ABCN process has received support and resources from BRAIN. Third, the page limitations of the AACN Oxford Workshop book series would make it impossible to do justice to the many topics that would need to be covered in content-based study materials. The popular books that offer study outlines for the medical boards are 500 to 700 pages long, with each page roughly twice the size of the book in your hands. Fourth, the cost that would be associated with making thorough study outlines and publishing them, when divided among the relatively small number of individuals pursuing ABPP/ABCN certification, would make this book prohibitively expensive. Most importantly, spending all that energy on outlines would simply miss the point of this book. Our goal is to help you chart your course, not to micromanage your studies. You’re a smart person. We are confident that, with some good advice and pointers toward the right resources, you can construct a study system and get the information that you need.

Supervisors and Trainees The process of preparing for ABPP/ABCN certification actually begins in graduate school, as trainees are developing foundation knowledge and skills in applied psychology broadly and in clinical neuropsychology specifically.

24

Board Certification in Clinical Neuropsychology

If you are a trainee reading this book: Congratulations! You’re right on time. At the time this book was written, most trainees obtained their doctorate—and many even finished their postdoctoral residency/fellowship—with only a vague sense of what ABPP/ABCN certification is about. That means they missed important opportunities to structure their training to best prepare themselves for board certification. If you pay particular attention to the “Supervisors and Trainees” sections of each chapter in this book, you will be able to catch those opportunities as they arise, putting you in an excellent position to pursue board certification down the road. If you supervise trainees: Thanks! Your efforts to prepare the next generation of clinical neuropsychologists are essential to the long-term health of the field and to the many members of the public who base key life decisions on the advice of a clinical neuropsychologist. The more you can build preparation for board certification into your training program, the better prepared your trainees will be. Indeed, simply demystifying the process can go a long way toward moving your trainees in the direction of this important professional landmark. As you read through this book, we encourage you to think of the best ways to prepare your trainees in advance for each step of the ABPP/ABCN certification process. Then check those against the ideas we have come up with in the “Supervisors and Trainees” section of each chapter.

Wrapping Up and Looking Ahead At this point, you should have a good sense of what is to be gained by pursuing ABPP/ABCN certification, a much better understanding of the reality of the process, signposts to key resources that you can access, and an understanding of how to use this book. We have covered a lot of ground already, but your work has just begun. The next step is for you to prepare the initial application and undergo credential review. As you will see in the next chapter that is a lot easier than you might think.

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2 ■■■ The Written Application and Credential Review Taking the Plunge

Now that you understand the various steps of the ABPP/ABCN process, you’re ready to take the first concrete step toward board certification. In our experience, this first step often feels much harder for people than it needs to be. To some degree, this might be due to some myths about the written application and credential review; we will deal with those in a minute. Mostly, though, the bottleneck seems to be emotional. As we noted in Chapter 1, working through the ABPP/ABCN certification process can feel as though you are risking your personal and professional identities. In that light, taking the first real step in the process is understandably anxiety provoking. It doesn’t need to be. This stage can be a lot of things—tedious, annoying, and somewhat costly, to name a few—but it is not challenging, and it sure isn’t risky.

Nuts and Bolts What Is the Task? Your job is to demonstrate that you are a viable candidate for board certification in clinical neuropsychology. Think about it: Anybody can apply for board certification, even your craziest neighbor, ex–college roommate, or relative. We know of some non-neuropsychology “vanity boards” out there that will take just about anybody who will pay the dues. ABPP/ABCN is not one of these “boards.” For serious applicants, the initial application and credential review is an easy hurdle to clear, but it does act as a

27

rough screen for those who really have no business pursuing ABPP/ABCN certification.

What Is the Process? You will be completing an application form, gathering supporting materials and letters of recommendation, writing a check, and mailing it all to ABPP. Anyone who has applied for entry into a graduate school, internship, or postdoc, or who has sent applications to a state licensing agency, professional practice group, or insurance panel will be painfully familiar with this sort of process. In other words, you are already an expert in this process.

What Is Being Assessed? Your educational and training background is scrutinized, with a particular eye toward the Houston Guidelines (Hannay et al., 1998). The reviewer is interested in whether your background indicates that you have a reasonable shot at getting through the board certification process. Frankly, if you did not have a shot, wouldn’t you like to know before you went through all the trouble of studying, not to mention the cost?

What Is Happening Behind the Scenes? All applications undergo initial review by ABPP to make sure you have appropriate basic credentials (e.g., doctoral degree, license), have not undergone ethics or legal disciplinary actions, and have all the needed paperwork (we will detail that a bit later). Applications that meet this initial level of review are then passed on to ABCN for a review of your specific background in clinical neuropsychology.

How Long Does This Take? This step requires you to pull together documentation of your training and background (e.g., transcripts, letters of recommendation), so you should figure on starting the process 1 to 2 months before you aim to submit the paperwork. Assuming that you have submitted all the needed materials, you should expect a notification of the decision within 4 to 6 weeks of submission. At the time we wrote this book, all notifications were by “snail mail,” rather than e-mail, phone, or fax. You can use that review time to prepare for the written examination if you have a good sense that your application will be accepted (the vast majority are accepted).

28

Board Certification in Clinical Neuropsychology

Myths, Distortions, and Plain Nonsense Myth 1: Having my application accepted would mean I would have to start studying right away (and I’m just not ready for that kind of commitment). This isn’t speed dating. ABPP and ABCN do not care how much of your allotted 7 years you take to get through the process. We think that it is better to build upon your momentum than to let it drop by waiting, but we suppose that you could stall for years before taking the written exam without losing eligibility. Don’t wait more than 5 years, though, or you will risk running up against the 7-year deadline if you hit any snags along the way. Myth 2: You are out of luck if part of your background or training is nontraditional. Yes, there are training “high-roads”: graduate programs, internships, and postdocs that have been pumping out excellent neuropsychologists for years. If you followed one of these paths (e.g., if you graduated from an APPCN postdoctoral program), you will not have to provide as much documentation. And, yes, as shown in Box 2.1, there are certain hard and fast rules about applying. For example, though the requirements are more flexible for folks who have been in the field for a number of years, anyone who completed his or her training on or after January 1, 2005, should be able to show that he or she has met the training guidelines of the Houston Model. These guidelines are outlined by Hannay et al. (1998), with relevant portions excerpted in the AACN study guide. Even within these seemingly strict guidelines, however, there is tremendous flexibility. For example, although some of your graduate school courses should have focused on brain-behavior relationships and at least some of your internship year should have been devoted to training in clinical neuropsychology, the actual amount of specialized training at each of these stages is flexible. It is not until the postdoctoral residency/fellowship that specific experiential guidelines are provided (the equivalent of 2 years of full-time supervised clinical neuropsychology training). Ultimately, all applicants are expected to have adequate training in general psychology, clinical psychology, brain-behavior relationships, and clinical neuropsychology practice. However, how each applicant obtains this training will vary. If you happened to have graduated from traditional training programs that are well known in the field and that incorporated these domains into your curriculum, you will not need to provide much documentation beyond the application form, your vita, and letters of support. The more nontraditional your background, the more you will need to document

The Written Application and Credential Review

29

BOX 2.1 Basic Eligibility Criteria Everyone needs the following: A doctoral degree from an accredited program in professional psychology (the specialty is flexible: clinical, counseling, educational, etc.). A license or certification at the level of independent practice (e.g., state or provincial license). Specialty training in clinical neuropsychology. The exact definition of this varies on the basis of when you completed training, as shown below. ●

●

●

If you completed training before 1981: You need ≥4800 hours (almost 3 years) of postdoctoral experience in a neuropsychological setting (supervised or unsupervised), at least half of which involved direct clinical service. ●

If you completed training between 1981 and 1989: You need ≥1600 hours (~1 year) of supervised clinical neuropsychology experience, either predoctoral or postdoctoral. ●

If you completed training between 1989 and 2004: You need to have had training in neuropsychology at an APA or CPA accredited university. three years of experience in the field, two of which were supervised by a clinical neuropsychologist, potentially including the predoctoral internship year. specialty training in the basic neurosciences, neuropathology, neuroanatomy, clinical neurology, psychological assessment, clinical neuropsychological assessment, psychological intervention, and psychopathology. ●

●

●

●

(continued)

30

Board Certification in Clinical Neuropsychology

If you completed training on or after January 1, 2005: Your background needs to conform to the training model of the Houston conference. For details, see Hannay et al. (1998) or the AACN study guide. Essentially, this is a flexible training model that requires the acquisition of a specified knowledge base and skills that are directly relevant to clinical neuropsychology. The acquisition of this knowledge base and these skills can occur at any level of training. Aside from the fact that these need to be acquired, the relative emphasis on each is flexible year to year throughout the predoctoral training and internship process. The equivalent of a 2-year full-time supervised postdoctoral residency/fellowship in the specialty is required. ●

●

how your training experiences provided you with adequate preparation to be a clinical neuropsychologist. The reviewers really do want well-trained people from a variety of backgrounds to become board certified; you need to help them understand your background experiences by providing adequate documentation. See Box 2.2 for ideas. Myth 3: Having primary mentors who are not board certified or who are certified by another neuropsychology board is a strike against you. This process isn’t personal. If you can document that you have adequate preparation, you will do fine. Myth 4: A lot of applications get rejected. According to the AACN study guide, about 92% to 95% of recent applications were accepted on the first try, and an additional 4% were accepted after the applicant provided supplemental clarification. Feel free to double check our math here, but that means that about 96% to 99% of applications are accepted. Fortunately, folks like your craziest neighbor, ex–college roommate, or relative seem not to bother applying. Myth 5: With a pass rate like that, I can slap things together in a day! We like your enthusiasm, but it takes some time to pull together the needed information and support materials. Channel your energy into the following steps.

The Written Application and Credential Review

31

BOX 2.2 Training Documentation Options Whenever possible, you should document the content and completion of each training experience. Here are some examples. Content

Confirmation of Completion

• Graduate school class name/description • Letter summarizing internship/postdoc • Syllabus of seminar • Detailed seminar schedule • Seminar advertisement with summary

• Official graduate school transcript • Letter confirming completion • Course continuing education (CE) credit verification • State licensing board CE transcript • Seminar certificate of completion

Steps to Success Step 1: Prep work (1 to 2 months pre-submission) Here is what you will need in advance: ●

32

A plan. Think about how you were trained in clinical psychology and in clinical neuropsychology. Think particularly hard about the eight topic areas listed in Box 2.3. Write them down, leaving a few lines between each heading. Then, for each area, list the formal and informal training experiences you have had, class by class, seminar by seminar, clinical training site by training site. Remember to include non– classroom experiences, such as radiology or neurology rounds. It is okay (and indeed likely) that some training experiences will cover more than one topic area. Make sure that every topic area is clearly covered, ideally with more than one experience. Now, make sure that you can document that each of these experiences really happened. Your graduate transcripts probably will cover

Board Certification in Clinical Neuropsychology

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a lot. Other aspects of your training may be documented via verification that you graduated from a well-recognized internship or postdoc. Anything else will require some form of additional documentation, such as a letter of support (see Myth 2). As much as is feasible, back up everything on your application with some sort of documentation (this may not be possible for some activities—e.g., attending radiology rounds— but try your best). Since that sometimes takes time to collect, it is good to plan in advance. In very rare instances, you may not be able to get all of the requested documentation. For example, suppose your postdoctoral supervisor passed away and—short of supernatural intervention—cannot document the nature of the training experience. If you find that you absolutely cannot get all the requested documentation, we recommend that you contact

BOX 2.3 Eight Key Training Areas You will need to show your training in the following areas: 1. Basic neurosciences (e.g., microarchitecture of the brain, neurochemistry) 2. Clinical neurology (e.g., neuro exam, classic neurological signs and syndromes) 3. Neuroanatomy (e.g., macrostructure of the brain, brainbehavior relationships) 4. Neuropathology (e.g., developmental, acquired, and neurodegenerative conditions) 5. Clinical neuropsychological assessment (e.g., common tools and approaches) 6. Psychological assessment (e.g., common tools and approaches) 7. Psychological intervention (e.g., therapy principles and application) 8. Psychopathology (e.g., diagnostic nomenclature, presumed etiology)

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●

●

34

ABPP and the ABCN for guidance. It is very likely that something can be worked out. Remember, the goal of the application and credential review is not to be obstructionist, but rather to screen out people who would be unlikely to succeed in the later stages. If you have a solid and relevant background, staff at the ABPP and ABCN will work with you to find a way to document that this is the case. Transcripts. At a minimum, you will need to request that an official copy of your graduate school transcript(s) be sent directly to ABPP. This is the only element that needs to be sent separately from your application; we recommend that everything else be mailed together in a single envelope. We also suggest that you get an extra transcript copy for yourself. Having your own copy can be helpful in your planning, and also when you fill in the parts of the application that ask for details regarding instructors and dates. While we have on very good authority that it is not a big deal if you ultimately cannot recall instructors’ names, generally it is a good idea to fill in everything on the application form that you can. References/Letters of support. You will need at least two letters of support, which means contacting potential references ahead of time. It is okay to have more than two (indeed, the AACN study guide says to send three, though the ABPP/ABCN application requests two), especially if you are trying to document aspects of your training that are nontraditional. Avoid trying to impress the reviewers with letters from “big name” folks who really did not train you and cannot speak to your abilities. Nonspecific pleasantries are unhelpful. It is much better to get letters from people who can speak positively and in specific terms about your training and abilities. Not all letters need to be from a senior neuropsychologist. On the other hand, the reviewer will need some assurance that one or more of your references really know what they are talking about when they write how very prepared you are to pursue ABPP/ABCN certification. Consequently, make sure that at least one of your letters is from a neuropsychologist who is either board certified or has an established reputation in the field.

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It can be helpful to let your references know how their letters fit your application plan. Are they simply giving an overview of a training program and indicating your success in it? Do you need them to speak about your background and/or abilities in a given area? It is important that your letters convey clearly that you are ready to pursue ABPP/ABCN certification. Other characteristics of good letters of support and recommendation are provided in Box 2.4. Finally, although your references may want to share their letters with you—and there is nothing at all wrong with that—make sure that the version you include with your application is a signed original on letterhead in a sealed, signed envelope.

BOX 2.4 Features of a Good Letter of Support/Recommendation Not every letter of support/recommendation should look alike. Even so, if you are writing such a letter, or if you have a chance to provide feedback on a letter written for you before it goes out, there are certain characteristics of good letters that you should consider. Good letters generally have the following features: ● ●

●

●

● ●

●

●

Are succinct (1–2 pages). Summarize the duration and nature of relationship between recommender and candidate. (If the recommender oversaw training experiences of the candidate) Summarize the experiences and indicate at least satisfactory (even exemplary) completion of training. (If the recommender is a colleague of the candidate) Summarize direct knowledge of candidate’s academic knowledge and clinical skill. Comment on professionalism and ethical standards. Make specific statements, ideally with examples, rather than sweeping generalizations. Make a clear statement that the candidate is qualified to practice clinical neuropsychology independently and to pursue board certification in clinical neuropsychology. Provide contact information in case there are further questions.

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●

An updated vita. There are no formatting requirements, but we suggest that you use an academic format, rather than an NIH-style biosketch. An academic format is more flexible. Be sure to summarize all of your relevant academic and clinical training experiences, current and past professional positions/ service, and publications and presentations.

Step 2: The actual application Once you have done your prep work, you should have all the information you need to complete the actual application form. If you do not already have the form, you can request it from ABPP, download it from ABPP’s web site, or download it from the BRAIN web site (see Chapter 1 for web site and brickand-mortar addresses). We like the third option because, unlike the others, the form on BRAIN loads readily into word-processing software. Remember, though, to cross-check the BRAIN form with the official one from ABPP to make sure that the BRAIN form is current. After you have completed the form, it is a good idea to have a colleague look it over, as well as take a gander at your vita, and any other supporting materials you have prepared. The goal is for the colleague to be able to easily identify and verify what you have done to prepare you for board certification, especially in the eight content areas listed in Box 2.3. He or she can also check for typos, inconsistencies, and anything else that might appear questionable or confusing. Just before you send off your application, photocopy it for your records. Then go ahead and send it and the requisite fee, following the checklist in Box 2.5.

BOX 2.5 Application Checklist All application and credential review materials should be sent to ABPP, not ABCN. After ABPP staff review the application, they will forward it to ABCN. Sent separate from your application packet: One copy of your official graduate school transcript(s) ●

(continued)

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Application packet (sent together): Completed application form Letters of recommendation in individually sealed, signed envelopes Updated vita (do not send article reprints or copies of poster handouts; just list them) Supporting documentation (e.g., copy of current state license, materials from Box 2.3) Application fee ● ●

●

●

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Supervisors and Trainees Your application and credentials will not be formally reviewed until you hold a state or provincial license in psychology. However, there are several things that trainees and their supervisors can do ahead of time. See Box 2.6 for suggestions on how to get a leg up on board certification.

BOX 2.6 Tips for Supervisors and Trainees Tips for Trainees If you can, get an unofficial copy of your graduate school transcript(s). Many schools allow you to download them for free, at least up to and shortly after you graduate. If you are a postdoc, go ahead and request several copies of your official transcript, but don’t open them. You are going to need them soon, not only for ABPP/ABCN, but also for other credentialing processes (e.g., insurance panel credentialing, professional practice panels). As long as they have not been opened (most come with an official seal), they should retain their “official” status, thereby saving time later. You can do most of Step 1 (“Prep work”) ahead of time. This has several advantages. First, it can help you identify weak areas that you can boost in the context of your ongoing ●

●

●

(continued)

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BOX 2.6 Tips for Supervisors and Trainees (Continued)

●

●

training. Second, it will get you thinking about the folks from whom you will want letters. Third, you will be able to collect any necessary documentation on training as it happens (rather than cobbling through your old records after the fact). Finally, having the materials all pulled together will make the application process go quickly and easily, when it is time. Consider ABPP’s “Early Entry Application” (see the ABPP web site), which was designed to help trainees “bank” their credentials as they earn them. As of the time we wrote this book, this option was brand new and essentially untested, but we can see the potential advantages. Post docs: work toward state licensure (e.g., take the EPPP exam) before you finish your residency/fellowship. You are going to want that for your first job anyway, and you can start the ABPP/ABCN process more formally only after you are licensed.

Tips for Supervisors Familiarize yourself with the eight areas on which your trainees will be evaluated (Box 2.3). Keep these in mind when designing the program for your trainees, and when writing their letters of recommendation. Help your trainees make a plan and find time for tackling the application and credential review process. Make it a priority; if you don’t, other obligations will fill their time. In fact, it would not hurt to require postdoctoral residents/ fellows to put together most of their application packet before their graduation. Read Box 2.5. Work to make your letters as useful as possible. ●

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●

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Wrapping Up and Looking Ahead The application and credential review portion of pursuing ABPP/ABCN certification is a crucial but straightforward step. In our experience, delays in getting moving on it are due more to candidate ambivalence than anything else. We urge you to set aside that ambivalence and approach the process step by step. If you take it seriously, this portion of the certification process is a piece of cake. You will almost certainly be successful. Once you have submitted your application, treat yourself to a nice dinner. This step is not the hardest thing you will ever do. Even so, just getting moving on the process is worth at least a small celebration. Once you have congratulated yourself, pull out your calendar and decide when you would like to shoot for the written examination (administered every year at the National Academy of Neuropsychology [NAN], International Neuropsychological Society [INS], APA, and AACN conventions). Including study time, you can take that exam as early as 4 months after you submit your initial application, if you are ready to push on to studying right away. Also, it’s not too early to start thinking about clinical cases you might want to submit as practice samples. We cover exactly how to select the right cases in Chapter 4. For now, it can be helpful to start a running list of assessments that you think you have done a particularly good job with. A good list would include patient age, diagnosis, perhaps a line or two about them to jog your memory, and enough identifying information that you can go back to the chart to find more details later. Alternatively, you can make an extra copy of reports you are particularly proud of and put them in a special file of “practice sample prospects.” Either way, taking a couple of minutes here and there for this kind of prep work just might save you some headaches later, when you have passed the written exam and need to pick your practice samples. You read correctly: We said when you pass the written exam, not if you pass it. Read on.

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3 ■■■ The Written Examination Less Painful Than You Think

For those of you who enjoy demonstrating the breadth of your neuropsychological knowledge, get those pocket protectors out, the written exam is your time to shine! For those of you who would rather show off the depths of your clinical acumen, don’t fret, the written exam is still immensely doable. Believe it or not, your clinical knowledge is even going to come in handy at this stage. Be patient too. The time to really show off those clinical skills arrives with the practice sample and oral exam stages, which we will get to just as soon as we notch this written exam in your professional belt.

Nuts and Bolts What Is the Task? The written exam is no different in form from countless other exams you have taken over the years. It is a closed-book multiple-choice test, made up of 100 questions with a 2-hour time limit. Pediatric- and adult-focused practitioners take the same exam, which is designed to evaluate your breadth of clinical neuropsychological knowledge. The exam is not meant to mine the depths of any particular topic area (re-read this sentence 100 times if your studying somehow leads you to the pterygopalatine ganglion!). You can bet that you will find the written exam difficult, but most people actually report that the exam seems fair and that the studying is relevant and useful. The preparation for the exam is most certainly not going to be a reprisal of your

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experience with the Industrial/Organizational Section of the Examination for Professional Practice in Psychology (EPPP)! Given the broad-based nature of the task, most people find that preparing for the written exam is the most time intensive of all ABCN stages. If this was to be your excuse for not signing up straightaway, however, you will be disappointed. Some people have taken and passed the exam with minimal to no studying (we do not support this approach!), and nearly all who have prepared for the exam have done so amidst hectic personal and professional schedules. Finding the time to prepare for this can be tough, but with a bit of juggling, it really is feasible.

What Is the Process? You are invited to sit for the written exam after your credentials have been deemed satisfactory by ABPP and ABCN. To sign up for the exam, all you have to do is complete a brief registration form and send in some nonrefundable money. One nice thing about the written exam is that it is offered at each of the major neuropsychological conferences (INS, AACN, APA Division 40, NAN), typically the day before the conference begins. Thus, there are plenty of opportunities for you to take the exam each year. Odds are you will be able to do so at a time and location that is reasonably convenient to you. However, once you have decided when you want to take the exam, do not dawdle in getting your registration form submitted. You want to submit it early enough to make sure you will have a spot at your desired location. Given ABCN’s popularity in recent years, long gone are the days when you could register for the exam on exam day. After you take the exam, you will get the results in about 3 to 6 weeks. Although you will be provided with your precise score, the exam is either passed or failed. A score of 70 or higher is a pass. You will not get a special honor, medal, pin, or Bozo Button for an especially high score—a point worth remembering when you are planning your studying. Once you’ve passed, you will be invited to move on to the practice sample stage. If you do not pass on your first attempt, you can take the exam a second or third time as needed. As was mentioned in the introductory chapter, there is a 7-year time limit to complete the entire ABCN certification process. In the rare event that someone fails the written exam three times within this 7-year period, that person would not be allowed to retake the exam until the time limit lapsed. At that point, he or she could register for the entire ABCN process anew and once again sit for the written exam. Keep reading. This will not happen to you!

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Examination History: The Abridged Version At some point during your studying, you will undoubtedly feel that the written exam is undeserved or perversely unjust (e.g., “I have to take another exam?”). Some consolation may come in knowing that pains have been taken over the years to ensure that the exam is at least a fair process. The test was first developed in the late 1980s and early 1990s by having neuropsychologists in AACN submit numerous possible exam questions, each with supporting references. The questions were then winnowed down through intensive test item-writing workshops, supervised by the Professional Examination Service (PES). You may or may not be reassured to know that this is the same company that develops the EPPP. From 1993 forward, all ABCN candidates have had to pass a written exam to become board certified. Since its introduction in 1993, the exam has been revised multiple times. With each revision, there is a comprehensive review of all items, and the best items for retention are selected. Psychometric performance of each item is one consideration in deciding whether an item will be retained. Items are also considered to ensure that the exam continues to reflect necessary core constructs and current knowledge and trends in the field. As repeat test takers are administered an alternate version, there are multiple tests in circulation at any given time. Though examinees are not privy to the information, all items are backed by scientific references. Despite what you may have heard, the exam is never discarded in toto for an entirely different exam. The number of new items in a given revision is always limited to some extent, in order to maintain the test’s essential psychometric properties. As the primary structure of the content is the same from test to test, when new items are introduced they reflect similar content areas to those that were removed. Members of the ABCN exam teams develop and review all new test items. The exam committee must come to a consensus on any item that is considered for inclusion. PES continues to coordinate and manage exam development. The whole process is purposeful and balances considerations of expected core knowledge, psychometrics, and an evolving content base. Although the exam may be many things to many people, it is most surely not undemocratically discriminatory.

Passing Rates As of June 2007, the written exam had been administered 882 times, with a cumulative passing rate of 66%. Gulp! This percentage likely seems low

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to us all. At this advanced professional stage, few of us are used to “failing” anything. For better or worse, these rates are not dissimilar to the passing rates for written specialty exams taken by our physician colleagues. Fortunately, in comparison to them, our psyches are not burdened additionally by the guilt associated with making lots of money! More seriously, in our experience, the passing rates are higher than this reported average for those folks who proceed with their preparation thoughtfully and with good guidance (you’re reading this book—this is you). It is also our understanding that those who need to take the ABCN exam more than once pass at a higher rate on their second attempt. That is, persistence does indeed pay off.

What Is Being Assessed? Okay, now for the million dollar question: What content is actually going to be covered in this exam? Officially, the content of the written exam is now structured to reflect the Knowledge Base section from the Houston Conference on Specialty Education and Training in Clinical Neuropsychology (Hannay et al., 1998). Essentially, the party line answer is that all things neuropsychological are fair game, which is likely one reason that many people feel so overwhelmed with preparing for the written exam. Our unofficial answer, however, is that this is a bit misleading. With proper consideration, we think the topic areas can be narrowed down considerably (which we do below in the What should I focus on? Steps to Success section). Still, the exam does cover a wide range of topics, including those from both adult- and pediatricfocused areas.

Myths, Distortions, and Plain Nonsense Myth 1: The exam is ridiculously tough or unfair. If people tell you the written exam is a piece of cake, they’re lying! You can bet you will find the exam challenging. After all, it’s supposed to be challenging; it’s part of the evaluation process for specialty certification in clinical neuropsychology. With thoughtful and appropriate preparation, though, the exam is not overly difficult for most candidates. It is most assuredly not an insurmountable obstacle. Myth 2: There is so much content that I will need years to prepare. Preparation for the written exam is likely to be the most time intensive of the certification stages. Even so, most applicants do not spend more than several months actively preparing. If you come to the exam with adequate background education and experience, the idea that you need to spend many, many months or a couple of years preparing is patent hogwash! Indeed, intensive studying for

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more than a few months may result in you actually forgetting much of what you covered early on. In other words, the longer you study the more likely it is that you will have to relearn the material you have already covered. We are quite confident that you can think of better ways to spend your time! Myth 3: The examination is unfair for those who practice primarily with children. It is true that certain questions on the exam have more salience for adult-focused practitioners. Some of the classic brain-behavior relationships, for example, are seen more frequently in adults than in kids. On the other hand, questions cover topics from cradle to grave, so pediatric practitioners will have the upper hand on a few items as well. In actuality, the bulk of the exam content is drawn from general neuropsychological or neuroscientific topics, theoretically relevant to all practitioners. Finally, the exam committee and Board of Directors (BOD), who work to continually keep the exam current and relevant, always have strong pediatric representation. The Bylaws of ABCN actually specify that there will be BOD members with pediatric emphasis. Myth 4: The examination was completely revised and the new version is . . . . As mentioned previously, the exam is never completely revised. The actual amount of content that can be revised is limited, as the core psychometric properties are maintained from test to test. So, although some of the item content will change as the test is continually updated, you will not be getting a substantively different test compared to recent examinees.

Resources As was mentioned in Chapter 1, unlike the EPPP, there are no commercially available study guides to assist you with exam preparation. Neither ABCN nor AACN has put out content-based study materials either. However, we would advise you not to voice too much irritation about this, lest your mentor overhear you and begin to tell you about the real lack of materials in the “old days” (and somehow once again work in that bit about IBM punch cards and his dissertation!). Truth be told, although there are not any officially sanctioned materials, there are plenty of resources available to support your studying. In fact, once you realize that everything is at your fingertips, we don’t think you will be looking for more stuff to study. Many people have gone through the process before you, and they were all faced with this same lack of official resources problem. Luckily, there were some generous and inventive souls among them. Lots of their study materials and tips are now freely available

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through the BRAIN web site (see Chapter 1 for the web site address and more information about BRAIN). While it’s a far cry from a success guarantee, their collective knowledge and materials can go a long way in guiding you down a fairly efficient preparation path. Before looking at specific study materials, we suggest you seek advice from some of the people who have successfully navigated the process before you. For example, if you know anybody who is board certified or who has recently taken the exam, talk with them. It would be unethical for them to share content specific information, but they can tell you about their general experience. Ask them what they found useful, and not so useful, in their preparation. If you signed up for a mentor through the formal AACN mentor program (something we strongly encourage), ask him or her questions about this as well. There is less for mentors to do at the written exam than later stages, but they should still be able to give you some relevant advice and support. The hundreds of people you can access through the BRAIN listserve are also a wealth of information. In fact, at any given time, many of the members will have just recently taken the written exam. So, not only can they provide useful advice, but they will also be able to feel your pain too. We encourage you to search the BRAIN listserve archives as one mechanism to get study tips. Don’t be bashful though. Post all questions to the listserve directly. If you are wondering about something, other people are undoubtedly wondering as well. Remember, though, no member of BRAIN or anyone else who has taken the exam is ethically allowed to share specific information about test items or any test content. Of course, talking with people is only going to get you so far. You also need concrete resources. The BRAIN web site is likely to be your single best source of study-ready material. At the time of this writing, the web site materials included sample study schedules, dozens of topic area outlines, thousands (!) of flashcards, and hundreds of mock exam questions. Some people have found these BRAIN resources useful simply as an organizational structure as they create their own materials. Many others actually use the BRAIN outlines and flashcards as their primary study tools, supplementing them with additional information (e.g., from texts) as they deem necessary. The BRAIN materials are far from perfect, but people generally find that at least some of what is on the site beats starting from scratch. Take a look and decide for yourself (see Chapter 1 for the web link). Keep in mind that none of the BRAIN materials were developed in conjunction with the written exam. All of the materials on the web site are

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“unsanctioned,” created by a diverse array of people in a position not too different than yours. If you are unhappy with the quality of anything, the only recourse is to create something better yourself. Indeed, many of those who contributed to the BRAIN web site have said that the actual process of creating the study materials was a very useful learning tool in its own right. Be warned, though, these were psychologists talking. They could have just been saying this to trick you into leaving something beneficial behind for others after you’re done with the process. In addition to the BRAIN materials, most people use textbooks to some extent in their preparation. Multiple neuropsychology, neurology, and related texts could be worth looking at. We believe having your studying be exclusively text-based is more cumbersome and less efficient than necessary. Some people have even passed the written exam without utilizing texts much at all. If you are going to use texts (which we do recommend), consider using them early in the studying process to provide you with general background knowledge or to flesh out concepts as you proceed through the other materials. Which texts will be the most useful for you personally will depend largely on your background knowledge (e.g., some might consider Kolb and Whishaw overly simplistic; others, the perfect resource for meaningfully simplifying). The AACN study guide provides “a selection of texts that board-certified neuropsychologists have found useful when preparing for the examination.” We encourage you to look over the most recent version of the study guide to get the latest listing. We also provide some selected texts in Box 3.1. Be advised that it is not an all-inclusive list of relevant texts—just a few that many have found useful in their preparation.

BOX 3.1 Texts to Consider for Your Preparation Blumenfeld, H. (2002). Neuroanatomy through clinical cases. Sinauer Associates, Inc: Sunderland, MA. Exceptional text for solidifying neuroanatomy and applied neurology topics. Beautiful illustrations. Level of detail much greater than you will need for the exam. Heilman, K.M., & Valenstein, W. (Eds.) (2003). Clinical neuropsychology (4th ed.). Oxford University Press: Oxford. (continued)

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BOX 3.1 Texts to Consider for Your Preparation (Continued) Detailed coverage of many neuropsychological syndromes. Classic text that can be used as needed to flesh out or conceptually ground unclear outlines. Level of detail greater than you will need for the exam. Kaufman, D.M. (2006). Clinical neurology for psychiatrists (6th ed.). Saunders: Philadelphia. Very easy to read neurology book. Includes many test questions similar in format to the exam. While many find useful, coverage of some topics overly simplistic or even incorrect. Use cautiously. Lezak, M.D., Howieson, D.B., Loring, D.W., Hannay, H.J., & Fischer, J.S. (2004). Neuropsychological assessment (4th ed.). Oxford University Press: New York. Many have found some of the introductory chapters on the practice of neuropsychological assessment helpful, especially Chapters 3 and 7. Written at a level likely not too different from the actual exam. Loring, D.W. (Ed.) (1999). INS dictionary of neuropsychology. Oxford University Press: New York. Handy reference to familiarize yourself with unclear terminology. Memorizing all terms probably not a good use of time. Snyder, P.J. Nussbaum, P.D., & Robins, D.L. (2006). Clinical neuropsychology: A pocket handbook for assessment (2nd ed.). American Psychological Association: Washington, DC. Summary coverage of many applied clinical neuropsychology topics. Limited pediatric-specific information. Strauss, E., Sherman, E.M.S., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). Oxford University Press: Oxford. First chapter provides nice broad-based coverage of psychometrics. Later chapters provide helpful reviews of relevant tests and domains. Do not get caught up in the details of every test. (continued)

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Yeates, K.O., Ris, M.D., Taylor, H.G., & Pennington, B. (Eds.) (in press). Pediatric neuropsychology: Research, theory, and practice (2nd ed.). Guilford: New York. Coverage of pediatric-specific medical and neurodevelopmental disorders. More detail than needed for exam.

Decisions about other potentially helpful materials are more personal. For example, some people might want to use their notes from graduate school or comprehensive exams for the unearthing of a long buried concept or two. If you still have them, certain sections of the EPPP study materials could have relevance as well. Although the EPPP notes are too simplistic for neuropsychology matters, they may provide an adequate refresher of more general psychology topics (e.g., lifespan development, psychopathology, applied psychometric and statistical concepts). Early in the studying process, we do recommend that you put together a notebook, binder, or folder (paper or electronic) that you can use to keep track of all of the terms and facts you will encounter that will be either new or only foggily familiar. This will allow you to readily ask for clarification during study group discussions and reference these insecure topics as you begin your consolidation before the exam. Most people also develop a variety of individualized mnemonics as they proceed through the material (if you’re okay with your colleagues thinking you’re even odder than they imagined, share these!). Systematically collecting all of this information in one place is an easy way to ensure you will have access to it during the occasional free minute along the way and during those last days before the exam. Some people, especially those who spend lots of time in their cars, also find it valuable to record mnemonics or other information and play it back during their commute or travels (“On my cue, kids: the wheels on the bus go round and round, round and round . . . and, cranial nerve IV moves the eyes in and down, in and down”).

Steps to Success: Managing Examination Preparation Given the vastness of the content covered in the study materials, trying to figure out where to begin can be daunting. Like any other complex task, we think it is easiest to just break things down into steps and then put one foot in front of the other. Our recommended step-by-step path and a rough timeline are summarized in Box 3.2, as well as detailed below.

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BOX 3.2 Timeline and Steps to Success for the Written Examination About 6 to 5 months before examination: Begin familiarizing yourself with available resources. Figure out how much study time you will need and begin carving this time from your schedule. Set a date. Join or form a study group. ● ●

● ●

About 5 to 4 months before examination: Conduct a serious knowledge self-assessment. Develop a study schedule. ● ●

About 4 months to a few weeks before examination: Study relevant materials (textbooks, BRAIN outlines, flashcards, etc.). Test yourself with existing mock exam questions and create your own. ●

●

Last weeks and days before examination: Prioritize remaining topics. Review insecure information and master those mnemonics. ● ●

About 6 to 5 Months Before the Examination Step 1: Begin familiarizing yourself with some of the available study resources The first step to preparing is an easy one. Simply look over some of the available study resources. Scan the lists of possible texts and the BRAIN web site. Whatever you do, do not learn anything! Just get a sense of what is there and begin considering how familiar the materials seem. If while doing this you notice that you have begun to gigantically inhale, rest assured, you are not about to drown in this stuff. While your initial reaction could be helpful in knowing how much study time you will eventually need, you are apt to be in the same boat as most everybody else after this first glance (the boat’s name is “HOLY COW!”). With a little up-front organization, we promise that your actual preparation will be much less

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overwhelming than it might seem at first. Some folks have even expressed that the studying process was fun, rewarding, or even good for them (neuropsychology nerds!). Step 2: Figure out how much study time you’ll need and begin carving that time As noted previously, the written exam is either passed or failed. So, the perfect amount of prep time is, of course, just enough time to earn a passing score of 70! The actual amount of time people will want to devote varies a good deal—from relatively little for the supremely confident or particularly harried to longer for those of us who might be a tad more obsessive or anxiety prone. What’s important is that you come up with an individualized plan that you feel comfortable with, not one based on the plans of your former postdoc officemate, Dr. Noah Tall. One of the more important factors in deciding how much time you will need is how you generally manage your anxiety. Will your anxiety be held in check by “overpreparing?” Or, would you be comfortable with the bare minimum approach, with sufficient ego strength to handle the increased potential of not passing on your first attempt? Another factor is how comfortable you are with multiple-choice tests in general. Have you historically done well in this format? Or, do you prefer more freedom in your test-taking, afforded by the likes of the oral exam? Think back to the EPPP. How much time did you put in studying? Was this an easy or more aversive obstacle for you personally? Another thing to consider is how up to date you are on the general neuropsychology literature. Have you recently completed your fellowship and other training? Do you have a generalist practice where you keep track of multiple lines of research? Or, have you been practicing in a specialized area for a number of years and need more time to update yourself on those general neuropsychology topic areas again? After all is said and done, most applicants typically devote somewhere in the range of 3 to 5 months for the preparation process, spending multiple hours each week. For those tempted to spend lots longer, consider that there is a point of diminishing returns for us all. Venture beyond and you risk forgetting what you have already covered and/or burning out well before test time. Though studying for extended periods may be useful for some people, most are unlikely to profit from rigorous studying for more than 6 months or more than 10 to 15 hours each week.

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Step 3: Set a date After figuring out how much preparation time you are likely to need, the next step is to set a date to take the exam. For some, this can be a psychologically difficult commitment and so they put it off. Don’t follow them. For this sort of exam, there is no time like the present. Delay and you will undoubtedly be busier than you are right now. Those of you who are reasonably fresh out of postdoc, take advantage of those primed neural networks while you can. Trust us, finely aged hippocampi before the exam are not nearly as pleasing as finely aged wine after! (Note to those with finely aged hippocampi: We, of course, are just saying this so that the young pups won’t feel intimidated by your years of accumulated wisdom.) Step 4: Join a study group Once you have a date in mind, we strongly encourage you to join a study group. You may not have participated in a study group since graduate school. Do not let this dissuade you from joining one now. The advantages of joining a group for this stage are just too numerous to ignore. We have heard countless professionals say that their study group was the single biggest reason they made it through the written exam. Regardless of where you are located, it is exceptionally easy to join a study group. You may have access to a local study group. That’s great. There are advantages to local groups. You will likely know and feel comfortable with the other members. You will also be able to hash things out grittily in person during those study sessions. If you do not have access to a local group, though, do not be concerned. There are advantages of participating in a noncentralized group as well, including having a more efficient study schedule, spending less time during weekly meetings covering topics, and learning from and bonding with neuropsychologists from varied backgrounds. Forming a group is really quite straightforward. Start with your colleagues. Peer pressure often works wonders in getting a group formed among like-minded people. However, if you have not been able to strong-arm any of your friends, don’t worry. Through BRAIN, there is an up-to-date list of people interested in taking the exam and forming groups. To join one, all you need to do is contact BRAIN’s coordinator for the written exam study group, whose contact information is on the BRAIN web site. Most people find that study groups numbering between three and five and having some mix of both pediatric- and adult-focused members are most effective. Larger groups can be unwieldy when scheduling and have a

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tendency to become unfocused. The benefit of having people from different training and professional backgrounds is obvious. It affords a breadth of knowledge larger than any one person’s (don’t forget: the exam taps breadth of knowledge too). Usually, study groups meet in person or talk by phone weekly for 12 to 16 weeks. The purposes of these meetings are threefold. First, you can review, discuss, and clarify any particular issues that were scheduled to be covered during the week. If you practice primarily with adults or children, this a grand opportunity to get any questions answered about those conditions that are more common on the other end of the age spectrum (e.g., What on Earth is Hallervorden-Spatz Disease?). Second, the groups are a wonderful way to provide accountability during the studying process. You will be surprised at how much more efficient your preparation becomes when the potential for social embarrassment is introduced. You just cannot help but take that extra step when other people are relying on you to summarize a topic or answer questions during a weekly meeting. Third, the preparation can be grueling at times. The support, collegiality, and commiserating available during the study groups are invaluable. Complaining to yourself is wholly unsatisfying!

About 5 to 4 Months Before the Examination Step 5: Conduct a knowledge self-assessment After you have committed to a study group, sit down with the study materials again and begin to conduct a more serious knowledge “self-assessment.” Get a sense of what areas you know well, what areas you learned well at some point but are now less familiar, and what areas you are likely to need considerable work to feel comfortable. Look at some of the sample study schedules, which you can get from the BRAIN web site, the AACN study guide, your mentor, or colleagues who have already taken the exam. Rate your knowledge (and anxiety level) for the topics. You will use this information in the next step as your study group develops a preparation schedule. Step 6: Develop a Study Schedule The next step is to actually create a study schedule with the other members of your group. As noted, there are numerous sample study schedules available to use as models. In putting together your group’s schedule, combine some relatively brief and more time-consuming topics each week, to balance the workload across the duration of your studying. Share your personal preferences here. You are definitely not going to want a bunch of “gimme”

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or “uh-oh” topics clustered together. If your group is really organized, you could also consider grouping certain topics by themes. For example, you could study the temporal lobes and language functioning in the same week and the limbic system and memory the next. If wanted, you could also put a bit of time at the beginning of the schedule (or “pre-schedule”) to allow people to start grounding themselves in less familiar topics. If possible, it also can be quite helpful to devote a few weeks at the end for review of those topics that will require pure rote memorization (read: leave time for cramming!). Some study groups also build in an occasional down week so they can play catch up on topics that they have missed as they have studied along. Take a look at your calendar and evaluate how much of your studying time revolves around holidays or summer months. You may also want to build a few extra weeks into your schedule to accommodate group members’ vacations and travel plans. What you put into the schedule and how much you and your group actually study any given topic are obviously up to you and your needs. Just don’t neglect the study schedule step. It is really beneficial to ensure adequate breadth of coverage and to help keep you organized and on track.

4 Months to a Few Weeks Before the Examination Step 7: Study relevant materials (e.g., textbooks, BRAIN outlines, flashcards, etc.) What should I focus on? We won’t kid you. Trying to narrow down which specific topic areas to focus on during your studies can be a challenge. As you solicit advice from colleagues who have taken the exam previously, remember that the specific items of the exam continually change, although as noted above, the general structure remains the same. Do not let your ears perk up too quickly if someone says a particular piece of information will or will not be on the exam. The particular questions on the version you’re taking are truly unpredictable. Moreover, as mentioned, people who have taken the exam before should not be providing you with specific information anyway—that would be totally unethical on their part—and ruin your preparation fun! The best you can hope for is general guidance, which is what we are aiming for in the following text. Key dos and don’ts for studying are also highlighted in Box 3.3. As we mentioned above, the exam is officially structured to evaluate the Houston Conference knowledge areas. The materials sent from

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BOX 3.3 Key Dos and Don’ts of Studying for the Written Examination Do ● ●

● ● ● ●

Brush up on applied neuropsychology concepts. Study diseases, disorders, and syndromes affecting the CNS. Know your gross and functional neuroanatomy well. Review behavioral neurology topics. Revisit DSM and psychiatric disorders. Remember to look over relevant psychometric and statistical topics.

Don’t ● ● ● ●

Overfocus on any one specific topic. Lose the forest for the neuroanatomical trees. Worry about esoteric research methods or stats concepts. Spend much time on ethics at this stage of the process.

ABCN confirming your attendance at the exam will also include an AACN document that outlines five domain areas to help guide your preparation: 1. Neuropsychological Assessment 2. Clinical Neuropsychology 3. Basic and Clinical Neuroscience 4. Behavioral Neurology 5. General Clinical Psychology If you examine both the Houston Conference knowledge areas and these five topics, you will see there is a good deal of overlap. Although ABCN does not specify the percentage of questions drawn from each area, inspection of the domains and the specific topics can actually provide a good bit of direction to your studying. We consider some of these specific topics below, organized within the five listed domains provided in the AACN document.

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1. Neuropsychological assessment. You will obviously see more than a few questions testing your knowledge of neuropsychological assessment, at both conceptual and applied levels. In this regard, you might want to review psychometric theory and decision theory including topics such as test construction, reliability, validity, sensitivity, specificity, base rates, and measuring change over time. You should also prime your test score interpretation knowledge to get ready for questions about normal and non-normal distributions and percentiles, z-scores, T scores, and other transformed scores. Estimating premorbid functioning is another relevant topic. You should also ensure that you have a solid understanding of the instruments that are commonly used in neuropsychology, including what they are designed to tap, their fundamental psychometric properties, and how demographic factors (e.g., age, race, sex) can affect performance. Professional practice surveys (e.g., Rabin, Barr, & Burton, 2005) can be helpful in determining which tests are commonly used around the time you are taking the exam. In general, you can assume that the more commonly used the test is, the more likely you will be asked about it. 2. Clinical neuropsychology. You also need to have a good understanding of the cerebral diseases and syndromes that present to neuropsychologists across the lifespan. Included here are neurodevelopmental, neurological, and non-neurological disorders that affect CNS functioning (ADHD, LD, TBI, MS, Alzheimer’s, hydrocephalus, cancers, epilepsy, etc.), as well as all of the classic neurobehavioral syndromes (aphasia, amnesia, apraxia, agnosia, neglect, etc.). When relevant for the disorders, consider reviewing data about epidemiology, etiology, pathophysiology, clinical course, expected assessment findings, and medical and neuropsychological treatments. Your review of the classic syndromes will also dovetail nicely with consideration of the important historical figures from neuropsychology and the neurosciences. While you may find little factoids about these figures intriguing (e.g., John Hughlings Jackson married his first cousin, who just happened to develop Jacksonian epilepsy late in life!), it is rather unlikely you are going to be asked biographical information. You should still have a thorough understanding of some of the chief figures’ theoretical models and contributions. Do not overfocus on neuropsychology’s early history at the exclusion of major works from the last few decades. Remember as well not to get lost in historical details.

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Of course, because brain-behavior relationships are the bread and butter of our practice, you can bet they will receive coverage in the exam. You have learned functional neuroanatomy well in your training and years of service. Brush up. Pay particular attention to these concepts as you review the various diseases and disorders, as well as when you review the neuropsychological networks (e.g., attention, language, memory, emotion). 3. Basic and clinical neuroscience. You should also be ready for questions at a more basic neuroscience level. Relevant topics here might include brain development, the organizational structure of the nervous system (e.g., CNS vs. PNS), and neuroanatomy at both the large scale (e.g., vascular system, CSF circulation, surface anatomy) and micro level (e.g., types of neural cells). The number of pure neuroanatomical questions will likely be limited, though some of this knowledge is obviously within neuropsychology’s purview. For example, although you should be familiar with relevant applied concepts, it is unlikely you will be asked to identify structures of the brain from a histological slice or the directional relationship between structures (e.g., which structure lies caudally and medially to structure X?). Neurophysiology and neuropathology questions are fair game, but these will also probably relate more directly to applied clinical concepts (e.g., types of abnormal cells in tumors, histological characteristics of cerebral diseases). You will not be expected to have an intimate knowledge of neuropharmacology, but you should have knowledge of the neurotransmitter systems, as well as common medications, their indications, and effects. 4. Behavioral (clinical) neurology. As you know, neuropsychology and behavioral neurology have a close relationship, both historically and in everyday practice. As a result, you can expect at least a few behavioral neurology-related questions. These could include questions about any number of neurological disease states and treatments. You should also definitely review ancillary tests and procedures, including the “classics” such as the neurological examination, EEG, CT, MRI, and the Glasgow Coma Scale. Having a working knowledge of some of the newer technologies (e.g., fMRI, BEAM, SPECT) is not a bad idea either. 5. General clinical psychology. Hidden beneath that rough neuropsychologist exterior of yours is a well-trained psychologist. The test writers know this! At some point in your career, you learned psychology topics well, and you are actually likely to access these topics on a regular basis in your everyday practice. Consequently, for the exam, you should review

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psychology areas that intersect regularly with neuropsychology. Topics to consider reviewing include theories and terminology of cognitive psychology. You might also consider touching on life span development principles and topics. The clinical characteristics, evaluation techniques, and treatments for psychiatric disorders may additionally be worth glancing over. You should most certainly spend time reviewing the current DSM. You should most certainly spend time reviewing the current DSM. Yep, we just said that twice! Finally, be alert to information about how psychiatric disorders can impact neuropsychological functioning and how psychiatric and neurological disorders can be comorbid, causally linked, or mimic each other. Is there anything I do NOT have to focus on? For an exam this broad, it is helpful to not only have some sense of what you’re going to need to study and hold onto, but also when it’s okay to walk away from study topics and materials—and, when to run! While considering what study materials you want to use, try hard not to get bogged down. Although a friend or colleague who has taken the exam may swear that certain texts were indispensable in his or her own preparation, do not feel compelled to read multiple texts from cover to cover. After all, your training or experience may have already exposed you to many of the topics that your colleague had never heard of before reading that “essential” book. Similarly, do not feel that you have to perform an exhaustive Pubmed search for every possible topic. For one, this is simply not feasible. For two, although you want to be current in your knowledge, the exam is unlikely to be based on the very latest research, as it takes some time for the test to actually come to publication. This does not mean you should avoid all journal articles in your studying. In fact, recent review or meta-analytic articles may be perfectly suited to your preparation, especially for topics that are in regular flux (e.g., mild cognitive impairment). When trying to exclude specific topics from your studies, consider first that the exam consists of 100 questions total. Because of the way the exam is structured, it needs to be divided among multiple content areas. Thus, there can only be a limited number of questions from any specific area. Remembering this will help you prioritize your study materials up front. It will become even more useful if you find yourself running out of preparation time closer to the exam. For example, logic dictates that if you are likely to see only a question or two about a given topic and that same topic will take you innumerable hours to learn, you probably could invest your study time more wisely on something else.

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Another thing to keep in mind is that you are studying to become board certified in clinical neuropsychology. The clinical part means you are not going to be expected to have mastery of esoteric research and statistical topics. Of course, certain statistical or methods concepts could be tapped; however, the focus of these questions will be applied and in reference to knowledge that neuropsychologists may need in everyday practice. Similarly, you are not getting board certified in neurology or radiology! Many people have a tendency to overfocus on neuroanatomy for neuroanatomy’s sake as they prepare for this exam. This can become a real sticking point, especially as the interstitial nucleus of the medial longitudinal fasciculus begins to mesmerize. Resist! You need to know general neuroanatomy reasonably well. You need to know your functional neuroanatomy even better. But, you do not need to learn lots of neuroanatomical minutiae that heretofore you had never even heard of. It is worth noting that some of the available study materials and commonly used texts are likely to provide a level of neuroanatomical detail unnecessary for this exam (the people comprehensively outlining Blumenfeld’s neuroanatomy book years ago did not know any better—you now do!). So again, we urge you to resist the temptation of falling into that neuroanatomical black hole. Finally, remember that the written exam is just one stage in a three-exam process. Certain topics are likely to be intensively covered during the latter stages, so you should worry less about them for the written exam. For example, it is highly unlikely that there will be much of a focus during the written exam on ethical topics. There will be better opportunities to evaluate your competence in ethics during the practice sample and oral examination stages. Hold off on a concentrated review of ethical topics for now. Step 8: Test yourself with existing mock examination questions, create your own questions, and exchange questions within your study group As of the time we wrote this book, there was not a mock exam series that could be used throughout your studying like there is for the EPPP. This does not mean that you will have no sample exams to turn to, just that you will not have the well-polished EPPP mock exams at your fingertips. There are currently two resources for sample questions. AACN has published one “official” 30-question mock exam as part of the AACN study guide. The BRAIN group is also continually collecting “unofficial” sample questions and developing their own mock exams. The BRAIN questions are written to resemble the scope and structure of the actual test items. They are not,

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however, subjected to the same design and development process as the real exam. So, there is no way to tell their comparative level of difficulty to the actual exam, and they should not be used as a precise way to gauge how you are going to do on test day. Nevertheless, the mock exam questions can be quite fruitful for getting used to the types of questions that you might see on the real exam. They also can help make sure you have covered most general topic areas and allow you to hone your test-taking approach. We also strongly recommend that you create your own sample questions for yourself and your study group. Other test takers have reported time and again that this process is an excellent preparation exercise. Actually writing questions forces you to wrestle with concepts at a deeper level than you might otherwise. It also gives you a potential eye into the test writers’ minds, which will serve you well on exam day. Of course, writing and sharing your own questions will also allow others to benefit from your experience, both those in your study group and those in BRAIN (currently and for the ages!).

The Days or Weeks Before the Examination By the time the exam nears, you will hopefully have budgeted enough time to have covered all necessary topics, and kept a few weeks at the end to consolidate. If, however, you feel that you are running out of study time and the exam is fast approaching, you are likely to be no different than many others who are preparing for the exam. So, what should you do? Prioritize the remaining information. De-emphasize esoteric details on all topics. Do not spend unneeded time on topics you know well. Trust yourself to be able to recognize the right answers in these areas. Spend your time reviewing general information for less familiar topics and those topics that you’re familiar with but might not have at the ready without review. For example, if you work primarily with the geriatric population, you may wish to assume that you are ready for questions on the various dementias. Instead, you may want to focus your energy on more pediatric-specific topics, neurological conditions that are more common in early adulthood (e.g., TBI), basic psychometrics and statistical concepts or the DSM. If you do have the luxury of more time (gold star for good planning!), you should use these last weeks for a systematic review of the topics you felt were insecurely lodged the first time through. If you haven’t already, develop your own outlines on any diseases or syndromes you did not feel comfortable with before. Create some more mock exam questions. Master those wacky mnemonics.

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Some people find that taking the last day or two off from studying before the exam can help ensure they are feeling rested, relaxed, and ready to spit out all of their accumulated knowledge. Others study up until the last possible minute. Do whatever you think is necessary to keep your anxiety in check. As the time finally has approached and you are due to take the exam the next day, you obviously should not forget about the importance of a good night’s sleep.

Managing Test Day Examination Day Logistics On exam day, you do not need to dress to impress. Dress for comfort. Groom to be non-malodorous. Show up to the exam with a photo id, which you will need in order to register for the exam (as if cousin Louie could pass this one for you!). Bring a non-beeping watch so as not to incur the pent-up wrath of those around you. You are not allowed to bring in notebooks, writing pads, or any other paper. Number 2 pencils will be provided (but bring a couple anyway). You are given exactly 2 hours to take the exam. The scheduled time slot is 3 hours to get everyone checked in and to review instructions. You will be taking the exam in a room with probably a few dozen other people. There is to be no talking during the exam. However, if you think you might be distracted by other people just flipping the test pages or their normal bodily functions, bring earplugs. If you wear them, the only thing you might miss is the proctor announcements at various intervals letting you know how much time you have left (e.g., 1 hour left, 30 minutes left).

Taking the Test Relax. Once the proctor announces it is time to take the exam, remember, this is what all that prep was for. You’ll be fine. Calm. Down. Throughout the exam, utilize whatever strategies work for you to manage your anxiety. A few deep breaths are often key. Self-talk can be critical as well. The time when this is most often needed is when you come to those questions for which you haven’t a clue. You are almost guaranteed to see at least a few of these. You will also see multiple items that you will be able to narrow down and then have to guess. Remind yourself that it is going to be exactly like this for everyone else too. That cool, collected face on the guy sitting next to you is an act! Find your test-taking groove and tune out both those internal and external distractions.

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Don’t forget about the time. While most people find the allotted 2 hours sufficient, some have not. A few time-management strategies are likely to come in handy. Do not spend too much time on any one item. On average, you have 1.2 minutes for each question. Some items are obviously going to take you longer than others. In order to finish, you will need to keep a pretty good pace throughout the whole exam. Don’t be careless, but don’t overthink the items either. If you find yourself spending longer than a few minutes on any one item, you may be overthinking. The exam is really not designed to “trick” you, so overanalysis is apt to lead you to the wrong answer. Keep the big picture time period in mind as well. Two hours is a long time to be super focused. Every now and again, you should likely force yourself to take a quick mental break to ensure you do not lose your mental edge toward the end of the exam. Stick to your game plan. Like any other timed test, you should have an up-front plan for how you want to approach the exam. To state the obvious, different people approach multiple-choice tests differently. Use whatever has worked for you in the past. The most straightforward approach is to complete all items the first time through, perhaps marking a few especially challenging items you want to go back to if you have time. A different approach is to complete only those items you know for sure on a very efficient first pass through, highlighting lots of items for more careful review the second time through. This latter approach is likely to be useful for those who might be especially anxious or want to get a sense of the whole test before spending more time on individual items. Whatever you do, do not leave any items blank! There is no penalty for guessing, so you might as well take the chance that your guess is right. There is, however, a penalty if you put down two choices for one item: It is marked wrong. Do not do this.

Managing That Post-Test Time The Soon After A lot of people who end up passing the exam walk out feeling as though they failed. Do not beat yourself up over items that you think you got wrong. There is a natural tendency to remember the items you struggled with. The passing score is 70, so you needed to get more than 30 wrong to fail. Obsessing over any one or a few items that you think you got wrong is just not smart and oftentimes unnecessary. This is one of those exams that you really should try to “let go of” after you are done.

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Another thing that you should consider doing after the exam is providing feedback to ABCN about the process or test itself. The ABCN board is interested in hearing both good and bad experiences. The written exam is a constantly evolving process. ABCN strives to make the exam as fair and transparent as possible. Your feedback will help ensure that this continues. Finally, because considerable time, energy, and money are spent on test development, we urge you not to discuss or in any way share specific test items or content areas with non-AACN members. If our urging is not enough, realize that divulging test items or specific content is unethical and a breach of the confidentiality contract that you will have signed before starting the exam.

The Waiting Officially, it takes upwards of 6 weeks to get your results. Though you may hear sooner, be prepared to wait. A number of steps occur behind the scenes to ensure the accuracy of the process. The lengthiest step is that it goes to PES for scoring and analysis. At different times of the year, PES may be more or less quick in returning the results to ABPP and ABCN. Whenever ABCN gets them, there is virtually no delay. They work hard to have an immediate turn around.

The News If you get news that you passed, feel good. No, feel great! Celebrate. Revel for awhile. You have just made it through the most time intensive stage in the whole certification process. If you did not pass, flip to Chapter 6 after you read this paragraph; it provides multiple ways to help you get back on track. In the face of getting news about not passing, you are obviously going to be disappointed and frustrated. We encourage you to do your absolute best not to get demoralized right now. In fact, if you can reach, we think that you should give yourself a pat on the back. In our experience, deciding to take the exam in the fi rst place can be a bigger hurdle than actually passing. Remember this. And, remember that you are not alone. Over a third of bright, successful neuropsychologists do not pass on their first attempt. After some of the initial disappointment has subsided, we encourage you to seize your momentum and try again. We consistently hear that candidates who use the exam as a learning experience, and then retake it while things are still percolating, fi nd the second time through considerably easier.

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Tips for Supervisors and Trainees The good news for trainees is that nearly everything you are currently learning is actually relevant. It is not like that calculus class you took in college (yeah, like you’ve used that knowledge since). Still, there are ways to make it most relevant to the ABPP/ABCN written exam preparation. See Box 3.4 for tips.

BOX 3.4 Tips for Supervisors and Trainees Tips for Supervisors Use Houston Conference Knowledge Base areas to ground development of didactics and guided reading series. In didactics, make disorders and syndromes meaningful by using case studies, videos, tape recordings, etc. Have trainees create synopses and mock exam questions after didactics and new clinical cases. Keep a bank of these for trainees to review. Systematically track student cases so they see a wide range of disorders and syndromes. If your patient population is limited in some way, arrange for trainees to get exposure to other populations. Foster active, across discipline learning experiences (e.g., encourage trainees to attend brain cuttings, genetics clinic). Reinforce trainees’ basic psychological knowledge and tools whenever relevant (e.g., DSM). ●

●

●

●

●

●

●

Tips for Trainees Look over the Houston Conference Knowledge Base areas. Continue to ensure your learning includes coverage of all domains. Create summary outlines and mock exam questions when you encounter new disorders or syndromes during didactics and clinical cases. Save these in an electronic folder or binder. ●

●

(continued)

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●

●

If your background so far has been with adults or children primarily, seek out opportunities with patients on the other end of the age spectrum. Avail yourself of whatever opportunities you have to make neuroanatomy meaningful, including taking a functional neuroanatomy course, attending brain cuttings or Wada procedures, and reviewing neuroimaging during cases with supervisors or medical colleagues.

Wrapping Up and Looking Ahead We recognize that some people will need a break from all things ABCN after they take the written exam. That’s understandable. The potential for burnout after intensively studying for several months (perhaps even while maintaining job, personal life, and sanity!) is high and real. Even so, we do urge you to at least begin thinking about the practice sample stage not too long after you are done with the written exam (if you haven’t already). As you will read in the following chapter, there is no such thing as a “perfect” practice sample. For many, it takes longer than they think to find a couple of cases they feel comfortable submitting for peer review. In other words, enjoy seriously the fact that you have finished the written exam. Just don’t exult in your passing so much or so long that you forget to keep efficiently rolling on to the next stage—and the next chapter!

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4 ■■■ The Practice Sample Showcasing Your Clinical Talents

Nuts and Bolts Now that you have successfully conquered the written exam, the sailing may seem a little smoother from here on out. You cannot coast exactly, but at least you can now focus your efforts on what you do every day . . . evaluate patients, conceptualize cases, and write reports. This is essentially what the practice sample portion of the ABPP/ABCN certification process is all about—showcasing your clinical skills. In theory, next to submitting your credentialing application and materials, it should be one of the least anxiety-provoking parts of the evaluation process, particularly since you have already shown that you possess all the essential training needed to become board certified. However, some people find the thought of other neuropsychologists scrutinizing their written work especially stressful. Fear not! This chapter will help you select your best cases to showcase your neuropsychological skills and talent. In other words, it will help maximize your chances of getting to the oral examination.

What Is the Task? The primary purpose of the practice sample is to show the reviewer that you have good, solid clinical neuropsychological skills. That is, it allows you to show the reviewers that you can ● ●

take a thorough history; choose a test battery that is appropriate for the referral question;

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● ● ●

interpret the results in the context of relevant history; apply your knowledge of brain-behavior relationships; and present this information in a clear, readable report.

In this way, you will demonstrate your skills in clinical practice and communication of findings. Think of it as a way to show your ability to work up a clinical case, particularly that you can conceptualize a case and answer the referral question in a way that benefits the patient, his or her family, and the referral source.

What Is the Process? When you receive the letter from ABCN notifying you that you passed the written exam (give yourself another pat on the back!), they will provide deadlines for submitting practice samples if you want to be considered for the next oral exam dates. Realize, though, that submitting your practice samples by these deadlines does not mean that you are guaranteed to sit at the next oral exam. Oral examinees are scheduled on a first-come first-served basis. In other words, if you and 20 other people wait until the day before the deadline to submit your practice samples, and there are only 24 slots open for the next oral exam, the 15 people who submitted their practice samples earlier and the first 9 people whose packets are opened (which may not be you!) will be given first dibs (assuming their cases are accepted). The moral of the story is do not dilly-dally in picking and submitting your cases if you want to take the oral exam on the next available date (oral exams are scheduled twice a year, usually in May and October—more on that in the next chapter). Ideally, while you are waiting for results of the written exam, you will be considering each case you see as a possible practice sample submission (if you have not selected your cases already). In this way, by the time you get the news you passed the written exam (think positively!), you will already be set to take the next step. You will pick two cases that are typical of your practice, redact all identifying information, both yours and the patient’s, and send copies of the reports, raw data, test score summary sheets, and a professional data sheet (which will be described below) to the ABCN office for review. If you are using regular mail, you will need to submit four copies of the reports, raw data, and test score summary sheets, one copy of your professional data sheet, a 3½" formatted disk or CD with copies of the reports and test score summary sheets, and a check or money order (see Box 4.1). Three of the copies will be sent to

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reviewers and one copy is retained in a central file to be used during the oral exam if your practice sample is accepted. If you would like to save a few trees and have access to a scanner, you can submit your materials electronically. You can find the current email address for electronic submission on the ABPP website (see Chapter 1 for web site address). You also may elect to send a cover letter and/or other supporting materials if you believe it would help the reviewers evaluate your work within a context (more on that later). You do not need to bind each set but do be sure to physically secure each case separately (e.g., via folders or large clips). See Box 4.1 for a summary of items to include in your practice sample submission.

BOX 4.1 Items to Include in Practice Sample Submission Required items: Two reports typical of your clinical practice, carefully redacted of identifying information, both yours and the patient’s Two test score summary sheets, one for each case, that include a key of test abbreviations, type of score clearly labeled (e.g., raw, z, T) and information about which norms were used Raw data, including test protocol forms and reports from scoring programs (be sure to redact all identifying information in the raw data, too!) Professional data sheet A formatted disk with your professional data sheet and copies of your reports and test score summary sheets (and cover letter and other supporting materials, if provided) Check or money order (ugh!) ●

●

●

● ●

●

Optional items: Cover letter explaining unique aspects of your setting and/ or report format Supporting materials, such as neurology reports and/or summary of pertinent medical records ●

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What Is Happening Behind the Scenes? Once the ABCN office receives your practice sample package, your cases will be sent to three ABCN-certified neuropsychologists for review. Reviewers are asked to decide if your cases can be defended at the oral exam. They are given general guidelines, along with examples of passing and failing cases. In essence, they are told that if your practice sample is generally sound, professional, and complete, it should be passed. Questions about how you approached the evaluation, why you chose the assessment methods you used, how you interpreted your data, and how you conceptualized your case that can be answered in the oral exam are not grounds to fail your practice sample submission. However, if your practice samples contain marked errors, reflect a questionable grasp of fundamental concepts, have several areas of weakness, or do not reflect an explicit and advanced understanding of brain-behavior relationships, they may not be accepted. In short, reviewers want to see that when you evaluate a patient you ● ●

● ●

use appropriate assessment methods; consider all relevant information in reaching your conclusions; offer useful recommendations based on data; and generate a report that is readable and answers the referral question.

Box 4.2 presents the essential elements of an acceptable practice sample submission plus elements that you do not need to worry about.

BOX 4.2 Essential Elements of Acceptable Practice Samples Your practice samples will be judged on the following points: How diverse the cases are (we will explain more about this below in Step 1 of “Steps to Success”) If the purpose or reason for referral is stated clearly If the conceptual basis for test selection is apparent Whether your tests are accurately administered and scored How clearly you present the test data If your conclusions are supported by the data ●

● ● ● ● ●

(continued)

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●

●

●

●

●

●

If relevant historical and medical factors are stated and integrated Whether emotional/psychological factors are assessed and incorporated into your conceptualization If your interpretation demonstrates advanced knowledge of brain-behavior relationships (to do this, the assessments have to be clearly neuropsychological in nature; general educational or psychological evaluations won’t cut it) How organized and clear your report writing is and if it is tailored to the needs of the consumer If ethical practices are followed, such as consideration of ethnocultural factors Whether treatment recommendations are substantive and well founded

Your practice samples will NOT be judged on the following points: Your theoretical approach Whether you use a particular test battery How long your report is If you do the testing yourself or use a technician If you have supporting materials or follow-up information ● ● ● ● ●

If all three reviewers, or even two of the three, agree that both of your practice samples are acceptable, then your practice sample as a whole is accepted. Conversely, if all three deem even one of your two cases unacceptable, then the practice sample is not accepted. But what if two reviewers say “reject” and one says “accept”? Your practice sample will be rejected only if 2 of the 3 reviewers deem one or both of your cases unacceptable, and this is upheld by a fourth reviewer (see Figure 4.1). As part of an automatic appeal process, the fourth reviewer’s job is to either uphold the majority decision or overturn the decision and deem your practice sample acceptable. If ultimately your practice sample is not accepted, you will receive written feedback about the strengths and weaknesses of each case and recommendations for improvement verbatim from the reviewers. It is possible that one of your cases will be accepted and the other one not. If this happens, you can resubmit the acceptable case along with a new one rather than submitting two new cases. This option would likely

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2 of 3 Reviewers Reject

At least 2 of 3 Reviewers Accept

All 3 Reviewers Reject

4th Reviewer

Accept

Work Sample is Accepted FIGURE 4.1

Reject

Work Sample is Rejected

Scenarios for practice sample acceptance or rejection.

have been suggested by one of the reviewers in their written comments or by ABCN in the decision letter they send you. If resubmitting your acceptable case is not explicitly stated as an option in your decision letter, we recommend double checking with ABCN before spending the time and effort to find two new cases. After all, why trash a good case if you don’t have to? Reviewers also generate questions based on your cases that may be used by the oral examiner should your practice sample be judged acceptable.

How Long Does This Take? This step requires you to choose two cases, gather and copy all related raw test data, prepare test score summary sheets (if you do not do this already as part of your report or test file), and generate a brief professional data sheet. If you have been planning ahead, then you have already identified potential cases while studying for the written exam or during the wait between taking the exam and finding out that you passed. Thus, picking your cases will only involve making a final decision on which two cases to submit (we’ll talk about how to select cases later in “Steps to Success”). As we noted above, if you are the type who tends to overthink, or dare we say, perseverate on the details, you may fi nd this part of the board certification process somewhat stressful. If not, you will find this part of the process much easier. Regardless, once you have narrowed down your choices and think you have your best two cases, we encourage you to enlist the help of

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colleagues and/or mentors who have already been through the ABPP/ABCN board certification process to review your potential cases and give opinions about their viability as practice sample submissions. Assuming your colleagues/mentors can review them quickly, you will soon be able to make a final decision and begin pulling together the raw data and preparing the test score summary sheets. These latter steps are tedious but not too time consuming, so depending on the turn around time of colleagues reviewing your cases, you could get your practice sample out within 1 to 2 months of passing the written exam. After the ABCN office receives your submission, in most cases, it will take about 4 months before you are notified via letter about whether your cases were accepted. Some of the reasons it may take this long are because reviewers sometimes are sent packets while they are on vacation or otherwise out of the office, or they are sent packets of cases they recognize (e.g., they helped the candidate choose the cases) and have to return. To minimize the chance of a delay, redact your name and any other information that may identify you or your institution. In this way, even reviewers who know you will not recognize that they are reviewing your practice sample and thus will not feel a conflict of interest. When conflicts of interest are identified, the reviewer is compelled to send back the practice sample, prolonging the review process. Don’t worry if that happens, though, because the ABCN office keeps track of when your cases were submitted and will hold an oral exam spot for you in anticipation that you may pass.

Myths, Distortions, and Plain Nonsense Myth 1: I must find the perfect cases for my practice sample submission. There is no perfect case. We repeat: there is no perfect case. Do not waste your time and emotional energy looking for completely “clean” cases or rejecting cases because the differential diagnosis is tricky or no neuroimaging was available or whatever the case may be. Rather, think of cases in terms of how well you can defend your choice of test battery, conclusions, and recommendations based on the information available to you at the time of the evaluation (e.g., background information, test data, relevant literature). As the competent neuropsychologist that you are, you should be able to do this with any clinical case you have seen; this is what you do on a daily basis! If you think about it this way, almost any case is a good case and worthy of consideration. Of course, you do want to submit cases that can showcase your understanding of neurobehavioral principles as noted above in

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Box 4.2. Similarly, there are types of cases that will be better than others for the purpose of this portion of the ABPP/ABCN certification process, which we will talk about more later. Myth 2: I must submit my cases in their original form, without any alterations. Yes, you are supposed to submit your original work, but if you find typos in your original report, no one is going to fault you for correcting them. In fact, the AACN study guide recommends fi xing typos, if you notice them. There is also that very important feature of most word processing programs that allows you to search and replace text. We strongly recommend you use this wonderful invention to change your original submission so that all patient names are located and changed, along with any other identifying information. Not only will this handy feature ensure patient confidentiality, but it will prevent you from failing because you missed that one place in the report with the patient’s name still apparent. This feature also makes it easy to insert pseudonyms (e.g., “John Doe” for the patient, “Rehabilitation Doc, MD” for the referral source) that maintain readability and convey important information without violating confidentiality. Of course, you can’t rely solely on the electronic “find and replace” feature. Your computer will not know to replace that one time you misspelled your patient’s name “Cicily” as “Cicly.” Also, the computer can end up changing things you did not intend. For example, when electronically redacting the name “Mary” from a report, you can really mess up the word “summary” unless you are sure to use the “whole word” feature. Proofread with this in mind. Box 4.3 suggests identifiers you should consider redacting.

BOX 4.3 Identifying Information to Redact From Practice Samples You should REPLACE names of the following: Patients Family members Friends Referral sources Treatment providers (e.g., physicians, hospitals) Schools or universities Employers ● ● ● ● ● ● ●

(continued)

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● ●

Cities States

You should MODIFY specific dates (i.e., include month and year only) of the following: Dates of birth Dates of accidents or injuries (unless specific dates are important to include so the reader can understand the chronology of events) Dates of evaluations ● ●

●

You should REMOVE the following: Your name Your institution Your city and state Patients’ medical record numbers Patients’ social security numbers ● ● ● ● ●

On the other hand, you should not take this advice to mean that we advocate changing the content of your reports. That is not what we are suggesting at all. If you find a significant error, scold yourself appropriately, decide if anything needs to be done clinically for that case, learn what you need to do better, and then take the case out of the running for the practice sample submission. There is no sense compounding your error by committing the ethically questionable maneuver of submitting a substantively altered report. You’re too good for that. Myth 3: I had my good friend and colleague, who is not board certified but who has solid clinical skills and training in neuropsychology, review my cases, and she said they were good to go. No offense to your friend and colleague, but we cannot emphasize enough how important it is to have someone who is board certified review your practice samples since he or she has been through the process and knows what the reviewers will be looking for. Nonetheless, both board certified and non board certified clinicians, some you know well and some you barely know, should review your samples. The more eyes that look over your potential cases, the better! Remember, three reviewers are going to look your cases over and have their fine-toothed combs out when they review your practice samples. Beforehand,

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it would be ideal if you could have at least three or four people review your practice samples as carefully as the ABCN reviewers are going to. This is another advantage of being a member of BRAIN; you have a variety of people at various stages in the process who are willing to help. Myth 4: The practice sample review process is not fair due to the subjective nature of the ratings. The practice sample review is by definition subjective (reports are not “right” or “wrong” after all!); however, the process is as fair as this type of review can be, and the pass rate is around 70%, similar to the other, more objective, parts of the board certification process. Removing your identifying information from the documents, having multiple individuals with various training backgrounds and specialty areas act as reviewers (although they will be either pediatric- or adult-focused or both depending on your practice samples), and providing explicit standardized criteria for judging acceptability of cases all help ensure that there is no rating bias. Furthermore, all of the reviewers have been through this process and they understand what constitutes essential components of a neuropsychological evaluation. Also, as mentioned above, there is an automatic appeal process for cases that are initially judged unacceptable by two of the three reviewers. In these cases, a fourth reviewer is called in to either uphold the majority decision or overturn it. The upshot of this automatic review is that, in fact, the only way your practice sample will fail outright is if three reviewers agree that at least one of your cases is unacceptable. Consequently, realistically speaking, if your practice samples are rejected, it will be for a reason other than subjectivity or bias. Your job is to maximize the likelihood of acceptance, and our job is to help you do that.

Steps to Success Step 1: Picking your cases Picking your cases is the hardest part of this step in the certification process, but it does not need to induce panic. The practice sample should be representative of your usual, day-to-day clinical work. Your cases do not have to be perfect; remember, the perfect case is an illusion! You want to choose cases that will showcase your knowledge and skills in assessment, differential diagnosis, brain-behavior relationships, and formulation of treatment recommendations. However, since you will be asked to defend your practice samples during one portion of the oral examination (which we will describe in detail in the next chapter), you should think very hard about submitting especially “interesting” or highly complicated cases as you will be potentially

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responsible for defending and explaining everything you reference in your reports during your oral examination. In order to be successful in this stage, you will need two different types of cases that will allow you to show breadth of clinical skills and versatility as a clinical neuropsychologist. As much as possible, the cases should be different in very obvious ways, such as ● ● ● ● ● ● ● ●

age of client referral question pathology diagnosis neurodevelopmental history assessment approach/test battery findings and/or treatment and follow-up considerations

For example, if one of your cases is a 75-year-old man with Parkinson’s disease, it would be best if your second case involved a younger person with a completely different type of pathology like moderate to severe head injury. One way to ensure that the pathologies of your cases are different enough is to think about the body of literature you would read to make differential diagnoses. In the example above, you would review the literature on cortical and subcortical dementias for the first case, while you would look to the literature on cognitive deficits associated with moderate to severe traumatic brain injury for the second case. If you work in a memory disorders clinic and have access only to a geriatric population with probable dementia, then you may maximize the diversity of your cases by choosing two types of dementia with very different clinical courses and/or treatment approaches. For example, your first case could be a fairly typical case of late-onset dementia of the Alzheimer’s type without significant psychiatric disturbance for whom you recommend consideration of medication to slow progression of deficits and increased supervision and assistance. Your second case could then be a case of frontotemporal dementia in which there is prominent psychiatric disturbance and an emphasis on managing behavior. Similarly, if you work in a specialized clinic evaluating children with cancer diagnoses only, you might maximize the diversity of your cases by choosing cases at different neurodevelopmental stages (e.g., a 6-year-old and a 16-year-old) for which you

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would use different test batteries and consider different academic and social consequences of cognitive impairment. If this is your situation, we believe it is absolutely necessary to include a cover letter explaining your unique practice circumstance and pointing out specifically how you have maximized the diversity of your cases given your particular setting. Avoid cases that are forensic (unless that is your only type of case or a large majority of your practice) or controversial in nature, either because the diagnosis itself is debatable or the presence of cognitive dysfunction associated with the diagnosis is debatable (e.g., malingering, chronic fatigue syndrome, fibromyalgia, mild traumatic brain injury/postconcussive syndrome). By their nature, controversial cases evoke strong and varied reactions in reviewers (and oral examiners) for which you may not be well prepared. Also avoid cases of rare or esoteric disorders; those are excellent for really interesting case presentations but do not represent your daily clinical work and can take you down unpredictable paths involving detailed questions in an area few neuropsychologists have expertise (except perhaps your oral examiner—gulp!). Shoot for moderately complex, noncontroversial cases. Stay away from cases that are too simple or have no neuropsychological dysfunction because then you do not get to exhibit your differential diagnosis skills or knowledge of brain-behavior relationships. If your report does not reveal this knowledge explicitly, the reviewers will be left wondering if you have a gap in this fundamental area of expertise. If you choose a case that is simple in terms of diagnosis, then make sure it is complex in another way, such as family issues or treatment considerations. Moderately complex cases actually allow your reviewers to really see that you can consider multiple issues in applying an appropriate assessment approach, conceptualizing the case, and offering thoughtful recommendations. Remember, the purpose of choosing different cases is to show your depth and breadth of experience and practice. Highly complex cases may be acceptable at this stage, but you may later come to regret submitting them. As we pointed out earlier, you will be expected to defend your practice samples during one portion of the oral examination. To prepare for that, you will need to study up on every possible angle on your cases. The more complex the case, the more you will need to cover. That’s why we suggest picking a case that is moderately complex, but not highly so. Finally, it is desirable but not necessary to have follow-up information on a case. How did things turn out? You won’t submit that information with your practice samples, but it can make for a nice talking point during the orals.

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Step 2: Ensuring your cases are acceptable For each potential case, be sure the test battery assesses the essential neuropsychological functions relevant to the patient and/or referral question and that important ethnocultural factors are considered in test selection and interpretation. Of course, we know you do this all the time, but be extra sure that all tests are administered and scored correctly and that this is evident in the raw data, which you will also be submitting (be sure to redact all identifying information on test protocol forms!). It is perfectly acceptable to turn in practice samples that involved a technician, just remind him or her to go above and beyond his or her usual level of obsessive-compulsiveness in ensuring the accuracy of the test administration and scoring. Remember, you are ultimately responsible for his or her work, including any errors. Use appropriate and up-to-date norms, including culturally appropriate normative data when available. You probably should refrain from using the test your graduate school mentor standardized and normed with his child’s elementary school class! While there is no “right” or “wrong” way to write reports, keep in mind who will be reading this report and what they are looking for (refer back to Box 4.2 if you need a reminder). We know your typical reports are readable and appreciated by patients, family members, and referral sources, but they may not demonstrate the specific skill set that is being evaluated by your practice sample reviewers. If this is the case, you may want to write a more “classic” neuropsychological report for potential cases in which you showcase your knowledge of brain-behavior relationships. Alternatively, you might consider adding this level of detail to a cover letter. This way the reviewers have no doubt that you know your stuff! Be sure that your report states clearly the reason for referral and referral source (in a de-identified manner). It should document relevant background information (or provide it in a cover letter or supporting materials), including patient demographics, neurodevelopmental and medical histories, current medications, family history, psychosocial issues, and so forth, and integrate this information into your conclusions. Historical and test data should be presented clearly and in an organized manner. Your report should be consistent in the way it presents test findings and make sure it reflects consideration of cultural, linguistic, and other social factors in your interpretation of the data. Unless there is a compelling reason not to do so, emotional and psychological functioning should be assessed and relevant findings integrated into your conclusions. Check that you have spelled out

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your thought processes in making differential diagnoses, if relevant, and linked brain-behavior relationships to specific aspects of your case. Finally, ensure your recommendations are well founded and of sufficient detail to foster implementation. Recommendations should be supported by data and relevant to the patient’s circumstances. Box 4.4 summarizes some of the “must dos” to increase the chances that your practice sample will be accepted, as well as some of the common mistakes that result in rejection.

BOX 4.4 Keys to Acceptable Practice Sample Submissions Must dos: Choose cases that are as diverse as possible. Have several colleagues and/or mentors review your cases, particularly folks who are already board certified. Anticipate problems and questions and have a good rationale for why you did what you did. Fix typos. Redact identifying information—even one slip up will result in failure of your entire practice sample. Make sure copies are readable. ● ●

●

● ●

●

Common problems that result in failed practice samples: Cases not diverse enough to demonstrate your breadth and depth of neuropsychological knowledge. Neuropsychological assessment was not the central focus of the evaluation. Identifying information not redacted. A relevant neuropsychological domain was not assessed. Conceptualization of data is flawed or does not accurately incorporate all findings. Did not assess effort or motivation objectively in forensic evaluation or in other cases with prominent psychological features. Emotional/psychological functioning not assessed. Insufficient documentation or elaboration on some aspect of the case. ●

●

● ● ●

●

● ●

(continued)

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●

● ●

Did not gather or consider pertinent medical or psychosocial information. Did not answer referral question. Recommendations are omitted, minimal, or “canned”/”cookie cutter.”

Step 3: Deciding whether to send a cover letter Including a cover letter is completely up to you. We recommend including a cover letter if you need to explain something about your cases or your setting that is not typical of the usual neuropsychological practice. For example, you might want to explain that your two cases are both in elderly populations because you work in a memory disorders clinic and are limited in the types of referrals you get. In this situation you might want to point out that to counter the lack of diversity in age, you selected cases that vary in other important ways, such as in neuropathological processes, in severity of cognitive dysfunction, and/or in ethnic origin. In this way, the reviewers would see that you are mindful of the need to demonstrate diversity and aware of the multiple ways in which your cases illustrate this concept. Another reason to submit a cover letter may be that abbreviated batteries are more practical in your work setting because your population is very sick and cannot tolerate long batteries. In the cover letter, you could then point out how your test battery covers the neuropsychological domains relevant in your particular population and/or answers specific referral questions in spite of its brevity. If you write short or abbreviated reports because you work on a multidisciplinary team and relevant medical/historical information is provided in another health care professional’s report, you should note that in a cover letter. In this case, you may also want to include this other professional’s report (carefully redacted!) so the reviewer can put the case into a context. Alternatively, you can include important background information as part of a summary of relevant records (medical, school, employment, etc.). This approach might be most useful when there is more than one extra source of information to consider; you can save your reviewers time by summarizing it for them. An added benefit to distilling the information for your reviewers is that they then get to see what you considered important in your particular case. Remember, you want the reviewers to have all the information they need to feel that you have done a thorough evaluation and considered all relevant information.

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You may have heard that you need to include a multi-page “case analysis” essay that reviewed the cases, their conditions, why you did what you did, and what the outcomes were. Believe it or not, this is one of those times that those coming before you had it worse than you do (though we’re still skeptical that they walked to school through miles of snow, uphill both ways). Yes, in the past, such an essay was expected. Thankfully, that is ancient history. Beyond the test data, report and data summary sheet(s), anything else (e.g., cover letter) is now optional, and usually absent. However, if you are in doubt about whether to send a cover letter and/or supporting materials, we urge you to heed the advice of Nike and just do it!

Step 4: Preparing your professional data sheet Since only the chair of your oral exam committee will have access to your full ABPP/ABCN application, you must prepare a brief professional data sheet for the other members of your oral exam committee. This data sheet should include the following: ● ● ● ●

●

●

Your name Doctoral degree and date awarded Institution from which you obtained your doctoral degree A list of positions held since obtaining your doctoral degree with dates An outline of duties in your current position and the percentage of time spent in each Types of patients or clients typically seen

As long as this information is present and reasonably organized, there is no “official” format for the professional data sheet. Box 4.5 provides one example.

BOX 4.5 Sample Professional Data Sheet Name: Nancy Neuropsychologist Doctoral Degree: PhD, Clinical Psychology Date Awarded: August 2003 Institution: University of Neurobehavior (continued)

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Positions Held Since Awarded Doctoral Degree: 2003–2005 Postdoctoral Fellowship in Neuropsychology, Department of Psychiatry, University of Brain HSC 2005– Assistant Professor Department of Psychiatry, Brain Univ. Med Ctr. Current Work Duties and Percentage of Time Allotted to Each: Clinical (40%): Perform evaluations of children and adults in a general neuropsychology clinic. Most referrals are from psychiatrists, neurologists, primary care physicians, and school systems. Supervise two doctoral-level psychology students as part of a paid externship experience to assist with evaluations. Clinical/Research (20%): Perform evaluations of persons with memory disorders as part of a research clinic. Conduct joint interviews with a psychiatrist and supervise a doctoral-level psychology student as part of a practicum experience to administer neuropsychological testing. Participate in consensus diagnosis meetings. Research (30%): Conduct studies on various research questions using data from the neuropsychology and memory disorders clinics, investigate neuropsychological aspects of chronic medical disease, and examine assessment issues related to memory. Support research interests of departmental faculty (i.e., Parkinson’s disease, cognitive dysfunction in psychiatric patients). Research lab is comprised of two doctoral-level psychology students, one bachelor’s level psychology student, and four undergraduate psychology students. Academic (10%): Course director for the required second year medical school course “Introduction to Psychiatry.” Provide lectures on the mental status examination, learning and memory, and dementia in “Medical Neurosciences,” “Skills for Patient Assessment”, and “Foundations of Medical Practice” courses.

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Tips for Supervisors and Trainees Neurobehaviorally focused clinical interviews, test selection, data interpretation, and report writing are core skills for neuropsychology trainees. If you are a trainee with a supervisor who is board certified by ABPP/ABCN, then odds are that your supervisor has made a commitment to teaching you how to generate reports that are likely to be accepted by ABCN practice sample reviewers. If your supervisor is not board certified, initiate discussion with him or her about your current training practices in these areas and how they compare to the suggestions in this chapter and the information provided in the AACN study guide. In either situation, periodically take a step back from what you are doing clinically to really understand why you are doing it. It is all too easy to parrot a supervisor’s words, test batteries, or writing style. The more difficult but infinitely more important thing to learn is the reasoning behind those words, that battery, and that style. Work with your supervisors to really understand why he or she does what he or she does. If you are a supervisor (regardless of board certification status), make sure you communicate why you do what you do. What are the reasons you interview, test, score, and interpret the way you do? What guides your choices and thought processes? How do you come to your clinical recommendations? Ask your trainees to anticipate what you might do or say in a given circumstance. Do not be surprised if they do not know, especially if it is a new circumstance where parroting does not work. Whenever possible, vary the cases they see so that simple parroting cannot work. For advanced trainees, before you tell them what to do, say, or write, ask them what they would do, say, or write. Have them describe their reasoning and provide guidance when necessary. The goal is to move them in the direction of a thoughtful, flexible approach to clinical work. That, coupled with patient but rigorous guidance in report writing, will prepare them well, not only for the ABPP/ABCN practice sample submission, but also for high-quality independent clinical work. We hope you will find the information in this chapter useful in preparing trainees for eventual board certification through ABPP/ABCN. We also hope that we may even be encouraging you to seek board certification as well!

Wrapping Up and Looking Ahead Although the whole board certification process can cause significant heartburn or angst, submitting your practice samples does not have to

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be overly anxiety provoking (relatively speaking). After all, performing neuropsychological evaluations and presenting your findings and recommendations in written form is something you do every day. The most egregious error you can make is failing to redact identifying information, and preventing this problem is as easy as using a word processing function (i.e., search and replace) and employing multiple reviewers. We urge you to call in favors and have several people review your practice samples before submission. Ask them to be overly critical and to point out any nitpicky flaw they can find. No case is perfect, so this will be easy to do and is an essential component in preparing you for the next step, which is to defend your practice samples as part of the oral exam. After you submit your practice sample, take a moment to reflect on your progress and to remind yourself that the sailing is smoother from here on out. Be prepared to receive your results in approximately 4 months, and in the meantime, consider beginning your preparations for the oral exam. It is not uncommon to receive notification that your practice samples were accepted a mere few weeks before the actual oral exam. For this reason, we suggest you take a peek at the next chapter to see what you can be doing while you wait to hear that your cases were accepted (here we go thinking positively again!).

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5 ■■■ The Oral Examination One More Hurdle to Go

Nuts and Bolts What Is the Task? Congratulations! You have made it to the last stage of the ABCN certification process: the oral examination. As you may already know, this step consists of three separate, but equally important parts. Although each element emphasizes different approaches and content, they will all be used to judge your depth of clinical knowledge, neuropsychological skills, and your general clinical practice. The three parts of the exam are described in Box 5.1.

What Is the Process? Oral examinations are held twice a year, in May and October. In order to verify specific dates, you can either check the ABCN webpage or call the ABCN office (see Chapter 1 for contact information).

Where Are the Examinations Held? When we wrote this book, the oral exams were held in Chicago and only in Chicago. This means that, unlike the written examination, you will not be able to take the orals at a conference when it comes near you. The odds are you will have to travel. Still, Chicago is centrally located and generally quite easy to fly to. As such, it is the most geographically accessible location available for the majority of the United States and Canada. So, rather than complaining that you have to travel to Chicago to take your orals, be thankful that ABCN did not decide to offer the examination in Sitka, Alaska (although we suppose a few of you might be excited about that prospect). 87

BOX 5.1 The Three Sections of the Oral Examination 1. Review of professional and ethical issues. This section evaluates your understanding of the current APA (or CPA) ethical codes and HIPAA. It also allows the examiners an opportunity to understand your current job responsibilities, approach to neuropsychology, and contributions to the field better. 2. Practice sample review. This section focuses on your knowledge and thought process regarding the cases you submitted for your practice samples. 3. fact-finding. This section emphasizes your approach to neuropsychological evaluations. You will be asked to solicit historical and medical data about a patient, gather information regarding the neuropsychological findings, and then offer a conceptualization of the case including possible etiologies and recommendations for treatment.

What Should I Expect When I Get There? An Overview of the Process The examinations are held over a weekend (Friday/Saturday). There are two examination groups per day, one each morning and one each afternoon. You will be assigned to one of these four groups. Depending upon how much notice you give the ABCN office, they may be able to accommodate specific travel schedules. Once you get to the examination site, you will be directed to sit in a room along with the other candidates. Although you may be too anxious to notice, refreshments will be provided for you while you wait. Before the actual examination, there will be a brief orientation. During this time, you will be provided with a general overview of the oral examination. You will also be given your specific examination schedule; each candidate will rotate through all three sections in a random order. Consequently, you may begin with the fact-finding, or you may end with it. You will also be provided with a list of your examiners at that time. ABCN will do its best to match you with examiners who share your preference for adult and/or child populations. However, one or more of your examiners may work with a different age range than you do. In the end, your performance will always

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be based on your stated area of expertise regardless of the specialty status of your examiners. After all candidates have received their examination schedules, you will meet with an ABCN official (usually the president) to discuss any possible conflicts of interest regarding your examiners. Your examiners will also have been asked to report any potential conflicts as the schedule is developed. Keep in mind that the field of neuropsychology is still somewhat small. Consequently, your examiners do not need to be total strangers. However, they should not be former supervisors, or individuals who you feel might not be able to judge your performance in an impartial fashion. A conflict is any pre-existing relationship that could reasonably impair the ability of the examiner to render an objective assessment of the candidate’s performance during the oral examination. This can be a positive OR a negative relationship (e.g., an examiner who was a primary supervisor for a candidate may be unable or unwilling to be sufficiently critical if the candidate performs poorly). If you or your examiners report any conflicts, a different examiner will be assigned. After these logistics are out of the way, the examination is broken into three 1-hour blocks completed back-to-back. Because of the need for travel time to different rooms, each segment will generally last closer to 50 minutes. At the beginning of each hour, your examiner will bring you to a separate room. He or she will briefly orient you to the specific task and provide any relevant instructions. At the end of each hour you will return to the waiting area until the next 1-hour block begins. You will not be permitted to bring any notes with you into the oral examination (aside from a copy of your own practice samples). However, you will be allowed and even encouraged to write down any notes you wish as you work through the exam. You will be asked to turn in these notes to the examiner at the end of each hour. While you may be tempted to think that ABCN realizes how much these notes will fetch on the neuropsychological “black market” or e-Bay and wish to cash in on the profit themselves, this is really just to maintain test security. Some candidates may be shadowed by an observer during their oral examination. If you are one of these “lucky” examinees, do not let this intimidate you. The observer’s presence has nothing to do with you or your expected performance. There are two kinds of observers, both of whom are there to watch the examiners, not you. The first is a senior neuropsychologist whose role is to ensure that the examining process (including the deliberation at its end) is following the standardized format, rules, and expectations.

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The second observer is a board-certified neuropsychologist who is training to become an examiner. Both types of observers will be as unobtrusive as possible. Be assured that they do not have a say in whether you pass or fail. Immediately after the examination is over you will be asked to complete a rating form. This is your chance to provide feedback about the oral examination process and your specific examiners. We encourage you to use this opportunity to share any information or concerns you had about your experience. ABCN takes this information very seriously and welcomes your input. As we mentioned in Chapter 1, this information will not be shared with your examiners until after they submit their ratings of your performance. So feel free to provide an honest appraisal of your experience. After you provide this feedback, we suggest you go out and celebrate your achievement! ABCN will get your results to you as quickly as possible. Typically results are sent out in 1 to 2 weeks.

What Is Being Assessed? During each stage of the oral examination, your performance will be closely observed and evaluated. Afterward your examiners will meet as a group to review your performance across all three portions of the examination. Keep in mind that the pass/fail judgment will be based solely on your performance during the examination, not on the quality of the practice samples, historical demonstration of commitment to the field or other extraneous factors. As summarized in the AACN Study Guide, the examiners will be rating your 1. approach to neuropsychological evaluations including knowledge of possible interventions and treatment; 2. breadth and depth of scientific and professional knowledge; 3. understanding and application of ethical responsibility; and 4. professional commitment. Of course, each examiner will observe different aspects of these skills through his or her individual portion of the oral examination. Nonetheless, your performance across all three sections will be equally important in determining your ultimate success. In other words, you do not pass or fail each section; you pass or fail the entire oral examination.

Oral Examination Preparation Timeline Unlike the written examination, you will not need months of intensive study time. Preparation for the orals is much more about preparing for the

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process of the examination, not memorizing factual content. If you are using a study group, we recommend you “meet” enough times for each member to practice at least two fact-findings, and for you to offer constructive criticism about each other’s practice samples (we will be providing more specific details regarding how to plan study group sessions throughout this chapter). Plan on scheduling a few extra sessions for discussions about ethics, how you want to present your professional background, and any other relevant topics. Using this approach, most people can adequately prepare for the oral examination in approximately 3 months’ time. Of course, there are some people who have taken less time to prepare for the orals and passed. So, figure out what you need to do in order to feel ready. There is one potential complication that can be somewhat challenging to work around. In particular, if you submit your practice samples on or slightly before the deadline for the next oral examination, you may not get your results 3 months before the day of the exam. Consequently, if you want to follow our 3-month guideline, the odds are high that you will need to start studying before you know whether your practice samples have passed. Alternatively, you can decide to wait another 6 months and take the oral examination during its next administration. Either choice has its own pros and cons, and only you will be able to decide what is best for you. However, we suggest you consider preparing for the oral exam before you get your practice sample results. This way you will be ready to go as soon as you get the good news that ABCN is scheduling you for your oral examination. On the off chance your practice samples are not approved, having worked through the preparation steps will still be to your advantage. After all, as will become clear in this chapter, we are firm believers that there is no such thing as “too much practice” for the oral examination. Furthermore, if you do decide to join a study group, reviewing other candidates’ practice samples may help you better prepare a second submission should you need to do so. Your study group may also be a source of support and encouragement to help you muster up the energy to try again. (We also recommend you refer to Chapter 6 for other sources of encouragement and redirection if your practice samples are not passed.)

Myths, Distortions, and Plain Nonsense Myth 1: The examiners will be looking for every excuse to fail me so my responses better be perfect or I will not pass. This is the last time you will be reminded about this, but ABCN is really not about perpetuating

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an “old boys’ network.” Believe us when we tell you the examiners sincerely want you to pass. They are not cold, dismissive, or personally judgmental, although many examiners do manage to put on one heck of a poker face! So, while you should not expect them to be nodding and smiling appreciatively when you speak, they will also not be looking for every misstep you make in an effort to exploit your weaknesses. In fact, if you seem to be on the right track but have not quite given everything they are looking for, your examiners may even probe a bit to see what else you know. Myth 2: You have to pass only two of the three sections to pass the oral examination. All three examiners are evaluating your neuropsychological knowledge, experience, and practice. While they are observing your performance on different tasks, you still need to demonstrate competency throughout the examination. In fact, (although it is unusual) we have been told that if you make significant enough errors in any one section of the oral examination, this could raise enough concerns for the group to vote against your passing. We are not telling you this to increase your anxiety level. However, it highlights the fact that all three sections of the oral examination are critical tools for the examiners to evaluate your competency level. It should also help you remember to take each part as seriously as the others.

General Study Tips Now that you have a general sense of the oral examination process, you are ready to begin your preparation in earnest. One of the first things you will want to do is speak to your AACN mentor if you have one (if you do not, now is the time to consider getting one; refer to Chapter 1 for more information). Your mentor should be able to help you develop a better understanding of the oral examination process and will be a great resource in helping you master your approach to the fact-finding. Ideally, you will want to schedule a “mock fact-finding” with your mentor that you can do in person or by phone (if you do not live near him or her) as part of this process. Take advantage of any and all ABPP neuropsychologists you know—now is the time to network! The more practice you get, the more comfortable you will be for the actual examination. That being said, although it is best to get help from as many people as possible, be prepared for differing opinions and advice. Some neuropsychologists who have not taken the examination recently may not remember the process as well as others. Alternatively, minor changes may have been made in the ensuing years. It is not uncommon for ABCN candidates to receive recommendations that are exactly the opposite of what

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another person has told them! Should this happen to you, the BRAIN listserve (join if you are not already a member!), your AACN mentor (if you have one), or the ABCN office could all be helpful in providing clarification. In addition to working with your mentor and other board-certified neuropsychologists, we strongly recommend that you consider developing a study group to help prepare for the oral examination. We do recognize that some people prefer to study alone. If you are one of these people, we suggest you take the advice from the following section and modify it for your particular circumstances. Even if you do not have study partners, you can ask colleagues and/or mentors to fulfill many of the roles described below. However, you will miss out on the opportunity to observe others as they work through the fact-finding process, which can be as useful as your own preparation. Additionally, you will miss out on the camaraderie, support, and the advantage of having socially enforced deadlines. Can you tell we think that study groups are the best way to go here? In fact, we are such strong fans of study groups, we have included specific tips for these groups in each of the following sections. Furthermore, once your practice samples have been approved, you can contact the ABCN office and try to schedule your orals to occur at the same time as at least one person in your study group. This will help reduce some of your anxiety at the actual examination, and it will give you someone to celebrate with when you are finished with the test. If you do decide to study with a group, we recommend that you find three to four colleagues who work with the same-aged population as you do (i.e., pediatric or adult). Unlike the written examination, this portion of the ABCN evaluation focuses more on depth than breadth of knowledge. Furthermore, it will be much easier to critique one another’s practice samples and to provide mock fact-findings when you all work with the same general population. That being said, some of us have successfully studied in “mixed” groups, and certainly this would be better than studying alone. As has been addressed previously for the written examination, the BRAIN listserve also has people who can help you form a study group with other neuropsychologists who are preparing for the same oral examination. As we have already mentioned, we suggest that you schedule enough sessions to discuss each member’s practice samples, and to allow each member to practice at least two fact-findings. Plan on including a few extra meetings to discuss ethics and other practical issues as well. Some people have chosen to hold frequent and/or many brief sessions that focus on only one task at a time. Others schedule longer meetings that cover both a fact-finding and a practice

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sample in the same session. Obviously, how you arrange your calls is up to you, and the number of calls will vary based on the size of your study group and the actual content you wish to cover in each phone call. Keep in mind that your phone calls may be considerably longer than the meetings you held while studying for the written examination. However, you will not need to study as long (or even as hard) as you did for that part of the ABCN process.

Specific Study Tips: The Nitty Gritty Details Because the oral examination involves three different portions, we will discuss each one in its entirety rather than breaking them up into the sections you have grown used to in this book. We will be covering all the relevant information; we are just going to do it one portion at a time.

Professional and Ethical Issues What Is Being Assessed? Your knowledge of current APA/CPA ethical codes Your understanding of HIPAA and its relevance to your practice Your educational history, professional practice and contributions to the field ●

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What Is the Task? Let us take each of these topics separately in order to understand their demands and expectations better. 1. Ethical issues: For the first portion of this hour you will be provided with an ethics vignette. You will be asked to read through the vignette and identify any and all ethical breaches you recognize. This is not a test designed to evaluate your ability to detect subtlety. Rather, the dilemmas will be significant and numerous. Most ethical breaches will be fairly obvious, although like many real-life situations there may be some transgressions that are more questionable, controversial, or defensible than others. Your job will be to list specific examples of what the clinician did wrong, and what he/she should have done instead. You will not need to know the APA ethics code by number, but you should clearly understand what the principles and codes are and how they apply to clinical neuropsychology (e.g., competency, limits of confidentiality, etc).

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We encourage you to take notes as you read the vignette. Each time you highlight specific ethical transgressions, include the specific standard/language from the ethical code in your notes. You may even want to jot down some ideas about what you might do differently. Before presenting your summary to the examiner, take a minute to pull together your thoughts. Consider how you want to present the ethical transgressions (remember there will be a plethora of them!). For example, do you wish to go in chronological order, or do you wish to discuss the more egregious problems first? There is no right answer, but realize the more organized and calculated you are in your approach the better you will look. Be comprehensive and discuss all of the issues you observe in the vignette. Finally, realize that you will not only be asked about the specific vignette, but also about your applied understanding of ethics in general. Consequently, be prepared to discuss what you would do if you were aware that someone was making similar mistakes in your own community. Advice for our Canadian Readers (as Canadians are boardeligible neuropsychologists too!): If you are Canadian (or a US citizen practicing in Canada), this portion of the examination still applies to you. While you do not need to learn the most recent APA ethical code in depth, you will need to know your own CPA code. It may be helpful to also be aware of how your code may differ from APA expectations. Similarly, you should have a good enough understanding of HIPAA, and US law, to discuss how your own requirements may be similar and/or different. By the way, do not assume that you will know more than your examiners. There are many Canadian ABPP/ABCN neuropsychologists, and for all you know, one of them may be your examiner! 2. Professional issues: In the second part of this hour you will be asked to summarize your educational history, professional practice, and contributions to the field of neuropsychology. In other words, you will be asked to share with the examiner the “what,” “where,” and “how,” of your professional practice. Topics that may be addressed include

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● ● ● ● ● ● ● ●

your education and training background your employment history your current job duties any research interests/activities any teaching experiences how you keep up to date with neuropsychological topics how you approach assessment any professional involvement with psychology and neuropsychology organizations

The above list is extensive (although not comprehensive) and not all topics will be covered with all applicants. Remember, each neuropsychologist also has his or her own strengths and contributions to make to the field. You should not be concerned if you are not well published or if you do not run a training program at a competitive hospital. While some of us may be getting NIH grants, others might not do research unless our very lives depended on it. Similarly, some of us may work in a rehabilitation unit and encounter “classic” medical neuropsychology cases on a daily basis, and others of us may be working in outpatient clinics where we specialize in learning disorders, attention-deficit/hyperactivity disorder (ADHD), or schizophrenia. No matter where you work or how you choose to specialize, if you have made it this far you are clearly a board eligible candidate. Furthermore, you will find other professionals with similar backgrounds and practices who are already board certified. Use this time to share with the examiner why you are excited about neuropsychology and what you are doing with your career. Share your passion and your knowledge, and we are confident you will do well. Finally, you may be asked to provide an ethical dilemma you yourself have faced. Your presentation will be evaluated based on your understanding of ethical principles and how well you resolved the issue. So think carefully about what experiences you wish to share. We recommend that you find a simple, straightforward example. Although we recognize that many real-life ethical cases are complicated, the more intricate your story is, the more possible it is that the examiner may disagree with how you decided to handle the situation or that you will simply run out of time to cover it well.

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Steps to Success This section of the oral examination is in many ways less threatening than the other two parts, primarily because a large part of it is simply a review of your own practice. However, do not let yourself become complacent. Your ability to express an understanding and application of appropriate ethical conduct is a critical part of the oral examination. Consequently, you will want to spend some time (re-)familiarizing yourself with the ethical code. Also, think about the ways you stay current with neuropsychology so you can share this list with your examiner. Do not restrict yourself to discussing your attendance at national and/or local conferences. Consider sharing which journals or texts you read and if you teach and/or attend any classes, seminars, or grand rounds or have regular meetings with other local neuropsychologists. Finally, some simple, but essential information about how to prepare for this portion of the examination is provided in Box 5.2.

BOX 5.2 Dos and Don’ts for the Ethics Portion of the Oral Examination Do ●

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Spend time reviewing your ethical code (either CPA or APA) and familiarize yourself with the ethics standards Consider reading articles or books that emphasize ethics within a neuropsychological framework Practice working through several ethics vignettes identifying specific breaches of conduct and using specific APA/CPA terminology Present the ethical transgressions in a meaningfully organized fashion

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Don’t feel compelled to memorize the code word for word, or memorize standard numbers Don’t plan on just “winging it” based on your previous training and the one or two times you read the new ethics code when it last came out Don’t assume that just because this section is less threatening that it is any less important Don’t forget to include a review of HIPAA

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Tips for Study Groups Many study groups choose to review ethics in one or two phone calls by developing and/or going through pre-written vignettes. You can come up with your own, or use the examples on the BRAIN web site (see Chapter 1 for URL). We suggest you have each member in the group read an ethical vignette and summarize the various transgressions. Remember to practice using specific terminology and phrases from the ethical codes (again, do not worry about the code numbers). We also recommend you spend some time discussing HIPAA requirements, considering both general requirements and any state (province) specific expectations.

Practice Samples Review What Is Being Assessed? ●

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Your knowledge of your own cases, including applied principles of functional neuroanatomy Your knowledge of psychometric principles, including your choice of test battery and its appropriateness for your particular patients Your knowledge of everything and anything even remotely related to your case and neuropsychologically relevant issues (don’t worry, it is not quite as bad as it sounds, read below for more details)

What Is the Task? The format of this portion of the evaluation is somewhat more informal and unstructured than the other two sections. That is, there is no formulaic outline to describe specifically how the process will unfold. That being said, you will essentially spend this hour answering a series of questions about the two cases you submitted as part of your practice samples. Some evaluators may ask you to provide a brief summary of each patient, others may not. There is also no guarantee how much time will be spent on each case. Often the time is split evenly between your two patients. However, if your reviewers have more questions or concerns about one case, you may find yourself talking more about that patient. Your goal is to talk intelligently about your patients, your findings, and your report. Just as in the Ethics portion of the evaluation, with the right preparation and a clear awareness of what to expect, this part of the exam should be fairly

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straightforward. After all, you will be discussing two of your own patients, and you are especially familiar with these particular cases or you would not have selected them in the first place. Nonetheless, your examiner is not the only person who will be preparing questions to evaluate your knowledge base. As you might recall, in order for your practice samples to be accepted, they were reviewed by three (sometimes even four) other board certified neuropsychologists. Each of these reviewers prepared a list of potential questions for the examiner to use during your oral examination. Furthermore, your practice samples did not have to be approved unanimously in order to be accepted. Consequently, one reviewer may have had pointed concerns about your report and/or conceptualization. Even the reviewers who did pass your practice samples may also have identified specific issues they felt you need to defend or explain further. So, your answers during the oral examination may be critical to convince your examiner that you did appreciate these concerns even if you did not address them in full detail within your reports. In addition to the questions provided by the reviewers, the examiner will also have a complete copy of your practice samples and will have had the chance to develop his/her own list of questions. This means that the examiner and up to four other board certified neuropsychologists (each with their own backgrounds and expertise) will have had the chance to come up with specifically tailored questions just for you—lucky you! Don’t Panic! Sounds intimidating, doesn’t it? Don’t worry. With a little preparation, you will it be able to handle the examiner’s questions with confidence. Before you even arrive in Chicago, you will have gone over your cases backward and forward. You also will have had your colleagues read through them, your mentors criticize them, and your study group search for every possible strength and weakness. If you play your cards right, and follow our directions, you will already understand nearly every nuance, potential controversy, and detail that might come up during your oral examination. Of course, we cannot guarantee you will be ready for every possible question that may be thrown at you, but you will certainly be ready for most of them. In fact, some people walk out of this part of the oral examination thinking, “That’s it? But why didn’t you ask me about x, y, or z?” or, “Come on, I was ready for the hard stuff!” (Of course, they did not actually say that to the examiners, but that has been a common experience.)

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Hey—I didn’t talk about that in my Practice Samples!!! Most of the questions in this portion of the oral exam will be geared specifically toward your practice samples. However, keep in mind that by reviewing your materials the examiner will also be observing how you approach assessment, what kinds of measures you prefer and why, your understanding of psychometrics, and how you go about conceptualizing your data. In other words, this is a hands-on way of evaluating your breadth and depth of neuropsychological knowledge. The good news is that you will get a chance to showcase your knowledge using cases that you have already put a lot of thought into. The bad news is that everything you reference in your report becomes fair game even if the diagnoses or issues do not end up being pertinent for your particular patient. For example: ●

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Your patient has a cousin with epilepsy? Great! Now your examiner can also ask you about seizure disorders. Did your patient’s maternal aunt die of Creutzfeldt-Jakob Disease? Now all prion disorders are fair game, even if your patient has been a vegan from the time he or she was conceived. Did you give a 16-year old child the Boston Naming Test? Then you should be prepared to explain what norms you used and your rationale for doing so.

Steps to Success Now that you know that up to five board-certified neuropsychologists will be developing tailored and specific questions for your oral examination, you may be slightly concerned about how to proceed. Actually, the answer is simple. Your “homework” for this part of the oral examination will be to ensure there are few to no surprises that the examiner can throw at you. So, follow the steps below to ensure your own success in this part of the oral examination. 1. Enlist colleagues to critically review your practice samples. We know it can be intimidating to have other people review your written work, but we think you might agree that it is preferable to answer to a friend, colleague and/or mentor rather than face an evaluator at your oral examination unprepared. So, ask your peers to tear apart your practice samples. Have them help you find every little hole, every

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little weakness, imperfection, or potential controversy. Use this information to think about how you might answer similar questions on the actual day of the examination. Nobody is perfect, but you will need to be able to articulate why you did what you did during the evaluation and write-up and, in hindsight, what you might have done better and how. In Box 5.3 we outline many of the issues you should consider for yourself as you prepare to defend your practice samples.

BOX 5.3 Topics to Consider When Reviewing Your Practice Samples ●

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Consider the population you are working with. What sociocultural issues are relevant? Are the recommendations tailored for your particular patient or are they more of the “canned” variety? Do they adequately address your patient’s needs or in retrospect do you wish that you had suggested x, y, or z as well? Did you consider all factors that may have affected your patient’s performance (e.g., medications, fatigue)? If your patient was on medications, what is/are the mechanism(s) of action and how may that have affected the testing results (in both positive and/or negative ways)? Review your conceptualization of the neuropsychological data. Now that you have a little distance, is it possible that someone might interpret the findings differently? For example, did you take into account how attention/ effort/language (etc.) may have impacted your patient’s performance on that verbal learning task? If you did not, how would you want to address this issue should you be given the chance? Understand the neuropathological mechanisms that underlie the patients’ conditions, and have some sense of prognosis. Re-examine your neuropsychological measures and battery choice, and be familiar with their strengths and (continued)

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BOX 5.3 Topics to Consider When Reviewing Your Practice Samples (Continued) weaknesses. For example, did you administer a fi xed battery or did you use a more flexible battery approach? You could also be asked to explain, for example, why you chose to give the Wisconsin Card Sorting Test instead of (or in addition to) the Halstead Category Test.

2. Prepare yourself to answer any challenging questions. As with many issues in neuropsychology, there may not be a clear “right” or “wrong” answer to some of the questions that will be posed to you. However, how you go about justifying your approach will show the examiners that you are versed in the potential controversy. Along these same lines, you should not feel compelled to memorize specific details about the normative sample and/or factor structure of every test you use, but you should be aware of any significant psychometric flaws or weaknesses of your measures (e.g., small normative sample sizes or poorly supported factors/indices). Once you have found the holes in your report, spend some time thinking about how you would respond to any questions should you be confronted with them. Sometimes this may entail a brief literature search to beef up your knowledge about a specific topic; you do not need to complete a thorough or extensive literature review. Reading recent review articles or a book chapter is generally sufficient. You do not need to be a national expert on the subject; you just need to be able to demonstrate a sound understanding of the principles at hand. A summary of key “dos and don’ts” as you prepare for the practice sample portion of the oral examination is provided in Box 5.4. Bottom line—know your diagnoses, know the rule-outs, know your tests, know your population biases. Tips for Study Groups We suggest that one person be assigned to present their reports for each conference call. This person should distribute his or her reports and data

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BOX 5.4 Dos and Don’ts for the Practice Sample of the Oral Examination Do ●

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Seek out constructive criticism from your friends, peers and mentors Become familiar with recent literature regarding the diagnoses discussed in your reports Be prepared to discuss any psychometric weaknesses inherent in the tests you used Do refamiliarize yourself with your cases So you can speak intelligently about your patients and your findings Be prepared to discuss the underlying neurological systems relevant to your cases Familiarize yourself with your patient’s medications, and their potential impact on his or her performance

Don’t ●

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Don’t ask them to “be kind” as they evaluate your case. You do not want to save the “hard” questions for your oral examination Don’t conduct an exhaustive literature review on each topic Don’t memorize the factor structures, sample sizes, or other specific statistical factors for each test you administered

summary sheets by e-mail the week before the scheduled phone call. This will give each group member time to review the reports and to highlight specific questions. If you are acting as a peer reviewer remember that this is not a time to be kind hearted. You will be counting on one another to find all the flaws in each other’s reports so you will be prepared for the oral examination. Therefore, plan on being as tough (although supportive) as possible. Whoever is presenting their case should practice responding to

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the questions as they are posed. However, this is also a good time to ask for recommendations regarding review articles and chapters, as well as how to handle gaps in a report. What to Do During the Examination Be sure to bring a copy of your practice samples to the oral examination so you can reference specific data in response to the examiner’s questions. You should also be prepared to provide a brief synopsis of each case, although you may not necessarily be asked to present it. If you have any follow-up information regarding your cases, consider sharing it with the examiner. This can be a good chance for you to show that your initial conceptualization was indeed correct. Alternatively, it can show how you are able to incorporate unexpected data to explore alternate possibilities.

fact-finding What Is Being Assessed? Your deductive reasoning, problem-solving skills, case conceptualization, and knowledge of functional neuroanatomy. In other words, what you do every time you see a patient in your clinical practice, though in a necessarily artificial context. What Is the Task? During the fact-finding you will be presented with two very brief vignettes, perhaps only a couple of sentences long. One vignette will be for a child case, and the other will be for an adult case. You are expected to complete only one case, and you will get to choose which one you will complete. We obviously recommended that you go into the examination already knowing whether you will pick the pediatric or adult case. Freezing up in your choice of cases is definitely not the way you want to begin this part of the examination! Once you select your case you will be expected to solicit the patient’s pertinent history and neuropsychological data, and then present your conceptualization. The examiner will have been provided data from a real patient’s case. Your job will be to ask questions of the examiner in an attempt to gather all relevant case information and then orally summarize your impressions and recommendations within the approximately 50-minute timeframe. Your summary should include neurological localization (at least in terms of anterior/posterior and left/right implicating profi les), possible etiologies, a concise summary of the testing results, and recommendations for treatment.

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Remember to address social and psychological issues that may be impacting the case and/or the neuropsychological data. Sounds easy enough, right? Actually, it really is, but there are a few hurdles that do make this exercise seem challenging. 1. You will have to collect the information and present your findings in only 50 minutes. This may sound like plenty of time, but time management is one of the biggest challenges in this portion of the orals. You are responsible for monitoring your time. You will not likely be given cues to speed up. If your time ends and you are still collecting history, your chances of passing the exam will be low. 2. Key information will initially be withheld from you. For example, usually you will not be provided with the patient’s specific medical diagnosis underlying his or her neuropsychological presentation, at least not until the very end. In fact, part of your job is to figure this out. Similarly, you will not always be provided with specific medical information when you ask for it, although if it is available you will likely get it later. More specifically, although you are expected to ask for medical test results (e.g., neuroimaging or EEG) or a list of current (or past) medications, this information may be withheld from you initially. This is done intentionally in order to observe how you would go about approaching case formulation and differential diagnostic decision making. Later, when the information is provided, you may be asked to explain whether the fi ndings would support your fi nal conceptualization or if they may have led you to a different determination. Most candidates report that this is the most frustrating aspect of the fact-fi nding process, and it does take a bit of experience to learn how to work with it. 3. You will be examined using real clinical cases that were provided by other board-certified neuropsychologists. This necessarily means the examining neuropsychologist will have a limited amount of information about the case, and may not have all of the data you want or that you may

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routinely include in your own reports. Furthermore, as with most real-life patients, it may not be a simple and straightforward case. 4. Finally, you will need to master the art of thinking out loud. In order for the evaluator to really understand what you know and how you are approaching the case, he or she will need to know the diagnoses you have ruled out and why. Even when you rule out an etiology that seems obvious, be sure to state that. For example, imagine your case is a 15-year-old boy with an acute onset of memory difficulties. From the moment you read the case description you have more than likely concluded that the memory complaints are not due to a developmental disorder or long-standing learning disorder—so say that. For example, you might say something to the effect of, “The patient’s difficulties developed acutely and premorbid functioning was presumably adequate, so I would assume at this point that the patient does not have a developmental learning disorder. But we’ll see if the remaining data lines up with that conclusion.” If you later get details that make you second-guess this conclusion, you can easily correct yourself. For example you could say, “Hmmm, well given this new information, I actually would lean more toward a developmental learning problem than I had previously thought.” You do not have to make these kinds of summarizing statements for every piece of data you collect. However, as you find yourself making certain determinations and/or ruling out specific diagnoses in your mind, do try to share this information with your examiner. In other words, you cannot hurt yourself by talking out loud unless you say something that is blatantly incorrect, like interpreting a T-score of 20 as being well above the average range. Believe it or not, we have been told that you can pass this portion of the exam even if you do not get the correct diagnosis or etiology, as long as your reasoning is sound and well stated. Conversely, if you do figure out the correct diagnosis or etiology, but do not “show your work” (so to speak) you may NOT pass. The goal of the fact-finding is not

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simply to figure out the patient’s medical condition. It is to show the examiner how you approach neuropsychological evaluations. Steps to Success Unlike the other two portions of the examination, you will not be able to prepare yourself for the specific content of the fact-finding examination. However, you absolutely can prepare for the process, and in doing so you will find yourself more than ready to perform well at the oral examination. We cannot encourage you enough to practice, practice, and practice. We recognize that some readers will already be familiar with this process, especially as more supervisors incorporate the fact-fi nding model into their training programs. (Indeed, several of us use this format as part of our seminar series for postdocs. It is an excellent way to learn how to conceptualize data efficiently!). If you are one of these readers, we believe that you may still find useful pointers in the following section that will strengthen your approach to the fact-finding portion of the exam. If you are not familiar with the fact-finding process, we imagine that at first this task will seem somewhat challenging. This is where many candidates can falter despite all their previous training and clear neuropsychological expertise. However, these very same neuropsychologists can excel in this task if they understand its components and yes, practice, practice, practice! The following steps will help you to both prepare for the fact-finding, and to work through it with grace on the day of the examination. 1. Familiarize yourself with the fact-finding process. The fact-finding seems a bit uncomfortable at first. It is almost like being asked to run a marathon with your shoes on the wrong feet. It seems backward, clumsy, inefficient, and even somewhat painful. However, the more familiar you become with the process, the more you will realize how similar it really is to your daily practice. We encourage you to think of the fact-finding as a kind of records review. When you get a new patient, your job is to sift through the material and find the salient and most important details that will help you formulate and test hypotheses. You typically want specific test results—and you may even read records referencing them (e.g., a primary care physician’s record indicating a plan to refer the patient for MRI testing), but that does not mean you will always have the results! Instead, you need to think

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about how else you might get the information. You will also need to figure out how to collect all of this information in a relatively short period of time. Our suggestion for the approximate amount of time to spend for each component of the fact-finding is outlined in Box 5.5.

BOX 5.5 Recommended Time Breakdown for fact-findings ● ● ● ●

●

5 minutes to write out your template 20 minutes to collect the patient’s history 10 minutes to collect, review and discuss test data 5 to 10 minutes to summarize the history, data conceptualization, and present your diagnostic conclusions 5 to 10 minutes to discuss other possible etiologies if the examiner provides new information to you

2. Develop a template to organize your history taking. Although you are certainly more than capable of gathering relevant history in the comfort of your own office, it can be easy to forget essential information when you are on the “hot seat” during the actual fact-finding. So, pull together a list of all the topic areas you will want to address during the examination such as current complaints, medical history, and psychosocial history. As you think about how you will solicit the patient’s history follow an approach that is comfortable for you. No two neuropsychologists follow the exact same approach. For example, you may be more comfortable going through a patient’s medical history and presenting complaints before assessing their developmental history, while others would prefer to work chronologically—great! Do it however it works best for you. There are enough new skills here to learn. You should not feel compelled to take on an unfamiliar approach to history taking. Sample templates for both adult and pediatric patients are available on the BRAIN web site (see Chapter 1 for the

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URL). These two examples differ in terms of how specific the cues are for each topic area. This highlights the fact that you may need a different degree of cues to help guide your own questioning during the actual examination. We encourage you to modify these models to suit your own style so that you can memorize and use it for the examination. 3. Learn and practice how to collect salient information within the constraints of the fact-finding model. Having a template to guide your data collection is the first step to ensure that you will adequately cover the relevant material during the actual examination. Next, you need to learn how to guide your specific questioning within the fact-finding model. As you are gathering the patient’s history, be thorough, but take care not to get lost in the details. For example, we have seen unprepared trainees or ABPP/ABCN candidates get frustrated when they are not given the results from an MRI or told specific details about a patient’s medical history. They spend the next 20 minutes trying to find different ways to ask the same questions. The next thing they know, they are out of time and they have not even had a chance to look at the test data yet. So, how do you go about collecting relevant information without getting sidetracked? One way to do so is to think of the fact-finding as a game of 20 questions. Everything you ask should help you rule out several possible etiologies and home in on other ones. Think about why you are asking the question, and what you hope to get from the answer. In other words, you should already have in mind what your next question will be depending upon the answer provided. This will help you from going off on a wild goose chase. It is also helpful to keep in mind that sometimes the information you are requesting is legitimately not available; these are real clinical cases, and some information was simply never gathered. So, try not to get overly distressed if it is not provided to you. Even though you may not be provided with medical results, you still absolutely need to ask for them. Why is this important? Because if you do not ask, the examiner will not know that you know this is important and/or relevant information. Remember that part about thinking out loud?

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This is one of the components. Think of it this way. If you were supervising a postdoctoral fellow and he did not report anything from a patient’s medical record, you would be concerned that it did not appear to cross his mind. Upon questioning, he might say, “Oh yeah, well I knew the chart was incomplete, so I didn’t bother presenting that to you.” That’s all well and good, but his summary should address the fact that medical records were incomplete or unavailable for review. This way he is showing you that he recognizes the importance of this information, even if it was unavailable. In the same manner, you need to show the examiner that you understand the importance of medical findings even if they will not immediately give you the results. Besides, even if you are not provided with specific medical results, sometimes just knowing the patient underwent a certain test can give you important and relevant information. For example, say the patient was hospitalized for an acute presentation of symptoms and you ask if he/she has ever had any neuroimaging. The examiner may say, “Yes, he had a CT scan, but no additional tests.” When you ask for the findings, the examiner will likely say something to the effect of, “. . . hmmm . . . looks like they are lost at the moment.” You can choose to be frustrated, or you can jot down the CT scan in your notes and perhaps even use this information to guide your potential differential diagnoses. Indeed, if you stop to think about it, you already know how to collect a lot of pertinent information without getting confirmatory evidence via test results. For example, regardless of whether your case involves a 6-year-old or a 96-yearold, the course of your patient’s illness and/or symptom onset will be critical in helping you to decipher the underlying etiology. If your patient is a 58-year-old female who was successfully employed until 5 years ago, what would your first thoughts be? Well, your preliminary impression might be that she is suffering the effects of an acute process and/ or an exacerbation of previously manageable symptoms. So, guide your questions to help confirm and/or rule out this hypothesis.

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4. Remember your role as a diagnostician. Many neuropsychologists who are new to the fact-finding process become flustered by the fact that they are not provided with specific diagnoses and medical test results. Some even start to panic and wonder, “How on earth can I find out if the patient has a seizure disorder/brain tumor/bleed (etc.) if I don’t get the medical test results?” If this thought has also crossed your mind, we would like to remind you that you are, at the most fundamental level, a diagnostician. You make these kinds of determinations every day (albeit in a different format and without an examiner breathing down your neck). In fact, this is where your hard-earned knowledge of functional neuroanatomy comes into play. Think about what symptoms a patient might have when experiencing a given neurological disorder and you will be better able to get at the patient’s medical etiology. For example, you will want to find out if your patient has any history of lateralizing symptomatology (e.g., sensory loss, neglect, weakness, parasthesias, or tremors). This is the kind of information the examiner will share with you, even when she will not provide specific medical test results. Furthermore, this information will help you begin to localize your findings and to consider possible etiologies. For instance, suppose you want to find out if your patient has a history of seizures. Of course, you could ask the examiner if the patient has had any known seizure activity, but more than likely he or she will not tell you. So, think about what you might ask your patient (or their parent or significant other) to evaluate for the possibility of a seizure disorder during a diagnostic interview. You would ask whether the patient has any history of ●

● ●

alterations in consciousness (if so, how long? how often? are they associated with periods of confusion or fatigue afterwards?) unusual motor activity or sensory experiences vacant looks, staring, with or without automatisms

Of course, these signs and symptoms in and of themselves do not guarantee a seizure disorder. So, if the patient does have any

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of these difficulties you will want to dig deeper to develop a full picture of the patient’s symptoms and whether another medical condition could better account for the presentation. However, this information will certainly give you a path to follow. Once you think you have gathered as much history as you need, will get, and/or can think to ask about at that point, it will be time to turn your thoughts toward the patient’s behavioral presentation and neuropsychological testing results. Before moving forward, we suggest that you provide a brief summary of the patient’s history and presenting complaints, as well as possible underlying etiologies. If you put a cue in your template to summarize things for the examiner, it will help you remember how important it is to think out loud and share your observations as you work through the case. 5. Don’t forget to ask for behavioral observations! When thinking about the patient’s behavioral presentation, remember to consider neurobehavioral symptoms. Some of these may have been discovered in your history taking, while others may become more evident when you ask about the patient’s presentation. Additionally, as you well know the interpretation of neuropsychological data is contingent upon how well the patient was actually engaged in the testing process in the first place. Furthermore, sometimes behavioral observations during testing are far more telling than the actual neuropsychological data. As you build your own template to guide you during the oral examination, think about the domains you typically address in your reports. For example, you may want to ask about the patient’s ● ● ● ● ●

affect and motivation use and comprehension of language psychomotor presentation apparent sensory functioning general mental status

This list is not comprehensive, and your particular patient’s history may lead you to ask other questions about his or her behavioral presentation. However, it should help you frame your

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own list of questions. Remember, though, the examiner may not know all of the information you want. If she tells you she does not know something, the information is legitimately unavailable. 6. Gather the test results. When asking for test data you will not need to ask for the results from each and every conceivable neuropsychological measure you can think of. Instead, plan on asking for information by domain (e.g., “Can you show me all of the testing data related to language skills?”). The examiner will hand you a piece of paper with all the results in that domain, and you will be able to keep these scores for the remainder of the hour. However, the test results are placed in plastic sheet protectors so you will not be able to write on, circle, highlight, or otherwise emphasize specific scores on the data sheets. Plan on writing out salient scores or important profiles so you can return to them when you are ready to summarize your thoughts about the case. Additionally, although the examiner will not withhold any data within the domains you specify, they also will not give you any information that you do not ask for. So, if you forget to ask about measures in a specific domain, you will not even know that your patient had been given any such tests. Furthermore, your examiner may infer that you are not used to considering that very important area of functioning, and that is not an assumption you will want to support if you actually want to pass the examination! While it is important that you demonstrate an understanding of the major neuropsychological domains, do not feel as though you need to be an expert on all neuropsychological measures ever published. If you are not familiar with a test, it is perfectly acceptable to ask the examiner about what domains the test purports to measure or any relevant details about its psychometric properties. For example, if you are provided with test results from the Reindeer Visual Depth Perception Test (truly, this is a real test!), you will not be looked down upon for asking the examiner how it is administered and what the task is designed to measure. Of course, if you ask for information regarding more commonly used tests (like the Boston Naming Test), your question may

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lead the examiner to be concerned about your educational background and clinical experience. 7. Summarize the findings. Some people prefer to review the results one domain at a time, pull the results together at the end and then present it. Others prefer to collect all of the data at once, and then present the results in a more consolidated fashion. Either approach is acceptable as long as you discuss all of the testing results and do not rely on a brief summary of the fi ndings. Along the same lines, it is more than acceptable to take a few minutes to look at the data and pull your thoughts together. However, remember that this is, in essence, a timed test. Additionally, the more you talk out loud (instead of “in your head”) the better your examiner will be able to appreciate the sophistication of your reasoning. So, take the time you need, but be sure to summarize all of the data (domain by domain) before providing the larger conceptualization or summary of the fi ndings. As you summarize the data, consider whether the fi ndings are diffuse, focal or multifocal. This will help you organize the results within your hypothesized etiology. Alternatively, it may lead you to reconsider other medical conditions that you had previously ruled out or not even entertained. In either case, remember to process these thoughts out loud. 8. Integrate the clinical history and test data. Now that you have collected all of the patient’s data, take a step back and provide a brief case presentation. At this point you will also be able to explain how the test data supports your hypotheses or suggests alternative interpretations. As you share your case formulation, be sure to address how (or if) the findings are localizing in any way, the possible etiology (or etiologies), prognosis and recommendations. At this point the examiner may (finally) give you those test results you have been wanting all along. As satisfying as this may be, the examiner will also now expect you to integrate these findings into your case conceptualization. In some cases the results will support your hypothesized conceptualization and will simply fill in the blanks you

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have been working around. In other cases the information may cause you to rethink your analysis. Don’t panic! If you need to change your formulation, it does not mean that you have done or said anything wrong. In fact, your logic may have been entirely correct given the information you were provided so far. However, the examiner will now be interested in seeing how you go about modifying your case summary based on this new data. She will also want to know how these changes might affect the patient’s prognosis and the kinds of recommendations you would provide to the patient, family, and/or medical team. Once you have integrated these findings your time will more than likely be up (if not before) and you will be free to return to the meeting room to eat those doughnuts you have been ignoring up to this point. 9. Practice MULTIPLE fact-findings. As you practice the fact-finding, we cannot encourage you enough to practice within the actual time constraints (i.e., approximately 50 minutes). You will be amazed how long this can take if you let it. Conversely, you will be surprised at how quickly you can work through a case if you know what you are looking for. Additionally, whenever you practice the fact-fi nding we encourage you to simulate the real process as much as possible. This includes not allowing yourself to write on the actual test results and having information provided to you only after you ask for it. Finally, you should try to practice at least one fact-finding with someone you do not know. This allows you to feel more of the anxiety you will almost certainly experience during the real examination; you will be surprised at how much more at ease you are practicing the exam in the comfort zone provided by your study partners, peers, and even mentors. It can be intimidating to set up a mock fact-finding with someone you do not already know. However, most boardcertified neuropsychologists are more than happy to help candidates practice a fact-finding before their oral examination. The best way to schedule a practice fact-finding is to ask your peers, study group and/or mentors to help connect

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you to an AACN neuropsychologist in your area. The BRAIN listserve also has a formal system established to help connect ABCN candidates with board-certified neuropsychologists for mock fact-findings. Ideally, you should complete this practice in person. However, you may work in a region where you either know all of the board-certified neuropsychologists and/or there are no AACN neuropsychologists nearby. In these instances, conference calls can be the next best thing to an in-person experience. While you may not develop all of the anxiety inherent in a face-to-face situation, you will still have the chance to feel “judged” by someone you do not know. 10. Review neurological syndromes and associated neuropsychological profiles specific to your population. Read the title of this step carefully. We are not suggesting that you review everything you learned for the written evaluation. Indeed, we will pointedly tell you not to spend hours and hours reviewing all of your notes for the written examination and relearning those crazy mnemonics that felt so “common sense” in the midst of your written examination frenzy. Instead, focus your energy on applied neuropsychological concepts such as specific neuropsychological disorders, relevant neuroanatomy and psychometric principles. This kind of targeted studying will help you recognize and identify the possible medical etiology (or etiologies) underlying the patient’s difficulties in your fact-finding. Tips for Study-Groups Assign one group member to act as the “examiner” and another member to be the ABCN “candidate.” The examiner can select one of his own cases to use as practice. If no one in your group has had any experience with a factFinding model, we recommend that each of you practice with your AACN mentor (or other colleague) before practicing within your group. Otherwise, you may develop bad habits that will be hard to correct later. Once you are at least familiar with the fact-fi nding format, the “examiner” should distribute the test data to the other study group members the week before the phone call. It can be helpful if, before they send it, the examiner organizes the test data into major domains (e.g., intelligence,

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memory, language, etc.) and places each domain on a different page. This way, the “examinee” can number the back of each page as it comes off of the printer while remaining blind to the tests that were given. During the mock examination, the examiner can then instruct the examinee to turn over specific pages by number as they ask regarding a particular test domain. We encourage all group members to remain blind to the data until the actual examination. Even if you are not the one on the “hot seat” you will be better able to learn from the experience if you follow your colleague’s lead. We also recommend that you try to make this experience as “real” as possible. This means that the examinee should keep track of his or her time, without reminders from the rest of the group. Additionally, try to get used to writing notes about the scores rather than writing directly on the test results data sheets. Finally, some people fi nd it helpful to use different colored pens and/or a highlighter to help emphasize specific details in their notes. Others find this to be distracting and time consuming. Figure out which approach will be the best for you and practice using it during all of your mock fact-findings. What to Do During the Day of the Examination You have practiced the fact-fi nding so much you are doing it in your sleep. You have reviewed the major neurological disorders that apply to your patient population (adult/child), and you have your template ingrained in your mind. You are ready for the fact-fi nding! Here are just a few last-minute reminders and/or pointers for you to remember during the examination. When you walk into the testing room, feel free to ask for the space closest to the table. You will be doing a lot of writing and you will want to be as comfortable as possible (and some rooms have less table space than others). Take a lot of notes, but don’t write so much that you are unable to follow your own thoughts. Remember to use those colored pens and highlighter if you found that helpful during your practices. Write down your template before you start. We know, we know: You have memorized your template backward and forward, so why “waste” your time to write it out? Because this is a pressure situation and you will be surprised at what you may forget. Don’t push your luck (or your memory); take a minute to write out your outline, then—follow it! Keep track of your time, and be careful not to get lost in random details. Remember how much time you should be allotting to each portion and try to keep yourself to that schedule. The Oral Examination

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Above all else, remember to think out loud! Essentially, if you are thinking more than you are speaking, you probably are not talking enough. Finally, try to have fun. While “fun” is the last word many would use to describe an oral examination under any circumstance, if you can think of the test as an intellectual puzzle, you may find it far less stressful than you feared. A few additional reminders about how to approach the fact-finding are included in Box 5.6.

BOX 5.6 Dos and Don’ts for the fact-finding Do ●

●

●

● ●

Don’t

Write out your template before you begin Ask for medical results (e.g., neuroimaging) Ask for neurobehavioral symptoms Keep track of your time THINK OUT LOUD!!

●

●

●

●

Don’t plan on “winging it”— the odds are good that you’ll forget to ask something Don’t expect to get medical results right away Don’t ask if the patient has a brain tumor (and expect to get the answer) Don’t forget to ask about psychosocial and emotional issues

Managing Test Day Although we have spent much of this chapter breaking down the oral examination into its component parts, it is time to acknowledge again that you really are only taking one examination. Consequently, there are many pointers that may be helpful for you to remember across the entire examination. Of course, you already know most of the things you should do to keep yourself calm and collected during the evaluation. You ARE a psychologist for goodness sake! Still, many of us are guilty of not taking our own advice, so in case you are one of those people, we will highlight a few recommendations here.

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●

●

●

●

●

●

Consider flying into Chicago the night before the examination so you will not have to stress about delayed planes, microscopic meals (that cost you $20), and crazy taxi drivers. In theory this will also help you get a full night of sleep before the exam. Do dress to impress. Remember that you are presenting yourself for intensive scrutiny; do not let your attire make the wrong impression. Try to arrive at the examination early so that you will not have to worry about getting lost or stuck in traffic. Once you find the location, you can wander around and grab a bite to eat, or if it calms your nerves, you could find a quiet corner to quickly review your ethics or other study notes one last time. Ask for clarification any time you are unsure of a question or what the examiner is trying to have you address. Remember that you will not be looked down upon for taking a few minutes to organize your thoughts; you should not feel compelled to answer a question before you have processed it and feel comfortable with your answer. Remember that despite the pressure of the situation, the oral examination is simply a measure of what you already do every day on the job. Keep this in mind and you will find it easier to demonstrate your knowledge as you go.

Wrapping Up and Looking Ahead The oral examination is the final hurdle in the ABPP/ABCN credentialing process. Although it can be intimidating, with the support of your peers, mentors, and of course this book, you will be able to prepare yourself for the process. If you have gotten this far, then you are ready for the challenge. As for looking ahead, ideally all you do now is wait to receive your results. If you pass, you will be sent a letter documenting this as well as your official ABPP certificate. Additionally, you will be added to the AACN listserve, where your entire new “class” of diplomates will be introduced and heartily congratulated. If you do not pass, we encourage you to use your first examination as a learning experience and try again. Use your study partners as support and call your mentors to help you muster up the energy to start over. Unfortunately,

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you will have to resubmit new practice samples before you can take the oral examination again. However, after having been through the actual examination you may have a better idea about what kind of cases you want to defend the next time around. We have said this before (and we will say it again in Chapter 6), but there are many board-certified neuropsychologists who did not pass this process on their first try. Don’t let this stumbling block hold you back! Read the next chapter to discover the “Six Rs” and how they may help you rebuild your momentum so you can fi nish this process. Above all, remember that board certification is still board certification, no matter if it was smooth sailing for you or you had to repeat a step or two.

Tips for Supervisors and Trainees Many aspects of the oral examination are especially good training techniques. See Box 5.7 for pointers on how to integrate oral examination preparation into the training experience. As we mentioned above, several of us use mock fact-fi ndings to teach our postdocs. We fi nd that it helps them learn how to conceptualize data quickly and easily. It also is a useful way to expose trainees to a wide variety of medical and psychiatric conditions. Finally, it gives trainees the opportunity to watch how other neuropsychologists approach history taking, interpretation, and neuropsychological conceptualization. Of course, trainees will require more or less support and structure during these exercises depending on their level of training, but all trainees can benefit from observing and participating in the process. So, if you are a trainee, we encourage you to share this book with your supervisors and ask them if there is a way to incorporate mock fact-fi ndings. If you are a supervisor, we cannot encourage you enough to consider adding this training technique to your didactic schedule. Similarly, allowing trainees to critically review one another’s reports may also prepare them better to act as supervisors in the future, and to recognize the strengths and weaknesses inherent in their own writing style and approach. Finally, having trainees review ethical vignettes is an excellent, hands-on way to remind or teach them about various ethical principles. There is a reason the oral examination is set up to test these three domains: It taps into the very core of what a competent neuropsychologist should be able to do. It makes sense, therefore, that this model may be useful for those of us who are training neuropsychologists as well.

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BOX 5.7 Tips for Supervisors and Trainees Tips for supervisors Consider incorporating the various components of the Oral Examination into your seminar series. For example, have trainees complete fact-findings (while providing whatever support they may need given their level of training). Teach your trainees how to interpret data they did not collect themselves. Build a review of professional ethics into your didactic series and help your trainees apply this information to their daily practice. Help trainees to learn to approach their own reports (and those of other clinicians) with a critical eye so they can improve their own writing style and defend the conclusions they write in reports. ●

●

●

●

Tips for trainees Encourage your mentors, supervisors, and graduate school faculty to incorporate the fact-finding process into your training. Seek out opportunities to observe and/or practice fact-findings so the process is more familiar to you (and consequently less intimidating). Keep yourself current and familiar with your country’s ethical codes and the latest HIPAA update. Read up on the most common neurological or neuropsychological disorders in your preferred population (child or adult) and seek out practicum experiences that expose you to as wide of a patient population as possible. Try to work with as many different neuropsychologists as possible to help you develop a breadth of understanding regarding neuropsychological measures, testing approaches, and interpretation. ●

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6 ■■■ Staying Motivated Surviving Bumps in the Road

Although we hope it does not happen to you, we know it happens to other competent neuropsychologists. Good, qualified neuropsychologists sometimes do not pass a part (or parts) of the ABPP/ABCN board certification process on the first or even the second try. When this happens, it is frustrating, to say the least, and usually upsetting and defl ating. You may feel shocked, angry, and indignant for a while or even embarrassed and depressed. Of course you are going to feel that way; chances are that you have never failed anything in your life! Furthermore, you have put a lot of time and energy into this process. Consequently, it may feel as though all of that hard work was just an enormous waste of your time! You may even feel like throwing in the towel and forgetting the whole thing. We hope you don’t. Instead, we hope that after these feelings pass, you will muster up the energy and courage to jump back in and use the knowledge and experience you have gained to be successful on your next attempt.

The Six Rs to Recovering Your ABPP/ABCN Groove We recognize that getting motivated to get back on track can be challenging and that everyone is motivated by different things. However, as starting points, we introduce to you in Box 6.1, the corny, but functional, “Six Rs to Recovering your ABPP/ABCN Groove.” Remember your strengths. We doubt that this is the first real challenge that you have faced in life. Even within your academic and professional career, you

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BOX 6.1 The Six Rs to Recovering Your ABPP/ABCN Groove 1. 2. 3. 4. 5. 6.

Remember your strengths. Rely upon your supports. Revive your inspiration. Reframe your embarrassment (or anger or frustration). Review your approach. Resume your preparations.

have probably run across real stumbling blocks: not matching with the graduate program, internship, or postdoc you wanted most; outlandish demands by thesis or dissertation committee members; disappointing research results; rejection of a manuscript you spent countless hours writing; and so on. Outside of that arena, you have probably faced personal challenges: deaths, estrangements, or other losses of significant others; hard financial times; medical crises; unexpected life events; and so on. The point here is not to dwell on past losses or failures but to recall how you lived through them. That took strength and perseverance. You still have that strength and perseverance, and while we would all rather plan when to exert ourselves, sometimes life (and the ABPP/ ABCN certification process) messes with those plans. Whatever you did to get through roadblocks and hard times before, you can do again. Rely on your supports. Make a list of the supportive people around you. Be sure to consider significant others, family, close friends, and colleagues. Do not forget your personal and professional mentors, as well as your “official” AACN mentor, if you have one (if you do not, maybe this is a good time to get one). Also, if you are a BRAIN member (if you are not by now, all we can do is sigh and waggle our disapproving fi ngers at you), consider joining the BRAIN Survivor’s Group for support from neuropsychologists who have been through it and know what it feels like. The BRAIN Survivor’s Group is a great place to vent your frustrations about the process and can help you realize that you do not have to feel alone. When you are done with the list, sit back and review it. Think about the incredible supportive power of those on it and how that support and encouragement can bolster your own strength to overcome this hurdle (and others)! Rely on that.

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Revive your inspiration. Make another list, this time reviewing the reasons you have been pursuing ABPP/ABCN certification all along. Maybe it is a boost in pay, prestige, or practice mobility. Perhaps it is a strong feeling of professional responsibility; you may train students or mentor colleagues and want to be a role model in this arena. Perhaps you firmly believe in the peer review process that protects the public at large. You may maintain the ideal that board certification should be the minimum standard to practice neuropsychology, much like physicians who have to be board certified to practice at all. Look back at Chapter 1 and consider which of the advantages of board certification—for you, the profession, and the public—resonate with you. Now, add to that list any new reasons for overcoming a bump in the board certification road. Maybe it is the significant amount of time and money you have already invested in the process or the fact that you are running up on the 7-year time limit for completing the process and do not want to start all over again. Perhaps you want to heal a bruised ego and show yourself that you can do it. Dusting yourself off to try again is oftentimes in and of itself helpful in feeling better about the process. These are good reasons to persevere! Reframe your embarrassment (or anger or frustration). Like we said before—it is natural to have some strong emotional reactions if you do not meet the cutoff for a stage in the board certification process. To keep that natural reaction from having too great an influence on you, try that proven cognitive strategy: reframing. You probably have some implicit beliefs that may not be accurate or helpful. For example, if you feel like you cannot face your colleagues or patients because you believe that you have been proven incompetent, reconsider. As we said a few hundred times, there are many reasons why people might not pass a step of the certification process on any given attempt, ranging from anxiety to plain bad luck (e.g., the items selected for the version of the written exam you took hit you at your personal weak points, but another version might have hit your personal strengths). While it is true that passing makes a statement about competence, not passing makes no such statement. Also, remember that the tough cutoffs used in the process are not personal; they were not developed to unfairly encumber you. The assessment process is an evolving, tough standard designed with the profession and public in mind. Taking a step back and using this and other information can help you to challenge unhelpful beliefs and reframe the situation. Review what went wrong. You may already have a good sense of what went wrong, and how you might correct it. Add to the feedback you might have gotten from the board, and check with others (including this book) on

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how your approach could be modified to overcome these weaknesses. This will be different for you than for someone else, so we cannot provide specific advice here, but it is important that you seek out specific information about how to revise your approach. Resume your preparations. Once you have gone through those steps, it is time to resume your preparations. Make a plan to execute your revised approach to the process, then execute the plan. And, while you are doing so, congratulate yourself for getting back up, dusting yourself off, and trying again. That is the strength and perseverance we were talking about!

Pointers for Moving Past Particular Stumbling Blocks Since each part of the examination process is a bit different, let’s take a moment to review some common snags and strategies to overcome them at each step.

Credential Review If your application for board eligibility was not accepted, then ABPP and/ or ABCN will give you brief but important feedback. Pay attention to it, because it provides information on what you need to do to remedy any areas that were determined to be lacking. The best case scenario is that you need a course or two to “fill in” a fund of knowledge gap. That critique is easy to address by taking courses, either online or through a local university, or finding other relevant educational opportunities to address the gap. A more difficult situation arises if the recommendation is that additional supervised experience is required. Filling this gap may be harder but is still possible by seeking supervised experiences with a local clinical neuropsychologist or completing a formal postdoctoral fellowship. Either way, you benefit by gaining clinical experience and training that will make the rest of the board certification process go much smoother.

Written Examination In our experience, the written exam is one of the biggest bumps on the road to board certification. This exam is no cake walk; about 35% fail the written exam on the first attempt. Common explanations for not passing include focusing on the wrong type of content (e.g., spending too much time studying detailed neuroanatomy and not enough time studying applied psychological or neuropsychological concepts), feeling as though the exam questions were worded differently than what was expected, and having insufficient time to

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think carefully about and complete all test items within the allotted time. However, keep in mind that the pass rate the second and third time around is higher. Experience with the test itself, particularly the complexity of items firsthand, goes a long way toward ensuring success on a second attempt. Getting motivated to take the written exam a second or even a third time is often the sticking point. One valuable step in this regard is to talk to those who passed and compare their study methods with yours. How long did they study? What did their study schedule look like? What materials did they use? Did they use a study group? If so, what worked well and not so well from their group? You should also think back on your own study approach. Now that you know what the exam is generally going to be like, what did you think was useful about your approach and what was perhaps less so? You may want to sit down and analyze which topic areas you wish you had studied more and which you over studied and should not have. Then focus on your weaker areas and read different books (see Chapter 3 for a list of suggested texts). Vary your study methods; for example, if you relied heavily on flash cards the first time, use syndrome sheets the next time. Focus on differential diagnostic skills and key clinical psychology concepts. Take more practice exams or make up practice exam questions. Commit to an exam date and study with a group weekly to help you stay focused and motivated. Keep a positive attitude, viewing your studying as a way to increase your overall knowledge base.

Practice Sample Submission Some people find that getting tripped up by the practice sample portion does not sting as badly as the written exam (although it still stinks!). Perhaps this is because generating written reports is what we do on a daily basis. Therefore, having to select and submit a new practice sample does not seem as overwhelming as studying again for 4 to 5 months for the written exam. On the other hand, having other neuropsychologists critique your work and find it lacking can cause some cognitive dissonance and ego bruising. If this has happened to you, it would not be unexpected to feel disappointed and judged; it doesn’t feel good to think that our primary product (aka, our reports), which we have been generating for years and distributing to all kinds of professionals, is viewed as lacking in some respect and may even be inadequate (gulp!). Of course, if you are going through this process in the first place, you likely strive to generate the best report you can and appreciate opportunities to improve your product. The bright side is that the practice sample

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submission process is your chance to get this kind of objective feedback. If you can allow yourself to take a positive reframe of this situation, you may be able view the constructive feedback you receive from ABCN as an enriching experience that facilitates your professional and personal growth. As with the written exam, if you can pick yourself up off the ground, the likelihood that your practice sample will pass on resubmission is high, especially if you enlist the help of several colleagues, both board certified and non–board certified, to review your cases with a critical eye before submission. We suggest you have your practice samples reviewed by as many colleagues as possible, especially neuropsychologists who have been board certified fairly recently, preferably within the past 5 years, and/or who have been active in the process, particularly as practice sample reviewers. One of the common reasons practice samples are judged as unacceptable is the failure to communicate essential information. In fact, the reasons your practice sample may not have been passed might have nothing to do with what you did say. Rather, it may be due to what you did not share with the readers. For example, one of the most egregious omissions from reports is the integration of patient data with knowledge of brain-behavior relationships. If you do not discuss how the patient’s behavior and test scores fit with known neurobehavioral profiles for a particular disorder, then how can the reviewers determine if you possess this fundamental knowledge? As was described in Chapter 4, this kind of information may not be relevant in your day-to-day clinical work, especially if you write primarily for parents, patients, or caregivers. However, it is essential for the practice samples. If this was some feedback you received from your reviewers, then in your next practice sample submission you may want to include a few sentences recapping the patient’s symptoms and relating them to the neuropathology evident in that particular patient. Another piece of advice many have found helpful is to explain any unusual circumstances in a cover letter and provide supporting materials when needed. For example, if you practice in a multidisciplinary clinic and do not conduct a portion of the clinical interview yourself, then indicate this in a cover letter and provide your reviewers with the other provider’s report so they have access to the same information you did in selecting your measures and drawing your conclusions.

Oral Examination Probably the second biggest bump on the road, after the written exam, is the oral exam, specifically the fact-finding portion. Individuals tripped up

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at this stage often say they did not prepare sufficiently or got too anxious when they did not know how to respond to a particular question, which then snowballed into greater anxiety and more difficulty thinking flexibly and expressing their thoughts. As the competent psychologist that you are, you, no doubt, know that desensitization is one of the most effective means of reducing situation-specific anxiety. This is partly why we so strongly recommend doing mock fact-findings with several people, especially folks you do not know well personally. In this way, you can simulate more closely the level of anxiety associated with the oral exam process. This process also helps to engrain your use of your template, so that you can rely upon it even in the face of anxiety. Many examinees who got tripped up by the oral examination feel the fact-finding or practice sample portions, as opposed to the ethics portion of the oral exam, were the likely stumbling blocks. However, it is important to take each portion seriously and thoroughly prepare for it. As noted above, do several mock fact-findings. For the practice sample portion, know your cases inside and out. Some people say they were surprised by the level of detail of the questions they were asked, and others say they were asked questions they had not prepared to answer. We may be sounding like a broken record by now, but we cannot emphasize enough how important it is to have your cases reviewed by several colleagues and to ask them to anticipate what questions you may be asked. For the ethics portion, know the basic ethical principles and be ready to talk about ethical dilemmas you have faced in your own practice. Take comfort in knowing that the pass rate on second and third attempts at the oral exam is higher than the first, and that familiarity with the process itself will help you prepare for the next time around.

Appealing a Decision Although there is a mechanism for appealing an unfavorable decision at every stage in the process, you are very unlikely to be successful unless you can demonstrate a procedural error in how the stage was conducted. Complaints that a given portion of the test was too hard are going to be met with a polite version of “Tough luck. Get over it. Try again.” On the other hand, even if you do not win the appeal, your feedback may prove to be very helpful in future revisions of the examination procedures. Small consolation, we realize, but hopefully consolation nonetheless.

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Concluding Statements Like all aspects of life that are worth pursuing, the board certification process can have unexpected setbacks. The key lies in how you respond to them. We hope that following the advice in this chapter will help you to get back on track toward ABPP/ABCN certification. We firmly believe that you will be successful and that, for you, the profession, and the public, the effort to reach that success is worthwhile.

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Epilogue

The Greener Grass on the Other Side For those who have completed the ABPP/ABCN process, we have three last things to say: Congratulations, Welcome, and Get to Work! The first is obvious. Congratulations on earning this honor! There is no more rigorous demonstration of your knowledge and skills in clinical neuropsychology than the process you have just completed. This was no fluke; you deserve to celebrate! Go on: Demand that your friends take you out for a night on the town. Go out to that fantastic restaurant. Spend some time with your family. (Remember them? They’re the folks who have been supporting you and putting up with your anxious nonsense all this time.) Sleep in. Smile more. Ceremoniously add the ABPP/CN or ABPP-CN or ABPP/ABCN designation to your e-mail signature, wall plaque, business cards and reports. Proudly display your ABPP diploma. When you finally come up for air, let us be the first to welcome you into the fold. You will soon be added to the membership of the AACN, most visibly via a formal introduction on the AACN listserve, where you will be hailed by a torrent of welcoming e-mails. You have earned entry as a voting member in the largest, most influential credential-based organization in clinical neuropsychology. Welcome. Now, get to work! With this achievement comes responsibility. Obviously, you are responsible for providing ABCN-level care every day in your clinical work. Beyond this, may we suggest that you consider “giving back” to the field? Undoubtedly, you have had help in this process, perhaps from a mentor, peer, AACN, BRAIN, or this book. Pass that support on. Here are just some of the possibilities: ●

Become a mentor for someone going through the process, either formally through the AACN mentorship program, or informally via a professional contact.

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Encourage your well-qualified friends and colleagues to go through the process, providing them with support, advice, and any needed nudging. Prepare your students for certification, using your personal experiences and our “tips for supervisors and trainees” as starting points. Educate others on the benefits of board certification and advocate for all qualified clinical neuropsychologists to become ABCN certified. Run for AACN office, volunteer for a committee, or help out with the annual conference. Take a more active role in BRAIN. If you have received any support from that group, it was because someone before you generously volunteered that support. Do the same. The BRAIN system and materials are not perfect, so help make them better. Stay on the listserve; your insights will be instrumental in helping others.

If you are able to give back in any of these ways, you will be fulfilling the promise of ABPP/ABCN to benefit the public and the profession, and you will feel darned good as a professional as well. Yes, the grass is greener on this side of the fence. Congratulations. Welcome. Now get to work!

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References

Hannay, H. J., Bieliauskas, L. A., Crosson, B. A., Hammeke, T. A., Hamsher, K. D., & Koffler, S. P. (1998). Proceedings: The Houston Conference on Specialty Education and Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13, 157–250. McSweeny, A. J., Ris, M. D., Ricker, J. H., & Westerveld, M. (2004). Board certification in clinical neuropsychology: A response to Rohling et al. The Clinical Neuropsychologist, 18, 494–508. Rabin, L. A., Barr, W. B., & Burton, L. A. (2005). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members. Archives of Clinical Neuropsychology, 20, 33–65. Rohling, M. L., Lees-Haley, P. R., Langhinrichsen-Rohling, J., & Williamson, D. J. (2003). A statistical analysis of board certification in clinical neuropsychology. Archives of Clinical Neuropsycholology, 18, 331–352. Sweet, J. J. (2008). President’s Annual State of the Academy Report. The Clinical Neuropsychologist, 22, 1–9. Sweet, J. J., Nelson, N. W., & Moberg, P. J. (2006). The TCN/AACN 2005 “salary survey”: Professional practices, beliefs, and incomes of U.S. neuropsychologists. The Clinical Neuropsychologist, 20, 325–364. Yeates, K. O., & Bieliauskas, L. A. (2004). The American Board of Clinical Neuropsychology and American Academy of Clinical Neuropsychology: Milestones past and present. The Clinical Neuropsychologist, 18, 489–493.

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Index

AACN. See American Academy of Clinical Neuropsychology ABCN. See American Board of Clinical Neuropsychology ABMS. See American Board of Medical Specialties ABPP. See American Board of Professional Psychology APPCN. See Association of Postdoctoral Programs in Clinical Neuropsychology Application. See Written Application and Credential Review American Academy of Clinical Neuropsychology (AACN), ix, 6, 14, 22, 47, 90 web site address, 22 American Board of Clinical Neuropsychology (ABCN), vii, 3, 5, 12, 13, 21–22 web site address, 21 American Board of Medical Specialties (ABMS), vii, 12 American Board of Professional Psychology (ABPP), vii, ix, 3, 5, 12, 13, 21 web site address, 21 American Psychological Association (APA), vii, 5, 12 Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), 6–7 Be Ready for ABPP in Neuropsychology (BRAIN), viii, ix–x, 7, 22–23, 36, 46–47, 52 Survivor’s Group, 124 web site address, 23–24 Board certification benefits

to practitioner, 4, 8–10 to profession, 10–11 to public, 10–11 BRAIN. See Be Ready for ABPP in Neuropsychology Cover letter, 69, 78, 81–82, 128 Ethical and professional issues. See Oral Examination Examination in Professional Practice Psychology (EPPP), 41, 49, 59 fact-finding. See Oral examination Houston Conference on Specialty Education and Training in Clinical Neuropsychology, 28, 44 knowledge areas, 54–55 Letter of support/ recommendation, 34–35 characteristics of good letter, 35 Oral examination, 13, 87–122, 128–129 fact-finding amount of time to spend, 108 dos and don’ts, 118 during examination day, 117–118 mock fact-findings, 92–93, 120, 129 steps to success, 107–116 study groups, tips, 116–117 task, 104–107 what is being assessed, 104 feedback, 90 managing test day, 118–119

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Oral examination (continued) myths, 91–92 nuts and bolts process, 87 task, 87 where examination held, 87 observers, kinds of, 89–90 practice sample review dos and don’ts, 103 during examination, 104 steps to success, 100–102 study groups, tips, 102–104 task, 98–99 what is being assessed, 98 preparation timeline, 90–91 professional and ethical issues dos and don’ts, 97 steps to success, 97 study groups, tips, 98 task, 94–96 what is being assessed, 94 study groups, tips, 92–94, 116–117 supervisors and trainees, 120–121 task, 104–107 wrapping up and looking ahead, 119–120 PES. See Professional Examination Service Practice sample, 13, 67–86, 88 dos and don’ts, 103 essential elements, of acceptable, 70–71 items to include, 69 myths, 73–76 nuts and blots acceptance or rejection, 70–72 amount of time, 72–73 process, 68–69 professional data sheet, 82–83 redact identifying information, 74–75 task, 67–68 steps to success cover letter, 81–82 enlist colleagues, 100–102 ensure accepted, 79–80 picking your cases, 76–78

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prepare to answer challenging questions, 102 professional data sheet, 82–83 study groups, tips, 102–104 submission, 127–128 supervisors and trainees, 84 task, 98–99 what is being assessed, 98 wrapping up and looking ahead, 84–85 Professional and ethical issues. See Oral examination Professional Examination Service (PES), 43 Six Rs to recovering ABPP/ABCN Groove, 123–126 Supervisor Tips, 38, 64, 84, 120, 121 Supporting materials, 36, 69, 128 Trainee Tips, 37–38, 64–65, 84, 120, 121 Written application and credential review, 13, 27–40, 126 basic eligibility criteria, 30–31 key training areas, 33 myths, 29–31 nuts and bolts process, 28 tasks, 27–28 time, 28 what is being assessed, 28 steps to success actual application form, 36–37 prep work, 32–36 supervisors and trainees, 37–38 wrapping up and looking ahead, 39 Written examination, 13, 41–66, 126–127 dos and don’ts, 55 knowledge self-assessment, 53 managing test day exam day logistics, 61 taking test, 61–62 mock exam questions, 59–60 myths, 44–45 nuts and bolts

Index

examination history, 43 passing rate, 43–44 process, 42 task, 41–42 post-test time, manage news, 63 soon after, 62–63 waiting, 63 preparation timeline, 42, 44–45, 49–61

Index

steps to success, 49–61 study group, 52 study resources, 45–49 study schedule, 53–54 supervisors and trainees, 64–65 texts to consider, 47–49 time needed, 51 what is being assessed, 44 wrapping up and looking head, 65

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About the Authors Kira Armstrong earned her Ph.D. in clinical psychology from the University of Victoria in 1999, with a specialization in neuropsychology. She completed an internship in neuropsychology at the University of Oklahoma Health Sciences Center and a 2-year postdoctoral fellowship in pediatric neuropsychology at Columbus Children’s Hospital. Dr. Armstrong is the lead clinical neuropsychologist at Cambridge Health Alliance where she has been managing the pediatric neuropsychology fellowship program since 2005. She became board certified in clinical neuropsychology in 2003. Dean W. Beebe earned his Ph.D. in clinical psychology from Loyola University in Chicago in 1998. He completed an internship at the University of Chicago Medical Center and a 2-year postdoctoral fellowship in pediatric neuropsychology at Cincinnati Children’s Hospital Medical Center. Dr. Beebe is currently an associate professor of pediatrics at Cincinnati Children’s Hospital and in the Department of Pediatrics at the University of Cincinnati College of Medicine. He has been training postdoctoral fellows and graduate students in pediatric neuropsychology since 2000. He became board certified in clinical neuropsychology in 2005. Robin C. Hilsabeck earned her Ph.D. in clinical psychology from Louisiana State University in 1999, with a specialty focus in neuropsychology. She completed an internship in neuropsychology at the University of Oklahoma Health Science Center and a 2-year postdoctoral fellowship in neuropsychology at the University of California, San Diego Medical Center. Dr. Hilsabeck is currently the director of postdoctoral training in clinical neuropsychology at South Texas Veterans Health Care System, assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio, and assistant clinical professor of psychiatry at the University of California, San Diego. She became board certified in clinical neuropsychology in 2003. Michael W. Kirkwood earned his Ph.D. in child clinical psychology from DePaul University in Chicago in 1998. He completed an internship at Columbus Children’s Hospital and a 2-year postdoctoral fellowship in pediatric neuropsychology at Children’s Hospital in Boston. Dr. Kirkwood

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is currently an assistant clinical professor of physical medicine and rehabilitation at the University of Colorado, Denver. He is co-director of the Concussion Program at The Children’s Hospital in Denver, where he has been training fellows, interns, and graduate students since 2001. He became board certified in clinical neuropsychology in 2003.

Authors’ note: The order of authorship is alphabetical and nothing is implied by the order of our names: we shared equally in the writing of this book.

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