The Section of Neuropsychology provides inpatient and outpatient consultation and evaluation services for the staff of the Cleveland Clinic Foundation and community referral sources. Currently, the Section of Neuropsychology receives the majority of its referrals from Adult and Pediatric Neurology, Epilepsy and Clinical Neurophysiology, Neurosurgery, the Center for Functional and Restorative Neurosciences, Adult and Child Psychiatry, Consultation-Liaison Psychiatry, Alcohol and Drug Recovery Unit, Internal and Geriatric Medicine, Cardiology, Anesthesiology, and Pediatric Oncology/Hematology.

A flexible battery approach is adopted by most staff. However, in order to facilitate outcome research, the Section has tailored a number of specialized test batteries for specific patient populations. For example, the Section has implemented a brief, repeatable "Pre-/post Concussion Battery" for the assessment and monitoring of cognitive functions among NFL players. A formal pre- and post-surgery protocol is in place for seizure surgery candidates, and standard protocols are in place for evaluating candidates for deep brain stimulation for treatment of movement disorders (Parkinson's disease, essential tremor, dystonia), shunting for hydrocephalus, and surgery for coronary artery disease.

The combination of a rich clinical referral base at the Clinic and an innovative service delivery model has created a strong trajectory of growth for the Section of Neuropsychology. More than 2,000 patients are referred for evaluation annually, making the Section of Neuropsychology one of the most clinically active neuropsychological services in the country for its size.

Clinical Component

On average, a minimum of 60% of fellows' time will be devoted to direct clinical service. A portion of this commitment can be focused on services directed at specific patient populations (e.g., epilepsy, pediatric, geriatric, or movement disorder patients). In addition, fellows are afforded the opportunity to work with culturally diverse populations due to the high number of international patients who come to the CCF seeking specialized health care.

Although the Section is largely a technician-based service, we recognize the importance of direct patient contact in developing a strong clinical understanding of process variables and those patient behaviors that underlie test performance. Consequently, the fellows will be responsible for testing at least two to three patients each week throughout the two year fellowship. It is anticipated that this assessment experience will provide the fellows with the opportunity to enhance their existing knowledge and experience with a variety of standard and research neuropsychological assessment procedures.

Assessment is only one component of the fellows' clinical duties. The primary goal of the fellows' clinical activities is to expand their expertise in clinical interpretation and reporting of neuropsychological data. Report writing and consultation with patients and other health-care professionals are, therefore, central to this postdoctoral experience. The fellows will also be expected to participate actively with members of the Section in one or more clinical team meetings (e.g., Epilepsy-Surgery Patient Management, MS trreatment team, DBS patient management etc.) on an ongoing basis.

Formal clinical supervision is provided on an individual basis, typically 2 to 3 hours weekly, to review cases. Informal supervision is also available on a daily basis. Group supervision in the form of weekly postdoctoral conference meetings to review topics of interest, deposition transcripts and videotapes, ethical issues, noteworthy cases, research data, etc. generally accounts for approximately 1 hour weekly.

Practice management issues, such as scheduling patients, managing technical support services, and billing and coding practices are often discussed. Formal written evaluations of the postdoctoral fellows' progress are prepared by the Neuropsychology staff at the conclusion of each rotation. A report summarizing these evaluations is forwarded to the Division of Education every six months in accordance with CCF Graduate Medical Education policy.

Fellows whose performance is not at an expected level of competence will be advised regarding the problem areas in their performance, and a specific plan to remediate those weaknesses will be developed. In the course of these regularly scheduled evaluations, fellows are asked to evaluate the program and to recommend changes to suit their individual goals.