2011-2012
BRUCE W. CARTER VA MEDICAL CENTER
MIAMI VETERANS AFFAIRS HEALTHCARE SYSTEM
MIAMI, FL 33125
The Psychology Service of the Veterans Affairs Healthcare System, Miami VA
Medical Center, Miami, Florida announces the availability of a one-year
fellowship position in Clinical Psychology with emphasis in
Gero-Neuropsychology. Applications will be accepted until the position is
filled. The training year will begin August 29, 2011. The Post-Doctoral
Residency program is accredited by the American Psychological Association.
For information regarding APA accreditation of this residency, or other
accredited programs contact the Office of Program Consultation and
Accreditation, APA, 750 First Street NE, Washington, DC, 20002-4242, or
phone (202) 336-5978, or email apaaccred@apa.org
The goal of the fellowship program is to prepare scientifically-minded,
doctoral-level psychologists to function effectively and autonomously in
priority areas of health care for veterans and military patients.
Applicants must have completed an APA-accredited Ph.D. or Psy.D. program,
including an APA- accredited internship, preferably within a medical
setting. Previous clinical and research experience in gero-neuropsychology
is highly desirable. The program places strong emphasis on clinical
activity. Residents are expected to achieve competencies based on the
practitioner-scholar model in psychological assessment and diagnosis,
psychotherapeutic intervention, professional consultation and supervision,
professional issues, administration, ethics and sensitivity to diversity,
and scholarly inquiry.
Six (6) month Post-doctoral clinical rotations:
1. Neuropsychology Rotation - The Post-Doctoral Clinical Neuropsychology
Rotation provides advanced training in neuropsychological assessment and a
solid foundation in brain-behavior relationships, the latter including
neuropathology and functional neuroanatomy. This is accomplished through a
wide range of clinical experiences, many of which involve
interdisciplinary collaboration. These experiences include training in
direct patient care, provision of supervision to interns and practicum
students, involvement in structured didactic activities, and research
opportunities. Skill enhancement will occur in numerous areas, including
clinical interviewing, behavioral observation, test administration,
scoring, interpretation, and clinical report writing. An over-riding
emphasis is on facilitating a better working knowledge of brain-behavior
relationships. A comprehensive standardized test battery is typically
used, which includes the Halstead-Reitan Battery, WAIS-IV, WMS-IV (Logical
Memory and Visual Reproduction subtests), MMPI-2, the Rey Complex Figure,
and a number of additional measures of executive and language functions.
Shorter test batteries are frequently used to evaluate patients who have
more severe cognitive deficits and are unable to provide valid or
meaningful results using the more comprehensive battery.
Additionally, training in functional neuroanatomy and geriatric
neuropathology will be provided through (1) A weekly case conference that
includes a review of the examinee's medical history and its relevance for
central nervous system functioning, (2) Neuropathology rounds that entail
brain cutting, which is a routine part of the autopsy conducted by several
faculty members in the Neuropathology Division of the Pathology Department
at the University of Miami Miller School of Medicine, (3) Neuropathology
grand rounds that are held weekly and consist of one-hour presentations of
one or two clinical cases, (4) Neurology grand rounds that are held weekly
and consist of a one-hour presentation of one or two clinical cases, and
(5) Neurology Case Conference which is a weekly one-hour presentation of a
neurology patient. The assessment philosophy embraced in the
Neuropsychology Clinic emphasizes the importance of quality service,
psychometric integrity, detailed observation, collection of essential
interview data, and the appropriate use of qualitative information.
Residents play an important role in the Neurology Department's weekly
Stroke and Epilepsy Clinics, providing brief neuropsychological
examinations of outpatients who present with evidence of cognitive and/or
psychological challenges.
2. Geropsychology Rotation - The skills required of psychologists as
professionals in nursing home settings and outpatient clinics have
expanded considerably beyond the once traditional duties of consultant
providing general assessment, psychotherapy, and behavioral interventions.
Additional duties now include neuropsychological screening evaluations,
pain management, preventive health interventions,
end-of-life/hospice/palliative care interventions, education of nursing
home residents/families/staff, participation as a full-time member of the
interdisciplinary treatment team working in collaboration with myriad
other disciplines, group psychotherapy, and
psychotherapy/bereavement/supportive interventions with family members.
The Postdoctoral Geropsychology Rotation provides training and clinical
experience in the Community Living Center (CLC) and the Geriatric Primary
Care Clinic (GPCC) concurrently for six months. The postdoctoral resident
work directly with the staff psychologist assigned to each of these units
(Dr. Peter Goldsmith for CLC and Dr. Paul Hartman for GPCC) at a more
advanced and independent level than predoctoral interns, essentially
assuming the role of "junior staff member." Examples of this include
supervision of predoctoral interns who rotate through the CLC and GPCC,
participation in selected didactic/training opportunities offered through
the Geriatric Research, Education, and Clinical Center GRECC), and
provision of didactic experiences for fourth year medical students
rotating through the CLC and for geriatric fellows in GPCC. More detailed
description of the CLC and GPCC training experiences follows.
COMMUNITY LIVING CENTER(CLC-Long-Term Stay): The CLC is home to
approximately 80 veterans who require a long term supervised
nursing/medical environment to ensure their health, safety, and well
being. Residents in the CLC range in age from 40 to 90 and reflect the
wide range of issues attendant to such a population including chronic
medical illness, persistent psychiatric illness, lack of decision making
capacity, end-of-life issues, and hospice/palliative care requirements.
Our goal is to ensure residents and their families receive the highest
level of care within an environment more reflective of home (in compliance
with the Culture Change movement) than a traditional institutional medical
setting. Veterans residing in the CLC reflect the full spectrum of
demographics found in the community, providing a rich base for sharing of
experiences and meaningful interactions between individuals. All care is
coordinated via the interdisciplinary treatment team, with any team member
able to request psychological services for a veteran (physicians, nurse
practitioners, nursing staff, recreation staff, dietitians, pharmacists,
rehabilitation staff, clergy, social workers, and housekeeping).
Postdoctoral fellows will learn to function as a vital member of such a
team, enjoying mutually respectful and valued exchange of ideas regarding
care of veterans. A full range of psychological services is provided to
veterans including assessment (decision making capacity, baseline
cognitive status, behavioral functioning, and current mental status) and
therapy (supportive, insight oriented, reminiscence, and life review to
assist in coping with depression, anxiety, loss and grief/bereavement).
Additional services provided include support/therapy for family members,
didactic presentations to staff as needed, and development of behavioral
interventions as needed. Given that residents of the CLC reflect a wide
range of medical/psychiatric diagnoses, it is vital the postdoctoral
fellow develop an awareness of and comfort with basic medical/psychiatric
diagnosis, terminology, and presentation. This is accomplished by
didactics and exposure via walking medical rounds. The impact such
physical/psychiatric illness has on well being and level of functioning
(both psychological and physical) will be stressed.
GERIATRIC PRIMARY CARE CLINIC (GPCC): Patients are seen for psychological
assessment, psychotherapy, and/or cognitive assessment in response to
referrals from the clinic's medical director and geriatric medicine
fellows, psychiatry staff housed in the geriatric primary care clinic, and
medical providers for veterans age 65 seen in general primary care,
cardiology, and other medical specialty clinics. Patients represent a wide
range of ages (mid-60's to 90's), ethnicities, and socioeconomic
circumstances. Psychological issues frequently encountered include
anxiety, depression, maladaptive anger, partner-relational problems,
parent-adult child relational problems, employment problems, difficulty
adjusting to health conditions or disability, caregiver stress, concerns
about aging, concerns about dying, and bereavement.
Assessment methods include biopsychosocial interview, standard instruments
such as MMPI-2, and instruments more specific for a geriatric or medical
population such as the GDS. A limited neuropsychological battery is used
for patients with suspected mild cognitive impairment or early-stage
dementia. We strive for clear and sensitive communication, both orally and
in writing, of assessment results and recommendations to patients, family
members, and other health care providers.
The primary therapy approach is cognitive-behavioral, in addition to use
of concepts and methods from patient- centered therapy, motivational
interviewing, interpersonal therapy, mindfulness approaches, and imagery.
When indicated, couple therapy or family therapy is provided. Recognition
and appropriate reporting of elder abuse and neglect is emphasized. In
addition to individual and family interventions, a support group for
positive aging will begin in spring 2011. Supervision is provided by
modeling, direct observation, review of audio tapes, review of written
reports and notes, and discussion of cases. Postdoctoral residents are
also encouraged to attend "mini-lectures" given by the clinic director to
medical fellows on various geriatric issues at the start of the day, as
well as geriatric grand rounds which are held once or twice a month.
3. Pain & Intermediate Palliative Care Rotation - Experiences will include
both outpatient (pain) and inpatient (i.e. GEM, ECU, and Hospice Unit)
involvement, though patients come from multiple settings. Psychological
assessment through interviews and utilization of a modified version of the
National Pain Data Base and the Multidimensional Pain Inventory is
emphasized in the Pain Clinic. Fellows will participate in assessments;
facilitate weekly group therapy/education/support groups; participate in
interdisciplinary staff meetings; attend bi- weekly multidisciplinary pain
grand rounds (with University of Miami's Miller School of Medicine staff
and fellows); and regularly consult with members of the interdisciplinary
Pain Clinic extended team. Fellows will also be available to patients
during pain procedures both in the Pain Clinic and the OR. If interested,
fellows may also be able to provide biofeedback to pain patients. As pain
management is often a major component of palliative care, the Fellow on
this rotation will also be expected to fully participate on the Palliative
Care team, frequently acting as the liaison between Palliative Care and
the Pain Clinic. Fellows will provide supervision to psychology
students/interns in both pain and palliative care settings.
Intermediate and Palliative Care Rotation: Inpatient psychological
services are provided to patients who are hospitalized on three separate
medical services: 1) Geriatric Evaluation and Management Unit (GEM), 2)
Community Living Center –short-term stay (i.e. Extended Care Unit), and 3)
Palliative/Hospice Care Program. Opportunities to conduct individual
outpatient psychotherapy and facilitate support groups, as well as
complete transplant evaluations are also available.
The GEM unit serves frail elderly veterans (ages 60+) who are not acutely
ill, but have multiple medical, functional, and psychosocial problems.
They are admitted with the goal of addressing their comorbid medical
conditions, functional impairments, and psychosocial issues with the aim
to avoid institutional placement. The typical length of stay is one month.
The CLC short-term stay service is tailored to veterans with acute medical
illness, who have specific treatment goals, such as being admitted for a
course of antibiotics, radiation therapy, wound care, or rehabilitation.
The length of stay can range from two months to one year. Veterans
admitted to the Palliative/Hospice Care Program are individuals who are
facing a chronic, potentially terminal illness including cancer, end stage
organ disease, and congestive heart failure. The Miami VA has a 10 bed
inpatient acute hospice unit and a outpatient Palliative Care Clinic.
Across these three medical services you will have the opportunity to work
with a range of ages (40's-90'), ethnicities, and socioeconomic
circumstances. All veterans admitted to these units are evaluated for
psychological services. Family members are also evaluated for caregiver
stress and bereavement. Psychological issues commonly encountered include
adjustment disorder, depression, anxiety, bereavement, substance abuse,
and PTSD. Pain and sleep disturbance are also common problems.
Assessment methods include a clinical interview evaluating the veteran's
adjustment to hospitalization, mood, and coping skills. The majority of
veteran's are administered a brief cognitive screening measure (i.e.
Mini-Mental Status Examination) and a mood questionnaire (i.e. Beck
Depression Inventory; Geriatric Depression Scale, Patient Health
Questionnaire). The primary therapy approach is supportive, bedside
therapy. Orientations used include patient-centered therapy, interpersonal
therapy, reminiscent / life review therapy, existential therapy, and
bereavement counseling. Anticipatory grief counseling and bereavement
services (i.e. individual and group counseling) is also offered to family
members of veteran's With regard to outpatient psychotherapy, patients are
referred for individual treatment to address issues such as being newly
diagnosed with cancer, having a reoccurrence of cancer, difficulties
adjusting to chronic medical conditions and treatment (i.e. renal
failure/dialysis), bereavement counseling, and concerns associated with
aging.
Consultation is an integral component of this rotation. Residents are
expected to actively participate in the weekly interdisciplinary team
meetings which are comprised of physicians, medical trainees, nurses,
social worker, recreation therapist, chaplains, physical and occupational
therapists, dietician, and pharmacist. The opportunity to attend weekly
medical rounds is also offered.
Extensive supervision is provided by modeling, direct observation of
intern's provision of service, review of written reports and notes, and
discussion of cases. There may also be opportunities for group
supervision. Opportunities are also available to supervise other trainees
including interns and practicum students.
The stipend is currently $44,692 for the year, paid biweekly, and cost of
individual or family health insurance is covered on par with other
Healthcare System residents and employees. The Miami VA Healthcare System
is an equal opportunity employer, and it serves one of the most culturally
diverse veteran populations in the nation. Applicants from minority and
traditionally underrepresented groups are strongly encouraged to apply.
To apply, please submit the following materials:
- A letter of interest describing post-doctoral training goals and
long-term career goals
- A current curriculum vita
- A clinical work sample (comprehensive assessment report that addresses a
gero-neuro issue)
- Three letters of reference from psychologists familiar with the
candidate's work
- A letter (via electronic mail is acceptable) from the candidate's
internship Training Director stating that an APA-accredited internship
will be completed by August 29, 2011, or transcripts that indicate that a
doctoral degree was granted
- A letter (electronic mail is acceptable) from the candidate's graduate
program Director of Clinical Training that the PhD or PsyD has been
awarded or that the dissertation defense has been scheduled to occur
before August 15, 2011, or transcripts that indicate that a doctoral
degree was granted
- Official transcripts will be required if an offer is accepted by the
candidate
Preferably, applications and associated documents are to be sent as a
single PDF file to regina.pavone@va.gov
Inquiries should be directed to:
Regina Pavone, PhD
Director of Training, Psychology Programs
Miami VA Healthcare System
1201 NW 16th St – 116B
Miami, FL 33125
Phone: 305-575-3215
Email: regina.pavone@va.gov
More information is available at http://www.psychologytraining.va.gov/miami
A selection committee composed of postdoctoral rotation supervisors will
review all completed applications. Selected candidates will be offered
interviews (either in person or by telephone). Following interviews, the
selection committee will extend an offer to the top applicant.
