John H. Denning, PhD, Staff Neuropsychologist
Vanderbilt University-Veterans Affairs Tennessee Valley Health Care System
Internship in Professional Psychology
The Vanderbilt University-VA Tennessee Valley (VU-VA) Internship in Professional Psychology offers an APA-accredited predoctoral internship meeting Houston Conference Guidelines for training in clinical neuropsychology. One intern per year is enrolled in the Neuropsychology Track, and neuropsychology rotations are also available to interns enrolled in the General Track of the Tennessee Valley VA placement. There are two neuropsychology training rotations offered, one at the Nashville, TN Campus and another at the Murfreesboro, TN Campus. John H. Denning, PhD, supervises the neuropsychology rotation at the Murfreesboro Campus. Dr. Denning earned his PhD at Louisiana State University before completing a two-year postdoctoral fellowship in neuropsychology at Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation. He has clinical and research interests in neuropsychological assessment of mild traumatic brain injury and mild cognitive impairment, as well as in symptom and performance validity assessment.
1. In addition primary neuropsychology rotations at both the Nashville and Murfreesboro VA Medical Centers, VU-VA neuropsychology interns also have opportunities to gain experience outside their area of specialty. To that end, what sorts of general clinical training opportunities exist? How much flexibility are neuropsychology interns given in selecting training experiences outside of their specialty?
Our VA internship setting is somewhat unique in that we consist of 2 major VA medical centers 30 miles apart. This large hospital system provides interns multiple opportunities to gain experience in neuropsychology as well as several areas of behavioral medicine and general mental health rotations. Other clinical opportunities include inpatient geriatric/hospice care, organ transplant, primary care psychology, pain psychology, PTSD/post-deployment clinic, inpatient psychiatry unit, and general outpatient psychotherapy. General clinical experience is also gained during the year-long secondary placement (1 day per week) typically at one of the Vanderbilt University School of Medicine’s training sites (e.g., Adult Psychiatry, Child and Adolescent Clinic, Counseling Center). Interns rank their preferred rotations and are then assigned a mix of rotations based on their clinical interests and training needs.
2. As you described, your program offers neuropsychology training in both Veterans Affairs medical center and academic medical center settings. What makes clinical work with Veterans unique?
Working with a Veteran population is unique in that their history in the military has often provided them a context in how they view others and the rest of the world. Some patients have had positive experiences during their time in service and this has contributed to successful personal lives and careers. At the same time, we also must recognize that many have been changed forever by their exposure to combat operations or injuries (physical and/or mental) resulting from their time in service. Exploring their experiences during that time and how it may impact their current physical, cognitive, and mental health status is unique compared to other patient populations. Veterans also tend to be quite challenging to assess because they often have medical, psychiatric, and substance abuse histories, which make differential diagnosis difficult.
3. You are currently involved in some interesting research regarding performance validity assessment among Veteran populations. Please give a brief overview of your recent and ongoing projects. What kinds of opportunities are there for your interns to supplement their clinical training with research productivity?
My research has primarily focused on the accuracy of performance validity tests (PVTs) across a variety of patient populations (e.g., mTBI, PTSD, dementia), settings (e.g., disability, clinical, research), and investigating unique/novel ways of interpreting well-known PVTs. I am particularly interested in exploring the most efficient grouping of embedded validity measures as well as shorter versions of freestanding PVTs (e.g., TOMM trial 1, errors on the first 10 items of the TOMM). There are many reasons why patients in the VA system may not put forth their best effort during cognitive testing (e.g., financial compensation, increased healthcare benefits, depression, lack of interest, etc.), and my research attempts to quickly and efficiently identify these profiles. Valid test results are extremely important in accurately determining diagnoses, treatment recommendations, and devising interventions for cognitive deficits. Interns may become involved in several ongoing research projects or can propose their own idea for a project. All interns must complete a year-long project as part of the internship program, which culminates in a written manuscript and presentation of results at the end of the year.
4. The Houston Conference Guidelines for training in clinical neuropsychology emphasize there are varying pathways to becoming a clinical neuropsychologist. A side effect of this flexibility is that students often feel unsure about what sorts of experiences they should acquire in order to meet their training needs. What should students keep in mind while selecting potential internship sites? Besides being APA or CPA accredited, are there other specific qualifications for making an internship program “Houston Conference Guidelines adherent”?
Quoted directly From the Houston Conference Guidelines… “The purpose of the internship is to complete training in the general practice of professional psychology and extend specialty preparation in science and professional practice in clinical neuropsychology… The percentage of time in clinical neuropsychology should be determined by the training needs of the individual intern.” As one can see, the guidelines do not suggest any percentage of time actively engaged in neuropsychology-related activities (many applicants are convinced there is some type of 6-month rotation requirement, which is not the case). Applicants should seek out programs that have at least 1 rotation in neuropsychology, research involvement to some degree, and neuropsychology-related didactics if available. Attending internship programs that have these opportunities available alerts postdoctoral program directors of one’s continued interest in comprehensive neuropsychology training.
5. With internship applications due in a few months, some students are already beginning to develop their essays and draft cover letters. As internship hopefuls start to prepare for this process, what advice do you have for them regarding the “do’s and don’ts” of the written application package?
At this stage of training, it is still important to provide enough detailed information about one’s duties during various rotations as experiences can vary greatly for trainees. For example, as part of a research team, did you test subjects? Interview them only? Keep track of a database? Assist with writing up the manuscript? Or did you participate in all aspects of the project? With clinical work, be specific about the tasks you completed (e.g., testing/scoring only, interviewing, writing reports, providing feedback, types of interventions, etc.) and patient populations. Keep the cover letter brief, but still mention areas of experience so that the reader can determine if you are a good fit for the internship program (e.g., clinical/research settings, patient populations, any specific areas of interest). One can typically omit from applications a list of classes, conferences, or individual seminars attended. In addition, it is often better not to “double dip” by listing a section of “posters” and another section of “abstracts” where projects included would greatly overlap with each other (just put things in one section).
For more information on the VA-VU internship program, please visit: https://medschool.vanderbilt.edu/vu-vapsychinternship/.