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Career Path Insights: Navigating the Landscape of Neuropsychology

Amber Watkins1h 2min

Afik Faerman, PhD

00:07

Hello and thank you so much for joining Palo Alto University and the Division for Continuing and Professional Studies for our Talking Mental Health Careers podcast. This episode featuring neuropsychology. My name is a Afik Faerman, and I'm an NIMH postdoctoral fellow at Stanford University and an adjunct professor at Palo Alto University. I'm very fortunate to be joined by experts today. Dr. Rayna Hirst and Dr. Saranya Patel, both affiliated with Palo Alto University as staff and alumni respectively. Thank you both so much for being here for this important conversation. I'd like to start by giving our listeners a little background information on each of you and then get each of you to tell us a little bit more about yourself and your career. Dr. Hirst completed her undergraduate education at Penn State University and her Master's and PhD in Clinical Psychology at the University of Albany SUNY, with a focus on neuropsychology and addictions. Dr. Rayna Hirst's BRAIN lab the Behavioral Research and Assessment in Neuropsychology, conducts research in brain behavior relationships, and neuropsychological assessment. Current research topics include the influence of chronic marijuana use on cognition, the neuro psychological effects of sports related concussions and factors that influence the valid and reliable neuropsychological assessment of patients. She is also on the boards of several committees for the National Academy of Neuropsychology, and the Society of Clinical Neuropsychology, and sees clinical patients on a regular basis through private practice. Saranya Sundaram Patel, PhD is a clinical neuropsychologist at one rehab in Dallas, Texas, and adjunct faculty at Emory University School of Medicine, where she completed her pre doctoral internship and postdoctoral fellowship in the adult geriatric neuropsychology track in the Department of Rehabilitation Medicine. She holds a master's degree in rehabilitation counseling from UT Southwestern, and earned her PhD in Clinical Psychology with an emphasis in neuro psychology at Palo Alto University. Clinically, she specializes in assessment and cognitive rehabilitation with adult and geriatric individuals presenting with neurological and neurodegenerative conditions. Dr. Hirst, I'd like to start with you. Please tell us more about your career path and the professional experiences you've had? Yes, thank

Rayna Hirst, PhD

02:33

you. So I had known from a fairly young age that I was interested in psychology in general, but didn't really know what I wanted to do with that, kind of think that I thought I wanted to be a student for the rest of my career, which actually lends itself very well to academia. I had discovered neuro psychology during my bachelor's degree in general psychology, just kind of through interest in memory and how the brain processes information. And as soon as someone explained to me what the field of neuro psychology was, I was very fortunate that it was like a light bulb going off, I was just like, this is exactly what I want to be doing for the rest of my career, and just fell in love with it. So I attended graduate school in a program that had a significant focus on neuro psychology. And during graduate school, I really was thinking that I was going to be a clinician, I just wanted to work with patients and do neuro psych evaluations all day long. And somehow, life just didn't turn out that way, which is kind of interesting. I was applying for jobs after my postdoctoral fellowship at Dartmouth Medical School. And the only academic position that I applied for was at Palo Alto University. I knew that I cared very much about teaching and mentorship. And was not as interested in the research side of things as maybe some other university programs might be. But I said, okay, if I'm going to make it work at any academic position, it's going to be a school like this one where you know, there really is a strong emphasis on teaching, mentorship and supervision. And so I figured I would give it a shot. 11, 12 years later, I've lost count now. I'm still here. And so I started as an assistant professor fresh out of postdoc, and I was promoted to associate professor a few years ago, and I've been director of the Neuropsychology program. So I get the wonderful job of getting to teach students how to do the job that I absolutely love, as well as maintaining a private practice so that I can continue to see patients clinically. So that's been kind of an unexpected road for me, but one that I'm thrilled to be in and really enjoy the variety that my job offers me now.

Afik Faerman, PhD

05:00

Thank you so much. Dr. Patel, please tell us more about your career path and the prepaid professional experiences that you've had.

Saranya Sundaram Patel, PhD

05:09

Sure. So I started out in college, I started out pre med, my parents are actually neurologists, and I tried, you know, to go down that path as well. But I took a psychology course, and I was super interested. And I found myself just wanting to bridge the gap between, you know, the brain and behavior, and neurology and psychology. So I interned with a neuro psychologist, and I loved it. So I kind of set my goal, then to try to have a career in this field. So I got my master's in rehab counseling, rehab was also something that I was deeply interested in. I liked the recovery aspect, I like being able to go past just doing an assessment, and being able to provide recommendations and also provide some interventions to help with individuals and their impairments. And then I landed at Palo Alto University, where I was fortunate to be trained and taught by Dr. Hirst as well, and primarily trained in academia. And it's interesting, because I always thought I would just do straight academia. And my experience has been a little bit different, where all my training has been in academia. But now I'm trying to find a way to do academia without actually being in academia. So I'm doing my clinical practice through a private practice. And I'm doing my research through Emory University. So I think it's pretty interesting that kind of the way, the different ways that you can actually have a career in this field, I think, in the beginning, it's not as clear, or sometimes you have a very set or focused path. And then actually, when you get to the end, trying to figure out what to do, and it kind of all comes together.

Afik Faerman, PhD

07:00

Thank you so much. You know, when we're thinking about neuro psychology, a lot of people have different conceptions in mind of what a neuropsychologist is, and what neuropsychologists do even within the training route, to become a neuropsychology, a neuropsychologist pardon me. So how about you guys, tell me, tell us our listeners. What does a neuropsychologist really do? What is the current day in your job look like? Rayna, we can start with you.

Rayna Hirst, PhD

07:30

Yes, thank you. Um, so I have, I consider myself very lucky for my skill set that my job looks different every day. And what I really like about that is that it means as far as I can tell, I'll never get bored. So there are days when I get up, I go to a research lab meeting, I have meetings with students individually to talk about research projects, or dissertation. And then I teach a three hour graduate level class, maybe stay after class to answer some questions, go home, answer some emails. And you know, that's my day. On a completely different day, I'm getting up early, driving down to Palo Alto and preparing for a six hour neuro psych evaluation with a particular patient, where I would spend the day administering assessments and then scoring them and working on the neuro psych reports. On other less exciting days, I might be in faculty meetings and committee meetings from the time I get up until the time I go to bed. And then it's more about kind of service giving back to Palo Alto University, contributing to the welfare of our faculty and the welfare of our students. And I guess that's just sort of some more research in there too. So there were days when I'm editing manuscripts, working on maybe a revise and resubmit for a manuscript that I've submitted for publication, editing students, first drafts of different parts of manuscripts, I'm working on abstracts for a conference, things like that. So, uh, you know, one of the pros that I see to this, you know, type of career is that every day is a little bit different. It's harder to get burnt out, it can still happen, but it is a lot harder. And, you know, every day looks a little bit different. And you know, there's something new going on that can challenge me. I think, ultimately, on reflection, if I had a career where I was only doing clinical work all day, every day, I actually might get burned out quick more quickly, or just kind of get a little bit more bored and seek some additional challenges. So there's definitely as Saranya said, a huge variety in what your day can look like and what kind of career you can kind of pull together from various resources once you do finish your postdoc and get licensed.

Afik Faerman, PhD

09:58

Thank you. Yeah, I completely resonate with the the kind of broad set of opportunities that becoming a neuropsychologist opens for a person. Anywhere from academia certainly mentioned, you know, medical kind of environments, industry, there's so much that we can do, and that we are doing. So it's really great to see to hear from you how your day is structured, or your days. Saranya. How, how was your week structured? Yeah, it's,

Saranya Sundaram Patel, PhD

10:31

it's a great question. Because I think, you know, I've always wondered that during my training, and being very early career, I'm like, What is my day going to look like? And really, it's a lot of working on the computer, in some form or fashion. But there's, you know, the clinical side, you know, it's conducting interviews, selecting test batteries, working closely with the psychiatrists, writing reports, doing feedbacks, you know, kind of the whole bit. And then, you know, on the days that I'm doing research, like Rayna, mentioned, you know, editing manuscripts trying to do revise and resubmit, or a poster or whatever it might be, or I'm in meetings, whether it's for clinic or for service related, you know, organization. So, every day is different. And I love it, I love that it's very flexible. I mean, even within the day of like seeing a patient, it can go one way or another, not any record review in the world is going to tell you exactly what you need to know about a patient. Like, for example, yesterday, I had a patient who turned out to be very visually impaired. So having to adapt and figure out what tests we had that we could actually accurately assess this person, and it's really fun, it's fun to be flexible. And to know those things, I think, coming from a trainee position, or I'm kind of maybe freaking out, like, Oh, crap, what do we do? To feeling like, Okay, actually, I kind of know what to do at this point, and feeling more confident in that decision. But yeah, it's a lot of being flexible. And you really wear a lot of different hats, people can be, you know, straight assessment, they might do intervention, like cog rehab, or psychotherapy. So I think you really can structure your career to really how you want it to be, but it's a pretty flexible day slash week.

Afik Faerman, PhD

12:18

Thank you. Yeah, you know, it's incredible how when, when a person is working towards becoming a psychologist, there's so much to learn. And there's so many different areas of expertise, even within neuro psychology that one can go through or towards. So just hearing how diverse your week is, or your, the set of experiences that you're structuring your, your weeks to, or your days to, to include, really touched a point of how different levels of interaction between brain and behavior you can do in one job, you know, anywhere from clinical layers of working with patients, to doing research about that to teaching the next generation, whether through supervision and or through classes. There's, I know, when people think about neuropsychologist, there's typically this picture of cognitive assessments, and it's definitely one of the major tools that we use. But it doesn't end there. It is way bigger than that. And that's, I think, important for our listeners to, to recognize, let's let's take this discussion even a step deeper. So what is typically a common myth that people have about neuro psychology, something that you hear from students or patients or even from within the field? What is something that most people misunderstand about it?

Rayna Hirst, PhD

13:46

Yeah, I think for me, you know, thinking about a general public misperception, it has to be the Oh, you're psychoanalyzing me response. So any, you know, dinner party social gathering that you go to, oh, what do you do for a living? Even if I say I'm a neuropsychologist, they still jump on the Oh, so does that mean, you're psychoanalyzing me? Do I need to lay on the couch? Those types of kinds of stereotypes about mostly therapy. And so then I explain, you know, actually, this is more looking at cognitive functioning for you know, neurological and psychiatric disorders that can affect how the brain works like memory and attention. And I'll usually give an example like, you know, if you think that your grandmother might be developing dementia, she might have an evaluation to see if her memory is worse than other people her age, or traumatic brain injury is the other one that I can kind of give as an example. I think for people who are kind of a little bit more knowledgeable in the field, I think the biggest myth that I see from students is, as you mentioned that it If you're going into neuropsychology, all you're going to do all day long is the assessment, you can't do therapy or it's frowned upon or discouraged in some way. And that you cannot like follow patients over time. And so I really use those opportunities with students to open up the discussion of cognitive rehabilitation of working in therapy with people who have neurological diagnoses, I actually happen to think that neuro psychologists are uniquely prepared to administer psychotherapy to people who have kind of life changing neurodegenerative illnesses, or maybe they've been diagnosed with a brain tumor or something like that, we really have a unique understanding of that interaction between the medical diagnosis and disorder and the psychological symptoms that can accompany that either due to pure physiological effects, or just a psychological reaction to having this diagnosis and, and having your daily functioning kind of change in significant ways. So so, you know, I welcome students to come and chat with me about that, because I do want to reassure them. In fact, when I was job hunting, most of the jobs that I applied to required the neuro psychologists to have a small therapy caseload every week of people that they would follow. And usually that was, you know, like I said, medical diagnoses or someone who had a traumatic brain injury and is coping with it, and those sorts of things. So they really don't have to be distinct. And in fact, they probably shouldn't be distinct because we can be so helpful to people who have those unique situations.

Saranya Sundaram Patel, PhD

16:48

Yeah, I agree. I think therapy is probably the the biggest kind of misconception, either that we do it or that's what we only do. So for example, when I say sometimes I'm a neuro psychologist, people are like, so you're a psychologist, so you, you just see patients for therapy. And it's a whole more load than that. You know, there's therapeutic assessments. There's, you know, like, Rayna talked about rehab, which is just a larger focus on recommendations and recovery. And intervention can be done in multiple ways and integrated throughout an evaluation. You know, sometimes there's a continuity of care, like I've seen a patient for assessment and then carried them on through a cog rehab intervention. Another aspect is where we work, like kind of what settings and you know, whether it's private practice or academia, or that we do inpatient and outpatient, I think, mainly, maybe from a trainee standpoint, it's understanding the different settings that we can be a part of. And that was something that was, you know, that I appreciated in my grad program is they made that very aware for us that these are the different types of settings that you could be in. And I wasn't really aware, I didn't know that we could do inpatient at the time when I was interested in in this field. And I turned out to do you know, more rehab, and I've been doing a lot of inpatient when I was on postdoc, and internship and I loved it. So, you know, kind of bringing awareness to that from a trainee standpoint, I think from patients, the biggest myth is that we can prescribe, I get patients all the time that asked me if they could change, they could change my medic, or I can change their medications, and you know, what dosage they recommend for different types of disorders and different medications and whatnot, and, you know, having to explain to them how my role is different. And you know, we're part of a treatment team, even if we're not part of the same multidisciplinary team, and how all that works. So I think the biggest thing is providing, you know, education to whoever has those kind of misconceptions about what we do.

Rayna Hirst, PhD

18:52

Yeah, that's a that's a great point. And I actually just thought of something else I'll add in just quickly is that from a student perspective, for the students who are very neuro psych focused, very assessment focus, that's what they want to do and, okay, okay, if you're gonna make me do therapy, I guess I'll do it along the way. I really try to remind them that there is a lot of therapeutic approach to the way that we handle even our one time assessments, the clinical interview, easily can turn into an inadvertent therapy session, you're asking patients to share information about psychological symptoms, medical symptoms, past trauma, abuse, and those topics need to be obviously handled, you know, very delicately and with a lot of clinical care. And similarly, the feedback session at the end of the evaluation, there's a lot of therapeutic skill that you need to use in order to for example, encourage someone to seek psychotherapy for people who were like, Oh, I don't need a head shrinker you can do some motivational interviewing with them to help them see some of the benefit and how it can be of help to them. Things like reducing substance use, if they're reporting memory difficulties, you know, that can be a really delicate thing to approach. And you really want your patients to leave each feedback session having tools that they can start to use immediately to help their daily functioning. So there's a lot of psychoeducation, suggesting changes that they can make in their daily lives to improve their functioning. So that's definitely a myth that I try to dispel very early in students careers and training.

Afik Faerman, PhD

20:38

Yeah, that's a fantastic point about how sessions could intake session or a feedback session in particular could turn into a therapy session. And it's kind of understandable when we think about it, that our patients are going through a lot, receiving the feedback and hearing about specific diagnosis and kind of getting a better picture but what they're experiencing and sometimes it could be actually a positive experience, putting a name on it, put a definition on it communicating to the patient that we understand what is going on. And at other times, it can also be very difficult to hear. So this could easily the the line between delivering assessment outcomes or results to therapy can sometimes be a little vague. And I think that's really important for us to develop those skills because we're probably going to need them. Let's talk about becoming neuro psychologists. So in general, neuro psychology is a specialty field within clinical psychology. So if you want to become a clinical neuropsychologist, you're necessarily need to go through a clinical psychology route and then specialize in neuropsychology. And most people do that during their graduate training in clinical psychology. But then you get into the clinical internship, and then the postdoc, and what happens after that, so let's talk a little bit about that route from kind of, officially or formally becoming a neuro psychologist. So let's start kind of like with internship, what people should look for. Is it even important to think about internship in the context of neuro psychology? What about finding a postdoc program? What are your general recommendations for people entering or navigating navigating the field?

Rayna Hirst, PhD

22:37

Yeah, it's a complex process. Actually, I do give a talk annually at Palo Alto University on how to become the neuro psychologist and I touch on this but it's mostly attended by first year students. And I don't know how often they actually go back to this talk, five years down the road when they're applying for postdocs to remember some of these key issues. But I do try to make this information available and it does require a little bit of extra homework on the students part to figure out. So within the actual internship application process, students are usually pretty well prepared by their graduate programs, they're looking at internships that offer at least one rotation in neuropsychology. Many internships offer up to 50% training in neuro psychology, and there is an expectation probably that you would have, you know, at least one rotation or 25% of your internship would be in training in neuro psychology, and some are much more specialized, as I said, where you would have a lot more neuropsych training. I think probably many students get a lot of their postdoc information during that internship training. And, and some of the key things to kind of think about is that neuro psychology does have a general expectation of a two year postdoctoral fellowship. So it is a little bit longer than than many other postdoctoral fellowships in clinical work, and that, you know, depending upon whether you want to be eligible to get board certified in neuro psychology, that may need to be at least 50% clinical work, as opposed to a two year research focused fellowship. And then I could go on a whole other tangent about the different types of board certification, but the most popular and common one that people are referring to when they talk about getting board certified in neuro psychology is ABPP, the American Board of Professional Psychology with the clinical neuropsychology focus. So ABPP-CN, if people want to Google that, and so you can actually look at the requirements for getting board certified and make sure that you're on track for things like that. Within the post doctoral application process, there is similar to what there is for internship a unified match program, where you can apply to be a part of a match and apply to different postdocs within that match process, go on your interviews, they used to very commonly do interviews during the INS International Neuropsychological Society conference every February, I think they're doing some more online interviews now, since the pandemic to be more accessible for people who might not be able to come to that conference. And so you can go through that, do your interviews, rank your postdoc programs and go through the match. And then there's a whole other half of postdoctoral programs that are not involved in the match, and that advertise outside of that. So they might use listservs APA division for the National Academy of Neuropsychology to advertise their positions. And these are called non match positions. They tend to interview earlier to try to get people to pull out of the match and go to their postdoc program. And, and the common recommendation from training directors is that trainees should choose to either go through the match and just stick to match programs, or go non match and just stick to non match programs. That's to avoid a situation where you interview with several non match programs, you interview with several match programs, and then you pull out of the match. And they've kind of wasted their time, so to speak on interviewing you, because you ended up not even going through the match, and they don't even have a chance to get you. In reality, I think what that often looks like is that people make the choice that's best for them. So maybe you decide to mostly go through the match. But there's two non match programs that are in your hometown, or near your family or in your desired city, that you apply to those as well. You know, at the end of the day, trainees have to do what's best for them. And I, you know, I think that is important to not kind of take that option away from them. But it can be a very confusing process for that reason. The other thing I'll just mention quickly is that during that postdoctoral training, then I really encourage students to get licensed somewhere, anywhere, because in the job hunt, many human resources departments will actually screen out your application if you're not at least licensed somewhere. And in other cases, they can even screen you out if they're not licensed in the state that you're applying for the job. And so if you know, you know, I want to end up in backup back in California, that's exactly where I want to work. Then during your postdoc, even if you're in Lebanon, New Hampshire, where I was in the middle of the woods, you could still apply to get licensed in California, you don't have to live in the state that you get licensed. So that might be a common misconception that people have. So if you're on postdoc in New Hampshire, you can get licensed in California, and then last, you know, year to six months of your postdoc just apply for as many jobs as you can in California. So that's kind of something to think about, including along the way as well.

Afik Faerman, PhD

28:28

Yeah, I think, thank you so much for this summary. This is really a coherent route from grad school to a licensed psychologist within the context of neuro psychology. I think it's also you mentioned the Houston Conference Guidelines. And I think this is really important for listeners to kind of make sure that they are familiar with it, because a lot of the the direction and pathways within neuro psychology as an independent field, follow the decisions and the guidelines that are advertised, were advertised after the Houston conference. And some of them are really crucial for designing your future career as a neuropsychologist, particularly if you're thinking about board eligibility. I'll just mention one thing in mind that, for example, if you actually if you read the recommendations, and if you go to the Board website, you could learn that there is actually not a formal requirement to complete an internship in neuropsychology, particularly if you had sufficient training in psychology throughout graduate school. But, and this is an important thing to consider. This is where the real real life kind of interferes with what's on paper. You know, last year, Lukas Driscoll and colleagues published a survey in the clinical neuropsychologist showing that overwhelmingly the number one factor in ranking applicants for postdoctoral fellowship in neuropsychology is the intensity of neuropsychological training during internship. So even though it's not formally a requirement, it communicates to the people that are going to review your application, what is the career direction that you're taking. So it's definitely going to make you a stronger applicant for postdoc. If you have had internship experience neuropsychological experience during internship.

Saranya Sundaram Patel, PhD

30:32

And I think a lot of that goes towards, you know, what is feasible and what is, you know, what access to certain sites and certain training experiences that a student has. You know, I was fortunate to go to a school that had a neuro psychology area of emphasis, but I have several friends who did not have that same opportunity. But they are great neuropsychologists, they just had to do it a different way. So I think that's something important to highlight is that there's different ways to go about it. But you know, keeping in mind that you're getting, you know, the the concrete foundations of neuro psychology, you're getting the didactics, you're getting the clinical training, you know, there's, it runs the kind of gamut of what kind of experiences you need to get to, to be competent in this field. But there's different ways to go about it. And I just want to add, you know, I think Rayna did a great job of kind of coherently talking about exactly how that goes just from a person who is an early career neuropsychologist as of like, two months. It's a huge identity shift, complete identity shift, I had a huge identity shift from internship to postdoc where somebody is calling you doctor. And then now like, it's all kind of rests on me as being early career. So that's just something I would, you know, kind of look out for as well, because it's something that I didn't really truly expect. But it's like kind of learning how to how to go with that identity shift. And, you know, I think a lot of people ask about, you know, what do I need to have in order to apply for internship, I still mentor a lot of students from PAU, and in the works and kind of other places. And that's probably the most common question I get, am I ready to apply? Do I have what I need? Again, PAU does a great job of providing you with the faculty advisor that looks over everything and helps you with all aspects of your application, and gives you kind of feedback on whether or not you're ready. But again, I just kind of want to highlight, not everybody takes, you know, four years, five years, depending on how long your program is, some people take longer. Some people want to round out their training in different ways. But one thing I would look for when you're applying to internship, and definitely when you're applying to postdoc is what are the gaps in your training? And how can you round those out? What have you gotten already that you want to emphasize more? Or you want to get something else that you haven't, you know, been able to experience yet? Is it more breadth versus depth. So there's different aspects. It's not just about hours, it's not just about, you know, the just the quality of your application does matter. But it also matters about what you want to do and what your goals are. There's so many goals that you can have in this field, it's very versatile. So just some things to think about. And as somebody who did attend Dr. Hirst's talk, and then look back at those slides, because it's really helpful. It's helpful when somebody breaks it down. And understanding exactly what you need and, and whatnot. But I highly recommend networking and finding somebody who is a neuropsychologist in this field, getting that mentorship and having somebody help you along the way. I think that was crucial for me, and it's still crucial for me as I'm going through.

Rayna Hirst, PhD

33:58

Yeah, absolutely. I appreciate that, Saranya. And the other resources I wanted to mention for listeners. So we talked about the Houston conference guidelines, which was a conference that occurred back in oh gosh, 80s, I believe, where a group of experts in neuro psychology established these guidelines for what training and neuro psychology would entail. There actually was a recent conference held, I believe, last year in Minneapolis to update these guidelines. And those have not been published or released yet, but just encouraging listeners to, you know, keep an eye on that and keep an eye out for that Minnesota conference guidelines that will probably become the next phase of expectations for training. The other thing I'll mention, in addition to the Driscoll article that you had mentioned, Afik was, which is a survey of postdoctoral training director Here's on the expectations for incoming candidates I actually published in, I think it was 2021, a similar survey of internship training directors. So if listeners want to search for that, or maybe we can include a link with the podcast somehow, we actually surveyed, you know, all these training directors and neuro psychology supervisors, what are the aspects of the application that are most important to you? What are the mean number of hours that you're expecting to see what are the mean number of publications you're expecting to see, with the hope that, you know, applicants can use that data to inform themselves about the training choices that they make during graduate school, because one of the things that happens during graduate school is you get tons and tons of different training opportunities, and you can't say yes to everything, or you will burn out. So you really want to be thoughtful and selective in what you say yes to and make sure that it will contribute to your competitiveness, and your career development. And similar to what Saranya was saying, thinking about choosing training opportunities that reflects the type of career that you want to have. So don't take an internship, that's mostly called rehab, if you want to be an outpatient neuropsychologist, just because it's in the city that you want to live in. Really think about how your training site reflects the type of career that you want to have the blend of skills that you want to be able to use on a regular basis. And, you know, if you select an internship that looks like the type of job that you want to have, and then a postdoc that looks like the type of job that you want to have, then you will just by de facto be more competitive for a career that looks like the type of job that you want to have.

Afik Faerman, PhD

36:45

Yeah, thanks so much for bringing up your article, Rayna I love this article. And I often refer students that I work with to the article because I think it really breaks down some of the misconceptions going into the field, because as you said, like you you want to say yes to everything, and you literally cannot. And you will kind of if you don't know exactly where you're going. And if you don't know, if you don't have a strong reference point to what is more important for the route that you're taking, then it could feel very hectic, and it could feel very exhausting to just try to get everything along the way. And I specifically remember from the article that the coming into the field, I thought I had to be an expert in cognitive rehabilitation, because that was the the natural next step right, a person comes in, gets a some sort of evaluation. And in many cases, the recommendations do actually include referrals for cog rehab. But then looking at the paper, it was important, but it wasn't important for all of the programs. And it wasn't important in all of the settings that kind of ties to what Saranya is saying about in a note where you're going and find the people that can actually give you relevant advice. So I think those resources are key for students that are kind of trying to get into the route of becoming a neuropsychologist and it's totally okay to shift your focus and, or to re specialize a little later in your career or to get a little more training that could make you a little more nuanced. But really, the bit the first steps that you're taking, you want to get you want to graduate with a PhD or PsyD in clinical psychology and complete a postdoctoral fellowship in neuropsychology, and there are a lot of steps to get there. So use all the resources that you can, and we will definitely provide some references in our podcast and our resources for listeners later. In hearing you I hear you describing the the this kind of tedious route of you know, from a graduate student to a neuropsychologist, you and Saranya, you mentioned, you're going through several identity shifts along the way. If you could talk to your younger self coming into graduate school and clinical psychology, knowing what you know today, what would you recommend yourself? What would you tell yourself? You know, you need more of that or what would you say this wasn't that important? What would you capitalize as professionally important but also personally important in this very long journey?

Rayna Hirst, PhD

39:48

Yeah, that's a great question. I think in my situation, I would have encouraged my younger self to not be so quick to rule out a career in research academia, I was very fortunate that the program, the graduate program that I attended, was more research focused. And so I did get the experience that I needed to be competitive for an academic job here at Palo Alto University. However, you know, I probably would not have been competitive for many other, you know, much more research focused, Grant focused types of institutions. And I think, you know, one of the best things about the the PhD in particular, and even the PsyD depending upon what opportunities you seize, while you're there, is that you get training in such a wide variety of types of the same job. So you get training in teaching, if you want to be a teaching assistant. And many times, you can actually teach an undergraduate class or even a master's level class, you get training in research through a dissertation or research projects, posters that you complete, and you get training in your clinical work through your external practicum at different hospitals and private practices and things like that. And, you know, even mentorship, you know, many times advanced graduate students are mentoring, the less advanced grad students and things like that. So you really can, if you take those opportunities, get that breadth of experience, so that you can be competitive for any type of job that down the road, you may want. And this is extremely helpful, because you just never know where your life is going to take you where your career is going to take you where your interests are going to take you. And you just never know when you might need to be competitive for a different type of job than you initially were planning. So graduate school is, you know, really such a great place to make sure that you get everything across the board. So that you, you can kind of manage any type of career that is offered to you down the road. And, you know, I just feel very lucky that I had that opportunity, because this is not where I thought I was gonna go. But I absolutely love my job. I just love teaching and mentorship and getting to chat about this stuff all day long. And if I hadn't, you know, PAU hadn't happened to have that job posting that particular year, I might never have ended up here. So it's just kind of crazy to think about. And now I do also have the skills that let's say I do burnout 10 years from now from academia, and I decide I want to work in a hospital and just see patients all day, you know, I'll be able to make that shift. So I think just kind of keeping yourself open to the possibilities and not ruling anything out. Because this is a really unique degree that offers you just a huge range of what you can do as a job with it. And it's something that I think, you know, trainees should really capitalize on. The other thing I'll add, which is a little bit of a cheat, because this wasn't available when I was in early in my training, but it is available now. So I want to make sure I highlight this for the listeners is that last year, they published a nice little book called The Neuropsychologist Roadmap. And it literally goes from I believe, undergrad, to grad school to internship to postdoc, it's just a nice little book, but it describes a lot of these things that we are talking about. And I think it's a good way, especially for people who are early in their training, to kind of look ahead to the future, hopefully, without getting too overwhelmed, but to really kind of be able to picture what it's going to look like down the road. So I do want to give a little plug for that. And maybe we can link that in the description as well.

Saranya Sundaram Patel, PhD

43:59

Yeah, that that's such a great question. Because I think having just kind of recently graduated from postdoc and starting out early career, I have kind of thought about this, like, what would I have told myself, you know, when I started on this journey, what, like, seven, eight years ago, or even actually, you know, more than that, you know, first off is that there is an end, you know, I think it's hard to see the light at the end of the tunnel and even just a little flicker, but it is there. I think it's you know, something to tell myself would be that it's a rewarding experience. Like no matter where you go, you will be rewarded in whatever way that you feel like it's very beneficial for yourself as a person and you know, in your career like, right I said I love what I do. I love my job. I love going into work and seeing all these you know, different types of cases and working with different people from different backgrounds. It's such a very challenging but rewarding kind of field. Um, something I wish I would have done more is actually done more networking. I think that, you know, we think about networking, maybe just like within our cohorts or with like, the faculty that's in our program and such. And, you know, something I wish I did is join more of the student groups and I, and maybe when I was, you know, in grad school, it wasn't as maybe well advertised or, you know, I just didn't know about it as much. But now like all the professional organizations, National Academy for Neuropsychology, the International Neuropsych Society, APA Division, 40, AACN, American Academy of Clinical Neuropsychology, they all have student groups, they all have, most of them have special interest groups, like there's so many ways to get involved, there's so many ways that you can apply for different types of scholarships and ways to go to conferences that make it more feasible ways for you to go to these conferences and actually join like student and internship or postdoc networking groups and things like that. So that's something I wish I actually did take more of an advantage of. And then I did, I mean, it worked out, I was able to do that more on internship and postdoc. And maybe, you know, when you're in graduate school, you know, you're, you're just with your people, you really haven't met the rest of the world yet. And so when you go when I went to internship, and then I was attending conferences, you know, I was exposed to all these people, even just interviewing for internship, I was like, the second to last cohort that actually flew everywhere for my interviews. And so I met so many people along the way, some of those people, I still talk today, and they're, they're my friends, you know, they're my colleagues, my friends, and you develop, you know, this collegiality between people just, you know, by a simple network. So that's something I would encourage our listeners, if they're interested in this field is to network, get to know these people, even the book that Rayna talked about. It's written by or it's edited by Katie block, and she's at Emory. And so I've gotten to know her and she's, she's great. She's a fierce advocate for those that are training in neuro psychology and wanted to provide a great resource. So, you know, reach out to people like that, you know, those that are that have written the chapters, those that have edited the book, they do a lot of great advocacy work and mentorship work, to help the growing, you know, next generation of neuro psychologists.

Afik Faerman, PhD

47:38

This is such a great point. And I think would just happen Rayna recommending a book and you know, Saranya saying, Oh, I worked with her. This is exactly the the point of how tiny relatively our field is in the sense that, you know, your involvement in those organizations, your involvement in conferences. It's a small field, for better or worse, right. So people know each other, you can probably get connected to someone you, you know, you read an article or a chapter, as you mentioned, Saranya, and you want to talk to the person who wrote it, you can get them by maybe two or three steps away from your immediate neuro psych network. And that's something that I totally want to interweave kind of like that into what both of you said, with regards to to advice, if you could give your younger self, I think, understanding how this field is definitely growing. But understanding how small it is, is a strength because you can make a lot of impact by just being there, and just talking and listening about what's important for you professionally or personally. And it kind of leads me into our kind of like our gazing to the future question. What do you think the field is becoming for is, where do you think the field is going towards, you know, in the next 5, 10 years, both in the sense of you know, how assessment tool change, but also, what are some significant social changes that happened within our field and how it may or may not change what it means to be a nurse psychologist?

Rayna Hirst, PhD

49:23

Oh, that is a giant question. And a great one. I'm having had, gosh, I'm like just now coming to grips with the fact that I've had some longevity in this field now. And seeing where things have gone in the past 10 years and thinking about where I'm seeing them going in the future. Yeah, I think we still as a field have a lot to take advantage of in technology and computer as the administration. And before the pandemic. I used to think that that would look like paper and pencil tests getting exchanged out for iPads or maybe down the road virtual reality. What the COVID 19 pandemic has also opened our fields eyes to is the accessibility issue. neuropsychology, as we said is a very small field. And what that means for patients is that many of your patients are driving two hours, three hours, sometimes more, just for this appointment that they've been waiting for for six, eight, if you're looking at pediatrics 12 to 18 months, and the previous view that every neuropsychological evaluation absolutely had to be completed in person or else it was not a valid reflection of cognitive abilities. I think that really got challenged a lot during the pandemic, because for for people's safety, we had to learn how to adapt things to an online format. So I've definitely seen a shift, while not, you know, moving toward any completely virtual clinics or assessments or things like that, but a greater openness to accommodations that will allow accessibility to a greater number of people, whether that's because they are, you know, in a lower socioeconomic class, whether it's because they're in a rural area where they just don't have as much access to resources. You know, there's just dozens of these examples where people either can't afford our services, or it's just too difficult for them, to get them to access those resources. So I am seeing a lot more openness to that. The other thing that has been particularly striking is the shift toward cultural sensitivity in neuropsychological assessments. And I will say having come from the East Coast, I feel that we are uniquely positioned in California to lead that charge that we have been aware of and fighting for some of these changes much longer than other areas of the country, and that there are still professionals in the field who are not as open to those shifts. And I think trainees may find it challenging to adapt their approach with different supervisors who may not be as open to challenges about the cultural sensitivity of a particular assessment or set of norms or conceptualization of a patient. But I am seeing the progress. I'm seeing all of the committees that we have for NAN and for INS and Division 40. And the youth, you know, the new trainees and the early career, neuropsychologist are the ones really leading that charge. So I'm just really excited to see where that's gonna go in the future and what that's going to mean for improved patient care.

Saranya Sundaram Patel, PhD

53:28

Yeah, I think it's transitioning into the era that we're in, you know, we mentioned that, you know, we had the Houston conference guidelines and a huge reason for the Minnesota conference guidelines was the need for a revision, because it's been so long, we're in a different era. There's new priorities, there's a lot of different types of things that we just didn't know about back then that we're trying to improve on, you know, for optimal patient care. You know, I think I agree with Rayna, with everything that she said, you know, telehealth is something that was in its nascent stage, and now we are growing it ever so much after COVID-19, and I think finding different ways to do that, whether it be you know, actually doing, you know, digital assessments, like using iPads or doing it through, you know, virtual reality, virtual reality through video conferencing, maybe. I mean, that's something for the future. I think the biggest thing I'm excited about this field is what else can we do? How else can we improve? Like, what other technology can we do? One thing I'm really excited about is the amount of progress we've made in understanding more diversity in neuropsychology. There's so much research going on right now with different cultural groups, ethnic groups. You know, that's just to name a few couple, but there's so many different realms that people are looking at diversity, whether it's getting updated normative data, you know, creating neuropsychological assessments tailored to individuals from a specific background, whether it be you know, their cultural or ethnic identities or whatnot, and still so much research to be done. I mean, that's actually part of my focus, too, is doing that for the South Asian community, and finding ways to integrate culturally appropriate approaches to assessment and treatment, getting updated norms for that population. And so we're already doing a lot, we're doing much more than we were before. And so I think, seeing where all of this could go and what new things are going to be out there to just better help our patients and help trainees to be the best neuropsychologist they can be as well.

Afik Faerman, PhD

55:55

Yeah, wonderful. I agree with everything. I would also like to kind of extend this too. Neuropsychology is relatively developed in the US. And there are a lot of places outside of the US that could benefit from making neuropsychology, its own specialty field. And, and maybe those efforts and creating a culturally appropriate neuropsychological service or services plural is not going to be a concentrated effort here in the US, it's actually going to be an international collaboration, which is already happening with the INS international International Society for International Neuropsychology Society. And the I think one of the things that really amazed me is that even though we're really advanced in neuro imaging, and with learning what happens in the brain at different situations or conditions, it's still decades maybe away from replacing, actually putting the brain through the test, and actually trying to get to learn something about how the brain works. That even if the modality of how we administer assessments is going to change. I think it's safe to say that neuropsychologist are going to be involved. And in this in a similar kind of capacity for many more years. So if you are thinking about should I choose this route? Should I specialize in this in this subfield do understand that this field is constantly changing. But it does seem like it is very relevant. And we address those through initiatives within the field. We're going to also put a reference to the 2050 initiative that I think 2050 relevance initiative that I think listeners would benefit from. All right, I kept you here super long. Any, any last thoughts? Questions? Anecdotes, jokes, anything that you would like to share with our listeners?

Rayna Hirst, PhD

58:15

Um, yeah, I think, you know, I know, I was thinking of two things that I hadn't gotten a chance to talk about yet, but I'll just mention briefly. The first is that in relevance to our discussion about the increasing diversity within our field, and within our kind of patient care is that we also need to see that diversity in our in neuro psychology as a field in the professionals. So there has been tons of recent outreach for, you know, bringing people in who maybe ordinarily wouldn't have gone toward this career that has been really dominated by majority culture for since its conception. And we really need to get more attention and more resources and support to bring in people from diverse backgrounds because you know, they are going to be uniquely qualified to conduct assessments and research and clinical work with these populations that we are working with. So you know, big shout out for, you know, any people who are from underrepresented backgrounds to really try to talk to and get mentorship and seek out some of those available resources to make that road a little bit easier for you. And the other thing I'll add is just talk to as many different professionals as you can. Yes, that might be your faculty advisor, and it might be your practicum advisor, but it might be someone standing next to you as you're reading a poster at a conference or it might be staying after a talk at a conference to ask a question. It's kind of goes with a networking thing. But, you know, there's just so much variation in what people do as neuro psychologists and so much, so many different opportunities that are available to trainees. And the more people that you talk to about what their day looks like, the more podcasts that you listen to the more people that you communicate with conferences that you attend, the better picture you're going to get. And you're just going to be opened up to so many different opportunities that you might not otherwise have gotten the chance to learn about. So I'll be the first to admit that I feel awkward sometimes staying after a talk and approaching the presenter and being like, Oh, I thought that was really interesting. I was wondering if you've ever thought about, you know, this, that or the other, but they're always welcoming. They're always friendly, you know. And I always tell my students, you know, and I was joking before this podcast, but I could talk about this stuff for hours. And I have, my students will tell you, so if, if nobody else, feel free to shoot me an email, and come and chat with me about it, because I just love the field, I love the profession. And I love talking about it, and sharing that passion with incoming students, and hopefully, you know, passing on some of that to the next generation of neuro psychologists. So get mentorship from wherever you can.

Saranya Sundaram Patel, PhD

01:01:23

Yeah, I couldn't have said it better right now. Like, it's, it's, there's so much more to be done. Like, I think, you know, I look back and I'm like, am I glad I went through all the blood, sweat and tears and yeah, 100% I am like, some days, it was rough. Some time, there was a moments where, you know, it was kind of touch and go, I felt like but at the end of the day, you know, I think it, it's been such a rewarding experience. It's such a rewarding field, you meet such a great people, you work with such great people. It's hard. It's challenging, especially when you're giving feedback about diagnosis to an individual. And it's not the best news or you know, something that they don't want to hear. But, you know, there's so much more to be said, I think this podcast only captures just a glimpse of it, and what we do and what there is to talk about. So you know, feel free to reach out to either of us, any of us to talk. We'll we're more than happy to chat with you if you're interested in this career.

Afik Faerman, PhD

01:02:22

Thank you so much for your time and your experience, and I'm sure our listeners would have benefited a lot from learning from you.

Rayna Hirst, PhD

01:02:30

Thanks for having us.

Saranya Sundaram Patel, PhD

01:02:31

Thank you so much.

Afik Faerman, PhD

01:02:33

Thank you again for listening. I hope you join us for the next episode, where I will discuss behavioral health with experts in the field.

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