Adult Psychology Post-Doctoral Fellowship Curriculum 

Fellows will meet criteria of the Wisconsin State Statute to be eligible for licensure of having a minimum of two (2) hours of supervision per week of fellowship training. This will amount to at least 100 hours of supervision time upon completion of the 1-year fellowship. 

Fellows will be offered an average of 2 hours of didactic training per week (though some weeks may be more or less) for a total of at least 100 hours of didactic and continuing education participation upon the completion of fellowship. Within this area, fellows are required to complete a minimum of the following:

• Weekly Friday Didactics: Fellows are required to attend a minimum of 80% of the weekly Friday didactic offerings over the course of their training year. These are scheduled from 1:00 – 3:00 pm.
• Gundersen Expert Lecture Series (GELS): Fellows are required to attend a minimum of 12 noon conference GELS opportunities out of the selected topics as identified by their supervisors.
• Peer Collaboration Group: Fellows are required to attend a minimum of 4 collaboration group meetings.
• Ethics: Fellows are strongly encouraged, but not formally required, to use one half of a meeting time day to attend the once annual Ethics conference presented on-site.
• Case Presentation: Fellows will be required to complete two formal case presentations by the completion of their fellowship.
• Journal Club: Fellows will be required to complete and present at two journal clubs by the completion of their fellowship. 

Fellows receive two hours of formal, scheduled, face-to-face or virtual individual supervision by doctoral-level licensed psychologists, with the intent of supervising psychological services rendered directly by the fellow. Fellows attend one hour per week of Professional Development Seminar, as well as one hour per week of regularly scheduled Didactic Training, which may be virtual or in-person. Additional continuing education opportunities are offered throughout the year as available to the hospital staff. 

The training program is directed and managed by Gundersen’s Medical Education Department. The program is assigned a Fellowship Program Administrator who is the go-to person for Fellows regarding attending interviews, accepting an offer, relocating, onboarding, housing, insurance, and benefits. The Program Administrator will also assist Fellows with documentation required for licensure, should this be requested.  

The Fellow has two actively practicing licensed PhD-level Psychologist supervisors who are on-site 5 days/45 hours per week with the exception of illness, vacation days, and holidays. Supervisors are credentialed within the hospital system, are independently practicing, and have clearance for patient care in the inpatient and outpatient settings. Supervising Psychologists have offices located next to the fellow's office, and are available to the Fellow by page, email, phone and/or Teams (instant message) at all times during office hours.  

In the Department of Behavioral Health, the Fellow has their own office, computer, printer, furniture, phone and panic alarm system. The Fellow has access to the DSM-5, testing kits and manuals, as well as online scoring systems (e.g., Q-Global) within the department and/or their office. They are supplied with business cards and office supplies. They also are assigned a secretary to assist with any clerical needs and are assigned a Patient Liaison to assist with patient scheduling, check-in, and general management of their schedules.  

The fellow is provided with $1,000 allowance to assist with purchasing any continuing education related materials which may include books, EPPP study materials, journal subscriptions, professional memberships and/or licensing fees. The Fellow also has access to the hospital's journal subscriptions both in print in the Medical Library as well as online using the hospital's intranet for any research needs.   

Fellows in the Adult Health and Rehabilitation Psychology program will begin their training shadowing supervisors providing care across the hospital system. They will be able to shadow intake appointments, consults, therapy sessions and multidisciplinary clinics. Additionally, they will shadow other providers in multidisciplinary clinics to get better oriented with the clinics flow and the roles of all participants. After shadowing, fellows will progress to providing care alongside their supervisors. During this training progression, supervisors will be providing additional feedback, recommendations and care as well as assessing the fellow’s readiness for more independence. Once supervisors feel the fellow is progressing at an expected level, fellows will be provided more autonomy and begin to provide more care with less supervision. Degrees of autonomy will continue to progress throughout fellowship as fellows improve skills and as supervisors feel is appropriate. Even with increased autonomy, supervising psychologists will continue to oversee all care of the fellows as well as be present for a portion of many appointments.

Fellows are based on Gundersen's main campus in La Crosse, Wis., and have an office located in Outpatient Behavioral Health, where they see virtual and in-person outpatient and testing patients. Work-from-home options may be available during the second half of the fellowship as independence increases and fellows demonstrate competence in a variety of care areas.

The Adult Health and Rehab Psychology Fellow will work under the supervision of licensed, board-certified Clinical Health and Rehab Psychologists primarily in the Departments of Behavioral Medicine (outpatient) and Physical Medicine.

Rotations in the above departments will occur concurrently throughout the year-long fellowship. The fellow will receive 2 hours of individual supervision per week, 1 hour of didactics, and 1 hour of professional development each week. The fellow will have access to numerous recurring training activities including Gundersen Expert Lecture Series (Grand rounds) weekly.

The Primary Care/ Behavioral Health Rotation includes opportunities to conduct brief evaluations, functional contextual interviews, and brief therapy interventions in a multidisciplinary primary care clinic. The fellow will have opportunities for evaluation and treatment of patients in (but not limited to) the following areas: eating disorders, pain management, diabetes, insomnia, and general mental health conditions that may be occurring in the context of adjusting to or experience of chronic medical condition.

The Rehabilitation Psychology Rotation includes neuropsychological and psychological evaluation, treatment and consultation within a 20-bed, acute rehabilitation unit servicing the full spectrum of rehabilitation populations across the adult lifespan. The primary population served consists of individuals with stroke, followed closely by those with traumatic brain injury (TBI).  

The remainder of the patient populations served includes those with debility, chronic and significant medical illnesses that compromise physical and/or cognitive functioning, limb amputation and spinal cord injury. The fellow will work closely with the rehabilitation team including two physiatrists, multiple mid-level staff (physician assistants and nurse practitioners), rehabilitation nursing staff, a rehabilitation psychologist, speech therapists, occupational therapists, physical therapists, recreation therapists, social workers, nutritionists and a chaplain. The fellow will have ample opportunity to work closely with these allied providers as part of a strong, collegial and well-integrated interdisciplinary team. The fellow will also have the opportunity to be a part of the Spinal Cord Injury Service Line, where the Rehabilitation Psychology Service follows all patients with traumatic spinal cord injury across the continuum of care, often intervening in the Critical Care Unit/ICU as well as the Neuroscience Unit prior to admission to the Rehabilitation Unit. There will also be opportunities for the resident to see clinic patients for routine follow-up from acute rehabilitation and for outpatient neuropsychological evaluation. 

Fellows are evaluated quarterly using the Psychology Fellow Competency Assessment Form by each of their supervisors. A deficiency is identified if a Fellow receives a rating of 2 or below on any competency in the 2nd quarter or later on the MedHub evaluation form. A rating of 2 or below would initiate a due process evaluation. It is expected that a fellow will reach a rating of at least 3 by the end of their fellowship training year.

Adult Evaluation

Due process

Grievance 

*This is a required rotation

Faculty: Bryan Kolberg, PsyD, ABPP

Time Commitment (number of hours/week): 20-24 hours per week.

The expectation is 16-24 hours of on-call coverage for the inpatient rehabilitation unit. If the fellow desires outpatient experiences, up to 4 hours of clinic contact per week can be added with concomitant decrease in inpatient hours (e.g., up to 20 instead of 24).

Goal of Rotation: To competently provide the spectrum of psychological and neuropsychological services to patients on an inpatient rehabilitation unit. The fellow will be able to assess patients from a psychological and neuropsychological standpoint and assist in behavioral management of, and treatment planning for, neurologically-compromised patients. The fellow will be able to implement evidence-based psychotherapeutic interventions tailored to the unique needs of rehabilitation populations, and will provide close consultation to the interdisciplinary rehabilitation team across the continuum of care.

Description of Patient Population: Adults (age 18 to 90+) as well as occasional older adolescents (age 16+) hospitalized on the acute rehabilitation unit. Populations also include individuals who are presenting for outpatient care following a rehabilitation stay. The fellow is expected to work with the full-spectrum of rehabilitation patients, including individuals with stroke, traumatic brain injury, spinal cord injury, limb amputation, other neurologic conditions (i.e., Parkinson’s Disease and related movement disorders), and other medical and metabolic disorders. The fellow will also be expected to evaluate and treat psychological and substance use disorders within these populations.

Setting: Inpatient Rehabilitation primarily. Neurosciences Clinic (if outpatient training is desired)

Opportunities for Program Development: Limited; The fellow may have the opportunity to participate in the development or modification of patient care procedures/models of care for inpatient rehabilitation.

If yes, current projects: Opportunity for refinement of service delivery and operation of the Rehabilitation Psychology service always exists. Additional opportunities to further refine models of care specific to each separate rehabilitation patient population exist as well.

Opportunities for Research: No projects currently, but opportunities exist for interested fellows.

If yes, current projects: N/A

Conduct psychological and neuropsychological evaluations of patients hospitalized on the inpatient rehabilitation unit. Evaluations include assessment of patient and family adjustment to physical and/or cognitive disabilities, evaluation of pre-existing or resulting psychological disorders, as well as evaluation of pre-existing substance use disorders in this patient population.

Utilize effective behavioral management principles to guide rehabilitation care in individuals with cognitive impairments.

Utilize short-term, evidence-based psychotherapeutic interventions that are tailored to the unique needs of individuals with cognitive and physical disabilities (when appropriate).

Provide direct consultation regarding patients to the interdisciplinary team, which consists of physiatrists, physician assistants/nurse practitioners, nursing, therapy staff (PT, OT, Speech Therapy, Therapeutic Recreation), nutritionists, chaplains, and social workers in order to guide care.

Provide clear and concise conceptualizations and recommendations to patients, families, and the interdisciplinary team that identify barriers to discharge, needs for supervision/assistance at discharge, and recommendations for guiding inpatient rehabilitation therapies. 

Objectives: 

• Complete a comprehensive outpatient evaluation of patients that identifies cognitive, emotional, and behavioral comorbidities and provides recommendations to guide outpatient rehabilitation therapies.
• Provide direct consultation to outpatient therapists (PT, OT, Speech Therapy) to guide outpatient therapies and address barriers to participation.
• Provide direct consultation to medical staff (Physiatrist and Mid-Level (PA and NP) staff regarding patients’ capacity to return to work and/or driving.
• Provide short-term, evidence-based psychotherapeutic interventions that are tailored to the unique needs of individuals with cognitive and physical disabilities (when appropriate). 

*This is a required rotation

Faculty: Savannah Whitemarsh, PsyD, LP

Time Commitment (number of hours/week): 19 hours per week.

The expectation is that the fellow will spend 19 hours in integrated care per week. 5-7 hours will be spent in face-to-face patient time. The fellow will see a minimum of 5 integrated care patients per week. This will include at least 2 hours of scheduled/billed patients and at least 2 hours of integrated care. During the scheduled/billed patient time, the fellow will see patients for brief episodic care of 1-4 appointments using evidence-based treatment protocols to treat behavioral health conditions presenting in integrated care. During the integrated care patient time, the fellow will see at least 4 integrated care patients who present with a behavioral health need during appointments scheduled with their primary care providers. Remaining 1 hour of time will be spent in Integrated Care Team Staffing.

Goal of Rotation: To competently provide an array of integrated care services for patients seen in an internal medicine primary care clinic.

Description of Patient Population: Adults (18+) who have primary care providers in Internal Medicine.

Setting: Internal Medicine Primary Care Clinic, Onalaska, WI.

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for development of automatic integrated care protocols exist for interested fellows.

Objectives: 

• Provide brief biopsychosocial assessment approach focused on primary care referral questions to assess functioning, symptoms, and readiness for change.
• Utilize evidence-based interventions and recommendations suitable for primary care for patients and primary care providers.
• Collaborates with multidisciplinary primary care team to: co-assess patients, integrate knowledge and expertise of all team members to inform decisions, engage in shared decision making and treatment planning, participate in shared care, and provide primary care provider with clear and direct feedback on patients. 

*This is an optional rotation

Faculty: TBD

Time Commitment (number of hours/week): 4-8 hours per week.

This is an optional, rural family medicine rotation for integrated care, and could include 1-2 full days per week for approximately 6 months. The expectation is that the fellow will spend 8 hours in integrated care per week. 5-7 hours will be spent in face-to-face patient time. The fellow will see a minimum of 5 integrated care patients per week. This will include at least 2 hours of scheduled/billed patients and at least 2 hours of integrated care. During the scheduled/billed patient time, the fellow will see patients for brief episodic care of 1-4 appointments using evidence-based treatment protocols to treat behavioral health conditions presenting in integrated care. During the integrated care patient time, the fellow will see at least 4 integrated care patients who present with a behavioral health need during appointments scheduled with their primary care providers. Remaining 1 hour of time will be spent in Integrated Care Team Staffing.

Goal of Rotation: To competently provide an array of integrated care services for patients seen in an internal medicine primary care clinic.

Description of Patient Population: Ages birth to death who have primary care providers in Family Medicine.

Setting: Rural Family Medicine Primary Care Clinic

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for development of automatic integrated care protocols exist for interested fellows.

Objectives:

• Provide brief biopsychosocial assessment approach focused on primary care referral questions to assess functioning, symptoms, and readiness for change.
• Utilize evidence-based interventions and recommendations suitable for primary care for patients and primary care providers.
• Collaborates with multidisciplinary primary care team to co-assess patients, integrate knowledge and expertise of all team members to inform decisions, engage in shared decision making and treatment planning, participate in shared care, and provide primary care provider with clear and direct feedback on patients.