Abstract

A conference specific to the education and training of clinical neuropsychology was held in 1997, which led to a report published in the Archives of Clinical Neuropsychology (Hannay, J., Bieliauskas, L., Crosson, B., Hammeke, T., Hamsher, K., & Koffler, S. (1998). Proceedings of the Houston Conference on Specialty Education and Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13, 157–250.). The guidelines produced by this conference have been referred to as the Houston Conference (HC) guidelines. Since that time, there has been considerable discussion, and some disagreement, about whether the HC guidelines produced a positive outcome in the training of neuropsychologists. To explore this question and determine how widely the HC guidelines were implemented, a meeting was held in 2006. Present and past leaders of the American Psychological Association Division 40 (Clinical Neuropsychology), the National Academy of Neuropsychology, and the Association of Postdoctoral Programs in Clinical Neuropsychology met to discuss the possible need for an Inter-Organizational Summit on Education and Training (ISET). A decision was reached to have the ISET Steering Committee conduct a survey of clinical neuropsychologists that could address the extent to which HC guidelines were present in the specialty and whether the influence of the HC guidelines was positive. An online survey was constructed, with data gathered in 2010. The current paper presents and discusses the ISET survey results. Specific findings need to be viewed cautiously due to the relatively low response rate. However, with some direct parallels to a larger recent survey of clinical neuropsychologists, the following general conclusions appear well founded: (a) the demographics of respondents in the ISET survey are comparable with a recent larger professional practice survey and thus may reasonably represent the specialty; (b) the HC guidelines appear to have been widely adopted by training programs, in that a large proportion of younger practitioners endorsed having had HC-adherent training; and (c) HC-adherent training is associated with a higher frequency endorsement of being well prepared to engage in key professional activities subsequent to the completion of training when compared with those not having HC-adherent training. Overall, the ISET Steering Committee has concluded that the HC guidelines have been widely adopted and that trainees associate participation in HC-adherent training as advantageous. A potential revision based on unfavorable outcomes is deemed unnecessary. Nonetheless, the ISET Steering Committee recognizes that training needs change as a function of the broadening of our field and the introduction of related new technologies, which may prompt updates. The ISET Steering Committee supports the idea that periodic review and updating of training models is prudent.

Introduction

In September 1997, a conference was held in Houston, Texas, to explore educational and training standards that would facilitate effective specialization in clinical neuropsychology. The specific aim was to document in writing an aspirational, integrated model of specialty training in clinical neuropsychology. Directors of training programs at the doctoral, internship, and postdoctoral levels as listed in The Clinical Neuropsychologist (Cripe, 1995) were among those invited. The conference was attended by 37 clinical neuropsychologists, who were selected by the Conference Committee to represent “diversity in practice settings, education and training models, specializations in the field of clinical neuropsychology, levels of seniority, culture, geographic location, and sex” (Hannay et al., 1998, p. 160). Five additional delegates attended as representatives of the sponsoring organizations: American Psychological Association Division of Clinical Neuropsychology (Division 40); National Academy of Neuropsychology (NAN); American Board of Clinical Neuropsychology (ABCN); American Academy of Clinical Neuropsychology (AACN); and Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). The document produced by the attendees of the Houston Conference (HC), as well as supporting materials pertaining to education, training, and practice within the specialty, was published as a special issue of the Archives of Clinical Neuropsychology (Hannay et al., 1998).

The authors of the HC document acknowledged that historically there had been multiple pathways for training neuropsychologists and stated explicitly that the standards they presented were not to be “applied retroactively to individuals currently trained or in training in the specialty of clinical neuropsychology. Individuals entering the specialty or training for the specialty of clinical neuropsychology prior to the implementation of this document are governed by existing standards as to the appropriateness of identifying themselves as clinical neuropsychologists” (Hannay et al., 1998, p. 235).

Although there was an effort to be inclusive, there was a perception by some neuropsychologists that there had been notable absences among the HC delegates. Moreover, in subsequent years and well beyond the publication of the proceedings, there were numerous debates and interpretations of the HC recommendations that created a degree of divisiveness within the field of clinical neuropsychology.

In 2006, NAN President-Elect Dr William Perry approached NAN President Dr Arthur Horton and the NAN Board with a proposal to re-examine the HC guidelines 10 years following its inception. With their approval, Dr Perry contacted Dr Russell Bauer, then President of Division 40, and they agreed to convene a working group at the APA conference in New Orleans to examine how the impact of the decade-long influence of HC guidelines could be evaluated.

On August 11, 2006, representatives from NAN (President-Elect Dr Perry and Past Presidents and Drs Sandra Koffler, Jim Hom, Ronald Ruff, Gerald Goldstein, and Munro Cullum) and APA Division 40 (President Dr Russell Bauer, President-Elect Dr Keith Yeates, and Past Presidents Drs Robert Ivnik and Ken Adams); Dr Neil Pliskin as Division 40 Practice Advisory Committee chair; and Dr Jacobus Donders as President of APPCN met in New Orleans during the APA annual convention. The purpose of the meeting was to discuss whether there was a need for an Inter-Organizational Summit on Education and Training (ISET) to update, expand, and refine the HC policy on education and training of clinical neuropsychologists.

After extensive discussion, the group reached a consensus that an appropriate first step would be to collect data about outcomes of the current HC guidelines from individual practitioners and professional organizations that were responsible for the training and education of neuropsychologists and, therefore, had experience working within the HC guidelines. The group also discussed the need to collect data from recently graduated psychologists who were trained according to the HC guidelines to see how well their training prepared them for their professional careers as neuropsychologists.

To this end, NAN and Division 40 invited representatives to form a steering committee to oversee the creation of a survey to be sent to the various stakeholders and constituencies involved in the training and education of neuropsychologists. The ISET Steering Committee was comprised of two representatives from NAN, two representatives from Division 40, and one representative from each of the following organizations: APPCN, the Coalition of Clinical Practitioners in Neuropsychology (CCPN), Association for Internship Training in Clinical Neuropsychology (AITCN), the ABCN, the AACN, Association for Doctoral Education in Clinical Neuropsychology (ADECN), and the American Board of Professional Neuropsychology (ABN). Following the dissolution of CCPN, the American College of Professional Neuropsychology (ACPN) replaced CCPN as the final member of the steering committee. The original members of the Steering committee were Drs William Perry and Ronald Ruff (NAN), Douglas Ris and Paula Shear (Division 40), Jacobus Donders (APPCN), Jim Hom (CCPN), Anne Herring (AITCN), Glenn Smith (ABCN), Jerry Sweet (AACN), Catherine Mateer (ADECN), and Bradley Sewick (ABN).

There was initial skepticism raised by some within the larger neuropsychology community about whether the ISET steering committee would in fact be inclusive and represent the viewpoints of all of the stakeholders. In this review of the HC training model, it is noted that members of multiple recognized board certifying, training, and membership organizations in clinical neuropsychology were included, with all representatives having input into the final document. Some individuals wrote letters to the committee expressing displeasure with the creation of an ISET committee. Each letter was responded to personally, and open meetings were organized at the NAN annual conference to answer questions and address any concerns related to the ISET discussions.

Following several meetings, the steering committee constructed a survey addressing issues relevant to the influence of the Houston Guidelines. Questions were posed to clinical neuropsychologists regarding educational history, current professional environment, knowledge-based training, skills-based training, and internship/post-doctoral training experiences. Lengthy discussions pertaining to the preferred target sample (i.e., recently trained specialists vs. all specialists) resulted in agreement to survey the broadest possible sample of postdoctoral residents and practitioners of clinical neuropsychology.

Method

Funding for ISET's activities was provided by NAN. Review and permission from the University of California, San Diego Institutional Review Board (IRB) was obtained, authorizing the group to conduct the survey for research purposes. E-mail lists were obtained from all of the participating organizations, and in December 2009, each non-student member who appeared on any of these membership lists was invited by e-mail to complete the online survey. The online survey was available to respondents for a number of weeks. Dr. Shear set up a Survey Monkey account and through the use of a technician, who was blind to the identities of the participants, the data were prepared for analysis. Dr Sweet, who has extensive experience with survey data, took the lead role in editing the survey and analyzing the results. His analysis was assisted by Drs. Leslie Guidotti Breting, Paula Shear, John Beauvais, Ron Ruff, and William Perry.

The results and a narrative summary of salient findings were reviewed and agreed upon by the ISET steering committee and then reviewed and approved for distribution by all of the participating organizations.

Results

Response Rate

Approximately 4,616 individuals were invited to complete the online survey, with 617 individuals completing the survey for a response rate of 13.4%. When compared with recent practice surveys, one of which (Sweet, Giuffre Meyer, Nelson, & Moberg, 2011) occurred at nearly the same time as the ISET survey, the present response rate is lower. Though the exact reason(s) cannot be known for certain, the lower response rate may be due to the nature of the survey, which deliberately focused narrowly on education and training issues that may have been of less interest to some practitioners. Because the present survey attained a low response rate, readers should consider a general caveat in reviewing the findings that follow. Within the context of the lower response rate, specific findings should be viewed as possibly less reliable, vulnerable to response bias, and subject to change if a larger sample is surveyed. When possible, comparison with other contemporary surveys or other data sources pertaining to the characteristics and widely held opinions of clinical neuropsychologists may be useful in determining whether specific findings are likely to be representative.

General Sample Demographics and Characteristics

As shown in Table 1, of the 617 respondents, 515 were licensed, 43 were not licensed, and 59 did not respond to the licensure question. Of the 43 unlicensed respondents, 42.9% had attained a PsyD degree, compared with only 11.5% of the licensed respondents. Other than including all respondents in demographic tabulations, the 43 unlicensed and the 59 who did not report licensure were excluded from separate analyses. Some tables below compare the licensed sample with the entire sample. In most tables, the percentage of respondents who did not complete a particular item is also shown.

Table 1.

Characteristics of overall sample of respondents

 Overall respondents (n = 617) Licensed respondents (n = 515) 
Age (mean [SD]) 49.54 (11.42) 50.59 (10.13) 
Gender (n [%]) 
 Men 324 (52.5) 284 (55.1) 
 Women 291 (47.2) 226 (43.9) 
 No response 2 (0.3) 5 (1) 
Degree (n [%]) 
 PhD 511 (82.8) 445 (86.4) 
 PsyD 84 (13.6) 59 (11.5) 
 EdD 3 (0.5) 3 (0.6) 
 No response 19 (3.1) 8 (1.6) 
Graduate program accredited (n [%]) 
 Yes 501 (81.2) 431 (83.7) 
 No 101 (16.4) 80 (15.5) 
 No response 15 (2.4) 4 (0.8) 
Field of doctoral degree (n [%]) 
 Clinical psychology 438 (71) 364 (70.7) 
 Counseling psychology 43 (7) 38 (7.4) 
 School psychology 25 (4.1) 25 (4.9) 
 Other 96 (15.6) 82 (15.9) 
 No response 15 (2.4) 6 (1.2) 
 Overall respondents (n = 617) Licensed respondents (n = 515) 
Age (mean [SD]) 49.54 (11.42) 50.59 (10.13) 
Gender (n [%]) 
 Men 324 (52.5) 284 (55.1) 
 Women 291 (47.2) 226 (43.9) 
 No response 2 (0.3) 5 (1) 
Degree (n [%]) 
 PhD 511 (82.8) 445 (86.4) 
 PsyD 84 (13.6) 59 (11.5) 
 EdD 3 (0.5) 3 (0.6) 
 No response 19 (3.1) 8 (1.6) 
Graduate program accredited (n [%]) 
 Yes 501 (81.2) 431 (83.7) 
 No 101 (16.4) 80 (15.5) 
 No response 15 (2.4) 4 (0.8) 
Field of doctoral degree (n [%]) 
 Clinical psychology 438 (71) 364 (70.7) 
 Counseling psychology 43 (7) 38 (7.4) 
 School psychology 25 (4.1) 25 (4.9) 
 Other 96 (15.6) 82 (15.9) 
 No response 15 (2.4) 6 (1.2) 

Also shown in Table 1, of the licensed psychologists, gender was fairly evenly represented. The majority of the sample had earned a PhD (86.4%) after attending an APA-accredited graduate program (83.7%). The specialization within the doctoral program was clinical psychology for the majority (70.7%), with specialties of counseling psychology (7.4%) and school psychology (4.9%) endorsed by fewer respondents. The category of “other” was the second highest endorsement of specialty (15.9%).

A relatively large percentage (35.8%) of the licensed psychologists reported being board certified. As shown in Table 2, of the 300 individuals who reported not being board certified, 26% indicated that they are planning to become board certified, whereas 32.2% were not, and 41.7% did not respond to this item. When data are stratified by age (Table 3), interest in becoming board certified in the future is proportionately higher as respondent age decreases (i.e., younger respondents are more likely to be planning on becoming board certified).

Table 2.

Board certification rates for overall respondents and licensed respondents

Board certification Overall respondents (n = 527) Licensed respondents (n = 520) 
No 339 (54.9%) 301 (58.4%) 
Yes 188 (30.5%) 186 (35.8%) 
No response 90 (14.6%) 33 (6.3%) 
If no, plan to Pursue Board Certification? Overall respondents (n = 337) Licensed respondents (n = 300) 

 
Yes 165 (26.7%) 134 (26%) 
No 172 (27.9%) 166 (32.2%) 
No response 280 (45.4%) 214 (41.7%) 
Board certification Overall respondents (n = 527) Licensed respondents (n = 520) 
No 339 (54.9%) 301 (58.4%) 
Yes 188 (30.5%) 186 (35.8%) 
No response 90 (14.6%) 33 (6.3%) 
If no, plan to Pursue Board Certification? Overall respondents (n = 337) Licensed respondents (n = 300) 

 
Yes 165 (26.7%) 134 (26%) 
No 172 (27.9%) 166 (32.2%) 
No response 280 (45.4%) 214 (41.7%) 
Table 3.

Age range of board certification in licensed respondents

Age range Yes (n = 184) No (n = 297) No, but plan to (n = 133)a 
28–39 years 
n 15 65 54 
 % row 18.8 81.3 79.4 
 % column 8.2 21.9 40.6 
40–49 years 
n 49 80 42 
 % row 38 62 53.8 
 % column 26.6 26.9 31.6 
50–59 years    
n 74 105 26 
 % row 41.3 58.7 26.8 
 % column 40.2 35.4 19.5 
60+ years 
n 46 47 11 
 % row 49.5 50.5 21.2 
 % column 25 15.8 8.3 
Age range Yes (n = 184) No (n = 297) No, but plan to (n = 133)a 
28–39 years 
n 15 65 54 
 % row 18.8 81.3 79.4 
 % column 8.2 21.9 40.6 
40–49 years 
n 49 80 42 
 % row 38 62 53.8 
 % column 26.6 26.9 31.6 
50–59 years    
n 74 105 26 
 % row 41.3 58.7 26.8 
 % column 40.2 35.4 19.5 
60+ years 
n 46 47 11 
 % row 49.5 50.5 21.2 
 % column 25 15.8 8.3 

aThe “Yes” and “No” columns and rows tally to 100%; however, the “No, but plan to” column is a subset of the “No” respondents and does not tally to 100%.

Clinical Internship

Table 4 shows that 75% of licensed respondents completed an APA-accredited internship. The largest percentage of licensed respondents (39.2%) reported spending 31%–60% of their internship time on clinical neuropsychology. By comparison, 32% reported spending a greater amount of time and 26.4% reported spending less time. A very large percentage (86.2%) of licensed respondents endorsed “agree” or “strongly agree” when asked if the clinical internship was an important component in preparing to become a clinical neuropsychologist. By comparison, only 7% endorsed “strongly disagree” or “disagree” with regard to the clinical internship being important. Finally, approximately three fourths of the licensed respondents endorsed “agree” or “strongly agree” in describing their clinical internships as “flexible” with regard to acquiring competencies in neuropsychology.

Table 4.

Internship characteristics of overall respondents and licensed respondents

 Overall respondents (n = 583) Licensed respondents (n = 504) 
Internship accredited? (n [%]) 
 Yes 439 (71.2) 386 (75) 
 No 144 (23.3) 118 (22.9) 
 No response 34 (5.5) 11 (2.1) 
Percentage of time spent on clinical neuropsychology (n [%]) 
 ≤30 164 (26.6) 136 (26.4) 
 31–60 233 (37.8) 202 (39.2) 
 ≥61 185 (30) 165 (32) 
 No response 35 (5.7) 12 (2.3) 
Important preparation (n [%]) 
 Strongly disagree 38 (6.2) 28 (5.4) 
 Disagree 11 (1.8) 8 (1.6) 
 Neutral 30 (4.9) 21 (4.1) 
 Agree 182 (29.5) 157 (30.5) 
 Strongly agree 317 (51.4) 287 (55.7) 
 No response 39 (6.3) 14 (2.7) 
Flexible regarding clinical neuropsychology competencies (n [%]) 
 Strongly disagree 39 (6.3) 31 (6) 
 Disagree 43 (7) 36 (7) 
 Neutral 76 (12.3) 61 (11.8) 
 Agree 191 (31) 162 (31.5) 
 Strongly agree 232 (37.6) 212 (41.2) 
 No response 36 (5.8) 13 (2.5) 
 Overall respondents (n = 583) Licensed respondents (n = 504) 
Internship accredited? (n [%]) 
 Yes 439 (71.2) 386 (75) 
 No 144 (23.3) 118 (22.9) 
 No response 34 (5.5) 11 (2.1) 
Percentage of time spent on clinical neuropsychology (n [%]) 
 ≤30 164 (26.6) 136 (26.4) 
 31–60 233 (37.8) 202 (39.2) 
 ≥61 185 (30) 165 (32) 
 No response 35 (5.7) 12 (2.3) 
Important preparation (n [%]) 
 Strongly disagree 38 (6.2) 28 (5.4) 
 Disagree 11 (1.8) 8 (1.6) 
 Neutral 30 (4.9) 21 (4.1) 
 Agree 182 (29.5) 157 (30.5) 
 Strongly agree 317 (51.4) 287 (55.7) 
 No response 39 (6.3) 14 (2.7) 
Flexible regarding clinical neuropsychology competencies (n [%]) 
 Strongly disagree 39 (6.3) 31 (6) 
 Disagree 43 (7) 36 (7) 
 Neutral 76 (12.3) 61 (11.8) 
 Agree 191 (31) 162 (31.5) 
 Strongly agree 232 (37.6) 212 (41.2) 
 No response 36 (5.8) 13 (2.5) 

Postdoctoral Residency

Information pertaining to postdoctoral residency (also referred to as “fellowship” at some institutions) is contained in Table 5. Among licensed respondents, 64.5% reported having completed a postdoctoral residency in which at least half of their time was clinical. The majority of respondents who reported completing a residency indicated that it had been a 2-year residency and that 2 years was the ideal length of time for residency training. Interestingly, the two questions pertaining to length of residency produced a “no response” rate of 30.9% and 28.2%, which is higher than for most items in the survey. The licensed respondents were split relatively evenly on reporting that their residency had been affiliated with a medical school (48% stating “yes”), but a higher percentage (58.6%) reported a hospital affiliation for their residency. Only 18.3% used residency to respecialize in clinical neuropsychology.

Table 5.

Postdoctoral residency/fellowship characteristics for overall respondents and licensed respondents

 Overall respondents (n = 617) Licensed respondents (n = 515) 
Postdoctoral residency 50% clinical (n [%]) 
 Yes 369 (59.8) 332 (64.5) 
 No 204 (33.1) 176 (34.2) 
 No response 44 (7.1) 7 (1.4) 
Length of postdoctoral residency (n [%]) 
 1 year 166 (26.9) 149 (28.9) 
 2+ years 231 (37.4) 207 (40.2) 
 No response 220 (35.7) 159 (30.9) 
Ideal postdoctoral residency length (n [%]) 
 1 year 137 (22.2) 123 (23.9) 
 2 years 263 (42.6) 237 (46) 
 3 years 12 (1.9) 9 (1.7) 
 6 years 1 (0.2) 1 (0.2) 
 No response 204 (33.1) 145 (28.2) 
Re-specialized in clinical neuropsychology (n [%]) 
 Yes 107 (17.3) 94 (18.3) 
 No 447 (72.4) 397 (77.1) 
 No response 63 (10.2) 24 (4.7) 
APA accredited (n [%]) 
 Yes 123 (19.9) 106 (20.6) 
 No 494 (80.1) 406 (78.8) 
 No response 3 (0.6) 
APPCN postdoctoral residency (n [%]) 
 Yes 79 (12.8) 70 (13.6) 
 No 538 (87.2) 442 (85.8) 
 No response 3 (0.6) 
Affiliated with a medical school (n [%]) 
 Yes 274 (44.4) 247 (48) 
 No 343 (55.6) 265 (51.5) 
 No response 3 (0.6) 
Affiliated with a hospital (n [%]) 
 Yes 332 (53.8) 302 (58.6) 
 No 285 (46.2) 210 (40.8) 
 No response 3 (0.6) 
Range of neurological patients (n [%]) 
 Yes 366 (59.3) 324 (62.9) 
 No 78 (12.6) 72 (14) 
 No response 173 (28) 119 (23.1) 
Sufficient supervision (n [%]) 
 Yes 392 (63.5) 350 (68) 
 No 69 (11.2) 62 (12) 
 No response 156 (25.3) 103 (20) 
 Overall respondents (n = 617) Licensed respondents (n = 515) 
Postdoctoral residency 50% clinical (n [%]) 
 Yes 369 (59.8) 332 (64.5) 
 No 204 (33.1) 176 (34.2) 
 No response 44 (7.1) 7 (1.4) 
Length of postdoctoral residency (n [%]) 
 1 year 166 (26.9) 149 (28.9) 
 2+ years 231 (37.4) 207 (40.2) 
 No response 220 (35.7) 159 (30.9) 
Ideal postdoctoral residency length (n [%]) 
 1 year 137 (22.2) 123 (23.9) 
 2 years 263 (42.6) 237 (46) 
 3 years 12 (1.9) 9 (1.7) 
 6 years 1 (0.2) 1 (0.2) 
 No response 204 (33.1) 145 (28.2) 
Re-specialized in clinical neuropsychology (n [%]) 
 Yes 107 (17.3) 94 (18.3) 
 No 447 (72.4) 397 (77.1) 
 No response 63 (10.2) 24 (4.7) 
APA accredited (n [%]) 
 Yes 123 (19.9) 106 (20.6) 
 No 494 (80.1) 406 (78.8) 
 No response 3 (0.6) 
APPCN postdoctoral residency (n [%]) 
 Yes 79 (12.8) 70 (13.6) 
 No 538 (87.2) 442 (85.8) 
 No response 3 (0.6) 
Affiliated with a medical school (n [%]) 
 Yes 274 (44.4) 247 (48) 
 No 343 (55.6) 265 (51.5) 
 No response 3 (0.6) 
Affiliated with a hospital (n [%]) 
 Yes 332 (53.8) 302 (58.6) 
 No 285 (46.2) 210 (40.8) 
 No response 3 (0.6) 
Range of neurological patients (n [%]) 
 Yes 366 (59.3) 324 (62.9) 
 No 78 (12.6) 72 (14) 
 No response 173 (28) 119 (23.1) 
Sufficient supervision (n [%]) 
 Yes 392 (63.5) 350 (68) 
 No 69 (11.2) 62 (12) 
 No response 156 (25.3) 103 (20) 

Notes: APA = American Psychological Association; APPCN = Association of Postdoctoral Programs in Clinical Neuropsychology.

Years of licensure and age of respondents are shown in Table 6 in relationship with whether an APPCN residency was completed. There is a clear and expected relationship between years since licensure and completion of HC-compliant training, with those who have been licensed for a longer period less likely to report having completed training that meets HC guidelines. The proportion of respondents who have had such training ranges from 70% in the group with 10 or fewer years of licensure to only 4.3% in the group with 21–30 years of licensure. Similarly, as might be expected, age of respondent appears directly related to the probability of having completed an APPCN residency, with 47.1% of those responding “yes” being in the age range of 28–39, whereas only 4% said “yes” in the age range of 60 or older.

Table 6.

Characteristics of licensed respondents regarding whether or not they had an APPCN postdoctoral residency

Years of licensure Yes (n = 70) No (n = 430) Total (n = 500) 
≤10 49 (70%) 104 (24.2%) 153 (30.6%) 
11–20 18 (25.7%) 125 (29.1%) 143 (28.6%) 
21–30 3 (4.3%) 161 (37.4%) 164 (32.8%) 
31–40  40 (9.3%) 40 (8%) 
Age (years) Yes (n = 68) No (n = 437) Total (n = 505) 

 
28–39 32 (47.1%) 54 (12.4%) 86 (17%) 
40–49 26 (38.2%) 106 (24.3%) 132 (26.1%) 
50–59 7 (10.3%) 179 (41%) 186 (36.8%) 
60+ 3 (4.4%) 98 (22.4%) 101 (20%) 
Years of licensure Yes (n = 70) No (n = 430) Total (n = 500) 
≤10 49 (70%) 104 (24.2%) 153 (30.6%) 
11–20 18 (25.7%) 125 (29.1%) 143 (28.6%) 
21–30 3 (4.3%) 161 (37.4%) 164 (32.8%) 
31–40  40 (9.3%) 40 (8%) 
Age (years) Yes (n = 68) No (n = 437) Total (n = 505) 

 
28–39 32 (47.1%) 54 (12.4%) 86 (17%) 
40–49 26 (38.2%) 106 (24.3%) 132 (26.1%) 
50–59 7 (10.3%) 179 (41%) 186 (36.8%) 
60+ 3 (4.4%) 98 (22.4%) 101 (20%) 

Table 7 addresses relationships between years of licensure and age of licensed respondents with regard to the broader question of whether postdoctoral residency adhered to the HC training guidelines. As was the case with APPCN residencies, both years of licensure and age of respondent were strongly related to the probability that the postdoctoral residency adhered to HC training guidelines. It is noteworthy that even though the “yes” respondents to the APPCN query represent a much smaller sample than the broader residency query in terms of those responding “yes,” the percentages that appear in the stratifications of years of licensure and age are comparable.

Table 7.

Characteristics of licensed respondents regarding whether their postdoctoral training adhered to the training guidelines

Years of licensure Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 141) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 146) Total (n = 401) 
≤10 85 (68.5%) 43 (47.3%) 12 (30%) 1 (0.7%) 141 (35.2%) 
11–20 29 (23.4%) 18 (19.8%) 17 (42.5%) 47 (32.2%) 111 (27.7%) 
21–30 8 (6.5%) 26 (28.6%) 10 (25%) 77 (52.7%) 121 (30.2%) 
31–40 2 (1.6%) 4 (4.4%) 1 (2.5%) 21 (14.4%) 28 (7%) 
Total 30.9% 22.7% 10% 36.4%  
Age (years) Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 125) No (n = 89) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 400) 

 
28–39 55 (44%) 21 (23.3%) 7 (17.1%)  83 (20.4%) 
40–49 43 (34.4%) 30 (33.3%) 12 (29.3%) 24 (16%) 109 (26.8%) 
50–59 20 (16%) 25 (27.8%) 14 (34.1%) 82 (54.7%) 141 (34.7%) 
60+ 7 (5.6%) 14 (15.6%) 8 (19.5%) 44 (29.3%) 73 (18%) 
Total 30.8% 22.2% 10.1% 36.9%  
Years of licensure Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 141) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 146) Total (n = 401) 
≤10 85 (68.5%) 43 (47.3%) 12 (30%) 1 (0.7%) 141 (35.2%) 
11–20 29 (23.4%) 18 (19.8%) 17 (42.5%) 47 (32.2%) 111 (27.7%) 
21–30 8 (6.5%) 26 (28.6%) 10 (25%) 77 (52.7%) 121 (30.2%) 
31–40 2 (1.6%) 4 (4.4%) 1 (2.5%) 21 (14.4%) 28 (7%) 
Total 30.9% 22.7% 10% 36.4%  
Age (years) Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 125) No (n = 89) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 400) 

 
28–39 55 (44%) 21 (23.3%) 7 (17.1%)  83 (20.4%) 
40–49 43 (34.4%) 30 (33.3%) 12 (29.3%) 24 (16%) 109 (26.8%) 
50–59 20 (16%) 25 (27.8%) 14 (34.1%) 82 (54.7%) 141 (34.7%) 
60+ 7 (5.6%) 14 (15.6%) 8 (19.5%) 44 (29.3%) 73 (18%) 
Total 30.8% 22.2% 10.1% 36.9%  

Work Setting, Academic Rank, and Work Activities

Work setting and academic rank are shown in Table 8. The three general work setting categories (private practice, institution, combination) are all well represented, with a slight majority of the respondents working in institutions. There was a 40.2% “no response” rate for a question about academic rank, with a relatively even distribution of respondents (ranging from 11.8% to 16.1%) across adjunct, assistant professor, associate professor, and full professor.

Table 8.

Current practice setting and academic rank of overall respondents and licensed respondents

 Overall respondents (n = 617) Licensed respondents (n = 515) 
Work setting (n [%]) 
 Private practice (P) 147 (23.8) 140 (27.2) 
 Institutional (I) 213 (34.5) 188 (36.5) 
 Combination (P & I) 159 (25.8) 155 (30.1) 
 Other 29 (4.7) 22 (4.3) 
 No response 69 (11.2) 10 (1.9) 
Academic rank (n [%]) 
 Instructor 21 (3.4) 20 (3.9) 
 Adjunct 80 (13) 76 (14.8) 
 Assistant Professor 87 (14.1) 83 (16.1) 
 Associate Professor 62 (10) 61 (11.8) 
 Full Professor 70 (11.3) 68 (13.2) 
 No response 297 (48.1) 207 (40.2) 
 Overall respondents (n = 617) Licensed respondents (n = 515) 
Work setting (n [%]) 
 Private practice (P) 147 (23.8) 140 (27.2) 
 Institutional (I) 213 (34.5) 188 (36.5) 
 Combination (P & I) 159 (25.8) 155 (30.1) 
 Other 29 (4.7) 22 (4.3) 
 No response 69 (11.2) 10 (1.9) 
Academic rank (n [%]) 
 Instructor 21 (3.4) 20 (3.9) 
 Adjunct 80 (13) 76 (14.8) 
 Assistant Professor 87 (14.1) 83 (16.1) 
 Associate Professor 62 (10) 61 (11.8) 
 Full Professor 70 (11.3) 68 (13.2) 
 No response 297 (48.1) 207 (40.2) 

Work activities were assessed via six rankings (1 = highest, 6 = lowest) of six specific activities: teaching, clinical practice, research, administration, forensic, and other. Results are presented in Table 9. The “no response” rates were uniformly low across all six specific activities. Only the category of clinical practice received a large percentage of “1” rankings (70.5%). Combining the “1” and “2” rankings for each category, the following percentages apply to the activities in which the respondents indicate that they most commonly engage: clinical practice (81.4%), teaching (29.7%), research (26.6%), administration (26%), forensic activities (25.2%), and other (6.4%).

Table 9.

Rankings of primary work activities of licensed respondents (1 = highest; 6 = lowest)

Teaching activities n (total n = 504) Percent 
Rankings of teaching activities 
 1 24 4.7 
 2 129 25 
 3 152 29.5 
 4 95 18.4 
 5 70 13.6 
 6 34 6.6 
 No response 11 2.1 
Clinical practice n (total n = 515) Percent 

 
Rankings of clinical practice 
 1 363 70.5 
 2 56 10.9 
 3 28 5.4 
 4 30 5.8 
 5 13 2.5 
 6 14 2.7 
 No response 11 2.1 
Research n (total n = 515) Percent 

 
Rankings of research activities 
 1 62 12 
 2 75 14.6 
 3 84 16.3 
 4 117 22.7 
 5 104 20.2 
 6 62 12 
 No response 11 2.1 
Administration n (total n = 515) Percent 

 
Rankings of administration activities 
 1 22 4.3 
 2 112 21.7 
 3 137 26.6 
 4 143 27.8 
 5 73 14.2 
 6 17 3.3 
 No response 11 2.1 
Forensic n (total n = 515) Percent 

 
Rankings of forensic activities 
 1 30 5.8 
 2 100 19.4 
 3 63 12.2 
 4 64 12.4 
 5 156 30.3 
 6 91 17.7 
 No response 11 2.1 
Other n (total n = 515) Percent 

 
Rankings of other activities 
 1 
 2 28 5.4 
 3 33 6.4 
 4 49 9.5 
 5 85 16.5 
 6 297 57.7 
 No response 18 3.5 
Teaching activities n (total n = 504) Percent 
Rankings of teaching activities 
 1 24 4.7 
 2 129 25 
 3 152 29.5 
 4 95 18.4 
 5 70 13.6 
 6 34 6.6 
 No response 11 2.1 
Clinical practice n (total n = 515) Percent 

 
Rankings of clinical practice 
 1 363 70.5 
 2 56 10.9 
 3 28 5.4 
 4 30 5.8 
 5 13 2.5 
 6 14 2.7 
 No response 11 2.1 
Research n (total n = 515) Percent 

 
Rankings of research activities 
 1 62 12 
 2 75 14.6 
 3 84 16.3 
 4 117 22.7 
 5 104 20.2 
 6 62 12 
 No response 11 2.1 
Administration n (total n = 515) Percent 

 
Rankings of administration activities 
 1 22 4.3 
 2 112 21.7 
 3 137 26.6 
 4 143 27.8 
 5 73 14.2 
 6 17 3.3 
 No response 11 2.1 
Forensic n (total n = 515) Percent 

 
Rankings of forensic activities 
 1 30 5.8 
 2 100 19.4 
 3 63 12.2 
 4 64 12.4 
 5 156 30.3 
 6 91 17.7 
 No response 11 2.1 
Other n (total n = 515) Percent 

 
Rankings of other activities 
 1 
 2 28 5.4 
 3 33 6.4 
 4 49 9.5 
 5 85 16.5 
 6 297 57.7 
 No response 18 3.5 

Competency for Independent Practice

Level of competency for independent practice after completion of training is depicted in Table 10 and suggests that those who completed HC-compliant training generally reported themselves as being more competent than those without this type of training. Those who were exposed to HC training reported a capability to practice independently with supervision only on more difficult/complex cases (95.1% vs. 69.7%). Moreover, no HC adherent reported lacking skills, whereas 7.9% without such training reported lacking skills when first beginning to practice. Those whose training occurred before the HC took place reported levels of competency that were most similar to those whose training was not based on the HC, in that they expressed concerns about their skill levels when they began independent practice.

Table 10.

Level of competency for independent practice after completion of training

  Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 122) No (n = 89) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 400) 
Lacked skills 
n  14 
 % row  50 14.3 35.7 100 
 % column  7.9 3.4 3.5 
Independent, but cases required review and supervision 
n 20 32 64 
 % row 9.4 31.3 9.4 50 100 
 % column 4.9 22.5 15 21.5 16 
Independent, with supervision only on more difficult/complex cases 
n 116 62 32 112 322 
 % row 36 19.3 9.9 34.8 100 
 % column 95.1 69.7 80 75.2 80.5 
  Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 122) No (n = 89) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 400) 
Lacked skills 
n  14 
 % row  50 14.3 35.7 100 
 % column  7.9 3.4 3.5 
Independent, but cases required review and supervision 
n 20 32 64 
 % row 9.4 31.3 9.4 50 100 
 % column 4.9 22.5 15 21.5 16 
Independent, with supervision only on more difficult/complex cases 
n 116 62 32 112 322 
 % row 36 19.3 9.9 34.8 100 
 % column 95.1 69.7 80 75.2 80.5 

Relevance of Training to Current Professional Activities

Table 11 provides a related look at the effect of the HC guidelines by examining the relevance of training to current professional activities. A similar pattern emerges as was seen in Table 10, with those who received HC training reporting a much larger proportion of “excellent” ratings (72.8%) than those without HC training (46.2%) or those whose training predated the HC (47.4%).

Table 11.

Relevancy of training/education received to current professional activities

  Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 125) No (n = 91) Do not know (n = 41) Prior to Houston Conference (n = 152) Total (n = 409) 
Not at all 
n    
 % row    100 100 
 % column    1.3 0.5 
Minimal 
n 14 25 
 % row 16 20 56 100 
 % column 3.2 5.5 4.9 9.2 6.1 
Adequate 
n 30 44 13 64 151 
 % row 19.9 29.1 8.6 42.4 100 
 % column 24 48.4 31.7 42.1 36.9 
Excellent 
n 91 42 26 72 231 
 % row 39.4 18.2 11.3 31.2 100 
 % column 72.8 46.2 63.4 47.4 56.5 
  Did your postdoctoral training adhere to the Houston Conference Guidelines?
 
 
Yes (n = 125) No (n = 91) Do not know (n = 41) Prior to Houston Conference (n = 152) Total (n = 409) 
Not at all 
n    
 % row    100 100 
 % column    1.3 0.5 
Minimal 
n 14 25 
 % row 16 20 56 100 
 % column 3.2 5.5 4.9 9.2 6.1 
Adequate 
n 30 44 13 64 151 
 % row 19.9 29.1 8.6 42.4 100 
 % column 24 48.4 31.7 42.1 36.9 
Excellent 
n 91 42 26 72 231 
 % row 39.4 18.2 11.3 31.2 100 
 % column 72.8 46.2 63.4 47.4 56.5 

Knowledge Base and Skill Base

To further judge the influence of the HC guidelines, a number of specific questions focused on key aspects of “knowledge base” and “skill-based training” that were emphasized within the guidelines. Tables 12–22 provide the results of the knowledge and skill-based survey questions that address the influence of the HC guidelines.

Table 12.

Knowledge base of “General Psychology” was sufficient to engage in independent clinical neuropsychology practice

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 150) Total (n = 406) 
Strongly disagree 
n  
 % row 11.1 44.4  44.4 100 
 % column 0.8 4.4  2.7 2.2 
Disagree 
n 
 % row 33.3 22.2 11.1 33.3 100 
 % column 2.4 2.2 2.5 2.2 
Neutral 
n  14 
 % row 28.6  14.3 57.1 100 
 % column 3.2  5.3 3.4 
Agree 
n 45 45 12 60 162 
 % row 27.8 27.8 7.4 37 100 
 % column 36 49.5 30 40 39.9 
Strongly agree 
n 72 40 25 75 212 
 % row 34 18.9 11.8 35.4 100 
 % column 57.6 44 62.5 50 52.2 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 150) Total (n = 406) 
Strongly disagree 
n  
 % row 11.1 44.4  44.4 100 
 % column 0.8 4.4  2.7 2.2 
Disagree 
n 
 % row 33.3 22.2 11.1 33.3 100 
 % column 2.4 2.2 2.5 2.2 
Neutral 
n  14 
 % row 28.6  14.3 57.1 100 
 % column 3.2  5.3 3.4 
Agree 
n 45 45 12 60 162 
 % row 27.8 27.8 7.4 37 100 
 % column 36 49.5 30 40 39.9 
Strongly agree 
n 72 40 25 75 212 
 % row 34 18.9 11.8 35.4 100 
 % column 57.6 44 62.5 50 52.2 

Notes: “General Psychology” includes statistics and research methodology, biological basis of behavior, learning and cognition, personality and perception, and developmental/lifespan psychology.

Table 13.

Knowledge base of “Clinical Psychology” was sufficient to engage in independent clinical neuropsychology practice

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 150) Total (n = 406) 
Strongly disagree 
n  
 % row 12.5 37.5  50 100 
 % column 0.8 3.3  2.7 
Disagree 
n 
 % row 44.4 11.2 11.1 33.3 100 
 % column 3.2 1.1 2.5 2.2 
Neutral 
n 10 18 
 % row 22.2 11.1 11.1 55.6 100 
 % column 3.2 2.2 6.7 4.4 
Agree 
n 41 40 15 57 153 
 % row 26.8 26.1 9.8 37.3 100 
 % column 32.8 44 37.5 38 37.7 
Strongly agree 
n 75 45 22 76 218 
 % row 34.4 20.6 10.1 34.9 100 
 % column 60 49.5 55 50.7 53.7 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 150) Total (n = 406) 
Strongly disagree 
n  
 % row 12.5 37.5  50 100 
 % column 0.8 3.3  2.7 
Disagree 
n 
 % row 44.4 11.2 11.1 33.3 100 
 % column 3.2 1.1 2.5 2.2 
Neutral 
n 10 18 
 % row 22.2 11.1 11.1 55.6 100 
 % column 3.2 2.2 6.7 4.4 
Agree 
n 41 40 15 57 153 
 % row 26.8 26.1 9.8 37.3 100 
 % column 32.8 44 37.5 38 37.7 
Strongly agree 
n 75 45 22 76 218 
 % row 34.4 20.6 10.1 34.9 100 
 % column 60 49.5 55 50.7 53.7 

Notes: “Clinical Psychology” includes psychopathology, psychometric theory, assessment techniques, and intervention techniques.

Table 14.

Knowledge base of “Neuroscience” was sufficient to engage in independent clinical neuropsychology practice

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 124) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 404) 
Strongly disagree 
n   
 % row  66.7  33.3 100 
 % column  2.2  0.7 0.7 
Disagree 
n 17 
 % row 29.4 23.5 17.6 29.4 100 
 % column 4.4 7.5 3.4 4.2 
Neutral 
n 11 24 45 
 % row 15.6 24.2 6.7 53.3 100 
 % column 5.6 12.1 7.5 16.1 11.1 
Agree 
n 51 50 22 77 200 
 % row 25.5 25 11 38.5 100 
 % column 41.1 54.9 55 51.7 49.5 
Strongly Agree 
n 61 24 12 42 139 
 % row 43.9 17.3 8.6 30.2 100 
 % column 49.2 26.4 30 28.2 34.4 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 124) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 404) 
Strongly disagree 
n   
 % row  66.7  33.3 100 
 % column  2.2  0.7 0.7 
Disagree 
n 17 
 % row 29.4 23.5 17.6 29.4 100 
 % column 4.4 7.5 3.4 4.2 
Neutral 
n 11 24 45 
 % row 15.6 24.2 6.7 53.3 100 
 % column 5.6 12.1 7.5 16.1 11.1 
Agree 
n 51 50 22 77 200 
 % row 25.5 25 11 38.5 100 
 % column 41.1 54.9 55 51.7 49.5 
Strongly Agree 
n 61 24 12 42 139 
 % row 43.9 17.3 8.6 30.2 100 
 % column 49.2 26.4 30 28.2 34.4 

Notes: “Neuroscience” includes functional neuroanatomy, clinical neurology/neuropathology, the development of the central nervous system, and psychopharmacology.

Table 15.

Knowledge base of “Neuropsychology” was sufficient to engage in independent clinical neuropsychology practice

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 405) 
Strongly disagree 
n 
 % row 25 25 25 25 100 
 % column 0.8 1.1 2.5 0.7 
Disagree 
n 
 % row 14.3 14.3 14.3 57.1 100 
 % column 0.8 1.1 2.5 2.7 1.7 
Neutral 
n 15 30 
 % row 16.7 23.3 10 50 100 
 % column 7.7 7.5 10.1 7.4 
Agree 
n 39 55 16 66 176 
 % row 22.2 31.3 9.1 37.5 100 
 % column 31.2 60.4 40 44.3 43.5 
Strongly agree 
n 79 27 19 63 188 
 % row 42 14.4 10.1 33.5 100 
 % column 63.2 29.7 47.5 42.3 46.4 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 149) Total (n = 405) 
Strongly disagree 
n 
 % row 25 25 25 25 100 
 % column 0.8 1.1 2.5 0.7 
Disagree 
n 
 % row 14.3 14.3 14.3 57.1 100 
 % column 0.8 1.1 2.5 2.7 1.7 
Neutral 
n 15 30 
 % row 16.7 23.3 10 50 100 
 % column 7.7 7.5 10.1 7.4 
Agree 
n 39 55 16 66 176 
 % row 22.2 31.3 9.1 37.5 100 
 % column 31.2 60.4 40 44.3 43.5 
Strongly agree 
n 79 27 19 63 188 
 % row 42 14.4 10.1 33.5 100 
 % column 63.2 29.7 47.5 42.3 46.4 

Notes: Neuropsychology includes theoretical systems, specialized assessment techniques, and specialized intervention techniques.

Table 16.

Knowledge base of Professional issues and Ethics was sufficient to engage in independent clinical neuropsychology practice

 Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
 Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 150) Total (n = 406) 
Strongly disagree 
n    
 % row  100   100 
 % column  4.4   
Disagree 
n 
 % row 11.1 22.2 11.1 55.6 100 
 % column 0.8 2.2 2.5 3.3 2.2 
Neutral 
n 18 27 
 % row 18.5 11.1 3.7 66.7 100 
 % column 3.3 2.5 12 6.7 
Agree 
n 47 45 18 62 172 
 % row 27.3 26.2 10.5 36 100 
 % column 37.6 49.5 45 41.3 42.4 
Strongly agree 
n 72 37 20 65 194 
 % row 37.1 19.1 10.3 33.5 100 
 % column 57.6 40.7 50 43.3 47.8 
 Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
 Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 150) Total (n = 406) 
Strongly disagree 
n    
 % row  100   100 
 % column  4.4   
Disagree 
n 
 % row 11.1 22.2 11.1 55.6 100 
 % column 0.8 2.2 2.5 3.3 2.2 
Neutral 
n 18 27 
 % row 18.5 11.1 3.7 66.7 100 
 % column 3.3 2.5 12 6.7 
Agree 
n 47 45 18 62 172 
 % row 27.3 26.2 10.5 36 100 
 % column 37.6 49.5 45 41.3 42.4 
Strongly agree 
n 72 37 20 65 194 
 % row 37.1 19.1 10.3 33.5 100 
 % column 57.6 40.7 50 43.3 47.8 

Notes: Professional issues and Ethics includes legal and licensing matters.

Table 17.

Skill-based training was sufficient for conducting neuropsychological assessment and generating a differential diagnosis

 Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
 Yes (n = 125) No (n = 91) Do not know (n = 39) Prior to Houston Conference (n = 150) Total (n = 402) 
Strongly disagree 
n  
 % row  40  60 100 
 % column  2.2  1.2 
Disagree 
n  
 % row 25 25  50 100 
 % column 0.8 1.1  1.4 
Neutral 
n 18 
 % row 5.6 33.3 11.1 50 100 
 % column 0.8 6.6 5.1 6.1 4.5 
Agree 
n 25 42 18 65 150 
 % row 16.7 28 12 43.3 100 
 % column 20 46.2 46.2 44.2 37.3 
Strongly agree 
n 98 40 19 68 225 
 % row 43.6 17.8 8.4 30.2 100 
 % column 78.4 44 48.7 46.3 56 
 Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
 Yes (n = 125) No (n = 91) Do not know (n = 39) Prior to Houston Conference (n = 150) Total (n = 402) 
Strongly disagree 
n  
 % row  40  60 100 
 % column  2.2  1.2 
Disagree 
n  
 % row 25 25  50 100 
 % column 0.8 1.1  1.4 
Neutral 
n 18 
 % row 5.6 33.3 11.1 50 100 
 % column 0.8 6.6 5.1 6.1 4.5 
Agree 
n 25 42 18 65 150 
 % row 16.7 28 12 43.3 100 
 % column 20 46.2 46.2 44.2 37.3 
Strongly agree 
n 98 40 19 68 225 
 % row 43.6 17.8 8.4 30.2 100 
 % column 78.4 44 48.7 46.3 56 
Table 18.

Skill-based training was sufficient for formulating and implementing a treatment plan and monitoring its outcome

 Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
 Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 148) Total (n = 404) 
Strongly disagree 
n  
 % row  50 12.5 37.5 100 
 % column  4.4 2.5 
Disagree 
n 12 25 
 % row 20 24 48 100 
 % column 6.6 8.1 6.20 
Neutral 
n 15 18 24 61 
 % row 24.6 29.5 6.6 39.3 100 
 % column 12 19.8 10 16.2 15.1 
Agree 
n 59 45 21 74 199 
 % row 29.6 22.6 10.6 37.2 100 
 % column 47.2 49.5 52.5 50 49.3 
Strongly agree 
n 46 18 12 35 111 
 % row 41.4 16.2 10.8 31.5 100 
 % column 36.8 19.8 30 23.6 27.5 
 Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
 Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 148) Total (n = 404) 
Strongly disagree 
n  
 % row  50 12.5 37.5 100 
 % column  4.4 2.5 
Disagree 
n 12 25 
 % row 20 24 48 100 
 % column 6.6 8.1 6.20 
Neutral 
n 15 18 24 61 
 % row 24.6 29.5 6.6 39.3 100 
 % column 12 19.8 10 16.2 15.1 
Agree 
n 59 45 21 74 199 
 % row 29.6 22.6 10.6 37.2 100 
 % column 47.2 49.5 52.5 50 49.3 
Strongly agree 
n 46 18 12 35 111 
 % row 41.4 16.2 10.8 31.5 100 
 % column 36.8 19.8 30 23.6 27.5 
Table 19.

Skill-based training was sufficient for communicating results and recommendations to patients, families, and referral sources

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 89) Do not know (n = 40) Prior to Houston Conference (n = 147) Total (n = 401) 
Strongly disagree 
n   
 % row  50  50 100 
 % column  2.2  1.4 
Disagree 
n  
 % row 12.5 12.5  75 100 
 % column 0.8 1.1  4.1 
Neutral 
n  16 
 % row 37.5 31.3  31.3 100 
 % column 4.8 5.6  3.4 
Agree 
n 34 48 13 71 166 
 % row 20.5 28.9 7.8 42.8 100 
 % column 27.2 53.9 32.5 48.3 41.4 
Strongly agree 
n 84 33 27 63 207 
 % row 40.6 15.9 13 30.4 100 
 % column 67.2 37.1 67.5 42.9 51.6 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 89) Do not know (n = 40) Prior to Houston Conference (n = 147) Total (n = 401) 
Strongly disagree 
n   
 % row  50  50 100 
 % column  2.2  1.4 
Disagree 
n  
 % row 12.5 12.5  75 100 
 % column 0.8 1.1  4.1 
Neutral 
n  16 
 % row 37.5 31.3  31.3 100 
 % column 4.8 5.6  3.4 
Agree 
n 34 48 13 71 166 
 % row 20.5 28.9 7.8 42.8 100 
 % column 27.2 53.9 32.5 48.3 41.4 
Strongly agree 
n 84 33 27 63 207 
 % row 40.6 15.9 13 30.4 100 
 % column 67.2 37.1 67.5 42.9 51.6 
Table 20.

Skill-based training was sufficient for designing, executing, and reporting the results of independent research projects

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 148) Total (n = 404) 
Strongly disagree 
n  10 
 % row  60 20 20 100 
 % column  6.6 1.4 2.5 
Disagree 
n 11 14 32 
 % row 9.4 34.4 12.5 43.8 100 
 % column 2.4 12.1 10 9.5 7.9 
Neutral 
n 27 14 11 31 83 
 % row 32.5 16.9 13.3 37.3 100 
 % column 21.6 15.4 27.5 20.9 20.5 
Agree 
n 54 36 52 151 
 % row 35.8 23.8 34.4 100 
 % column 43.2 39.6 22.5 35.1 37.4 
Strongly agree 
n 41 24 14 49 128 
 % row 32 18.8 10.9 38.3 100 
 % column 32.8 26.4 35 33.1 31.7 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 148) Total (n = 404) 
Strongly disagree 
n  10 
 % row  60 20 20 100 
 % column  6.6 1.4 2.5 
Disagree 
n 11 14 32 
 % row 9.4 34.4 12.5 43.8 100 
 % column 2.4 12.1 10 9.5 7.9 
Neutral 
n 27 14 11 31 83 
 % row 32.5 16.9 13.3 37.3 100 
 % column 21.6 15.4 27.5 20.9 20.5 
Agree 
n 54 36 52 151 
 % row 35.8 23.8 34.4 100 
 % column 43.2 39.6 22.5 35.1 37.4 
Strongly agree 
n 41 24 14 49 128 
 % row 32 18.8 10.9 38.3 100 
 % column 32.8 26.4 35 33.1 31.7 
Table 21.

Skill-based training was sufficient for teaching and/or supervising students and trainees in neuropsychology

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 124) No (n = 91) Do not know (n = 39) Prior to Houston Conference (n = 147) Total (n = 401) 
Strongly disagree 
n   
 % row  44.4  55.6 100 
 % column  4.4  3.4 2.2 
Disagree 
n 15 17 42 
 % row 7.1 35.7 16.7 40.5 100 
 % column 2.4 16.5 17.9 11.6 10.5 
Neutral 
n 18 15 25 66 
 % row 27.3 22.7 12.1 37.9 100 
 % column 14.5 16.5 20.5 17 16.5 
Agree 
n 63 45 14 73 195 
 % row 32.3 23.1 7.2 37.4 100 
 % column 50.8 49.5 35.9 49.7 48.6 
Strongly agree 
n 40 12 10 27 89 
 % row 44.9 13.5 11.2 30.3 100 
 % column 32.3 13.2 25.6 18.4 22.2 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 124) No (n = 91) Do not know (n = 39) Prior to Houston Conference (n = 147) Total (n = 401) 
Strongly disagree 
n   
 % row  44.4  55.6 100 
 % column  4.4  3.4 2.2 
Disagree 
n 15 17 42 
 % row 7.1 35.7 16.7 40.5 100 
 % column 2.4 16.5 17.9 11.6 10.5 
Neutral 
n 18 15 25 66 
 % row 27.3 22.7 12.1 37.9 100 
 % column 14.5 16.5 20.5 17 16.5 
Agree 
n 63 45 14 73 195 
 % row 32.3 23.1 7.2 37.4 100 
 % column 50.8 49.5 35.9 49.7 48.6 
Strongly agree 
n 40 12 10 27 89 
 % row 44.9 13.5 11.2 30.3 100 
 % column 32.3 13.2 25.6 18.4 22.2 
Table 22.

Skill-based training was sufficient for recognizing and integrating multicultural issues in neuropsychological assessment, treatment, and research

  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 147) Total (n = 403) 
Strongly disagree 
n  10 
 % row 20 30  50 100 
 % column 1.5 3.3  3.4 2.5 
Disagree 
n 23 44 
 % row 11.4 20.5 15.9 52.3 100 
 % column 9.9 17.5 15.6 10.9 
Neutral 
n 21 22 44 92 
 % row 22.8 23.9 5.4 47.8 100 
 % column 16.8 24.2 12.5 29.9 22.8 
Agree 
n 60 50 18 57 185 
 % row 32.4 27 9.7 30.8 100 
 % column 48 54.9 45 38.8 45.9 
Strongly agree 
n 37 10 18 72 
 % row 51.4 9.7 13.9 25 100 
 % column 29.6 7.7 25 12.2 17.9 
  Did your postdoctoral training adhere to the Houston Conference Guidelines
 
 
Yes (n = 125) No (n = 91) Do not know (n = 40) Prior to Houston Conference (n = 147) Total (n = 403) 
Strongly disagree 
n  10 
 % row 20 30  50 100 
 % column 1.5 3.3  3.4 2.5 
Disagree 
n 23 44 
 % row 11.4 20.5 15.9 52.3 100 
 % column 9.9 17.5 15.6 10.9 
Neutral 
n 21 22 44 92 
 % row 22.8 23.9 5.4 47.8 100 
 % column 16.8 24.2 12.5 29.9 22.8 
Agree 
n 60 50 18 57 185 
 % row 32.4 27 9.7 30.8 100 
 % column 48 54.9 45 38.8 45.9 
Strongly agree 
n 37 10 18 72 
 % row 51.4 9.7 13.9 25 100 
 % column 29.6 7.7 25 12.2 17.9 

Knowledge base at the completion of training was queried with regard to degree of sufficiency to engage in independent practice for the following five areas, each of which was identified as salient within the HC guidelines: general psychology (Table 12), clinical psychology (Table 13), neuroscience (Table 14), neuropsychology (Table 15), and professional issues and ethics (Table 16). In each of these five areas, there is a much larger percentage of those who report their training adhered to the HC who responded “strongly agree,” in comparison with those whose training was not HC compliant. Among the HC adherent respondents, the range of endorsing “strongly agree” across these five topic areas is 34%–43.9%, whereas among the HC non-adherent respondents the range of endorsing “strongly agree” across these five topic areas is 14.4%–20.6%. Those whose training preceded the HC had “strongly agree” percentages that fell between those of the first two groups, and those who did not know whether or not their training met Houston guidelines had a range of “strongly agree” percentages that was below the other three groups.

Skill base at the completion of training was queried with regard to degree of sufficiency to engage in six specific clinical activities: conducting neuropsychological assessment and generating a differential diagnosis (Table 17); formulating and implementing a treatment plan and monitoring its outcome (Table 18); communicating results and recommendations to patients, families, and referral sources (Table 19); designing, executing, and reporting the results of independent research projects (Table 20); teaching and/or supervising students and trainees in neuropsychology (Table 21); and recognizing and integrating multicultural issues in neuropsychological assessment, treatment, and research (Table 22). In each of these skill domains, those who reported that they had completed HC-compliant training were more likely to “strongly agree” that they had this skill than were those whose training did not meet these guidelines.

Discussion

When compared with recent practice surveys, the present response rate is lower. Though the exact reason(s) cannot be known for certain, the lower response rate may be due to the nature of the survey, which deliberately focused narrowly on education and training issues that may be of less interest than professional practice and income surveys to some practitioners. Whatever the reason, we must consider that specific findings may be less reliable, vulnerable to response bias, and subject to change were a larger sample to be surveyed. With that caveat in mind, the broadest thrust of the present survey can be compared with the recent “Salary Survey” (Sweet et al., 2011), which had 1,685 respondents. That is, a single question regarding compatibility of training with HC guidelines was included in the Salary Survey, with responses from this larger sample demonstrating a comparable high endorsement of HC compatible training, as well as a significant relationship between age and having had training that was adherent to HC guidelines. Given the fact that the HC guidelines have only been in existence for 12 years, this relationship with age is understandable, and in fact expected. Importantly, the fact that these specific results from the ISET survey mirrored those from the larger salary survey sample adds interpretive weight to the ISET findings regarding the extent to which the HC guidelines are used and that the influence of the guidelines has been positive. We would also like to acknowledge that the present results are based on the degree to which respondents reported that their training was consistent with HC compatible training, rather than on objective data about variables such as the percentage of the internship or residency time that was devoted to neuropsychology-specific training.

Demographics of the ISET sample can also be compared with larger surveys. Among the licensed psychologists in the ISET sample, gender was fairly evenly represented and the majority had earned a PhD (86.4%), 70.5% identified clinical practice as the number 1 of 6 ranked professional activities, and 70.7% had received their doctoral degree in clinical psychology. These characteristics are comparable with a number of prior practice survey samples (Sweet, Moberg, & Suchy, 2000; Sweet et al., 2011).

There have been signs within the specialty that the presence of board certification within the specialty has been growing (e.g., McCrea, 2011) and also that it is more common in clinical neuropsychology than in other psychology specialties (Cox, 2010). Of the present licensed sample, 35.8% reported some form of board certification, which is comparable with the findings of a larger practice survey of neuropsychologists (Sweet et al., 2011) and higher than is evident in other psychology specialties. Equally impressive is the fact that among those not board certified, approximately one fourth reported plans to become board certified; 41.7% did not report their intentions.

More than four of five licensed respondents endorsed “agree” or “strongly agree” when asked if the clinical internship was an important component in preparing to become a clinical neuropsychologist. The majority of respondents (72.7%) agreed or strongly agreed that the internship was sufficiently flexible to allow the development of necessary competencies in clinical neuropsychology. Whereas the majority of internship programs attended by respondents were APA accredited (75%), the majority of postdoctoral residency programs were not APA accredited (78.8%), which reflects the national accreditation scenario at present. As would be expected, younger clinicians were much more likely to have completed APPCN residencies (37.2% of respondents age 28–39; 19.6% of respondents age 40–49; 3.7% of respondents age 50–59), which reflects the relatively short existence of APPCN (founded 1992). Only 13.9% of the overall licensed sample reported having had an APPCN residency. A plurality of the sample reported having completed a 2-year residency (40.2%) and identified the ideal length of the residency as 2 years (46%). With regard to the latter two items, ∼30% of licensed respondents did not provide answers. Based only on valid responses (i.e., omitting the no response category), the percentages indicating the completion of a 2-year residency and identifying ideal length of residency as 2 years were much higher, at 58% and 64%, respectively.

Having a postdoctoral residency that was compatible with the HC guidelines resulted in 95.1% of individuals believing that they were prepared to practice independently at their first job, compared with 69.7% whose training was not adherent to the HC. Of those who were not trained under the HC guidelines or were trained prior to the HC, 7.9% and 3.4%, respectively, believed that they lacked numerous required skills, whereas 0% of those trained under the HC guidelines believed that they lacked such skills. Those trained according to HC guidelines also reported more frequently that their training was relevant to their current professional activities than those not trained according to HC guidelines.

In general, psychologists who completed an HC adherent postdoctoral residency reported their knowledge-based training of general psychology, clinical psychology, neuroscience, neuropsychology, and professional issues and ethics was sufficient for practice in clinical neuropsychology. Additionally, those whose postdoctoral residency adhered to HC guidelines reported sufficient skill-based training in several areas as preparation for practice, research, and teaching. In contrast, a greater proportion of the psychologists who completed a non-HC adherent postdoctoral residency reported that training in the various areas was “insufficient or less sufficient” for these activities. For example, 42% of those who trained in an HC-adherent postdoctoral residency strongly agreed that they acquired a sufficient knowledge base in neuropsychology versus 14% of those who did not have an HC-adherent postdoctoral residency. As a second example, with regard to the skill base for conducting neuropsychological assessment and generating a differential diagnosis, 43.6% of those who trained in an HC-adherent postdoctoral residency strongly agreed that sufficient skill was attained versus 17.8% of those who did not have an HC-adherent postdoctoral residency.

In summary, the ISET survey results indicate that the HC guidelines, which were published only 12 years prior to the 2010 survey, are perceived by respondents as having a positive influence on multiple outcomes. In most, if not all specific outcomes, response patterns indicated that those who had HC-adherent training reported being more prepared for clinical practice, teaching, and research, and more knowledgeable in areas fundamental to the practice of clinical neuropsychology. It appears that the majority of the respondents reported HC-compliant training, even those whose training was prior to the development of the guidelines. This latter finding suggests that the education and training guidelines published in 1998 were a concretization of years of pre-existing education and training practices.

The present ISET survey specifically sought to address the impact of the HC on preparing individuals to practice neuropsychology. With this narrow focus, the present survey data indicate that the HC guidelines are in widespread use. Many of these respondents aspired to board certification or had attained it, suggesting strong commitment to or demonstrated excellence in the practice of neuropsychology. Those who had trained under HC guidelines reported a higher degree of preparedness to practice than those who had not. There was no indication that survey participants viewed the HC guidelines as having had any negative impact on their education, training, or practice. Instead, the present survey data suggest that the HC guidelines provide a solid model for training within the specialty of clinical neuropsychology at this time.

Nonetheless, the ISET Steering Committee recognizes that training needs change as a function of the broadening of our field, such as the introduction of new technologies (e.g., inclusion of genomics, new neuroimaging procedures, informatics and other technologies) or current trends in education and training more broadly, such as the impetus to develop competency-based training guidelines. For these reasons, the ISET Steering Committee supports the idea that periodic review and updating of training models is prudent.

In closing, we believe that the present survey is important not only in the information about outcomes of the HC guidelines that it conveys, but also in the collaborative process that it reflects. In forming the ISET executive committee, it was a goal to have a broad representation of invested parties work together to survey the implementation of HC training model. The success of this collaboration provides a model for future inter-organizational processes related to clinical neuropsychology training and practice.

Individuals who represented organizations during some or all of the ISET Steering Committee meetings (in alphabetical order of organizations): Jerry Sweet, PhD: American Academy of Clinical Neuropsychology; Glenn Smith, PhD and Deborah K. Attix, PhD: American Board of Clinical Neuropsychology; Bradley Sewick, PhD: American Board of Professional Neuropsychology; Al Lewandowski, PhD and Robert Perna, PhD: American College of Professional Neuropsychology; Catherine Mateer, PhD and Maria Schultheis, PhD: Association of Doctoral Education in Clinical Neuropsychology; Anne Herring, PhD, John Beauvais, PhD, and Beth Slomine, PhD: Association of Internship Training in Clinical Neuropsychology; Jacobus Donders, PhD, Brad Roper, PhD, and Douglas Bodin, PhD: Association of Postdoctoral Programs in Clinical Neuropsychology; Jim Hom, PhD: Coalition of Clinical Practitioners in Neuropsychology; Paula Shear, PhD, Douglas Ris, PhD, and Cynthia Cimino, PhD: Division 40, American Psychological Association; William Perry, PhD and Ron Ruff, PhD: National Academy of Neuropsychology.

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