Neuropsychology trainee concerns during the COVID-19 pandemic: A 2021 follow-up survey.

OBJECTIVE: As the COVID-19 pandemic continues, the impact on neuropsychology trainees continues to evolve. This paper describes the results of a survey of neuropsychology trainee (graduate student through postdoctoral resident) perspectives on the COVID-19 pandemic and compares them to a previous survey conducted in Spring 2020. METHOD: The survey used several questions from the 2020 survey and added applicable new questions based on the results of the 2020 survey. The survey was distributed to listservs, training directors, and student organizations in neuropsychology with snowball sampling used. RESULTS: Respondents were primarily female (82.4%) and white (63%). The majority of trainees (66%) reported loss of clinical hours. Interestingly, the average training time missed was approximately 3.36 weeks (SD = 9.27). Trainees continue to report that they have experienced increased anxiety, depression, and stress since the beginning of the pandemic; however, compared to a prior survey, rates of increased anxiety/stress remained stable, but more trainees reported increased depression. Approximately 31% of trainees reported that they were differentially impacted by the pandemic due to racial/ethnic background and female trainees were more likely to report increased personal stress, anxiety and depression than their male counterparts. CONCLUSIONS: Results suggest continued wide-reaching pandemic related impacts on neuropsychology trainees. For example, trainees continue to be concerned about the impact of lost clinical hours on their professional futures. The most notable of the personal impacts included increased rates of mental health concerns and differential impacts on trainees from ethnoracial minority communities. Recommendations are provided to assist trainees in coping with pandemic-related disruptions.

Boston Naming Test: Lose the Noose.

OBJECTIVE: Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation. METHOD: Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA. RESULTS: Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance. CONCLUSIONS: Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student Affairs Committee survey of neuropsychology trainees.

Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.

2015 American Academy of Clinical Neuropsychology (AACN) student affairs committee survey of neuropsychology trainees.

OBJECTIVE: Surveys of practicing neuropsychologists have been conducted for years; however, there have been no comprehensive surveys of neuropsychology trainees, which may result in important issues being overlooked by the profession. This survey assessed trainees' experiences in areas such as student debt, professional development, and training satisfaction. METHOD: Survey items were written by a task force of the AACN Student Affairs Committee (SAC), and neuropsychology trainees were recruited via neuropsychology-focused listservs. In total, 344 trainees completed the survey (75% female) and included participants from every region of the US and Canada. RESULTS: Based on the survey questions, nearly half of all trainees (47%) indicated financial factors were the greatest limitation in their training. Student debt had a bimodal distribution; 32.7% had minimal debt, but 45% had debt >$100,000. In contrast, expected starting salaries were modest, but consistent with findings ($80-100,000). While almost all trainees intended to pursue board certification (97% through ABPP), many were 'not at all' or only 'somewhat' familiar with the process. CONCLUSIONS: Results indicated additional critical concerns beyond those related to debt and lack of familiarity with board certification procedures. The results will inform SAC conference programming and the profession on the current 'state of the trainees' in neuropsychology.

Implementation of Actigraphy in Acute Traumatic Brain Injury (TBI) Neurorehabilitation Admissions: A Veterans Administration TBI Model Systems Feasibility Study.

BACKGROUND: Sleep problems and disorders are prevalent in patients with traumatic brain injury (TBI) and are associated with negative outcomes. Incidence varies because of challenges including differences in assessment methods, particularly in the acute stages of recovery when patients are cognitively impaired and unable to complete traditional self-report methods. Actigraphy (ACG) recently has been validated in the acute TBI rehabilitation setting and may serve as a superior method of assessing sleep-wake patterns at this stage of recovery. Although a few studies with small sample sizes have described the use of ACG, none have described feasibility and implementation protocols. OBJECTIVE: To describe the feasibility and implementation protocol of ACG to evaluate sleep-wake patterns and white-light exposure data in patients with acute TBI during inpatient rehabilitation. Sleep-wake patterns and light exposure data are presented to characterize the sample using these methods to inform future research. DESIGN: Retrospective study. SETTING: Acute inpatient rehabilitation unit at a Veterans' Affairs Polytrauma Rehabilitation Center. PARTICIPANTS: Veterans (age ≥18 years) admitted to inpatient rehabilitation and enrolled in the Traumatic Brain Injury Model Systems study who were admitted and discharged in the calendar year 2013. METHODS: Veterans underwent actigraph watch placement as soon as possible after admission. Records from the calendar year 2013 were reviewed to determine the number of admissions that met study criteria and what percentage of those patients had 3 days of continuous ACG data collected. The barriers to successful watch placement in this population were reviewed. Average sleep, light, and wake data from available records were collected for the study sample. MAIN OUTCOME MEASUREMENTS: Percentage of patients who met study criteria and who had 72 hours of continuous ACG data collected. The barriers to successful watch placement in this population were reviewed. Average sleep, light, and wake data from available records were collected. RESULTS: Of 22 eligible Traumatic Brain Injury Model Systems admissions, 3 consecutive nights of ACG data were successfully obtained for 86% (n = 19) of the sample. Barriers to data collection included patient access due to abbreviated lengths of stay, staff availability for ACG placement, and data collection protocols to prevent loss of data in Veterans' Affairs computing systems. CONCLUSIONS: ACG is feasible for collecting data about sleep, wake, and light exposure in patients who are in acute TBI inpatient rehabilitation settings. LEVEL OF EVIDENCE: III.

Subjective sleep quality and postconcussion symptoms following mild traumatic brain injury.

PRIMARY OBJECTIVE: The goal of this investigation is to examine the prevalence of poor subjective sleep in patients with a history of mild traumatic brain injury (mTBI) and examine the relationship between subjective sleep quality and postconcussive symptoms (PCS), above and beyond the typical demographic and psychological distress variables. RESEARCH DESIGN: Individuals with a history of mTBI completed online questionnaires. Regression analysis was utilized to determine if subjective sleep quality would predict PCS severity, above and beyond demographic variables and psychological distress. METHODS AND PROCEDURES: Individuals with a history of mTBI (n = 158) completed surveys online. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and PCS with the Neurobehavioral Symptom Inventory (NSI). Demographic information was collected and psychological distress was measured using the Brief Symptom Inventory-18 (BSI-18). MAIN OUTCOMES AND RESULTS: In this sample, 92% of patients with mTBI reported poor sleep. Sleep quality significantly accounted for the variance in PCS, above and beyond demographics, time since injury and psychological distress (p < 0.001), although only a small amount of the variance in PCS was explained. CONCLUSIONS: Results indicate that poor subjective sleep quality is a significant problem in those with mTBI. While sleep is associated with PCS severity, psychological distress is a more potent predictor.