P1251328600KDBEA

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An Algorithm of Neuropsychological Assessment
Effects on Student Training and Perceived
Self-Efficacy Luton, Lindsay M., Burns,
Thomas G.
INTRODUCTION As the field of Neuropsychology
continues to develop, training in
neuropsychological assessment will necessitate an
understanding of increasingly complex
decision-making processes. One factor that may
complicate training is the steady growth in the
number of neuropsychological tests. Implicit in
adequate training is an understanding of
test-specific administrative and developmental
restrictions thus, an increase in test
availability requires the acquisition of
additional, test-specific knowledge. Further,
departmental inconsistency in test selection may
deter effective student training. To address
these issues and enhance the training of
doctoral-level practicum students, an educational
initiative in neuropsychological assessment was
piloted in the Neuropsychology Department of a
large, Southeastern childrens hospital.
Specifically, clinical pathways were developed to
facilitate students diagnostic decision-making
skills. Through the implementation of these
pathways, we hoped to provide students with a
step-by-step approach to neuropsychological test
selection. Further, we anticipated that exposure
to these algorithms would promote the acquisition
of test-based knowledge (e.g., developmental
restrictions). As such, we hypothesized that the
introduction of clinical pathways would enhance
student perceptions of related to ones
assessment-based, decision-making abilities.
METHODS Development of the algorithm. Twelve
department-sanctioned, domain-specific clinical
pathways were developed and integrated into a
single, comprehensive algorithm of
neuropsychological assessment (See below). Tests
were selected for inclusion in the algorithm
through the collaborative efforts of six licensed
neuropsychologists. Participants. Ten
doctoral-level, diagnostic practicum students
(n10) were trained to use clinical pathways as a
means of facilitating neuropsychological test
selection. Students were educated on the
conceptual bases for the algorithms, exposed to
examiner modeling of algorithm use, and provided
with in vivo, supervised practice using case
examples.
Procedure. Self-perceptions of assessment
abilities were obtained via completion of
identical questionnaires prior to algorithm
training and again after using the pathways for
three weeks. Due to the paucity of training-based
questionnaires, we developed a 19-question survey
that allowed for responding on a 7-point Likert
scale questions (e.g., I feel confident in my
ability to determine which measures of executive
functioning are most appropriate when evaluating
patients of different ages). Statistical
Analysis Using the SPSS version 12.0 statistics
package, a series of paired samples t-tests was
conducted to compare pre- and post-intervention
responses so as to determine if utilization of a
neuropsychological algorithm enhanced students
perceptions of assessment abilities. RESULTS
DISCUSSION Results from paired sample t-test were
demonstrative of significantly enhanced
perceptions of diagnostic, decision-making
abilities in 18 of the 19 areas assessed. For
example, after using the algorithm, students
reported feeling more confident in their ability
to develop a case-specific, comprehensive test
battery, t(9)5.471, p .001, a.01. They also
endorsed feeling more efficacious when
identifying age-appropriate measures for
evaluating different neurocognitive domains, such
as visual-spatial skills (p.001), receptive
(p.001) and expressive language (p.001),
attention (p.003), and executive functioning
(p.003). These findings are consistent with
our hypothesis, as the use of an assessment-based
algorithm appears to augment the perceived
self-efficacy of diagnostic trainees. Although
there are clearly limitations to the current
study (e.g., small sample size, potential
response bias), results lend support to the
utility of clinical pathways in facilitating the
acquisition of neuropsychological test knowledge.
Future studies should include objective measures
as a means of evaluating training effectiveness.
Additionally, including larger sample sizes and
multiple training institutions may help to
clarify the usefulness of this program. Finally,
longitudinal studies examining residual effects
are also warranted.