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Hey folks. Welcome back to The Testing Psychologist. Glad to [00:01:00] be here with you today.
I’m glad to be here with my guest, Dr. Lynette Abrams-Silva. She is a board-certified neuropsychologist who serves on the board of directors of the American Board of Clinical Neuropsychology. A native New Mexican, she is the director of clinical training for the University of New Mexico Hospital’s post-doctoral fellowship program in neuropsychology. Her career has been focused on the intersection of providing quality care to resource-poor communities, excellent training for future neuropsychologists, and increased diversity in the field. This last topic is what we are tackling here today during our interview.
As many of you know, we have a diversity problem in neuropsychology. We have a field of about 85% white neuropsychologists in a country that is only about 58% white. So we tackle this and try to dig in and figure out what might be happening here and how to change that.
We talk about things like why this is a problem in neuropsychology. We talk about the [00:02:00] chicken or the egg issue of recruiting diverse trainees without having diverse staff to support them. We talked a little bit about Relevance 2050, the initiative to increase and address the lack of diversity in neuropsychology. We also talk about Lynette’s didactic series, which has been running for many years and can be a fantastic resource for anyone who’s training, trying to board, or just trying to get better at being a neuropsychologist.
So lots to enjoy from this episode. I loved talking with Lynette. She’s a very dynamic individual and a prolific educator. She’s been doing this didactic series for years now. So lots to enjoy in this conversation.
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All right, let’s jump to my conversation with Dr. Lynette Abrams-Silva.
Lynette. Hey, welcome to the podcast.
Dr. Lynette: Thank you for having me. I’m honored to be here.
Dr. Sharp: Likewise. We have a mutual acquaintance, I suppose, or friend or colleague, and one of our psychologists used to be down there in your area and have spoken very highly of you. I know you’ve done a lot of training in this field and [00:04:00] you’re an incredible educator. So, I’m honored to have you here. Thanks for being here.
Dr. Lynette: What a fantastic introduction. Thank you.
Dr. Sharp: It’s only downhill from here, probably. I’m glad to have you and glad to have the opportunity to have a really important conversation about… It started with your presentation on the AACN agenda on recruiting diverse trainees. I think it’s grown a little bit from there. We’re going to be talking about diversity broadly in our field and many other things. So, thanks for being here.
I’ll start with the question that I start with most times, which is why this is important to you; of all the things that you could focus on and spend your time and energy on in our field, why this?
Dr. Lynette: That’s a great question. I ponder this from time to time. How did I [00:05:00] get here? Why can’t I let this go, for example? I guess it’s the combination of aside from, of course, my friends and family and pets, the things that I love the most in the world are neuropsychology, my community, and where those intersect.
My community, just so you know, is in New Mexico. My family has been here for 500 years at least, so we are very New Mexican. I’m very connected to my community, and we are often overlooked. We are a minority-majority state with very few resources, and most people that I meet out in the world have said things to me like, I didn’t know New Mexico was a state. I thought it was a territory. I didn’t think people lived there.
We tend to get forgotten about. [00:06:00] I have wanted so badly to bring the highest quality neuropsychological services to my community. In doing so, I have hit diversity issues in our field at every turn. So it’s impossible to focus on serving my community without considering diversity issues. And then it’s a can open worms everywhere. There’s so much to be done that I will spend my entire career on these issues.
Dr. Sharp: Sure. It seems like it’s driven by a highly personal experience as well. I think that’s super powerful.
Dr. Lynette: It is driven from my personal experience stumbling my way into my career, and that’s part of what [00:07:00] I try to address is I started grad school to become a clinical psychologist without even knowing what neuropsychology was or that it was the thing I could do. It wasn’t until that 1st class that was required for all of our graduate students in neuropsychology that I fell in love with it.
I think everybody has a challenging time getting through training and education. It’s not easy for anyone, but I wonder if I would have had a somewhat easier time if I had known earlier this is neuropsychology, this is what I want to do, this is how I prepare to be good at this, instead of stumbling around in the dark, essentially.
Dr. Sharp: I hope that we can dig into some of those things as we go along. That’s an experience that I [00:08:00] imagine or know a lot of folks are still having, and like you said, it’s been a big motivator for you over the course of your career, right?
Dr. Lynette: A lot of times.
Dr. Sharp: Yes. Well, as we get going, I want to lay some groundwork and do some language discussion, and how we might talk through some of these things. This is, I feel like Déjà vu. This is the second time this week I’m coming at a topic with real humility, a beginner’s mind, and a preemptive apology around language. I did an interview earlier this week on gender-affirming assessment and stumbling through all sorts of things. I’ll go ahead and throw that out there, but I would have to talk a little bit about language as we get going and how you would choose to address some of these things. If diversity is a word that [00:09:00] you’d like to use, if there are other better words to use, maybe we just start there.
Dr. Lynette: I think in many ways, I’m exactly where you are in that I have spent my entire early career focused on these issues, yet terminology changes. I have difficulty keeping up with what we’re calling things these days.
I know that diversity is such a blanket term. APA very rightly has pointed out that diversity is more than just racial, ethnic diversity, or socioeconomic. It encompasses everything including ability, gender, sex, and all of these factors that pretty much go into the human experience. I agree with that in terms of classifying what [00:10:00] diversity is but my focus has been on racial-ethnic diversity, particularly focused on the Hispanic population, mostly because that is my own background and it is the background of the majority of my community. So that has been my focus.
When I say diversity, equity, and inclusion, I think I’m using the term possibly dated around 2016, or 2017. So it may be a little bit outdated. I think that it has grown to include again many more facets of diversity. For me personally, I can’t manage that many issues. And so, I have to focus on the thing that’s in front of me, and the thing that’s in front of me happens to be racial-ethnic diversity, [00:11:00] specifically the Hispanic population.
Dr. Sharp: That’s fair. That’s reasonable. Okay. Well, language is important as we know.
Dr. Lynette: And it’s a living thing that seems to change faster than I can keep up with it.
Dr. Sharp: Exactly. Maybe we both agree to do our best through this conversation.
Dr. Lynette: I think that that’s exactly what is the best way to approach things. What you said about approaching with a beginner’s mind, I’ve spent a decade on this and I still have a beginner’s mind. So we’re sort of in the same place.
Dr. Sharp: That sounds good. A good place to start from.
Dr. Lynette: Yes.
Dr. Sharp: To get into the discussion, I may open it with a similar question. We talked about why this is important to you personally. I think there’s probably some overlap here, but I’d love to hear from you why this is important for our field to even be [00:12:00] addressing this material.
Dr. Lynette: I’m going to steal from AACN and the Relevance Project, which was created because the US population, in particular, is rapidly diversifying and we, as a field, run the risk of being irrelevant at that tipping point where we become a minority-majority country. There are a lot of limitations already that we have faced, particularly cross-cultural neuropsychology and cross-language neuropsychology in particular.
We don’t have measures for every culture and every language and the idea that we can just translate it linguistically, first of all, is terrifying to me because you miss a lot of the things you can’t [00:13:00] necessarily detect just from language. You miss the culture; what do certain cultures, what kinds of things are they exposed to? Are we measuring the same thing? What is our construct validity across cultures? So there’s that that we already are facing.
This stands to get much worse in the future when our measures have aged out and do not apply and our normative data does not apply to the US population. So, in order to maintain relevance, because I do believe that neuropsychology has more to offer than anyone realizes, we do have to adapt and keep up with the populations that we serve.
There are many fronts to this particular issue where we do need better normative data, but that’s not going to be enough. We also need to [00:14:00] increase our competence with the limited tools that we have, because even if we did have, say, the perfect normative data, how long will that last? 5 years? 7 before we then again, have to make better normative data and better-updated measures. We do need to increase representation within the field to make these changes.
It is a lot like the Tower test. I’m moving disks here trying to get some change to happen.
Dr. Sharp: Right. What’s the correct order? How do we solve and plan for this? It’s complex.
This is a question you may not know the answer to, but I wonder, just knowing the life cycle and development cycle for a lot of our major measures, have you heard of anything from the major test publishing companies as far as preparing [00:15:00] for some of these shifts over the next… I mean, 20 years is going to go by really fast especially when we’re talking about new versions of the WAIS or whatever; that goes by really fast. I haven’t necessarily heard of any of those conversations, but you’re closer to this than I am.
Dr. Lynette: There is a push from within APA to encourage the development of measures and the updating of normative data. Again, these things take time. There are committees, there are test companies, there is a lot of work that goes into creating new normative data and developing new measures, and we can’t wait for that.
So, not only do we have time that’s going quickly, as you said, 20 years can go by in a blink, but also we can’t wait for the perfect measures even if they were possible, we [00:16:00] still have patients we have to see tomorrow and how do we do that? For me, that always comes back to the competence that we have with imperfect tools and how important it is to promote the highest level of competence, particularly when doing cross-cultural work.
Dr. Sharp: Right. I’m framing our conversation a little bit here as we’re going along. There are these 2 prongs, there’s almost the, I don’t know if you call it the client-facing side, but that’s what we’re getting into now is the measures and how do we do good work with the folks who are at least at this point, not majority. Then there’s the… what’s the other side, what want to call it? The recruitment side or our practitioner side and how we [00:17:00] support and develop more diverse trainees and neuropsychologists.
Dr. Lynette: I think we need to address both at the same time.
Dr. Sharp: Yeah.
Dr. Lynette: Which is a tall order.
Dr. Sharp: Of course. Well, maybe we talk about the client-facing side first. We’re dipping into that already. You’ve made two comments around, we can’t wait for the perfect measure if that was ever even a thing that we could have. So I’m curious from your perspective, what does that look like right now?
Dr. Lynette: I can give you an example from my own experience, which is in New Mexico. I think a lot of places in the United States are suffering from the lack of Spanish-bilingual neuropsychologists increasingly. So it’s [00:18:00] not even just a New Mexico problem, but it is very pronounced in my state. I do not speak Spanish. I am part of that generation, I’m going to give away my age here. In the 80s, which in my mind are perpetually 20 years ago, to your point of 20 years going quickly,
Dr. Sharp: I’m right with you. You’re among friends here.
Dr. Lynette: in the 80s, there were these studies that suggested that bilingual children did poorer in school. And so my mother being an educator made that decision not to teach me Spanish. It was my father’s first language. I have little excuse for not learning it later. But when I was a child, I did not grow up bilingual by design. My parents wanted me to be successful in America. And they thought that that meant monolingual English speaking to get through [00:19:00] school.
And I think that that’s not just a footnote in this conversation. A lot of what is contained within that story about my background is what drives my work today because I think about, had I been bilingual, I think my difficulties getting through to this point in my career might have been exacerbated because everything that contributes to your growing up Spanish bilingual contributes to the distance you have to travel to get to where I am today. I feel very fortunate, but it does feel like it was a choice, even though we know now, newer research, it is not true that bilingual children do poorer in school. So we know that, but there are all these socioeconomic factors and social capital and social [00:20:00] mobility that still go into that.
So, I am not bilingual and that has, especially in the last few years, been sort of a problem in my community because I shouldn’t be the first choice to see Spanish-speaking patients, but there is almost no one else available. So my goal in the last few years has been to try to bring trainees who are Spanish bilingual into my state to lure them to New Mexico and even temporarily have them work under my supervision so that I can see those patients.
I have worked. I was very fortunate on fellowship to be able to train with the use of interpreters. So, I do have that background in my training and education. I can do Spanish [00:21:00] evaluations and they are easier than, say, Polish, which I also had to do when I was on fellowship because I do understand. I understand Spanish perfectly well, I just, when I speak it, I sound like a 6-year-old, so I’m not able to be a neuropsychologist to speak Spanish. I do need someone fluent. So, in the past 4 years, I’ve had 2 trainees who have spent some time working with me and that is how I’ve tried to address some of these issues and barriers.
Dr. Sharp: That gets to the question of how do you find these trainees and how do you get them to New Mexico or anywhere else that might need this. This seems like a ubiquitous problem. We say the same thing in Colorado here, which is, that there’s a huge Latino population in Colorado. I think there is [00:22:00] one Spanish-speaking neuropsychologist here in our town of 200, 000. And even that person only works from birth to five. And so, it’s a huge problem. And I hear this all over.
Dr. Lynette: It is. This is one of the things that I’m working hard to try to overcome. I lurk, that’s the 1st thing that I do, I lurk on listservs just waiting for someone to post something saying, is there training available for a Spanish bilingual person at any level? Lurking has its advantages.
The student that we had over the summer was a Concordia student and Concordia is in Canada. You’re probably thinking, why would someone from Canada want to come to New Mexico for the summer for training? It turns out Canada has had its own struggles with [00:23:00] training issues and whatever was going on up there, they couldn’t provide training last summer for practicum students. There was a student who posted on the HNS, the Hispanic Neuropsychological Society listserv asking for options for training in a Spanish-bilingual population. I responded in 3 seconds and I sold New Mexico as hard as I could.
I think that New Mexico and neuropsychology have this in common. I don’t think we’ve been very good at PR. We haven’t sold ourselves as well as we could have, and this is definitely true for New Mexico because it’s a beautiful place with a low cost of living. I sold the idea to the student who came for the summer and he became part of our little neuropsych [00:24:00] family. He did great and we were able to see Spanish-speaking patients. Not only Spanish-speaking patients.
That’s another issue entirely, which is when you get a Spanish-speaking trainee, they tend to be pigeonholed and they become the Spanish-speaking neuropsychologist, and that’s all they do. And it’s true. You could do nothing but Spanish evaluations but I don’t find that that’s valuable for training. So we did cap the percentage of Spanish evaluations for our trainees to make sure that they get a broad experience.
Dr. Sharp: That’s fantastic. It seems like a big-picture problem, right? You’re the expert in this area. It seems very chicken or egg to me because well, the field of neuropsychology is [00:25:00] pretty white in general. I think we know this, right?
Dr. Lynette: We do.
Dr. Sharp: And so then how do you recruit non-white neuropsychology students without mentors or advisors or professionals to look up to or whatever but then how do you get non-white neuropsychologists without the trainees who go through the program? I’m just laying it out. I know there are no answers, but this seems like a complex problem.
Dr. Lynette: If you keep going, just keep doing what you just did for about eight years, then you’ll be where I’m at today. This is the stuff that wakes me up at 2 o’clock in the morning thinking how do I… It’s like trying to join an already started game of Double Dutch, just trying to jump in and okay, what do I do? How do I fix this? How can I contribute?
My second story about recruiting someone from somewhere [00:26:00] else to New Mexico is my fellow. I have an institution job and I also work in private practice. I do enjoy the freedom that private practice allows. A friend of mine had come to me for advice saying she was mentoring an intern who could not get a fellowship in mainland US, this was someone from Puerto Rico. She wanted to know what resources were there. How could she help him?
It was a story that was very familiar and frustrating. The training in Puerto Rico is a little bit different than in mainland US. He wasn’t able to break into these fellowship programs because of that. But being Spanish bilingual, there were plenty of people who were offering him unpaid externships. It just enraged me.
And [00:27:00] so when I was talking to my friend, I said, there’s no reason I can’t have a fellowship. Again, I don’t know where I get these ideas about what I can and cannot do, but I essentially the next day went to the practice owner and said, we’re going to make a fellowship. I’m going to run it and we have someone that I want to try to recruit.
I have to give so much credit to the practice owner. His name is Rex Young. He said, okay, and allowed me to run with this idea. So I met with the then intern, and we recruited him to come to New Mexico. I think it helped that everything I know about Puerto Rico, we have a lot in common. New Mexico and Puerto Rico are very similar.
And so we got him for two years and it was amazing and fantastic. I was [00:28:00] not easy on him. I trained the heck out of him and he accepted his first job at Barrow. For our first fellow, we’re very proud of that, but it was jumping into an already started game of Double Dutch. It was saying, here’s someone that could contribute to our field and our community in particular, how can I invest in this person to make sure that he gets what he needs out of training and we can also help serve the community at the same time? It seemed like everyone would win.
So, yes, I feel like some of it is having that freedom to be able to create something for someone. I know that not everybody has that, especially in institution jobs. [00:29:00] When you’re part of the match, there are a lot more uniform standards. So, this was a blessing to be able to do that.
Dr. Sharp: Do you think that private practices have more leverage and more of a heavier influence in this whole process?
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Dr. Lynette: I think it’s a double-edged sword. We do know that neuropsychology is overwhelmingly Caucasian. Our last salary survey, which I think was in 2020 suggested something like 85% white. We’re not really keeping… It does represent an improvement, I do have to say that, but we’re not keeping up with the rate of diversification in psychology overall, much less the U.S. population.
And so what my fellow encountered, I think, is part of the problem where we’re saying, sure, we can use your services [00:32:00] but we’re going to give you an unpaid externship. I think we need to start to value these qualities. So it wasn’t just, oh, he’s Spanish bilingual, but he did have those metrics that constitute distance traveled and that predicted in retrospect, you predict something in retrospect, predicted his success.
So these qualities that contribute to the whole theory of distance traveled that people have also predict success. We just don’t look at them because they’re harder to measure and he did. He had perseverance and he had intellectual humility, all of these things. He did end up being a successful outcome. So I think, yes, private practice would be, I think it would be easier to facilitate these kinds of [00:33:00] training programs, but we do have to be careful. We do have to make sure that supervisors are competent and good supervisors and are willing to invest.
The other problem is we can’t just open the doors and say, yes, we’re going to admit everyone. We do have to take into consideration the system. The system was not built for marginalized populations, and it is very hard for us to navigate these systems. So there needs to be some support. I could have benefited from that as a student in particular. I felt very lost. The academic system is very confusing and I was not prepared for that. I thought graduate school was going to be like school.
Dr. Sharp: Reasonable assumption.
Dr. Lynette: And it’s not at all. There’s a whole what they call that invisible curriculum. [00:34:00] Trying to navigate that, there needs to be mentorship. There needs to be an infrastructure to support marginalized students and trainees. So, yes, I think there’s a lot of capability in private practice. And I think it would be great… I’m already volunteering myself for more work, which is my Achilles heel, but it would be great if private practices interested in this had a group that could discuss and consult because I find consulting is one of the most important things you can do when doing something new like this.
It sounds obvious, but I think we don’t emphasize consultation enough. I feel like I consult with my pediatric colleagues all the time to the point where they’re irritated with me for asking questions. We can learn so many things from each other. [00:35:00] I feel like that would be a great model to have a group of private practice fellowship supervisors who consulted with each other.
Dr. Sharp: I agree. I think there’s a lot of vulnerability in that and people maybe are feeling protected or protective or defensive or something. It’s hard to reach out and admit that we need help, but every time it happens, it is super helpful. That connection goes a long way, especially when we’re doing something new ish like this where there’s no real playbook.
Dr. Lynette: Absolutely, especially when it’s just a little bit different. One example I have is traumatic brain injury in the Navajo population. I feel like neuropsychologists, we have to know about traumatic brain injury and [00:36:00] we get education and training, and hopefully we’re all really solid on what it looks like on testing unless you’re Navajo.
Not a lot of people know that. So my dream of the future is that someone, somewhere has a Navajo patient and has that aha moment of, I should probably talk to someone about this and not assume that I know exactly what this is going to look like on testing. Here’s the kicker. Block design in particular from the WAIS has been shown to be inflated in the Navajo population. They call that the Navajo effect. So if you’re looking to block design to confirm, yes, this is TBI, you’re going to be disappointed and you could miss it.
So, I feel like having that moment’s thought of, I think I should reach out to someone, and of course, you’re going to think about Ted Judd [00:37:00] because that’s who we all think about when we think about cross-cultural neuropsychology. This has happened. Someone has reached out to Ted Judd who reached out to me because I have a lot of experience with the Navajo population. So it sometimes does really work. I just wish it was more widespread.
Dr. Sharp: I hear you. I want to go back to something that you talked about, the system, right?
Dr. Lynette: Yes.
Dr. Sharp: There’s a piece of that I feel like I can identify with. I was the first person in my family to go to grad school and maybe the 2nd to go to college. There was no script. And even for me, lots of privilege, right? It’s all right here. Lots of privilege. That was still very challenging. I had a lot of difficulty in grad school and thinking about [00:38:00] how much having a parent or a mentor or anyone who could have helped pave the way.
I’m curious for you and having talked to folks, and thought about this, that’s a big thing to work with, a big thing to change. How does one even start to change a system like that? Even if we’re just talking about grad school, mentoring folks through that process.
Dr. Lynette: I think this was my experiment in my current position. I was hired by my old grad program to be the director of the student training clinic. Unfortunately, I am the only local Hispanic representation within all of the psychology department at this level at UNM in New Mexico, which is [00:39:00] unusual and it’s sad.
I do believe that more representation from the local Hispanic population would make a difference, which is part of why I pursued this position. I did that because I wanted to be the Latina supervisor that I would have benefited from having as a student, not because I’m any better at navigating the system now than I was then, because I still can’t, I’m still baffled by the way it’s set up and I still don’t understand half of the bureaucracy, but because having someone who has reached a particular level in their career, who looks like you and who has your same background and who can understand your profound confusion about everything is so valuable.
I think what needs to happen there is infrastructure to support that particular [00:40:00] faculty member or staff member to be that person. There does have to be a lot of work that I think, I don’t want to say people don’t want to do, but I’m not sure they know where to start in addressing these problems. You could go round and round in your head thinking of where to jump in on this problem and drive yourself crazy.
So increasing representation is important, but we do have to have the infrastructure for anyone who we invite into the system that, frankly, was not made for them. This system was not made for me. It was actually made to keep marginalized people out. And no matter how much we try to adjust, we have to accept that the system was built from a very specific worldview and we can’t change that.
Dr. Sharp: Yes.
Dr. Lynette: Bleak, I [00:41:00] know.
Dr. Sharp: I’m just sitting with that. It’s true. It’s the reality. For folks who may not be as plugged in or aware of some of these factors, when you say that are like our grad school system, or maybe the educational post-secondary system is geared toward keeping marginalized people out, can you say more about what you mean by that just to make it super explicit?
Dr. Lynette: Yes. To get into grad school in particular, there are a number of things that we use as metrics for admissions. I think people are moving away, I know of a lot of programs that have moved away from the GRE. But for what, 50 years, we relied on GRE scores and transcripts with really good grades and possibly a research background, [00:42:00] which often required that you volunteer in a lab for no pay and do research under a particular mentor. And in order to do that, you had to know that that’s what you were supposed to do. So, starting very early, there are barriers to achieving even admission. I think some of that has started to change, but we do still rely on factors that are tied to socioeconomic status and social capital and marginalized people tend not to have a lot of either.
Dr. Sharp: Yeah, that in itself is huge. It goes back to that script idea, if you don’t have the script for preparing for grad school, which starts really early,
Dr. Lynette: Really early. In my wildest dreams, I would be giving talks about neuropsychology to 5th graders.[00:43:00]Not that I’m bad kids. I’m an adult person. So kids might not be my thing. Maybe I’ll get one of my pediatric neuropsychologist friends to do it but I think reaching out earlier to communities like mine. And again, I think we are as a field, very concerned. We do for the most part, want to diversify. I have heard colleagues of mine in anguish about how do we do it? How do we reach these populations? I think that a lot of mentorship and outreach at a younger age is part of it. I think both of those would be key.
Dr. Sharp: Yeah. Are there any cues to be taken from other fields? I have to imagine that this is a similar problem in medicine or engineering or other advanced [00:44:00] degree field law. I don’t know. I would have to imagine that there are other disciplines who are trying to tackle the same problem. Is there anything out there that can help us?
Dr. Lynette: Absolutely. I like to think of medicine as our cousin because we do work together. We’re not exactly the same, but we have a similar model, and medicine as far back as 2015 has been looking at admissions a little bit differently. There are many programs that have moved to a holistic recruitment model and the Association of American Medical Colleges is promoting this which is to look at the whole background of the person for those factors that I was talking about that do also predict success.
It is easy to say, okay, so someone who has [00:45:00] really high SAT scores is going to be more successful in higher education because all of these are coming from the same worldview. So, of course, they’re going to predict each other, but what else predicts success? Can we use some of that? The holistic recruitment model is meant to do that; to look at how far someone had to travel from their socioeconomic status of origin to even get to the point where they’re applying for your program.
I didn’t know about this. So the way that it happened for me was I had created the fellowship in that way that I described where I decided one day that we were going to have a fellowship and I would figure it out. After I did, I found out from my colleague and friend, Stephanie Towns, that there was already a model [00:46:00] Called holistic recruitment that focuses on everything I was talking about.
So I was really pleased to find that there are other disciplines that are interested in changing how we look at admissions and there already is a bit of research and material out there that describes it. So that was very helpful to find that. I wasn’t just hitting on something that had no name because that is very frustrating when you’re trying to describe something and it has no name and people look at you like you’re crazy. So, at least there was already something out there.
Dr. Sharp: Right. I would love to, I’m going to go check that out, trying to learn a little bit more about it. But just from what you know about holistic recruitment, is there, I’m a data person, so is this a rubric-based strategy? [00:47:00] Does it get that granular or is it more a qualitative approach to finding and evaluating candidates?
Dr. Lynette: Both it can be quantitative or qualitative. It depends on how much you wait certain factors. Let’s say, first generation, higher education, you can wait however you like Spanish bilingual or any bilingual or born on the mainland US or not. You can wait for these factors however, is consistent with what goal you’re trying to achieve. I think people do it differently. There are some grad programs in psychology that are doing this now. I think it is a struggle because we’re data people too. We want that number that [00:48:00] is going to predict success. But if you take into consideration these factors, and as you look at more of them and wait certain factors more than others or equal to others, then it can be more quantitative.
Dr. Sharp: Right. You mentioned Relevance 2050 I think back at the beginning of our discussion. I wanted to highlight that a bit. For folks who may not be aware of that, can you give a brief overview of Relevance 2050. I see that as macro organizational, most coherent effort. Feel free to disagree with any of that, but within neuropsychology. I’d be curious what you have to say about that.
Dr. Lynette: I think that’s right. I’d never actually seen a push like this from within the [00:49:00] field to diversify and to approach it from different perspectives meaning, not just focused on let’s get perfect normative data. I think that Relevance 2050 talked about a lot of what I’ve talked about here today, which is these multiple-faceted areas that have to be addressed at the same time, which is why it’s an initiative. So it needs an initiative in order to have multiple people working on multiple facets of a very difficult problem.
The goal is to increase diversity in the field in AACN and in leadership of neuropsychology. People are working on it, which is great. I’m really grateful that it’s out there that we have some direction from, I guess I’m going to [00:50:00] call it the field and that this has become a value within neuropsychology because it is very needed, particularly for communities like mine we have very few resources as it is. And so, we do need more of us in the field.
Dr. Sharp: I’ll make sure to put some info in the show notes for people who want to go learn a little bit more. I know there’s a lot of information out there.
Dr. Lynette: There’s a lot.
Dr. Sharp: Yes. We’ve been talking primarily about macro strategies for recruiting diverse trainees and changes within the systems and whatnot. I wonder if we can move to micro strategies a little bit more and detailed, I’m not sure if it’s one-to-one or [00:51:00] even small group intervention that comes to mind for you in this whole process
Dr. Lynette: Of how to save the world?
Dr. Sharp: Yes. How do we do that one person at a time?
Dr. Lynette: Well I think it depends on your position. Everyone out there, your position in your organization, and what you can do. What do you have the most control over within your organization? At a minimum, I think it’s very valuable to volunteer your time, all the time so that you don’t have to mentor students and trainees who are headed in this trajectory.
Even if you’re not of that same background, there are a lot of mentorship programs that have popped up through our various organizations. Some of them are structured, some of them might not be, [00:52:00] but just volunteering to share your knowledge and experience and your ability to navigate a system with those who you see struggling to get through it. I think each one of us can do that at least once.
Dr. Sharp: Yeah, that’s reasonable.
Dr. Lynette: I think that mentorship is one of the biggest things that we can do to create that infrastructure that supports people from marginalized backgrounds getting through this process. I think we can model really good consultation behavior and talk more with each other.
The other thing that wakes me up at 2 o’clock in the morning is what is our community nationwide going to look like in 5 years or 10 years. I feel like we’re becoming more divided and more isolated and I would [00:53:00] do anything, frankly, to reverse that process by creating connections with each other. I do want to call up Ted Judd and ask his opinion about a Peruvian patient and I want people to call me up and ask about people from New Mexico or the Navajo population. The more conversation we can have with each other, I think the better that’s going to be for each of us and for what we have to offer our trainees.
Dr. Sharp: I love that. I think a big question in all of this with so many of these related topics is, are there particular things that I would say majority culture folks can do to do more lifting in this whole dynamic so it is not solely pinned on marginalized folks?
[00:54:00] Dr. Lynette: I have to say, I was trained almost entirely by white men and they were wonderful. I adore them. They all treated me with respect. Almost like a little sister. I feel like they’ve been very invested in me and I’m so grateful. I’m so lucky. I know that that’s not necessarily the norm.So, I want to encourage people who have any level of privilege to invest in people who have less. That doesn’t mean doing things the way that you do them for everyone, looking at the strengths and weaknesses of a particular person and being a true mentor to that person.
I’ve been so lucky to have some of the greatest mentors ever. I would not be the neuropsychologist I am today without them. And so, finding that area where you can [00:55:00] contribute the most.
I know that there’s a lot of nerves about this. Like, I’m going to say something wrong. I’m going to be offensive. I’m going to use the wrong term and it’s going to upset this person who is from a different background from me and who I’m trying to help and mentor. But that too is consultation-worthy; reaching out to those of us who are from marginalized backgrounds, who are your colleagues, and asking us, how do I handle this particular situation with this Latina student, for example. I would love to get those questions. I would love to have more conversations like this where I can point out you can’t necessarily do things the same as you would for the majority of your trainees, but investing in training success and seeking consultation about that [00:56:00] is a fantastic thing to do.
Dr. Sharp: I appreciate the permission to do that. Yes.
Dr. Lynette: Please. I feel like I’m also volunteering myself for more work probably like 3 times already in this conversation. I’m absolutely happy to discuss any of these issues with others who struggle with this because I have seen my colleagues struggle with how do I help contribute to the solution to these problems and doing innovative things.
I’m pitching an outreach program, I’ll call it with didactics, that I would like to get some volunteers for and have free online didactics through my new position that I’m about to start next [00:57:00] month. We’re in talks about that and being open to ideas like that. We have virtual free neuropsych didactics that can reach rural areas.
And again, with all the time that we do not have, engaging in that kind of activity, I think helps us on a lot of levels. It reaches people who don’t have the resources readily available and it makes us who are in the field less scary. We’re not intimidating. We’re all just a bunch of nerds, and builds a community better, I think. Initiatives like that. I would encourage people to do it when they have the means.
Dr. Sharp: Absolutely. You mentioned your didactic program. I think that’s a great segue to talk more about your didactic program. What does that look like?
Dr. Lynette: If you took away [00:58:00] everything from my training and said, you only have one thing that’s going to make you a neuropsychologist, what’s it going to be? I would pick fact-finding. I love fact-finding. I think it is like a parlor trick to work through a case in real time and doing that on a weekly basis accomplishes a lot. You get case conceptualization, you get functional neuroanatomy, you get psychometrics, you get so much out of just going over case after case after case and you get prepared for the board exam because there is a fact-finding portion in the board exam.
I found once I left Chicago, where I trained, this is not standard in all training programs. At least it wasn’t at the time. I think it’s still. There are places where they don’t necessarily have the resources to do fact-finding weekly. [00:59:00] And that was disturbing to me. I wanted to provide that for people who could benefit from it.
I also got feedback from a lot of, particularly my Hispanic counterparts everywhere in the US that fact-finding was, they found it unpleasant. That broke my heart because I love it so much and you get so much out of it, but the Socratic method isn’t for everyone. That also comes from a very specific worldview and can feel very hostile, especially if you are the only person of color in the room and the person doing the fact-finding is privileged or part of the majority, or maybe really famous in the field and you feel intimidated.
And so I thought I could do this. I could be a fact-finder person and host online didactic. So, in 2017, I started online fact-finding before Zoom was cool. I did it over Zoom. We started with something like [01:00:00] 4 students, word of mouth spread, and so far since 2017, I’ve had more than 150 people come through. There’s no requirement. So people can sometimes just come for one if they want to, but I do have a registration on Zoom. And so I can count more than 150 people who have at least come once. I did it when I had covid, which might have set a bad example for people. I looked terrible and people were worried about me, but I couldn’t cancel fact-finding.
It warms my heart when people say that they value it and it’s their favorite time of the week, or that it helped them pass the board exam. I feel like it’s my own little, not necessarily podcast podcast, where I can do fact-finding with people who want to learn and I’m hoping to transition that [01:01:00] now that I am transitioning jobs and broaden and partner with an organization to get more volunteers because it has been a one-woman show pretty much for the past, Oh, gosh, 7 years. People got to be tired of hearing from me by now. I would like more people to get involved.
I think that solves a lot of problems; it gives people access to those of us who maybe have a big name somewhere. It offers opportunities to build connections with people that we wouldn’t maybe otherwise even meet. So, I’m hoping that I get this off the ground. We’re hoping it will be hosted by Project ECHO, which the values of Project ECHO are to reach out to, it started with physicians in rural areas who don’t have a lot of [01:02:00] colleagues to consult with. And now hopefully we can be part of that. That’s my new pie-in-the-sky plan.
Dr. Sharp: That sounds great. I’m going to go way back, I should have interrupted you, but I’m not a good interrupter. I know there are people listening who are wondering what fact-finding is; those who aren’t in formal neuropsych training. Tell us real quick when you say fact-finding what’s happening in these meetings.
Dr. Lynette: Fact-finding is you get almost no information and you have to figure out pretty much what is going on with a patient and what recommendations you are going to make. It is working a case in real-time and you only get information that you ask for. So, if you don’t ask about sleep, you don’t get information about sleep and you could miss something. And then you’re resulting diagnosis and recommendations could be off. [01:03:00] It’s starting with nothing; starting with I have a case, and people have to ask, okay, can you tell me the demographics of the patient to start early knowing nothing?
Dr. Sharp: I know you said it’s not for everybody, but I love that approach because it puts the onus. I think it builds interviewing skills, obviously, like there’s a big translation to what questions do you ask and ask good questions?
Dr. Lynette: Absolutely. In a group setting, at least mine, I don’t force people to engage. So when I do fact-finding, if you just want to watch and see how it works, students have come and done that, and to get that rhythm of, okay, here, we’re going to ask about current symptoms. We’re going to ask [01:04:00] about sleep. We’re going to ask about medical history and psychiatric history. So you get that flow and hit the major points. And it does, I hope, build interviewing skills, but also your whole case conceptualization gets faster the more that you do this. I love it too. I often say I get more out of it than the people who attend. And I think that’s true.
Dr. Sharp: There’s good research behind that. The facilitation or the teaching part of it is huge. Well, this is great. This is such a big topic to tackle. I hope that we’ve been able to take a couple of little steps here today and get some folks interested and maybe motivated to dive deeper and explore some of the resources, and pursue some of these strategies that you’ve talked about. I know you’re very [01:05:00] passionate in this area and there’s a lot that you have to offer and many other people as well. I hope it sparks some energy for folks around this.
Dr. Lynette: I hope so. I’ll be in touch so that you can present a case at fact-finding.
Dr. Sharp: Okay. I just got nervous. I was pretty chill this whole podcast, Lynette. And now, I just got a little nervous. That’d be awesome. Thank you so much for being here. It was a privilege to be able to talk to you for a little while.
Dr. Lynette: Well, thanks for having me. I love talking about this stuff. So I appreciate that you wanted to listen to it.
Dr. Sharp: You’re welcome back anytime.
Dr. Lynette: Thank you.
Dr. Sharp: All right y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those [01:06:00] out.
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