The one-year Consultation-Liaison Psychiatry Fellowship curriculum offers advanced training in a rich variety of care models in both inpatient and outpatient settings. Fellows are immersed in a multitude of clinical and educational experiences designed to optimize development of skills needed to appropriately screen, diagnose and treat psychiatric illness in people with additional complex medical comorbidity. Each fellow acquires specialized clinical skills strongly grounded in a theoretical knowledge base, while learning to work effectively with allied mental health professionals.
Didactic instruction — including lectures, seminars, assigned readings, written exercises and online modules — is provided to help residents build and integrate medical knowledge of the biomedical, clinical, epidemiological and social-behavioral sciences. Didactic instruction is a priority, and thus residents are not assigned clinical responsibilities during class time. Residents are required to attend at least 75% of classes.
At least three hours of protected educational time occurs weekly. All regularly scheduled didactics:
- Utilize a flipped-classroom, case-based design with instructional time devoted to applying knowledge and skills expected of an expert consultation-liaison psychiatrist;
- Are integrated into the fellow’s day of clinical experience at their primary training site;
- Cover in-depth medical knowledge content areas directly relevant to consults being encountered in their training site;
- Are specific to level of education expected of PGY-5;
- Are accompanied by pre-assigned evidence-based references for further inquiry.
Fellows accompany select program faculty for bi-weekly interviewing seminars, during which fellows interview a patient with a particularly challenging case. After a brief fellow case presentation, faculty and fellows together interview the patient and discuss key points from the evaluation. As the year progresses, fellows gain expertise in identifying and connecting with a patient’s personhood in challenging scenarios. They then take a more active role in leading the interviewing seminar with less-experienced trainees including residents and medical students.
Fellows develop skills in utilizing consult cases to appropriately formulate questions, search literature and critically appraise evidence-based literature with a focus on their own clinical decision-making. Once per month, seminal consultation-liaison articles are selected on the basis of clinical questions that arise during treatment rounds. During integrated liaison block assignments, the program director and fellows co-facilitate discussion of influential articles pertaining to psychiatric evaluation and treatment of patients in the liaison specialty of the month.
Fellows complete 12 rotation blocks of clinical service throughout the program. Blocks are four months each and include inpatient care, outpatient care, electives and value-based care selectives.
Throughout training, fellows engage in patient care by obtaining patients’ medical histories; completing mental status examinations; reviewing records and test results; developing complete differential diagnoses; creating comprehensive treatment plans that include other providers; and identifying and providing psychotherapeutic and somatic interventions. Fellows also coordinate discharge plans with families and outpatient providers and assess capacity and patient autonomy pertaining to medical, legal, ethical and end-of-life issues.
By the end of training, fellows are able to describe psychiatric and psychological complications of medical/surgical/obstetrical illnesses and treatment; psychopharmacological considerations in treating people who are psychiatrically and medically ill; and the evaluation and management of: delirium, dementia and other cognitive disorders; somatoform disorders and chronic pain; and people who are intoxicated and/or withdrawing from substances.
Fellows acquire interpersonal and communication skills by establishing a therapeutic rapport during patient interviews; relaying written and verbal findings and recommendations to consulting physicians; identifying and addressing transference/countertransference issues; and providing guidance and resources to hospital treatment teams, patients and their families.
Training prepares fellows to identify deficiencies in their own skills and knowledge; accurately locate a diverse range of resources to addresses these deficiencies; critically evaluate the quality of these resources and apply them to clinical practice; facilitate the learning of other health care professionals and stay current on psychosomatic literature.
Throughout training, fellows learn methods of professionalism, such as accepting and modeling appropriate responsibility for patient care; following policy manual descriptions of attendance, responsibilities, appearance and procedures; appropriately delegating to others and asking for help when necessary; and acknowledging errors and seeking and incorporating feedback.
Fellows learn to lead and coordinate a multidisciplinary treatment team; identify and utilize appropriate hospital and community resources; achieve optimal patient care given system limitations; and recognize and implement cost-effective treatment strategies.