Consultation-Liaison Psychiatry Rotation

Contact: Theodore Stern, M.D.; [email protected]

Barbara Burns; [email protected]

Duration: 4-months; half-time involvement.

Educational Goals: This rotation seeks to familiarize psychiatric residents with the particularities of psychiatric pathology in medical and surgical patients. In general, psychiatric consultations are requested to deal with psychiatric presentations of “organic” disease (including the psychiatric complications and psychiatric reactions to “organic” disease), somatic presentations of psychiatric disease, and the management of psychiatric disease in chronic psychiatric patients with concurrent medical illness. More specifically, residents become familiar with the evaluation and treatment of anxiety, depression, delirium, dementia, and pain, and with the evaluation of decision-making capacity. Residents are frequently involved in the evaluation and management of suicide potential, the evaluation of a patient's mental status, the evaluation and management of grief, bereavement, and posttraumatic stress, and the management of substance use, abuse, intoxication, and withdrawal. Residents also gain expertise in the management of character-disordered patients and they assist medical and surgical teams in managing stressful reactions to patients.

Course Description: Residents spend approximately 20 hours per week on the Consultation-Liaison Service during their four-month rotation. This time is divided between direct patient care, supervision, and didactics:

1. Approximately ten hours per week are spent in direct patient care, including new evaluations and follow-ups of medically and surgically ill patients. Private and non-private patients from all services in the Massachusetts General Hospital (including all of the critical-care areas), and the Massachusetts Eye and Ear Infirmary (MEEI), are assigned to residents on a rotating basis.

2. Supervision includes five and one-half hours per week of C-L rounds, which involve presentation of the new patients and follow-ups, review of the differential diagnosis and treatment, and interviews of the patients by Dr. Stern. Each resident is also supervised for three to four hours per week by one of the permanent attendings of the C-L Service, who follows all the patients seen by residents. Each resident has two additional hours per week of individual supervision devoted to teaching, with one of the senior attendings of the C-L Service.

3. The didactic curriculum includes the weekly (90 minute) Psychosomatic Conference, where each resident will present (twice during the rotation), an in-depth review of a subject at the interface between Psychiatry and Medicine. In addition, a 20-hour seminar series is provided at the beginning of each rotation that covers practical topics specific to C-L Psychiatry.

Expectations: Each resident will perform approximately 50 new consultations during the four-month rotation. The resident is expected to see new patients within 24-hours from the time the consult is requested; residents will also see consults on an emergency basis during assigned times (on average three days/month). Attendance at rounds, psychosomatic conferences, and introductory seminars is mandatory. Residents prepare two Psychosomatic Conferences during a four-month rotation.