Integrating the Psychiatrist into an Internal Medicine Residency: An Opportunity for C-L Psychiatry

Background/Significance:
Aspects of Psychiatric knowledge are relevant to every area of Internal Medicine. Internal Medicine residency program directors have agreed that Psychiatry training is important, and 60-70% felt that training was minimal or suboptimal and more was needed (Chin, 2000; Leigh, 2008). A combination of consultation and liaison curriculum has had a greater effect size on primary care residents’ psychiatric knowledge than either alone (Cohen-Cole, 1993). We sought to integrate a Psychiatrist into an Internal Medicine residency to develop an integrated Psychiatry curriculum.

Methods:
In July 2019, a Psychiatrist with previous consultation-liaison experience joined the Internal Medicine residency faculty. A curriculum was developed incorporating established models of care such as proactive consultation and Collaborative Care, with additional didactics and learning modules to build knowledge. The curriculum addresses inpatient and outpatient topics, and is integrated into all years of the residency.

Results:
The integrated Psychiatric curriculum consists of yearly core didactics, co-rounds with inpatient resident services, outpatient psychiatric consultation through Collaborative Care, and a two-week rotation.

Psychiatrist co-rounds occur biweekly with inpatient teaching teams. Prior to co-rounds, a proactive chart review is completed to identify areas of discussion and need. Co-rounds educate not only residents, but also attendings who continue to reinforce topics between Psychiatrist co-rounds.

The Psychiatrist completes indirect consultations through Collaborative Care at the resident outpatient clinic site. Residents refer outpatients to Collaborative Care, communicate with the Care Manager, and follow-up on the Psychiatrist’s treatment recommendations. This builds their experience managing primary care outpatients with Psychiatric complaints.

Residents complete a two-week rotation in which they co-round and provide recommendations for Collaborative Care. Residents complete ten learning modules developed to review additional topics. Didactics focus on assimilating knowledge and clinical experiences gained throughout the rotation in the context of the residents’ post-graduation plans. Residents have consistently rated the rotation as good to excellent with positive comments relating to preparation for their future careers.

Discussion/Conclusion:
Integrating a Psychiatrist into an Internal Medicine residency program is a feasible and effective way to provide multidimensional Psychiatric education in residents’ existing core clinical experiences across an Internal Medicine residency. Consultation-Liaison psychiatrists are in an optimal position to serve in this role, expanding knowledge and understanding of basic hospital and primary care psychiatric management.

References:
1. Chin HP, Guillermo G, Prakken S, Eisendrath S. Psychiatry training in primary care medicine residency programs: a national survey. Psychosomatics. 2000;41:412-417.
2.Leigh H, Stewart D, Mallios R. Mental health and psychiatry training in primary care residency programs. Part I. Who teaches, where, when and how satisfied? Gen Hosp Psychiatry. 2008;28:189-194.
3. Cohen-Cole SA, Boker J, Bird J, et al. Psychiatric education improves Internists’ knowledge: a three-year randomized, controlled evaluation. Psychosomatic Medicine. 1993;55:212-218.