The Fellowship emphasizes its strengths of Transplant Psychiatry, Neurology and collaborative care with Medicine. There are required rotations and the opportunity for electives. Didactic offerings include a weekly lecture series, a monthly Journal Club, and the weekly Department of Psychiatry Grand Rounds. The Fellow will receive two 1-hour supervisory sessions weekly, in addition to the rotation-specific ‘bedside’ supervision. Scholarly activity will include a Consultation-Liaison Psychiatry project suitable for a poster presentation at the national level, and a written Medical Ethics case summary suitable for publication.
Psychiatric Consultation Liaison Service
The Psychiatric Consultation Liaison Service (PCLS) provides consultation to Strong Memorial Hospital, the center of the URMC health care delivery system. Strong Memorial has 800 patient beds and approximately 1400 full-time faculty members and 650 voluntary clinical faculty members organized into 32 departments and centers. It is the only Level 1 Trauma Center and quaternary care center in the region. The director of the PCLS is Jennifer Richman M.D., who is board certified in Psychiatry and Consultation-Liaison Psychiatry. It is staffed by psychiatrists and advanced practice nurses, and provides training to PGY-2 residents, Neurology residents on required two-week CL rotations, and medical students. While on this service, the Fellow will do some inpatient consultations to the transplant programs. The fellow will also participate in telepsychiatry consultations to URMC affiliated regional hospitals and ERs, and can have exposure to the ECHO GEMH (Extension for Community Healthcare Outcomes in Geriatric Mental Health) project. This full-time rotation is a minimum of 3 months.
Organ Transplant is a signature program of URMC, offering liver, kidney and heart transplantation. Annually, there are 100-150 transplants in these programs. In addition, there is a Total Artificial Heart program and a robust VAD program. The VAD team follows over 150 VAD patients. Transplant Psychiatry has a full-time consultative presence in these programs. The transplant psychiatrist is Mark Nickels, MD, who has been involved with the transplant programs since 1998. The clinical work occurs in inpatient and outpatient settings, and involves candidacy assessments of both recipients and donors, consultative short-term management of psychiatric issues, assessment and management of delirium, and helping patients and families with emotional adjustment when dealing with worsening health and also during recuperation. The Fellow will participate in recipient listing and donor evaluation committee meetings. This full-time rotation is a minimum of 2 months.
The Medicine In Psychiatry Service (MIPS)
The MIPS is a team comprised of primary care physicians interested in the biopsychosocial approach to patients specializing in the medical care of patients with psychiatric and behavioral difficulties. URMC has one inpatient medical unit dedicated to the MIPS; in addition, MIPS has a community-based outpatient practice. The inpatient unit is directed by Marsha Wittink, MD, MBe, a family practitioner and the MIPS program is overseen by Telva Olivares, MD, who is board certified in both Internal Medicine and Psychiatry. The Fellow will work on the inpatient unit and round with the medical team and provide case consultations and education to the team, will provide formal psychiatric consultations, and will work with the on-unit psychology staff. An important aspect of this rotation is learning about and experiencing an embedded model of psychiatric consultation. This full-time rotation is a minimum of 1 month. The rotation can also include a half-day experience in the MIPS outpatient office, an experience that could be longitudinal depending on the interests of the Fellow.
The General Neurology Consultation Service
This busy service provides neurology consultations to Strong Memorial Hospital inpatients. The emphasis of this rotation is on learning about neurological issues and especially how these can intertwine with psychiatric issues, both as cause and effect. While there may be opportunity for the Fellow to offer psychiatric input on referred cases, the Fellow will work with the Neurology residents and assist in working up cases from the neurological perspective. During the rotation, the Fellow will attend Neurology conferences and rounds, in addition to the didactics offered through the Fellowship. This full-time rotation is a minimum of 2 weeks.
The Epilepsy Center
The Epilepsy Center is the only certified, level 4 Epilepsy Center in the region. Its multidisciplinary team offers both inpatient and outpatient services. The rotation occurs on the inpatient Epilepsy service, where the Fellow will round with epileptologists and attend unit meetings, and will work up admitted patients from a psychosocial perspective. This rotation exposes the Fellow to the interface of psychiatry and epilepsy, with an emphasis on somatic symptom disorders through contact with the Epilepsy Center’s dedicated psychologist and neuropsychologist, both of whom have been with the Epilepsy Center for over 20 years. This is a full-time 1-month rotation. Fellows can have the opportunity to spend one half-day per week in the outpatient Epilepsy Center working with the Epilepsy Center psychiatrist.
The Clinical Ethics Consultation Service
This service is part of the Division of Medical Humanities and Ethics. The service helps patients, families, and caregivers to explore the issues and choices surrounding difficult decisions. Clinical ethics consultations are typically arranged by attending physicians or other members of the healthcare teams, although patients, family members, or others may contact the Service directly. Through both clinical cases and readings, this full-time rotation provides exposure to basic concepts in bioethics as well as more in-depth consideration of the often complex ethical issues that can arise in the care of medical and surgical patients. The rotation includes preparation of a written Ethics case commentary suitable for publication. This is a 1-month requirement.
Palliative Care Consultation Service
The URMC Palliative Care Consultation Service began inpatient consultations in 2001. The service now includes 11 board-certified physician consultants, four board-certified nurse practitioners, medical residents, and an experienced multidisciplinary team. In addition to doing consultations on inpatients in Strong Memorial Hospital, the program provides outpatient and in-home consultations. The Palliative Care Program is designed to help alleviate patient suffering for those experiencing serious illness through high-quality pain and symptom management, patient-centered care, and by providing support for patients or family members and friends. In addition to learning about palliative care, during this rotation the Fellow can learn about handling patients and families when dealing with difficult clinical news or when in end-of-life situations. Additionally, the Fellow can learn about working with providers who refer such cases. This full-time rotation is a minimum 2-week requirement.
Collaborative and Integrated Care
The Department of Psychiatry provides psychiatric care in a variety of Internal Medicine and Family Medicine practices, both large and small, located throughout Rochester and the region. Some practices are Medical Homes, and some operate under a value-based payment structure. In some sites, the psychiatric care is co-located, and in others it is integrated; at some sites the IMPACT (Improving Mood: Providing Access to Collaborative Treatment) model is used. The IMPACT model is an evidence-based model for treating depression in primary care. In some sites, e-consultation is part of the care. By being exposed to different models of integration and to different practices throughout the region, the Fellow can explore not only the clinical work in differing patient populations, but also how various care models can work. Depending on the practice sites involved, the Fellow has the opportunity to work with several different CL Psychiatrists.
UR Medicine Obstetrics and Gynecology physicians are ranked among the nation's best in U.S. News & World Report's America's Best Hospitals list. The Women’s Health Practice, located in a community office nearby URMC, offers comprehensive outpatient Ob/Gyn services ranging from initial exam to childbirth and through menopause and beyond. Mental health care is provided within the practice. In this co-located setting, the Fellow will learn about how Ob/Gyn issues can intertwine with psychiatric issues. This part-time outpatient rotation is overseen by Aspen Ainsworth M.D. Because this is a part-time experience, it would be arranged longitudinally throughout as much of the Fellowship year as possible.
This rotation occurs at UR Medicine’s Wilmot Cancer Institute (WCI), where the Fellow can learn about management of psychiatric issues in cancer patients and their families. WCI features an 86-bed cancer center with 11 outpatient locations throughout the Rochester and Finger Lakes region. It cares for more than 5000 patients, and has over 2900 inpatient admissions a year. WCI, a component of Strong Memorial Hospital, is one of upstate New York’s largest blood and marrow transplant programs and the Rochester area’s only ACOS-accredited breast cancer center. Mental health care at WCI is provided by a dedicated mental health therapist, the psycho-oncologist and PCLS. This elective includes both inpatient and outpatient experiences, and is overseen by Jennifer Richman, MD.
The URMC Headache Center is dedicated to providing the highest level of care for people who suffer from chronic headache disorders. The Headache Disorders Division of Neurology is headed by Raissa Villanueva, MD, PhD. Working directly with the neurologists, this half-time outpatient rotation will give the Fellow an opportunity to learn about the interplay between medical and psychological issues, including somatization while exploring how neurologists think. This half-day elective is for a minimum of 2 weeks.
The Division of Neuroradiology is one of the specialties of the URMC Imaging Sciences Department. It has six faculty members and two physician assistants, and has its own Fellowship. The Division operates three MR scanners, five CT scanners, and has a biplane neuroangiography room. Neuroimaging has at times an important role in the practice of Consultation-Liaison Psychiatry. This half-time rotation will help the Fellow understand when neuroimaging, and which tests, can be helpful, and to gain some experience reading scans. This elective is for a minimum of 2 weeks.
The URMC Pain Treatment Center, part of Strong Memorial Hospital, offers a multidisciplinary approach that includes psychological, behavioral and rehabilitative care. This full-time outpatient rotation offers the opportunity for the Fellow to learn about assessing pain while better understanding pain syndromes and treatment options, both pharmacological and nonpharmacological. This elective is for a minimum of 2 weeks.
In addition to these electives, the Fellowship is interested in providing its Fellows with experiences in areas that are of interest. Because URMC is an integrated academic health center that has specialists in every area of medicine (including featured areas such as Neuromedicine (Neurology and Neurosurgery), Heart and Vascular Care, Primary Care, Cancer Care, Diabetes, and others), other electives can be arranged, through discussions with the Program Director.