The Fellowship provides immersion in an array of clinical environments and experiences, emphasizing its program 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 psychosomatic medicine project suitable for a poster presentation at the national level, and a written Medical Ethics case summary suitable for publication at a national level.
The Psychiatric Consultation Liaison Service (PCLS) – The PCLS team at URMC 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 both Psychiatry and Psychosomatic Medicine. 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 also do some inpatient consultations to the transplant programs. 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; the VAD team follows over 150 VAD patients. It has living kidney and liver donor programs. Transplant Psychiatry has a full-time presence in these programs. This Fellowship rotation provides psychiatric consultation to these transplant programs as well as the Ventricular Assist Device (VAD) and total artificial heart 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 3 months.
The Medicine In Psychiatry Service (MIPS)
The MIPS team is comprised of primary care physicians interested in the biopsychosocial approach to patients, and specializes in the medical care of patients with psychiatric and behavioral difficulties. URMC has one medical unit dedicated to the MIPS; in addition, MIPS has a community-based outpatient practice, where the patient population is comprised of those with significant psychiatric issues. The inpatient unit is directed by Marsha Wittink, MD, MBe and the 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, providing case- specific consultation to the team with or without doing formal psychiatric consultations, and the Fellow will work with the psychology staff to learn about bedside counseling techniques. An important aspect of this rotation is learning about and experiencing an embedded model of psychiatric consultation. In the process, Fellows will learn how internists think and work. 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 extended across parts of the Fellowship year 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, and offers both inpatient and outpatient services. It is comprised of epileptologists, neurosurgeons, neuropsychologists, a psychologist, a part-time psychiatrist, neuroradiologists, researchers, nurse practitioners, nurses and specialized technicians. The Fellowship rotation occurs on the inpatient Epilepsy service. The Fellow will round with epileptologists and attend unit meetings, including the EEG conferences, and will work up admitted patients from a psychosocial perspective. This rotation exposes the Fellow to the interface of psychiatry and epilepsy, and there will be an emphasis on somatoform disorders. The Fellow will have access to 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. The Fellow will participate on the Consultation Service. Through clinical cases and readings, this full-time rotation will provide 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 has the scholarly activity of a written Ethics case commentary suitable for publication. This is a 1-month requirement.
Palliative Care Consultation Service
The URMC Palliative Care Program formally began in 1999 with an innovative educational program for undergraduate medical students. Toward the end of 2001, URMC initiated an inpatient consultation service, which has grown to now include 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.
The URMC Headache Center is dedicated to providing the highest level of care for people who suffer from chronic headache disorders. Its team of physicians, nurse practitioners, nurses, and techs work to help patients regain their lives. The Headache Disorders Division of Neurology is headed by Raissa Villanueva, MD, PhD. This half-time outpatient rotation will give the Fellow an opportunity to learn about the interplay between medical and psychological issues. Working directly with the neurologists who specialize in headache, the Fellow will have the opportunity to learn about pain and somatization while exploring how neurologists think. The Fellow can learn about providing psychiatric input to the neurologists on patients being seen for headache complaints. This half-day elective is for a minimum of 2 weeks.
The URMC Pain Treatment Center, part of Strong Memorial Hospital, is the only center of its kind in the area, and offers an in-depth, holistic, 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 complaints while better understand pain syndromes and multidisciplinary treatment options. The Fellow will become more facile with narcotic pain medications and with an array of possible treatments for pain syndromes, both pharmacological and nonpharmacological. This 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 psychosomatic medicine. 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.
UR Medicine Obstetrics and Gynecology offers care to patients by physicians who were 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 obstetrics and gynecology services ranging from a patient’s initial exam, to childbirth and through menopause and beyond. Mental health care is provided through an integrated model within the practice. This part-time outpatient rotation is overseen by Jennifer Richman M.D. In this co-located setting, the Fellow will learn about how ObGyn issues intertwine with psychiatric issues. Because this is a part-time experience, it would be arranged longitudinally throughout as much of the Fellowship year as possible.
Telemedicine and telehealth are initiatives that are growing at an exponential rate in tandem with advances in technology – by some estimates 7 million patients will utilize telemedicine and telehealth services by 2018. These services can deliver specialty care to difficult-to-access rural areas, and can improve continuity of care, treatment adherence and coordination of care. The Department of Psychiatry has been actively involved in telepsychiatry. This is a half-day per week elective provides Fellows with the opportunity to learn about providing psychiatric care at a distance. Patients are ‘referred’ from URMC-affiliated regional hospitals and ERs. During this rotation the Fellow can also have exposure to the ECHO GEMH (Extension for Community Healthcare Outcomes in Geriatric Mental Health) project. This project utilizes simple, widely available and inexpensive web-based video conferencing technologies to remove geographical barriers and facilitate care. The Telepsychiatry rotation is overseen by its Medical Director, Jennifer Richman M.D. Because this is a part-time experience, it would be arranged longitudinally throughout as much of the Fellowship year as possible.
IMPACT Model of e-Consultation
The Improving Mood: Providing Access to Collaborative Treatment (IMPACT) is an evidence-based model for treating depression in primary care. This type of mental health consultation is provided by the Department of Psychiatry at Highland Family Medicine (HFM). HFM is the home of the Department of Family Medicine. It is a large practice consisting of 20,000 patients from 7,000 families who come from neighborhoods throughout Rochester, and represent the full spectrum of age, race, and socioeconomic backgrounds. The practice has seven teams of faculty and resident physicians, nurse practitioners, registered nurses, medical assistants, and secretaries. This Fellowship elective is a half-day per week experience that is overseen by Michael Privitera, MD, Professor of Psychiatry, who is highly experienced in psychiatric consultation. Because this is a part-time experience, it would be arranged longitudinally over at least several weeks.
In addition to these electives, the Fellowship is interested in providing its Fellows with experiences in other areas that might be 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.