The fellowship is composed of organized clinical experiences, didactic instruction with formal seminars and clinical supervision, and research training.
The first part of the clinical experience includes both inpatient and ambulatory consultations. General hospital consultations are performed on a daily basis when advice about patient diagnosis and management are requested from the medical staff. A unique aspect of our fellowship program is that fellows do not assess patients admitted for self-harm attempts as this skill is considered to be comprehensively covered during general psychiatric residency training. This feature allows our fellows to have sufficient time to work with patients with comorbid medical conditions. Ambulatory consultation experience is provided through specialized clinics at Fairfax and GW. The fellow will have a unique opportunity to understand the genesis of a psychiatric consultation, the practice of consultation psychiatry, and the management of clinical problems within a wide variety of settings. Fellows also execute direct orders regarding patient care, rather than simply provide recommendations about care, another feature of the program that is often not available at other hospitals. This provides the fellow with an opportunity to function more closely as an “attending-level” psychiatrist in the consultation service.
The second part of the clinical experience is that of liaison activities. These activities take the form of “applied medical sociology,” wherein the fellow truly obtains a longitudinal perspective of the unique patient characteristics, stresses, and strains which arise on a medical/surgical unit. Such background serves both to complement and to expand on the consultative experience. Liaison activities include working with clinical programs: oncology, organ transplantation, HIV, geriatric medicine, ob/gyn, as well as cardiac and pulmonary rehabilitation.
The final part of the clinical experience is the elective opportunity to provide ongoing psychotherapy while under supervision. Each fellow may manage approximately five outpatient psychiatric patients. This experience provides an opportunity for further development of psychotherapeutic skills and underscores the psychiatrist's heritage as a sophisticated psychotherapist. The patients receiving treatment may have a spectrum of psychological problems that are psychosocial sequelae of chronic medical illnesses.
Our didactic program complements the clinical experience (see Appendix B). Regular attending rounds by a consultation-liaison faculty member ensure that every patient interaction in psychiatric consultation is supervised. This serves as an important framework for the development of skills in consultation-liaison psychiatry. Opportunities for supervision of ongoing liaison projects are also readily available. Formal course work is included which covers a broad range of topics within and related to consultation-liaison psychiatry. This includes regularly scheduled seminars on classic C-L literature, current clinical practices and developments, C-L cases, behavioral neurology, and aspects of illness impacting pediatric populations. Furthermore, there is a research seminar designed to assist the fellow in developing clinical research skills. Overall, the curriculum will serve to build a solid foundation in consultation-liaison psychiatry for the fellow.
The research element of the fellowship is viewed as an important educational component of the program. It is included because of the essential nature of clinical research within psychiatry. Activities are designed to teach organization, rigor, and better appreciation of investigatory studies. Research skills also provide the fellow with the basis for pursuing future academic interests.
Any fellowship within a medical subspecialty should offer a research experience. It is the philosophy of the Inova Fairfax-GWU Psychosomatic Fellowship that such research be conducted in a structured and supportive environment. Examples of prior studies include the role of psychiatric consultations among family practitioners, the relationship of alexithymia in abnormal illness behaviors, sexual dysfunction in the medically ill, compliance with psychiatric consultations, and a variety of other topics within consultation-liaison psychiatry. In addition to the more extensive, multi-subject investigations, interesting case reports have also been generated by previous fellows in our program.
Excellent library resources, secretarial and manuscript capabilities, statistical consultation, computer and data-based help are all readily available to facilitate research projects. Instruction and supervision by faculty members are essential components of such activities. An ongoing research seminar where projects are evaluated, reviewed, and discussed makes this an important and essential element of the fellowship. Many of the graduates of the fellowship have published at least one paper in a peer-reviewed scientific periodical.