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Service Based Teaching in Consultation-Liaison Psychiatry:
Development and Results of a Novel Curriculum
Kristen Brooks, MD; J. Jewel Shim, MD
University of California San Francisco Departments of Psychiatry
BACKGROUND AND OBJECTIVE
Historically, teaching on the Consultation-Liaison
Psychiatry (CLP) Service was case-based. As a result,
second year residents (R2s) were not systematically
exposed to core CLP topics. With this project we
developed and implemented a formalized didactic
curriculum for R2s rotating on the CLP Service.
METHODS
Content derived from multiple sources:
•Literature on service-based curricula in CLP
•ACGME and RRC requirements in CLP
•Residency Training Program core requirements
•Academy of Psychosomatic Medicine training
guidelines
•Faculty input
Structured to facilitate learning:
•Thirty minute didactic sessions facilitate high-yield,
focused learning on a busy clinical service
•Content begins with the most urgent topics, and moves
through diagnostic categories, covering diagnosis and
management issues
Teaching techniques vary to best cover a topic:
•Didactics
•Case-based learning
•Evidence Based Medicine
REFERENCES
1. ACGME Program Requirements for Graduate Medical Education
in Psychiatry; Revised Common Program Requirements Effective: July 1,
2007
2. Recommended Guidelines for Consultation-Liaison Psychiatry Training in
Psychiatry Residency Programs: A Report from the APM Task Force on
Psychiatric Resident Training in Consultation-Liaison Psychiatry. Gitlin,et al.
ORIGINAL CURRICULUM CONTENT
DISSEMINATION
Initial 12 week course:
Dissemination is planned in 3 ways:
1. Service: Ensure sustainability
2. Department: Application of teaching principles and
structure; collaboration within our multi-site system
3. National: Poster presentation in the academic psychiatry
and CLP communities; publish the curriculum with both
objective and subjective data
Introduction to Consult-Liaison Psychiatry, PGY-2 Guided learning objectives
How to take and complete a consult – effectively working with consulting services, gathering data,
evaluating the patient, and providing recommendations
Delirium: identification, differential, management, follow up
Capacity evaluations: basic principles and concepts
“My Patient Seems Sad”: Etiologies and Management of Depression in the Hospital Setting
“My Patient is Acting Weird”: Etiologies and Management of Psychosis and Mania in the Hospital
Setting
Common Psychiatric Sequelae of Neurologic Illness
Cancer: The Psychiatric Ramifications of Diagnosis, Disease, and Treatment
Somatoform Disorders: Identification and Management in the Inpatient Setting
Personality Disorders on the Hospital Unit: Patient and Team Management
Brief Therapy in the Hospital Setting
Feedback
EVALUATION STRATEGIES
Anonymous,
end of rotation
summative feedback
Feedback incorporated
rotation to rotation
Ongoing verbal
feedback
Feedback incorporated
week to week
Results:
•Content adjusted
•Sequence streamlined
•Curriculum expanded
FEEDBACK FROM RESIDENTS:
“Weekly didactics are well-organized and thought-out, great quality. The teaching is
thorough, engaging, up to date, and diverse”
“Teaching is outstanding, including the organization of teaching, with the time for teaching at generally
the same time each morning”
“Excellent teaching! Rotation takes advantage of uneven flow with ample didactics and ad hoc
teaching”
“I developed increased confidence in my clinical decision-making skills on this rotation more than
any other rotation”
“Definitely one of the best educational experiences as a resident I have had thus far”
“Teaching sessions were frequent and useful”
•100% of residents agree (18%) or strongly agree (82%) that “the teaching is of high quality”
and that the rotation is “an excellent overall educational experience”
WHERE WE ARE NOW, AND THE FUTURE:
Based on positive feedback, we have implemented the
following expansions:
• 28 lectures on core topics in CLP following a similar
developmental plan
• 5 Evidence Based Medicine literature reviews on key topics
in CLP
 Feedback on the current curriculum structure is
overwhelmingly positive and this rotation is amongst the most
highly ranked by residents in terms of education and learning
Ongoing research: Obtain quantitative data on the
curriculum’s effectiveness, including early and end of rotation
evaluation of:
•Resident self-evaluation of knowledge and competency in
core CLP topics
•Attending evaluation of residents using 2 standardized
cases with a systematic scoring system. Residents will be
evaluated on their ability to demonstrate:
•Application of DSM IV criteria in the medically ill
•Recognition of common medication issues
•Consideration of medical co-morbidities
•Identification of systems issues
•Appropriate use of collateral
Supported by: UCSF Psychiatry Faculty Fellowship in Educational Scholarship