The fellowship consists of inpatient consultation experience (approximately 80% of training), elective experience which must include outpatient care (10%), and didactic training (10%).
Inpatient Consultation Experience
Fellows complete rotations at both the Yale-New Haven Hospital (6–9 months) and the VA Connecticut Healthcare System (3–6 months).
Yale-New Haven Hospital (YNHH) is a 700-adult bed tertiary care hospital. It is the primary teaching hospital for Yale University School of Medicine, with a full range of advanced specialized units. Recent research on our service has indicated that increased, proactive psychiatric consultation can improve care, decrease length of stay and reduce expenses (PubMed link). In consequence, the hospital has provided funding for a proactive, multidisciplinary team including psychiatrists, advanced practice nurses and social workers on certain units. Fellows will therefore have the opportunity to learn both the traditional consultation model and a newer more integrated model of consult service delivery. Click here for a complete description of our Behavioral Intervention Team.
The VA Connecticut Healthcare System (VACHS) in West Haven is a 200-bed tertiary care hospital also affiliated with the School of Medicine. VACHS offers a full range of inpatient, outpatient and rehabilitation care, in medicine, surgery, psychiatry, and neurology.
At both facilities, fellows work as part of a close-knit team. Fellows receive instruction in CL psychiatry at the bedside, and also assist in the education of residents in psychiatry, medical students, and other trainees.
Fellows typically complete three elective rotations, each four months in length, for one half day per week. Depending on the fellow’s educational goals, this schedule may be adjusted and fellows may chose to complete a larger number of rotations of shorter duration, or they may chose to concentrate on one or two experiences. The elective experience must include exposure to the outpatient consultation role.
Electives based at Yale New Haven Hospital include serving as psychiatric consultant in the primary clinic, HIV clinic, organ transplantation clinic, geriatric clinic, or psychiatric emergency department. Fellows might alternatively choose to develop a consultant role in a medical specialty clinic or an inpatient medical unit. Past fellows have served in the neurology clinic, or on inpatient medical units.
Electives based at the VA Connecticut Healthcare System include psychiatric consultation in the women’s clinic, the addiction medicine clinic, or the geriatric clinic. Fellows may also choose a cognitive behavioral therapy elective, which includes didactic seminars followed by supervised psychotherapy with relevant patients, or fellows may choose to work with the PTSD clinic, which is a well-known center for research and treatment in the condition.
Finally, fellows may elect to pursue a research project in CL psychiatry or related area of psychiatry, or other supervised academic work.
Fellows participate in weekly didactic seminars in psychosomatic medicine over the course of the year. The seminar series is divided into core topics in the initial part of the year, followed by specialized topics later in the year. Faculty are drawn from the psychosomatic program faculty, but also from a range of other medical specialties.
Another seminar series is oriented towards research methodology. Fellows learn about methodology for clinical trials, case control series, epidemiological research and other types of studies, and then participate in seminars where current published research is used to illustrate these techniques and their difficulties in the consultation population.
Fellows also participate in a case conference series, and have the opportunity to present cases and moderate discussion. The series offers a particular opportunity for multidisciplinary collaboration, both learning from other colleagues and teaching other colleagues.
In addition to these activities, many of the elective rotations offer site-specific rounds/seminars that include case based discussion and relevant literature review.