What Does a Day in the Life of a Consultation Liaison Psychiatry Fellow Look Like?

UT Southwestern Consultation-Liaison Psychiatry Fellowship Graduate Anne Louise Stewart, M.D., prepared the below description after many applicants asked her for an example of a day in the fellowship.

Parkland

The Parkland Memorial Hospital Consultation Liaison Psychiatry Service is a large service made up of multiple teams to serve Dallas County. On average, the daily number of consults is 10, with each resident and fellow taking 2 new consults per day. The service includes the Triage Team, made up of a postgraduate year 4 resident, a social worker, up to two advanced practice providers, and a psychiatry registered nurse. This team organizes the consults by acuity and complexity and assigns consults to the rest of the teams. The rest of the service includes two teaching teams, often with two residents who can be psychiatry residents, neurology/psychiatry residents, neurology residents, or internal medicine/psychiatry residents. A separate addiction team is composed of an addiction fellow, multiple psychiatry residents, two social workers, and an advanced practice provider. All these teams have medical students and often physician assistant students as learners. Also, a separate psychology team is staffed by three psychologists with multiple psychology interns. The Consultation Liaison Psychiatry Fellow will meet with Dr. Fernandez and Dr. Robinson to develop a personalized schedule based on interest, which can be a combination of experiences. An average work day is 8 am to 5 pm.

Parkland Faculty

Consultation-Liaison Psychiatry

Mallory Cash, M.D.

Pedro Fernandez, M.D.

Chandan Khandai, M.D.

Diana Robinson, M.D.

Addiction Psychiatry

Abbie Ewell, M.D.

Kapila Marambage, M.D.

General Psychiatry

Meitra Doty, M.D.

CL Psychiatry Fellow Inpatient Work at Parkland

  • Addiction: Rotate with Dr. Marambage and the addiction fellows treating substance use disorders and psychiatric comorbidities. On this team, one can gain more confidence treating complicated alcohol withdrawal, starting Suboxone (buprenorphine/naloxone) or methadone, treating stimulant withdrawal, and practicing motivational interviewing.
  • Junior Attending: Rotate as the junior attending for one of the general CL teaching teams. On this rotation, one can gain experience guiding junior residents in evaluations and treatment of all psychiatric illnesses found on the CL service with evidence-based care, practice giving feedback to junior residents, learn to attest notes, and improve teaching skills for learners at all levels. This is a rotation for a fellow interested in an academic career.
  • Psychiatric Early Assessment Team: The PEAT pilot program, started by Dr. Fernandez, screens the overnight admissions on one Parkland Hospital floor. The initial screening identifies risk factors for needing a psychiatric consultation. Secondary screening involves a structured evaluation of the patient to identify if a full psychiatric consultation is needed. This experience is important, as this model of psychiatric care delivery is becoming more common across the country.
  • Burn Trauma: The Parkland Burn Center is one of the largest in the United States, caring for over 2,000 burn victims annually. The CL fellow joins the weekly multidisciplinary burn meetings and provides the psychiatric consults for the burn trauma team. This rotation is for the fellow with interest in not only Burn Psychiatry but also ICU Psychiatry and who enjoys being part of a multidisciplinary team.
  • Ethics: The ethics rotation is for the CL fellow interested in the intersection of ethical dilemmas and psychiatry. The CL fellow will take the ethics consults that overlap with CL consults and have the opportunity to work with the Chair of the Parkland Ethics Committee on general ethics consults.

CL Psychiatry Fellow Outpatient Work at Parkland

  • Psycho-Oncology: Work with Dr. Robinson embedded within the outpatient hematology-oncology clinic treating specific cancer-related and cancer-treatment-related neuropsychiatric symptoms. The CL fellow will work with patients in all stages of illness, from diagnosis to survivorship. This experience also includes a psycho-oncology journal club that the fellow can continue throughout the year.
  • Maternal Fetal Medicine: This rotation is an experience for fellows interested in learning not only maternal fetal medicine psychiatry but also another model of collaborative care. The fellow works with Dr. Doty, providing informal and formal consults to the Parkland OB-GYN outpatient clinic.
  • Other Outpatient CL Rotations:
    • HIV Clinic
    • Integrated Pain Management Clinic
    • Primary Care-Diabetes

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Clements University Hospital

UT Southwestern Clements University Hospital Consultation Liaison Psychiatry Service comprises two teams made up of psychiatry residents, internal medicine/psychiatry resident, or neurology/psychiatry resident, and the CL faculty. Medical students and physician assistant students are learners on the service. The average number of consults on this service is 4 daily. The Consultation Liaison Psychiatry Fellow will work with Dr. Orsak to develop a schedule based on interest while at Clements, which can be a combination of rotations. In general, the workday is 9 am to 5 pm.

Clements University Hospital Faculty

Consultation Liaison Psychiatry

Cate Orsak, M.D.

Michael Rafferty, M.D.

Jasmine Stephens, M.D. (outpatient psychiatry women’s clinic)

Addiction Psychiatry

Sidarth Wakhlu, M.D.

General Psychiatry

Dennis Le, M.D.

Geriatric Psychiatry

Molly Camp, M.D.

Chad Lane, M.D.

Transplant Psychology

Ben Lippe, Ph.D.

CL Psychiatry Fellow Inpatient Work at Clements University Hospital

  • Junior Attending: One learns the triage process by holding the consult pager and dividing consults as appropriate into curbside consults or full consults. In addition, the CL fellow is the junior attending for the team. One can gain experience guiding junior residents in evaluations and treatment of all psychiatric illnesses found on the CL service with evidence-based care, practice giving feedback to junior residents, learning to attest notes, and improving teaching skills for learners at all levels. This rotation is for a fellow interested in an academic career.
  • Transplant Psychiatry: Work with Dr. Lippe, the transplant psychologist at Clements, providing transplant evaluations and participating in multidisciplinary lung and kidney transplant meetings to discuss listing patients for transplant. When a patient needs specific psychiatric treatment, the fellow has the opportunity to follow that patient while in the hospital with the CL psychiatry faculty.

CL Psychiatry Fellow Outpatient Work at Clements University Hospital

  • Geriatric/Neuropsychiatry: Work with Dr. Camp and Dr. Lane in an outpatient Geriatric Psychiatry clinic, helping patients and families navigate the challenges of neurocognitive disorders and other psychiatric illnesses. One can also spend time with one of the neuropsychologists, observing formal neuropsychology testing and feedback sessions.
  • Addiction Psychiatry: Work with Dr. Wakhlu in his outpatient addiction psychiatry clinic treating all substance use disorders. This rotation is good to follow the Parkland inpatient addiction rotation.
  • Other Outpatient CL Rotations:
    • Obstetrics/Women’s Health
    • Opportunity is also available to develop skills as a psychiatrist working in the emergency medicine department of a large academic medical center

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Sample CL Fellow Schedules

Junior Attending Rotation Example

Day/Time 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

8am – 12pm 

Psycho-oncology clinic 

Table rounds & rounding with junior resident 

Table rounds & rounding with junior resident 

Table rounds & rounding with junior resident 

Table rounds & rounding with junior resident 

12-1pm 

CL Conference 

No conference 

Psychiatry Grand Rounds 

No conference 

No conference 

1-3 pm 

Staffing cases with resident 

Staffing cases with resident 

Staffing cases with resident 

Staffing cases with resident 

Staffing cases with resident 

3-5 pm 

Staffing cases with resident & checking out with faculty 

Staffing cases with resident & checking out with faculty 

Staffing cases with resident & checking out with faculty 

3pm – Supervision with Dr. Orsak 

4 pm - Didactics 

Staffing cases with resident & checking out with faculty 

Combination Schedule Example

Day/Time 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

8am – 12 pm 

Rounds on Burn Trauma and Ethics patients 

Rounds with Addiction Team 

Rounds on Burn Trauma and Ethics patients 

Rounds on Burn Trauma and Ethics patients 

Rounds on Burn Trauma and Ethics patients 

12-1 pm 

CL Case Conference 

Ethics Meeting & Grand Rounds  

Psychiatry Grand Rounds 

Burn Trauma Multidisciplinary Meeting 

No conference 

1-3 pm 

Rounds continued 

Rounds with Addiction Team 

Rounds on Burn Trauma and Ethics patients 

Maternal Fetal Medicine Clinic 

Rounds on Burn Trauma and Ethics patients 

3-5 pm 

Rounds and checkout with faculty 

Rounds with Addiction Team 

3 pm – Supervision with Dr. Orsak 

4 pm - Didactics 

Maternal Fetal Medicine Clinic 

Rounds on Burn Trauma and Ethics patients 

Transplant and Addiction Schedule Example

Day/Time 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

8am – 12 pm 

Rounds on general CL service 

Lung transplant meeting & outpatient transplant evaluations 

Rounds on general CL service 

Rounds on general CL service 

Outpatient Addiction Clinic 

12-1 pm 

CL Conference 

No conference 

Psychiatry Grand Rounds 

No Conference 

No Conference 

1-3 pm 

Rounds on general CL service 

Inpatient transplant evaluations 

Rounds on general CL service 

Rounds on general CL service 

Outpatient Addiction Clinic 

3-5 pm 

Rounds on general CL service 

Kidney Transplant meeting 

Rounds on general CL service 

3 pm – Supervision with Dr. Orsak 

4 pm - Didactics 

Academic scholarly project time 

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