PGY-1 and PGY-2 Consultation-Liaison Rotation Learning Objectives

Patient Care

The PGY-1  resident will be able to:

  • Fully gather data from all available sources, including the patient, paper and electronic chart (including physician's notes, nursing staff notes, social work notes, other staff member notes, medication administration records), hospital staff, and family or friends of the patient
  • Adapt his/her interview style to suit the clinical setting and medical and/or psychiatric condition of the patient (i.e. communicate effectively with patients on ventilators, recognize stress and fatigue in patients, communicate effectively with difficult or agitated patients, prioritize questions and perform multiple, brief interviews if necessary)
  • Ascertain all required information related to a patient's family history, personal history, substance history, premorbid personality, allergies, past medical history, current medications, review of systems, detailed past psychiatric history, detailed history of present illness (including history of present medical illness), and mental status examination, including MMSE
  • Thoroughly formulate a patient's case based upon the above information with particular consideration to perspectives of disease, temperament, behaviors, and life story
  • Comprehensively assess self-injury risk, risk of injury to others, dangerousness and appropriate use of constant observation
  • Accurately assess patients for capacity to make medical decisions (“competency”) in medically ill patients
  • Perform routine follow up of already evaluated patients, monitor the patient's course during hospitalization and provide continuing input (both pharmacologic and psychotherapeutic) as needed to the patient and treating team
  • Accurately and fully document all elements described above on the resident physician consultation form as well as the patient's chart, including medical and legal facets, when necessary
  • Remain aware of the overall medical status of the patient and general disposition plans as the patient's hospital course proceeds
  • In addition, the PGY-2 resident will demonstrate improvement in formulative abilities with progressive experience on the consultation service
  • The PGY-2 resident will make initial treatment recommendations and assessments of need for immediate intervention
  • The PGY-2 resident will handle more complex CL cases

Interpersonal and Communication Skills

The PGY-1 resident will be able to:

  • Facilitate the consulting service's ability to formulate a clinical question relevant to our capacity to aid in the care of the patient
  • Directly and promptly reply verbally to the consulting service the clinical impression of the patient as well as specific treatment recommendations and guidelines
  • Document in the medical chart all follow up evaluations of patients remaining in the general hospital, including subjective matters, mental status exam and MMSE (if needed in follow up), continued assessment as well as ongoing recommendations
  • Advise and guide consulting services about the role of medical disease in a patient's presentation, further diagnostic testing required to clarify the clinical picture and medications that are accordingly recommended
  • Advise and educate consulting services about the current diagnostic assessment of the patient and, if applicable, how it may be distinguished from the working diagnosis prior to psychiatric consultation
  • Work as a valued member of a multidisciplinary staff to maximize the care of complex medically ill patients
  • Provide appropriate direction to consulting services regarding management of dangerous, agitated and/or psychotic patients who are treated on general hospital units
  • Develop a therapeutic alliance with respect for privacy in medically ill patients
  • In addition, the PGY-2 resident will provide supervision and teaching to the medical students, PGY-1 psychiatry resident and other non-psychiatry residents on the CL service
  • The PGY-2 resident will further develop interdepartmental alliances via serving as a respected medical colleague in the hospital and attending multidisciplinary task-specific meetings about problematic cases

Medical Knowledge

The PGY-1 resident will be able to:

  • Understand the indications for a variety of somatic therapies in medical and surgical patients
  • Understand the use of psychotropic medications and ECT in medical and surgical patients and appreciate physiologic effects, contraindications, drug interactions, and dosing concerns
  • Understand the use of psychosocial treatments including supportive psychotherapy, behavioral management techniques, family therapy, and psychoeducation
  • Understand risk factors, recent precipitants, classical and atypical presentations, screening tests, etiologies, appropriate medical evaluation, and the comprehensive treatment strategies of delirium
  • Effectively advise medical and surgical teams on appropriate use of antipsychotics and benzodiazepines in agitated patients
  • Understand how to perform a comprehensive evaluation for organic causes of psychiatric symptoms or syndromes
  • Distinguish demoralization from other depressive syndromes in the medical setting
  • Understand the medications that have psychiatric symptoms as side effects
  • Understand classes of or specific drug interactions between psychotropic medications and non-psychotropic medications
  • Understand the appropriate indications and dosing strategies for psychostimulants in the medically ill
  • Understand the clinical settings that further justify continued medical or surgical inpatient admission while a patient's disposition is coordinated
  • Understand the appropriate use, risks and benefits, and dosing strategies of psychotropic medications in pregnancy
  • Understand the clinical syndrome of NMS and appreciate its evaluation and management
  • Understand how to perform a pre-transplant psychiatric evaluation
  • Understand the differences between somatization disorder, conversion disorder, factitious disorder and malingering
  • Understand the core concepts of competency and the legal process that may be invoked once a patient has been deemed incompetent
  • In addition, the PGY-2 resident will have a more comprehensive knowledge base in the areas outlined above, and will be able to convey that knowledge to medical students and medical colleagues.

Professionalism

The PGY-1 resident will:

  • Dress in professional business attire at all times defined as:
    • Wearing a clean white coat in all clinical settings involving contact with medical colleagues or patients
    • Replacing scrub outfits with standard professional work attire when post-call
  • Obtain and provide cross-coverage as needed during one's absence or during other scheduled clinical responsibilities
  • Behave collegially and demonstrate willingness to help other members of the team and other departments
  • Assist with and ask for assistance in the case of emergencies or clinical uncertainty
  • Maintain a thorough list of current patients being followed on the consultation service, addressing pertinent issues for patients, including current medication regimens
  • Demonstrate a commitment to ethical principles when dealing with patients, families, and colleagues
  • In addition, the PGY-2 resident will provide role modeling and supervision for the PGY-1 resident and medical students

Systems based practice

The PGY-2 resident will:

  • run the Consult Liaison team, supervising schedules, cross-coverage and assignment of patients
  • negotiate workload issues among team members
  • demonstrate an understanding of the role of the CL Team in providing care vs providing consultation to the medical/surgical services, and work effectively and collaboratively with consulting teams.