Health Psychology/Consultation Liaison
The Health Psychology track teaches the medicine-psychology interface so those with career goals involving working with the medically ill have the knowledge and skill base needed to work closely with physicians. The primary emphasis is to help the intern gain a keen sense of the effects of medical disorders and therapies on behavior, behavioral influences on symptoms and compliance, and placebo effects so as to develop strong differential diagnostic skills when working with the medically ill. Learning to communicate effectively with physicians and other health care providers is another major goal.
Interns complete three four-month long rotations spanning a wide variety of services. Possible rotations for the internship year include:
General Consultation-Liaison Service
The intern on the general Consultation-Liaison (C/L) service will provide consultations for inpatients on both the general medical and specialty floors. Brief follow-ups are often conducted while the patient remains in the hospital. Common reasons for consultation include depression, anxiety, suicidal ideation, behavioral changes, psychosis, delirium, cognitive impairment, substance abuse and decisional capacity. The intern will gain substantial knowledge in differentiating between medical and psychiatric illness and how these impact each other. Interns can also expect to learn general medicine, interpreting lab and imaging results, and pharmacology. Team meetings with senior staff and psychiatry residents occur daily and supervision occurs regularly throughout the day as you complete consults.
Internal Medicine/Primary Care
The intern on the Internal Medicine rotation will provide psychological evaluations for outpatients in the Internal Medicine Primary Care clinic. Reasons for consultation requests include depression, anxiety, pain management, weight management, adjustment to life stressors, noncompliance with medical regimens, substance abuse, psychosis and somatoform disorders. Most of these patients also have co-occurring chronic illnesses. Consults are typically received with the “warm-handoff” model from the patients’ primary care physicians. Other opportunities include brief follow-up with patients, participation in interdisciplinary staff meetings, resident teachings and developing and implementing psychotherapy groups. Currently, the intern co-leads a 6 week behavioral weight management psychotherapy group. Interns will gain knowledge in assessment and diagnosis, pharmacology, general medicine, and learn to work with primary care physicians within an interdisciplinary setting. Supervision occurs regularly throughout the day.
Transplant Surgery consists of performing inpatient and outpatient evaluations for suitability for transplants including liver, kidney, bone marrow, and intestinal transplants. Henry Ford Hospital is a high volume provider of such transplants and requires a psychological evaluation to assure compliance with the rigorous self-care and follow-up needed for patients to survive and thrive following transplant. Interns assess cognitive functioning, behavioral processes relevant to compliance including psychiatric status and stability, quality of social support, motivation for transplant and other factors relevant to decision making. They collaborate with the surgery staff to assure optimal outcomes and participate in interdisciplinary team listing meetings. Interns will also conduct consultations on an inpatient basis for transplant recipients who may be struggling with various psychosocial concerns. Supervision occurs regularly throughout the day. Interns may have involvement in the supervision of practicum students.
The Emergency Department (ED) is a fast-paced, level one trauma center in the heart of Detroit. It is within a medically underserved community with a poverty level of 40% or higher. There is a strong cooperation with community mental health and other community services to facilitate appropriate placement and care for the many patients who come to the ED with psychotic disorders, homelessness presenting as psychiatric need and substance abuse. Interns evaluate these patients, make a diagnosis, and help facilitate both proper care within the ED and an appropriate disposition. Supervision occurs daily and on a case by case basis.
The Bariatric Surgery service consists of performing outpatient psychological pre-surgical evaluations for suitability for patients pursuing bariatric surgery. The intern will also have the opportunity to provide brief treatment for patients aimed at improving psychological symptoms and problematic eating behaviors. The intern will co-facilitate 2 support groups per month; one for behavior change and one for relapse prevention and may have involvement in the supervision of practicum students. Supervision occurs daily.
Outpatient Mental Health
Outpatient Mental Health consists of interview based assessment, diagnosis, treatment planning, and psychotherapy in a busy, urban outpatient clinic. This clinic is the primary outpatient teaching clinic for the department; as such, it is host to the PGY III psychiatric residents who provide one year of outpatient service as part of their residency. The intern will work closely with this group of residents and will participate in weekly case conference with them. Daily meetings with the outpatient supervisor provides close supervision particularly for new and problematic cases.
Interns will receive daily supervision from their primary supervisor on their current rotation. The intern will discuss each new case with the supervisor as well as any difficult cases the intern is following with. Interns can also request meetings with supervisors for discussion of other areas such as to receive individualized feedback or professional growth. Interns from all tracks also participate in a one-hour, weekly group supervision with the Director of the Psychology Internship Program. Interns will rotate presenting a case paired with a question or topic for discussion for the group.
A monthly Medicine for Psychologists conference reviews a wide spectrum of medical disorders discussing the nature, etiology, diagnosis, and treatment of those disorders with special emphasis on behavioral aspects.
Friday mornings include “Bagel Rounds” and a Team Meeting. Bagel Rounds is a weekly teaching conference. For the early part of the year, staff members present topics designed to orient trainees to the service and provide a crash course for needed medical information. The weekly Team Meeting occurs after Bagel Rounds in which senior staff, health psychology fellows, and the health psychology interns participate. This meeting includes discussion of patient care, professionalism, and brief teachings.
Interns in the Health Psychology/Consultation-Liaison track will be evaluated in a number of ways. Informally, the interns are evaluated on clinical progress via individual supervision. Additionally, the intern will be formally evaluated at the end of each rotation by their primary supervisor. Interns will also be formally evaluated through case presentations. On each of the three rotations, the interns are expected to make a formal case presentation at the Friday morning Bagel Rounds. This case presentation includes a presentation by the trainee of the nature of the pathology, a review of the literature regarding the disorder, and an assessment of the specific case in light of that literature.