| Fellowship in Psychosomatic Medicine (Consultation-Liaison Psychiatry)
Beth Israel Medical Center
Eligibility Requirements
All fellow applicants must be graduates of an ACGME accredited Psychiatry Residency program. All candidates must have passed Part 3 of the USMLE Boards. International Medical Graduates (IMGs) must have a valid ECFMG certificate and be eligible for visa.
The Application Process
Candidates are encouraged to submit applications starting in July prior to the year of fellowship. Candidates must submit an application with two letters of reference. Appropriate candidates will be offered interviews which begin in August.
Background
Beth Israel Medical Center is a major tertiary care teaching hospital located near the village in Manhattan, which has been serving New York City for the past century. In addition to the general medical-surgical units, Beth Israel boasts several specialty inpatient units covering Oncology, Physical Medicine/Rehab, Cardiology, Nephrology, Intensive Care, Cardiac Surgery, and OB-Gyn. There are a number of outpatient programs including Oncology, Palliative Care, HIV and Internal Medicine. Beth Israel has an academic affiliation with the Albert Einstein School of Medicine and is a major clinical campus for the medical students' psychiatry rotation.
The C-L division at Beth Israel had its informal beginnings in the 1960's under the leadership of Dr. Max Needelman. Dr. Joel Wallack assumed direction of the division in 1982 and established the Fellowship Training Program in 1986. Dr. Philip Bialer led the Division from 1992 through 2008. Dr. Nancy C Maruyama, the current Fellowship Training Director and Physician-in-Charge of the Division, is a graduate of the Memorial Sloan-Kettering Cancer Center Fellowship. Dr. Joel Wallack, a graduate of the fellowship program at Montefiore and Mount Sinai is presently Chief of the Division and Associate Director of the fellowship program. The program has trained over 30 fellows, many of whom have taken on leadership roles in C-L Psychiatry nation-wide.
The program has received full accreditation from the American Council on Graduate Medical Education (ACGME) as of July 1, 2004. We were one of the first of seven programs in the nation to receive such accreditation. There are four full-time faculty members. The length of training is for 12 months beginning on July 1.
Training Program
The training consists of several year-long activities:
- Clinical and service activities
- Liaison activities
- Didactics and supervision
- Teaching and supervision of residents and medical students
- Administrative duties
- Research
Inpatient and outpatient consultations and clinical supervision
The consultation service at Beth Israel is a busy one with an average of 140 consultation requests per month. The fellows are assigned 3 consults per week. Over the course of the year, they see a wide range of patients with varying diagnoses from all services in the medical center; the fellows are often assigned the more complicated cases. Daily work rounds, led by C-L attendings, are held with the fellows and residents during which all cases seen the day before are presented and discussed. In addition, there are two weekly case conferences. The fellows receive abundant supervision every week with daily supervision provided by Dr. Maruyama, Dr. Daniel Safin, and Dr. Jean.
As the year progesses fellows take on greater responsibility; they lead daily work rounds, and clinical case conferences.
Fellows also see out patients in the Peter Krueger Clinic for the Treatment of Immunological Disorders for 3- 5 hours per week to gain knowledge and experience working with people with HIV/AIDS. The clinic is a multidisciplinary care environment and fellows receive supervision from Dr. Kenneth Ashley and Dr. Dickson Jean, experts in the psychiatric care of HIV patients. Fellows round with Dr. Mark Groves, who specializes in psychiatric aspects of movement disorders, and Dr. Jeremy Winell who specializes in outpatient psychooncology. Several times a year fellows participate in complex ethics consultations and are integral members of the Beth Israel Medical Center Ethics Committee. Lastly, interested fellows have the opportunity to follow an outpatient with co-morbid medical and psychosocial issues in supervised weekly psychotherapy.
Liaison Activities
The liaison experience is tailored to meet the fellows' specific interests. Past fellows have focused on HIV, Oncology, Physical Medicine/Rehab, Nephrology, Cardiology, and OB-GYN units. There is one monthly liaison “ombudsman-type” case conference co-led by Dr. Wallack, a pioneer in liaison psychiatry, and senior faculty from Family Medicine. These rounds are organized by the fellows and are attended by medical house staff, C-L residents and fellows, and medical students. Coping and personality styles, psychosocial histories, managing difficult patients, and counter-transference issues are examples of topics explored in the conferences. Fellows will also have an opportunity to lead these case conferences. Fellows spend six months working with Dr. Joel Wallack as preceptors in the outpatient medical clinics at Phillips Ambulatory Care Center. Under the supervision of Dr. Wallack, fellows act as preceptors of medical residents on their interactions with their patients. Emphasis is placed on interviewing skills and obtaining psychosocial information from their patients.
Didactics and Supervision
The full-time faculty supervises all clinical work and liaison activities. There are two formal didactic courses. One is a 22 week-long course on C-L psychiatry. Experts in this field are invited as guest lecturers for this course to complement our own faculty. The areas covered in this course include:
Introduction to Psychosomatic Medicine: History and Overview
Legal and Ethical Issues
Delirium
Psychopharmacology of the Medically III
Capacity
Substance Abuse
Neuropsychiatry of HIV/AIDS
Psycho-oncology
Coping, Personality Styles, and the Hateful Patient
Malingering and Factitious Disorders
The Patient-Physician Relationship
Psychogenic Non-epileptic Seizures
Transplant Psychiatry
Death and Dying/ Palliative Care
Psychiatric Aspects of Movement Disorders
Pain Evaluation and Management
Cross Cultural Issues
Reproductive Related Disorders
Primary Care Psychiatry
Somatoform Disorders
There is also a weekly Fellows’ Seminar, organized by Dr. Dickson Jean, with didactics on Research Design and Methodology, Adjustment to Medical Illness, Psycho-oncology, review of CL aspects of Cardiac, Renal, Endocrine, Gastrointestinal and other areas. The course is organized around several of the major textbooks in Psychosomatic Medicine as well as current and classic papers. Journal Club meets monthly to critically evaluate recently published studies.
Teaching and Supervision of Residents and Medical Students
Fellows play a major role in teaching. They are responsible for supervising Psychiatry or Family Medicine residents who rotate through C-L as part of their training. Third year medical students also rotate through C-L and are taught by the fellows. Fellows present formal lectures to the medical students on Delirium and other Psychosomatic Medicine topics. The third year psychiatry clerkship for Albert Einstein College of Medicine students is primarily based on the inpatient psych units. However, the students attend C-L rounds weekly and one of our liaison conferences. Ad-hoc lectures for med-surg staff on topics such as Delirium or Depression are arranged during the course of the year.
Administrative Duties
The fellows will have a minimum of two months experience coordinating the consult service under the supervision of the faculty. This will involve triaging of consultation requests, assigning them to residents and staff, and maintaining the patient log and database. Fellows will also learn about the financial aspects of the C-L service and about billing for consultations. This will include learning proper diagnostic and CPT code documentation, as well as the process of working with Medicare, Medicaid, and other third party payers. Fellows will participate in the selection process of new fellows.
Research
Fellows are required to participate in scholarly activity. Although not a requirement of the training, the fellows are encouraged to develop their own project or focused literature review. Alternatively, they can participate in ongoing projects within the division. Past and current projects include “Missed Cases of Delirium in the General Hospital,” Health Behaviors in Bipolar Patients,” “Documentation of Risk Factors for Cardiac Arrhythmias in the Treatment of Delirium with Neuroleptics.” Fellows work on a joint research / academic project that will be presented at Grand Rounds. Previous topics have been the Psychosocial Evaluation of Bariatric Surgery Candidates, and Death and Dying: Who Decides When, Where and How. Each year the presentation has been presented at the Academy of Psychosomatics Annual Meeting. Fellows are encouraged to write up their findings for publication.
Conferences
Fellows attend the Annual Meeting of the Academy of Psychosomatic Medicine in November each year. Expenses are paid for by funding from the Division.
Benefits
Beth Israel Medical Center supports a generous package of benefits to its trainees and staff. There is guaranteed housing at attractive subsidized rates. Fellowship stipend and a detailed description of the benefits package can be obtained from the BIMC GME Website. Access codes for the website will be provided at the time of interview. Fellows may contribute to a tax-deferred annuity through the Medical center.
Beth Israel has an excellent full-service medical library, the Seymour J. Phillips Library. It is conveniently located on the 12th floor of Fierman Hall.
Finally, the Division of Consultation-Liaison Psychiatry as well as the Department of Psychiatry at Beth Israel is sincerely interested in fostering a pleasant and collegial working environment. The concerns of trainees are taken seriously. There are many opportunities to socialize within the department and with other medical colleagues.
For an application and/or other inquiries, please contact:
Nancy C. Maruyama, MD
Physician in Charge & Fellowship Director
Consultation-Liaison Psychiatry and Psychosomatic Medicine
Beth Israel Medical Center
First Avenue at 16th St., Fierman Hall, 5F09
New York, NY 10003
Phone: 212-420-4094
Email: nmaruyam@chpnet.org
or
Joel Wallack, MD
Chief, Consultation-Liaison Psychiatry and Psychosomatic Medicine
Phone: 212-420-2398
Email: jwallack@chpnet.org
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