IOL continues to Lead the Way in Psychosomatic Medicine

The Psychosomatic Medicine Fellowship at the Institute of Living, previously known as the Consultation/Liaison Psychiatry Fellowship, has been training psychiatrists in clinical practice and scientific inquiry at the interface of medicine and psychiatry since its inception in the 1980s.

The program received accreditation from the Accreditation Council for Graduate Medical Education in 2004, and continues to evolve in the midst of growing national realization that multidisciplinary collaborative care is the future of excellence in healthcare.

The practice of psychosomatic medicine includes the comprehensive knowledge of — and care for — patients with medical, neurological, or surgical illness in whom psychiatric morbidity or simple emotional distress affects their medical condition. Their conditions also interfere with medical care and/or impact their quality of life; they may also have a psychiatric disorder that is the direct consequence of a primary medical condition or treatment. Finally, such patients may also have somatoform disorders, whereby emotional distress is expressed in physical symptoms.

Fellows in the IOL program begin their 12 months of training after completing psychiatry residency training at an accredited program in the US or Canada. The IOL program trains fellows to consider the entire patient experience: the molecular disease process, the organ-system interactions, the pharmacologic principles, the patient’s phase of life, their psycho-socio-spiritual context, the nature of the care needed and the care providers with whom they are working. They integrate all of the layers that inform symptoms, health behaviors, idioms of distress, and that individual patient’s style of participating in care as well as disease outcomes.

The clinical components of the program are closely woven in with training in education and scientific inquiry. The mainstay is a yearlong immersion in inpatient consultative psychiatry. Fellows begin by consulting individually on one to four new consults per day. They progress to a role as attendings-in-training, supervising more junior trainees on the service including PA students from two schools, third and fourth-year medical students, second and fourth-year general psychiatry residents and emergency medicine residents. They are also supervised in teaching and training nursing staff on working with complex patients.

The fellows choose from a number of outpatient specialty clinics where their work includes initial comprehensive consultations, brief periods of follow-up and liaison work with other providers including sitting in on a variety of clinical meetings. Options are tailored to the fellows’ interests and as such continue to grow. To date, choices include neuro-epilepsy, solid-organ transplantation, women’s health and peripartum clinic, HIV, psycho-oncology, chronic renal failure/dialysis, and child and adolescent chronic pain.

Psychosomatic fellows also function in a liaison capacity to inpatient disease management teams of their choosing in the hospital. They all spend one to two weeks with the inpatient pharmacy pain management service and choose from one or two of the following: palliative care, psycho-oncology, women’s health, cardiology, and child and adolescent pain.

There is also a formal seminar series taught by our own program faculty as well as guest speakers on special topics in dermatology, toxicology, sleep, neuropsychiatry, eating disorders and others. The fellows prepare an academic project during their year of training. Recent topics have included end-of-life care in young patients; a nursing education initiative on working with patients labeled as “difficult”; and treatment of anxiety and depression in patients with atrial fibrillation. Fellows present locally and our current fellow has presented at a national meeting for two years in a row.

All of the learning possibilities are made richer by the fact that the psychosomatic medicine fellowship clinical training is centered at Hartford Hospital and nurtured by the traditions and robust resources of the Institute of Living. Hartford Hospital, one of the largest hospitals in Connecticut, has seven intensive care units: medical, cardiac, pulmonary rehabilitation, surgical, cardiothoracic surgery, neurosurgical and neonatal. The intellectual and academic resources at the Institute of Living on which fellows draw include John W. Goethe, MD, and the Burlingame Center for Psychiatric Research and Education, Godfrey Pearlson, MD, and the Olin Neuropsychiatry ResearchCenter, and others.

The ultimate goal of the program is to train psychiatrists who will not only weather the upcoming changes in healthcare successfully, but thrive in the new environment and become excellent leaders in the wise clinical care of complex patients.