Division of Child & Adolescent Psychiatry, Department of Psychiatry and Human Behavior

Consultation Liaison Pediatric Psychiatry
Overview of Rotation
Revised – February 2010
Consultation Liaison psychiatry rotations in the Child & Adolescent Psychiatry Residency constitute a core training experience during which trainees learn to perform competent consultation to pediatric medical personnel regarding psychiatric and behavioral problems in pediatric patients. The rotation provides opportunities to care for patients with co-occurring psychiatric and medical illnesses, illnesses that present with mental status changes and/or psychiatric symptoms, as well as normal and pathologic responses to medical illnesses. The rotation emphasizes learning about the role of a consultant.
I. GENERAL INFORMATION
Name of Rotation / Consultation Liaison Child & Adolescent Psychiatry
Rotation Director / Emily Katz, MD
Other Faculty and Team Members / Jill Craham, RN (case manager, treatment coordinator); Fran Pingitore, RN (nursing liaison)
Contact information
Time Commitment / 70% time
Patient Population / Medically hospitalized children, diverse SES, ethnic, racial backgrounds
II. SCHEDULE DURING ROTATION
Trainees are expected to be available to see new consults and follow-up on their patients during mornings (except Wed), and Tues, Thurs, and Friday afternoons. The team has attending rounds Tues 9:30-11 and Thursday 10-11. Residents are encouraged to attend pediatric morning report from 8-9 Tues-Thurs when the CL schedule allows.
III. TOPICS/TEACHING METHODS/MATERIALS USED DURING THIS ROTATION
Topics to be covered are based upon:
The patient population cared for by the team over the course of the rotation and
The twice weekly rounds
Cases selected for presentation
Topics listed under “Objectives”
Principal teaching methods:
Attending Multidisciplinary Rounds
Direct supervision of cases
Monthly case presentation and patient interview with a senior faculty attending as a discussant
Periodic presentation in rounds of a scholarly article pertaining to a case
IV. RESPONSIBILITIES OF THE ATTENDING ON ROTATION
The attending will see patients and will supervise the care of the patient by the trainee, offering guidance but allowing for autonomy for the trainee.
The attending will be available for, or be present, at all activities where their involvement is needed.
The attending will observe the trainee interview a patient and family during the month and provide feedback.
The attending will conduct formal multidisciplinary attending rounds 2 times per week. Each attending rounds includes discussion of the patient from a diagnostic and therapeutic perspective, as well as leading to an educational discussion of relevant literature.
Support trainees interested in pursing academic endeavors such as writing up a case presentation.

V. RESPONSIBILITIES OF THE TRAINEE

Trainee performs requested child psychiatric consultations assigned to him/her by the C-L service. A trainee may be the primary clinician and have primary responsibility for a consult (under the supervision of the attending) or may provide medical input to a consult whose primary clinician is not an MD.
Trainee will discuss the diagnostic and management strategy with the attending on all consultations.
Trainee is responsible for examining and monitoring the progress of those patients on a daily basis and documenting their evaluations.
Trainee is responsible for working collaboratively with primary pediatric/surgical services working with the patient through written and verbal communication.
Trainee is responsible for family and patient communication as needed and may serve as liaison between the pediatric service who requested the consultation and the patient/family on an as needed basis.
On Wednesdays, trainees should round on their CL patients prior to Grand Rounds as clinically indicated. On Wednesday, other (non-MD) trainees are “first call” for receiving consults. Trainees are expected to respond to pages about their CL patients during the times they are away from the hospital, or to arrange coverage if responding to a page is not possible.
Trainees should ask the attending about vacation requests preferably before starting the month, but at least 2 weeks in advance, of the requested date.
Trainee will submit an online evaluation of the attending upon completion of the rotation

VI. EVALUATIONS

Evaluation of the trainee's successful completion of the goals listed below will be carried out by the attending.
Evaluation of the trainee's skills as a member of a multidisciplinary team will be assessed by other members of the CL team.
Evaluation of the attending's successful completion of the goals listed below will be carried out by the trainee.
Evaluation of the rotation will be completed as part of the annual trainee retreat report and annual trainee program survey.

VII. GENERAL EDUCATIONAL OBJECTIVES

Objectives - By the end of this rotation, the trainee will be able to:
  • Perform comprehensive psychiatric evaluations of medically ill children, including those with normal responses to extreme stresses, those with CNS disorders that exacerbate/cause psychiatric symptoms, and psychiatric disorders presenting secondary to their primary medical illness or treatment. PC, MK, SBP
  • Assess, diagnose and manage acutely agitated patients on the pediatric unit. PC, MK
  • Develop a biopsychosocial formulation of pediatric patients. PC, MK
  • Develop a treatment plan that includes appropriate use and monitoring of pharmacological and non-pharmacological interventions. PC, MK
  • Demonstrate skill in the use of psychopharmacological interventions for comorbid psychiatric syndromes and for behavioral manifestation of medical and neurological syndromes. PC, MK
  • Recognize indications for and effectively use non-pharmacological interventions including cognitive-behavioral techniques, systemic interventions. PC, MK
  • Work cooperatively as a member of a multidisciplinary team composed of pediatricians, psychologists, social workers and other medical subspecialties. PC, SBP, PBL, P, ICS
  • Use written and verbal communication effectively to discuss treatment with physicians, nurses, other medical staff, and families. PC, ICS
  • Make appropriate referrals (both inpatient and outpatient) for services for patients seen in psychiatric consultation.
  • Triage and categorize problems among multiple patients, to use their time most effectively while responding appropriately to the needs of each patient. PBL, SBP

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