LAUSR

To the Editor: Inpatient psychiatry is a cornerstone of training. The Accreditation Council for Graduate Medical Education requires that psychiatry residents spend at least 6 months on inpatient psychiatry and that child and adolescent psychiatry fellows complete at least 4 months in acute care settings [1, 2]. Though there is no specific requirement for psychology trainees, they are increasingly being integrated into inpatient psychiatry. The “unit” is a rich venue for education across disciplines due to the acuity and intensity of patient presentations and the robust team experience. On many inpatient units, there are learners of different disciplines and at different levels of training within those disciplines. There is little guidance from existing literature on how to effectively leverage the perspectives of these learners while optimizing their educational experience. The Psychiatry and Behavioral Medicine Unit (PBMU) is a 41-bed acute inpatient psychiatric unit within Seattle Children’s Hospital. Child psychiatry fellows, general psychiatry residents, fourth year medical students, and psychology residents do full-time rotations lasting 1–3 months. Postdoctoral fellows and psychology externs/practicum students spend portions of time for a full year on the PBMU. We recently undertook changes to optimize the model of care on the PBMU. This has included alterations to our educational structures. Three specific modifications will be described: the formation of a Teaching Service, shifts in the psychology role, and the creation of a Multidisciplinary Didactic Seminar. In the past, psychiatry residents and fellows (generally 1 or 2 of each at a time) were paired with different attendings, which was satisfactory but did not optimize the educational experience. Thus, we established the Teaching Service, comprised of an attending, fellow, resident, and, for a portion of the year, medical student. Perhaps the main shift is in the team’s name – educators may feel more inclined to go the extra mile, and learners more aware of the educational mission, simply by “calling out” that teaching comes first. Psychology trainees are assigned one patient on this team to provide them with direct patient care experience within this structure. The benefits of this Teaching Service include opportunities for more advanced trainees to serve in a teacher and leader role. Having multiple trainees, each serving as “primary” for 4–5 patients, has allowed the attending to safely care for more patients than if he or she were supervising just one trainee. This also broadens the exposure for all trainees. For example, a general psychiatry resident who is not assigned to the patient with severe obsessive-compulsive disorder will hear about their care and may see them on rounds. A challenge is scheduling. We are fortunate to have several skilled clinician educators who are motivated to be “on service” and are fine-tuning how to best schedule the Teaching Service attending role to maximize trainee exposure to different styles, while maintaining continuity of care for patients and a stable experience for trainees. If there are numerous residents or fellows at a time, we have each trainee spend at least 4 weeks on the Teaching Service and rotate to a particular specialty inpatient service while not on the Teaching Team. Another change has been in the role of psychology interns/ residents. In the past, these residents have essentially served in the role of masters’ level therapists, by “carrying” a team of patients for whom they provided individual and family therapeutic interventions. This arrangement provided an immersive direct patient care experience, but did not allow for the full range of activities that would be expected of a psychologist. We have revamped their role to allow them to perform activities that utilize their full expertise, under the supervision of a licensed psychologist, including providing consultation, evaluation, testing, and/or behavioral treatment planning in cases * Shannon Simmons [email protected]