Consultation-Liaison Psychiatry Fellowship
Consultation-Liaison Psychiatry is the newest board-certified subspecialty in psychiatry. Consultation liaison psychiatry is the psychiatry of the medically ill. Specialists in this area provide consultation and continuing care in both inpatient and outpatient medical settings.
The subject matter of the field includes psychiatric aspects of medical illness, both its physiological effects and its psychological aspects, ranging from delirium to the emotional adaptation to the ill state. The subject matter also includes the medical aspects of psychiatric illness, ranging from side effects of psychiatric medications to the sequelae of anorexia.
Board certification requires completion of an ACGME-approved 12-month fellowship. Our program provides supervised clinical training in both inpatient hospital and outpatient clinics, based at the Yale-New Haven Hospital and the VA Connecticut Healthcare System.
Core Philosophy
Direct clinical experience with sophisticated supervision is the primary forum for learning to care for patients in the Yale fellowship program. Adequate training involves knowledge and skill acquisition in direct patient care, often as a member of a multidisciplinary team.
In the process of training it is anticipated that each psychiatric fellow will acquire specialized clinical skills strongly grounded in a theoretical knowledge base, while learning to work effectively with allied mental health professionals. The advancement of qualities central to professional identity development, including a strong sense of patient responsibility, integrity, empathy and respect for patients, is emphasized.
Core Values
Current 2023-2024 CL Fellows recently visited Fellowship Place in New Haven whose mission is to serve adults living with mental illness by offering a full range of therapeutic support and rehabilitation services.
L to R: Elizabeth Meller, MD, Grace Fredman, MD, Deborah Benevenuto, MD, Fellowship Place Director of Psychosocial Rehabilitation Services, Charlotte Sabovic, LCSW and Ben Jacobi, MD.
- Medical Knowledge – Knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of the knowledge to patient care.
- Patient Care – Provide patient care that is compassionate, appropriate, evidence based, and effective for the treatment of health problems and the promotion of health.
- Interpersonal Communication Skills – Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and multidisciplinary health professionals.
- Professionalism – A commitment to carrying out professional responsibilities and an adherence to ethical principals.
- Practice Based Leaning and Improvement – Ability to investigate and evaluate their care of patients, appraise and assimilate scientific evidence and continuously improve patient care based on constant self-evaluation and life-long learning.
- Systems Based Practice – Understand the system of care, how it functions and how to advocate for their patients receiving the best available care.
- Innovation and Self Development – Active in improving their practice and contribute to the development and dissemination of new knowledge.
Program Components
The fellowship consists of inpatient consultation experience (approximately 70% of training), outpatient clinics (20%), and didactic training (10%). Training occurs at Yale-New Haven Hospital (YNHH) and the Veterans Administration Connecticut Healthcare System (VACHS): trainees will spend 9 months at the YNHH and 3 months at the VACHS (duration of these rotations may vary depending on number of fellows in training). At YNHH, outpatient experiences will include service in the Transplant Clinic and in the HIV Clinic, as well as other sites depending on individual interests. At the VACHS, outpatient experiences will include the Women’s Clinic and the Telepsychiatry Clinic, and possibly other options reflecting personal training goals..
Inpatient Consultation Experience
Fellows complete their inpatient rotation at the Yale New Haven Hospital (YNHH).
Yale-New Haven Hospital (YNHH) is a 700-adult bed tertiary care hospital. It is the primary teaching hospital for Yale University School of Medicine, with a full range of advanced specialized units. Recent research on our service has indicated that increased, proactive psychiatric consultation can improve care, decrease length of stay and reduce expenses (PubMed link). In consequence, the hospital has provided funding for a proactive, multidisciplinary team including psychiatrists, advanced practice nurses and social workers on certain units. Fellows will therefore have the opportunity to learn both the traditional consultation model and a newer more integrated model of consult service delivery. Click here for a complete description of our Behavioral Intervention Team.
The Veterans Administration Connecticut Healthcare System (VACHS) is a 200-bed tertiary care hospital also affiliated with the School of Medicine. VACHS offers a full range of inpatient, outpatient and rehabilitation care, in medicine, surgery, psychiatry, and neurology. The VACHS offers a full range of inpatient, outpatient and rehabilitation care, in medicine, surgery, psychiatry, and neurology. It also offers the Comprehensive Cancer Center, the National Center for PTSD, the Eastern Regional Blind Rehabilitation Center (ERBC), the Northeast Program Evaluation Center (health services delivery research), and the Women’s Health Center. The VACHS is recognized nationally as a psychiatry research center, including research in the areas of Addiction Psychiatry and PTSD. It is approximately 4 miles from YNHH. A shuttle runs continuously between the VACHS and YNHH during the day.At both institutions, fellows work as part of a close-knit team and receive instruction in CL psychiatry at the bedside, and also assist in the education of residents in psychiatry, medical students, and other trainees.
Outpatient Experiences and Electives
Outpatient experiences include serving as psychiatric consultant in clinics at YNHH or at the VA Connecticut Healthcare System (VACHS) in West Haven.
Depending on the fellow’s educational goals, the fellows may also choose outpatient electives such as bariatric psychiatry, palliative care clinic, sickle cell clinic, the addiction clinic, the women’s sexuality, intimacy, and menopause clinic, and other sites.
Finally, fellows may elect to pursue a research project in CL psychiatry or related area of psychiatry, or other supervised academic work.
Didactic Experience
Fellows participate in weekly didactic seminars in consultation-liaison psychiatry over the course of the year. The seminar series is divided into core topics in the initial part of the year, followed by specialized topics later in the year. Faculty are drawn from the consultation-liaison psychiatry program faculty, but also from a range of other medical specialties.
Another seminar series is oriented towards research methodology. Fellows learn about methodology for clinical trials, case control studies, epidemiological research, and other types of research designs. Fellows then participate in seminars to study how these designs are used in published research. The seminar series emphasizes the challenges of implementing these designs in the context of consultation-liaison psychiatry.
Fellows also participate in a case conference series, with the opportunity to present cases and moderate discussion. The series offers a particular forum for multidisciplinary collaboration, both learning from other colleagues and teaching other colleagues.
In addition to these activities, many of the elective rotations offer site-specific rounds/seminars that include case-based discussion and relevant literature review.
Sample Didactic Topics
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(Seminars presented in Academic Year 2018 – 2019) |
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Seminars In Consultation-Liaison Psychiatry Principles of evaluation:
Psychiatric disorders in the medical setting:
Clinical settings of consultation-liaison psychiatry:
Pharmacological considerations:
Systems issues in consultation-liaison psychiatry:
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Research Seminar Series
Chapter Reviews
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Scheduled Seminars and Conferences
Seminar in Consultation-Liaison Psychiatry
Brief Description: Seminars will be offered by staff from the Fellowship program and by invited faculty from other departments, and will cover the subject matter of Consultation-Liaison Psychiatry at an advanced level. Seminars will include core issues in consultation. Drs. Desan, Zimbrean, Matos Santana Yonkers, Forray, Shenouda and staff.
1 hour; Weekly (approx.); 50 sessions with an additional 10 review sessions
Consultation-Liaison Psychiatry Case Conference
Brief Description: This seminar will focus on selected cases from the service, presented by staff or fellows. Fellows will have the opportunity to present cases and lead discussion. Drs. Desan and staff at YNHH.
1 hour; 1-2 per month; at least 15 sessions
Psychological Medicine Service Rounds
Brief Description: The Psychological Medicine Section holds monthly “Service Rounds” which provide a forum for our faculty to present on their current research and academic activities. It also provides a venue to host outside speakers to present on topics pertinent to Consultation-Liaison Psychiatry and behavioral medicine.
1 hour; Monthly (September-June); at least 9 sessions
Consultation-Liaison Psychiatry Research Conference
Brief Description: This seminar will review selected research studies in the area of Consultation-Liaison Psychiatry, with a view to understanding the design of clinical studies in this area. Observational and epidemiological studies, prospective and retrospective designs, controlled trials, statistical and meta-analytic methods will be covered. Dr. Desan and staff.
1 hour; Monthly; 6-9 sessions
Outside Supervision in Consultation-Liaison Psychiatry
Brief Description: Fellows at the YNHH Psychiatric Consultation Services have important educational, supervisory and administrative roles. The fellow(s) have the option to meet with 1 or more voluntary faculty to discuss ongoing issues in these areas, including didactic methods used in their teaching with junior trainees on the service and in their liaison activities with individuals from other departments, approaches to providing feedback and supervision, and performance of their organization role for each service.
1 hour; Monthly; 12 sessions
Department of Psychiatry Grand Rounds
Brief Description: The Grand Rounds series of the department brings invited speakers from many areas of psychiatry and offers a superb update on current work in the field.
1 hour; Weekly, except in the summer; approx. 36 sessions
Additional didactic events may be available by special arrangement for trainees with specific interests in the following topics: substance abuse, geriatric psychiatry and medicine, investigative medicine, and responsible conduct of scientific research and bioethics.
Teaching, Administrative and Research Role
Research
Our trainees and faculty members engage in cutting-edge, translational research to develop novel and improved strategies to prevent or treat psychiatric conditions among the medico-surgical patients. The three primary research goals of the Yale PM Service are:
- To elucidate etiopathogenesis and discover innovative treatment strategy of common psychiatric syndromes among medico-surgical patients.
- To examine the impact of presence, incidence, detection, and treatment of psychiatric co-morbidities in the quality of life, morbidity and mortality of the medico-surgical patients.
- To develop innovative ways to efficiently deliver medico-surgical services for mentally ill patients both in the inpatient and outpatient setting and bridge the disparity gap in health service between those with severe mental illness and without.
Health Services
Three Strategies for Implementing Motivational Interviewing on Medical Inpatient Units: See One, Do One, Order One
PI: K. Yonkers, MD/S. Martino, PhD; Funding Source: NIDA R01.
The goal of this project is to compare the success of three strategies geared to implementation of motivational interviewing. Interviewing techniques would be provided by physician assistants in the general medical units of Yale New Haven Hospital.
Behavioral Intervention Team: A Model of Proactive, Multidisciplinary CL Psychiatry Service
PI: W. Sledge, MD; Funding Source: The George D and Esther S Gross Professorship Endowment.
The goal of this on-going study is to assess the quality and cost-effectiveness of an innovative, proactive model of screening for psychiatric issues among and delivering mental health services to medical inpatients with psychiatric co-morbidity
Study of Very High Cost Primary Care Patients in a University ClinicPI: W. Sledge, MD; Funding Source: The George D and Esther S Gross Professorship Endowment.
The goal of this on-going study is to assess the quality and cost-effectiveness of an innovative, proactive model of screening for psychiatric issues among and delivering mental health services to medical inpatients with psychiatric co-morbidity.
Transplant Psychiatry
Pre-Transplant Behavioral Weight Loss Treatment Trial for Patients with End-Stage Liver Disease
PI: D. Fehon, PsyD; Funding Source: Yale Transplant Psychiatry Development Fund.
This is a Stage 1A treatment development study which examines the feasibility and preliminary effectiveness of a group behavioral weight loss intervention for liver transplant candidates.
Eating disorders and body image beliefs in liver transplant recipients
PI: P. Zimbrean, MD; Funding Source: Yale Transplant Psychiatry Development Fund.
This cross-sectional study examines the prevalence of eating disorder symptoms and body-image issues among post-liver transplant patients.
Transplant psychiatry training- a curriculum for advanced psychiatry trainees
PI: Paula Zimbrean, MD. Funding Source: Yale Transplant Psychiatry Development Fund
This study is assessing the effect of a teaching curriculum in Transplant Psychiatry upon the level of knowledge and communication skills of psychiatric trainees.
PMS, Perinatal, and Postpartum Psychiatry
Progesterone Augmentation for Smoking Cessation in Women
PI Kimberly Yonkers, MD and Mehmet Sofuoglu, MD, PhD; Funding source: National Cancer Institute, R21 198187
This study will manipulate the hormonal milieu by adding progesterone to the follicular phase of the menstrual cycle in order to enhance women’s response to nicotine replacement therapy.
Prenatal Substance Use Screening Measures
PI Kimberly Yonkders, MD; Funding source: Centers for Disease Control, R21 DP006082-01
This study would test the validity and reliability of 6 screening measures for substance use and misuse in pregnancy.
Progesterone Augmentation for Smoking Cessation in Women
P.I. Kimberly Yonkers, MD and Mehmet Sofuoglu, MD, PhD; Funding source: National Cancer Institute, R21 198187
This study will manipulate the hormonal milieu by adding progesterone to the follicular phase of the menstrual cycle in order to enhance women’s response to nicotine replacement therapy.
Prenatal Substance Use Screening Measures
P.I. Kimberly Yonkers, MD; Funding source: Centers for Disease Control, R21 DP006082-01
This study would test the validity and reliability of 6 screening measures for substance use and misuse in pregnancy.
Progesterone for Smoking Relapse Postpartum: Feasibility, Breastfeeding and Infant Safety
PI: A. Forray, MD; Funding Source: NIDA R21
The purpose of this study is to examine the utility of oral micronized progesterone as an intervention to prevent smoking relapse in postpartum women.
Ecological Momentary Assessment and Postpartum Smoking Relapse: A Pilot Study
PI: A. Forray, MD; Funding Source: NIDA K12
This is a pilot study using ecological momentary assessments (EMA) to evaluate the impact of situational and affective stimuli on relapse to smoking in the postpartum period. Abstinent smokers, recruited during pregnancy, are asked to carry a small handheld computer (PDA) which will prompt the women to complete an assessment about cravings, affect and environmental cues at four random times per day. The results from this study will provide an assessment of the process of relapse in relation to a number of covariates.
Chronic pian and Obesity
Neural Mechanisms of Obesity in Chronic Low Back Pain
PI: P. Geha, MD; Funding Source NIDA K08
The purpose of this grant is to examine the interrelation between chronic pain and obesity using psychophysical testing and functional brain imaging. Chronic pain is associated with changes in the limbic system; the limbic system is in turn critical in determining the risk of over eating in an environment where highly caloric food abounds. Therefore, the project examines pain patients’ response to food and feeding behavior early in the course of their back pain and one year later as they convert or not to the chronic phase.
Cancer/Tobacco Treatment
Gain-framed Messages and NRT Sampling to Promote Smoking Cessation in Lung Cancer Screening Programs
PI: Benjamin Toll, PhD; Yale Site PI: Lisa Fucito, PhD. Funding Source: NCI R01
The purpose of this study is to test a combined behavioral and pharmacological tobacco intervention for promoting smoking cessation among smokers receiving lung cancer screening.
Yale SPORE in Lung Cancer: Core Project: “Personalized prevention: smoking cessation in lung nodule patients
PI: Roy Herbst, MD; Co-Investigator: Lisa Fucito, PhD. Funding Source: NCI P50
The purpose of this study is to develop and test the efficacy of a new personalized approach to gain-framed messaging to improve smoking cessation in Americans with asymptomatic lung nodules who continue to smoke.
Sickle Cell
Psychiatric Screening of Adults Living with Sickle Cell
PI: A. Forray, MD; Funding Source: Adult Sickle Cell Fund
The purpose of this study is to screen adults living with sickle cell disease for psychiatric disorders and symptoms and determine the impact of psychiatric conditions on patient outcomes such as inpatient hospitalizations, emergency room visits, adherence to treatment and opiate medication utilization.
Resting State Connectivity and Pain Processing in Adults with Sickle Cell Disease
PI: A. Forray, MD; Funding Source: Adult Sickle Cell Fund
While acute episodes of pain are the hallmark of sickle cell disease, many patients also experience chronic daily pain. Intrinsic brain connectivity has been shown to play a role in sickle cell related pain. The default mode network (DMN) has been implicated in the expression and modulation of spontaneous chronic pain. The purpose of this study is to utilize functional magnetic resonance imaging (fMRI) to assess the resting state connectivity of adults with SCD and its potential link to frequent hospitalizations and high pain burden.
Our Sites
The principal component of the fellowship is training in inpatient hospital consultation psychiatry at the YNHH and VACHS.
Yale-New Haven Hospital
Yale-New Haven Hospital (YNHH) is a 700-adult bed urban tertiary care hospital. It is the primary teaching hospital for Yale University School of Medicine, with a full range of advanced specialized units, and a diverse group of patients spanning all socioeconomic strata. The hospital also offers a range of outpatient clinics. Both inpatient and outpatient units provide settings for training of fellows in our program.
The hospital provides the opportunity for a vast diversity of consultations across the spectrum of medical fields. The Psychiatric Consultation Service is well-integrated into the hospital. Consultations seen by the service are reviewed daily in morning on rounds, permitting team discussion of the fellows’ consultations and also permitting each trainee exposure to all consultations seen by the service. Fellows receive close supervision, as virtually all consultations are also seen by an attending psychiatrist. Fellows will also participate in education and supervision of more junior psychiatry residents and medical students. Fellows and other members of the consult service often are invited to participate in case conferences and rounds on other services in the hospital, allowing the fellows experience in the liaison and educational aspects of the consultant role. As noted elsewhere, part of the psychiatric consultation service operates in a multidisciplinary, proactive model: fellows will also receive training in this new system, which we believe may become a standard approach in the future.
The Veterans Administration Connecticut Healthcare System (VACHS)
Fellows may complete their outpatient experiences at the VACHS. VACHS is a tertiary care facility associated with the Yale University School of Medicine. The VACHS offers a full range of inpatient, outpatient and rehabilitation care, in medicine, surgery, psychiatry, and neurology. It also offers the Comprehensive Cancer Center, the National Center for PTSD, the Eastern Regional Blind Rehabilitation Center (ERBC), the Northeast Program Evaluation Center (health services delivery research), and the Women’s Health Center. The VACHS is recognized nationally as a psychiatry research center, including research in the areas of Addiction Psychiatry and PTSD. VACHS is situated approximately 4 miles from YNHH. A shuttle runs continuously between the VACHS and YNHH during the day.
Apply
If you are interested in applying for the Consultation-Liaison Psychiatry Fellowship Program at Yale University School of Medicine, please contact the program coordinator, Veronica Korn. Beginning in 2024, we will only accept applications via ERAS. We participate in the National Resident Matching Program. Most applications are received in August, September and October and we conduct interviews from September through November. All interviews conducted in the Fall of 2023 will be virtual.
Feel free to contact our office, if you have any questions at 203-785-2618.