(199) Integration of a Unique Health Equity Rotation Experience into the Consultation-Liaison Psychiatry Fellowship

Abstract: Background/Significance: Consultation-liaison psychiatry (CLP) fellows must develop an appreciation for diversity, equity, and inclusion (DEI) principles, particularly as they relate to enhancing the delivery of care to marginalized and underrepresented populations (ACGME, 2023). Fellows can learn about the impact of biases and sociocultural inequities through readings and lectures; however, incorporation of experiential learning into the fellowship curriculum is also worthy of exploration. The Healthcare Equity Consult Service (HECS) at Michigan Medicine, consisting of representatives from medicine, social work, and spiritual care, launched in August 2022 in response to biases impacting patient care. Here, we present a case highlighting the value of the CLP fellow’s interface with HECS.


Case:  A 46-year-old Mexican woman was admitted for hyperosmolar hyperglycemia in the context of social complexity precluding healthcare access. Psychiatry was consulted due to concerns for depression and started venlafaxine for mild symptoms with positive past response.  Psychiatry was re-consulted weeks later due to concern that depression interfered with physical therapy (PT) participation.  We suspected that daytime sedation related to multiple CNS-active analgesic medications, as opposed to depression, was causing reduced participation in care.
Other members of the health care team hypothesized the patient was intentionally not participating in PT as a way to extend stay and avoid legal consequences. A team member consulted HECS due to concern that these beliefs were influenced by the patient’s immigrant and socioeconomic status, as well as criminal allegations. The CLP fellow joined members of the HECS to see the patient, who acknowledged that she felt bullied and misunderstood by her medical team. We reflected on these concerns in a multidisciplinary meeting and discussed approaches to support equitable care. These were also reviewed with her medical team. On HECS follow-up visit, the patient shared she no longer felt stigmatized by her team. 


Discussion:  This case demonstrates how rotating with HECS allowed the CLP fellow to gain an understanding of biases emanating from social and structural determinants of health and how to challenge them. Since its inception, HECS has been involved in 155 cases, many of which related to race (48%), communication barriers (45%), medical system distrust (27%), and mental health and substance use (21%). In the future, leveraging institutional resources to fuel other pragmatic DEI-focused initiatives and quality improvement projects should also be considered to facilitate the fellow’s transition from learner to advocate (Isom et al 2021, Caravella et al 2023).
Conclusion/Implications: Strategies to equip CLP fellows with the knowledge and skills to develop structural competency merits further attention.

References

1. 
   Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Consultation-Liaison Psychiatry. July 1 2023. Retrieved March 20, 2024 from https://www.acgme.org/globalassets/pfassets/programrequirements/409_consultationliaisonpsychiatry_2023.pdf
   


2. 
   Isom J, Jordan A, Goodsmith N, et al. Equity in Progress: Development of Health Equity Curricula in Three Psychiatry Residency Programs. Acad Psychiatry. 2021;45(1):54-60.
   


3. 
   Caravella RA, Ying P, Siegel C, et al. Quality Improvement Framework to Examine Health Care Disparities in Behavioral Emergency Management in the Inpatient Medical Setting: A Consultation-Liaison Psychiatry Health Equity Project. J Acad Consult Liaison Psychiatry. 2023;64(4):322-331.
   

Presentation Eligibility: Not previously published or presented.

Diversity, Equity, and Inclusion: Rotating with the Michigan Medicine Healthcare Equity Consult Service (HECS) is a unique opportunity for the consultation-liaison psychiatry fellow to work with multiple disciplines to learn about navigating bias and discrimination in the hospital setting. We present this programmatic innovation to shed light on the utility of incorporating practical experiences for consultation-liaison psychiatry fellows to understand the impact of inequities as it relates to patient care. The authors of this poster include the current consultation-liaison psychiatry fellow, the fellowship program director, and the clinical social worker who helped spearhead the HECS at our institution.