Is it Time to Rethink Consultation-Liaison Psychiatry Training? New Perspectives from National Voices in Psychiatric Education

Abstract: The US faces a shortage of subspecialty trained psychiatrists, including Consultation-Liaison Psychiatrists (CLP). While applications to psychiatry residency and fellowship training programs have increased over the past decade, there remains a dearth of psychiatrists to manage medically complex patients in a dynamic healthcare landscape, provide education to non-psychiatrists, and improve healthcare delivery systems. Fellowship recruitment alone will not solve the current deficits.

Additionally, CLP training has not fully evolved to meet the needs of today’s trainees, patients and healthcare systems. In many programs, training remains traditional in nature - heavily weighted towards inpatient med-surg settings, with limited exposure to outpatient settings, such as collaborative care, and to complementary and novel approaches. Formal didactics often do not teach “soft skills,” such as leadership and negotiation. There are missed opportunities for collaboration with other psychiatric subspecialists, and at least 20% of residency programs lack a CLP-trained faculty member. Once in practice, there is little guidance to ensure continued acquisition of competencies needed to practice in an ever-evolving healthcare environment.

The time is right to rethink CL psychiatry training. This session convenes a diverse set of perspectives from within and outside of CLP, including national leaders in residency training, to explore novel approaches to CL education over the entire learner spectrum. Questions raised will include whether programs should train all residents to do subspecialty work, whether training should be competency-based rather than time-prescriptive, and whether CL fellowships should broaden the scope of training to include topics such as integrative medicine, interventional psychiatry, and leadership.

Dr. Adam Brenner, Editor-in-Chief of Academic Psychiatry, Director of Adult Psychiatry Residency Training, and Vice Chair for Education in Psychiatry at UT Southwestern Medical Center, will propose revising general psychiatry residency requirements to ensure that graduates are able to serve as true “generalist” psychiatrists, able to treat a variety of problems within subspecialty populations (15 min).

Dr. John Q. Young, the President of American Association of Directors of Psychiatry Residency Training (AADPRT) and Chair and SVP for Psychiatry at Northwell Health, will discuss the importance of anchoring educational reforms, especially aimed at addressing workforce shortages, in competency-based principles and the related role of Competency-Based Assessment in maximizing learning, enabling a trustworthy process for high-stakes judgements, and facilitating life-long, self-regulated growth and clinical competence (15 min).

Dr. Scott Beach, former Director of the MGH/McLean Residency, will review results of a national survey and present 2024 guidelines for residency training in CLP, developed by ACLP’s Residency Education Subcommittee. These guidelines provide a roadmap to craft an optimal CLP rotation while balancing the competing demands of national requirements and resident preferences (10 min).

Dr. Carrie Ernst, Program Director for Mount Sinai Hospital’s CLP Fellowship and Chair of AADPRT’s Subspecialty Caucus, will explore novel approaches to fellowship training, including non-traditional electives and the development of a multidisciplinary didactic curriculum (10 min).

Breakout sessions will provide a space for participants to consider innovations in CLP education and define desired competencies and assessment strategies for both trainees and in-practice CL psychiatrists (25 min).

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