Reproductive Psychiatry Tracks in Consultation-Liaison Fellowship

Abstract:

Background: Reproductive psychiatry (RP) is a growing subfield of psychiatry concerned with the study and treatment of psychiatric illness during reproductive hormonal transitions. Training in RP is neither required nor standardized (Osborne et el., 2015). One avenue to obtain specialty training in RP is through a Consultation-Liaison (CL) psychiatry fellowship, but little is known about the extent of training in RP during CL fellowship.

Methods: We used Qualtrics to send a comprehensive survey on RP training to all CL psychiatry fellowship program directors (n=66, results already presented). We then sent a follow-up survey to determine which programs have an RP track (n=63). To those who responded “yes” to the question “Does your program have an RP track?” we sent a second survey assessing details about the RP track.

Results: Forty-five programs responded to our initial survey (71% response rate); of these 10 indicated the presence of an RP track. An additional three programs were unsure whether or not they had a track. Of the 10 who did, 9 (90% response rate) responded to the follow-up survey. Respondents were mostly fellowship directors (n=8) or RP track directors (n=1). Most programs were established between 2015-2020 (n=6). All reported accepting 1-2 fellows per year. Programs graduated an average of 2 fellows from their RP track with a range from 0 to 6. The mean number of hours per year spent on RP didactics was 35 (median: 40; range: 4 to 78 hours/year). Programs reported an average of 2.9 faculty members with a focus on RP (median: 2.5; range: 1 to 6). Fellows spent an average of 26.88% of their clinical time in RP settings over the course of their fellowship year (median: 25%; range: 10% to 50%). Most tracks did not require a scholarly project (n=8, 89%). 89% of RP tracks paired fellows with an RP mentor (n=8).

Discussion: This survey highlights the variability and lack of standardization in RP training within CL fellowships even for those who believe they are offering enhanced training. This confusion about the definition of a track and whether programs did or did not have a track highlights the inconsistency of the RP training across CL psychiatry programs. Among those who thought they did have a track, there was great variability noted in the didactic and clinical hours required; thus fellows graduating from RP tracks at different programs are not getting the same level of training. As those graduating from these tracks may feel they are qualified in this specialty, this inconsistency highlights the need to standardize training to ensure consistently and rigorously trained physicians.

Conclusion/Implications: RP tracks during CL fellowship are inconsistent in their definition of a track and in clinical and didactic requirements, highlighting a need to further standardize training in RP.

References:

Osborne LM, Hermann A, Burt V, Driscoll K, Fitelson E, et al. Reproductive psychiatry: the gap between clinical need and education. Am J Psychiatry. 2015;172(10):946–8.

Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: Historically women were underrepresented in research and less was known about conditions unique to women. Though this gap in understanding reproductive transitions has decreased as research is now more inclusive, education in this field has lagged behind. Training in reproductive psychiatry is often inadequate or inconsistent leading to limited experience to best treat women and birthing persons during times of reproductive transitions. This project attempts to identify these inconsistencies and advocate for standardizing training in this field.