Clinical Rotations

 

C&L Team

Consultation and Liaison Service

The Inpatient Consultation and Liaison Psychiatry Service is an active training service which provides fellows with expertise in clinical care, teaching and administration in Consultation and Liaison Psychiatry.

CL Lunch

The Stony Brook Inpatient Consultation and Liaison Psychiatry Service is an active training service, staffed by five psychiatry attending physicians, a Consultation-Liaison Psychiatry, Psychologist, Clinical Nurse Specialist, Licensed Clinical Social Worker and residents and fellows rotating from psychiatry, neurology, geriatric psychiatry, family medicine, geriatric medicine, physician assistant students, and medical students from the Stony Brook University School of Medicine.

The rotation aims to provide fellows with expertise in clinical care, teaching and administration in Consultation and Liaison Psychiatry. The service provides psychiatric evaluation and management of approximately 2,500 unique patients each year throughout Stony Brook's 650 bed acute care inpatient hospital, including general and specialty medical and surgical floors, the medical intensive care and step down units, the neurosurgical trauma and surgical intensive care unit, the cardiac acute care unit, the cardiothoracic surgery care unit, and the burn unit.

During training on the Consultation and Liaison service, fellows will provide direct patient care, working with patients, their families and multidisciplinary primary teams, as well as supervise more junior trainees on the service, as they progressively assume the functions of a junior CL attending. Fellows will also have a leadership role in the organization of didactic activities on the service, including the journal club and weekly clinical case conference. Additionally, fellows will participate in CL service administrative processes, including our weekly CL staff meeting and hospital quality improvement initiatives aimed to improve patient care, such as our hospital delirium early identification and intervention initiative. From these experiences, we expect our graduating fellow will be well prepared for a position on an academic CL service or to lead a CL team of their own.


Palliative Care Service

Fellows in the Stony Brook Fellowship in Consultation-Liaison Psychiatry will receive an in-depth exposure to the subspecialty field of palliative medicine.

Fellows in the Stony Brook Fellowship in Consultation-Liaison Psychiatry will receive an in-depth exposure to the subspecialty field of palliative medicine during a four week rotation with the palliative care service, led by Grace Latorre, MD. Fellows on their palliative medicine rotation will work with an interdisciplinary team consisting of palliative care physicians, nurse practitioners, a social worker, and a chaplain in the inpatient hospital setting. Through lectures provided by members of the palliative care team and experiential learning as an active member of the palliative care team, fellows will gain knowledge about key palliative care topics such as family meetings, prognostication, pain and non-pain symptom management, and ethical and legal issues in palliative care. The overarching goal of the rotation is to prepare fellows in essential communication and symptom management skills necessary for the care of patients with serious illness.


Primary Care Mental Health Integration

Primary Care Mental Health Integration is a collaborative program between Primary Care and Mental Health to address the mental health needs of the veterans within the Primary Care setting.

Primary Care Mental Health Integration (PCMH-I) is a collaborative program between Primary Care and Mental Health to address the mental health needs of the veterans within the Primary Care setting aiming to  improve overall health outcomes.  It is designed to improve treatment of mental health conditions and behavioral aspects of chronic medical conditions in patients by improving access and reducing barriers to mental health services.  PCMH-I provides a suite of services to support the Patient Aligned Care Teams (PACT) of at least 25 providers.   Services provided include curbside and formal consultations, medication management, diagnostic evaluation, brief counselling, specialized care coordination through Care Management, individual health psychological services such as Cognitive Behavioral Therapy for Insomnia, Cognitive Behavioral Therapy for Chronic Pain, as well as Group Programs such as Mindfulness for Stress Reduction and Healthy Choices/Harm Reduction.   PCMH-I is staffed by a fulltime psychiatrist and 2 fulltime psychologists.  Additionally, PCMH-I trains 3 psychology doctoral student interns annually.   For more complex and severe cases, PCMH-I will connect patients with specialty care mental health programs. 


Consultation-Liaison Fellows Clinic

The fellowship includes a half-day clinic each week for completing outpatient psychiatric evaluations and short-term follow-up of medically complex outpatients referred from a variety of medical and surgical specialty areas.

The Psychosomatic Medicine fellowship includes a half-day clinic each week for completing outpatient psychiatric evaluations and short-term follow-up of medically complex outpatients referred from a variety of medical and surgical specialty areas. These include the Stony Brook Medicine Center for Pain Management, Kidney Transplantation Services, Bariatric and Metabolic Weight Loss Center, and Left Ventricular Assist Device Program, among others. The fellow will attend the interdisciplinary team meetings of these programs to discuss referred patients and to enhance their skills in working as part of an integrated medical or surgical team. In addition, the clinic provides an opportunity for fellows to provide outpatient follow-up for patients that s/he consulted on during an inpatient medical hospitalization.


Hospital Medicine Proactive Consultation-Liaison Psychiatry Service

The Stony Brook Medicine Program in Collaborative Care for Hospital Medicine aims to improve the management and outcomes of co-morbid psychiatric symptoms through the full integration of psychiatric services on inpatient medicine units.

The Stony Brook Medicine Program in Collaborative Care for Hospital Medicine aims to improve the management and outcomes of co-morbid psychiatric symptoms through the full integration of psychiatric services on inpatient medicine units. The program strives to improve early case finding and intervention, and improves the coordination of inpatient medical and psychiatric care.

The psychiatry team consists of a psychiatrist/team leader, psychiatric nurse practitioner, and rotating fellows, residents and students. The team participates in daily interdisciplinary team rounds, and works closely with the range of healthcare providers on those units, including the hospitalists, nursing and social work staff.

Fellows participate in the role of a psychiatrist on one of the hospital medicine units, providing comprehensive consultations as well as less formal ‘curbside’ consultations to the interdisciplinary medical teams.


Child and Adolescent Consultation-Liaison Psychiatry

The fellowship includes a one-month block in psychiatric consultation for pediatric populations. The fellow will respond to consultation requests from the pediatric medical and intensive care units. The fellow will work with both the children and the parents of children with a variety of medical conditions leading to hospitalization. The fellow will gain expertise in psychiatric diagnostic evaluation of medically ill children, evaluation of the family system from which these children come, and the use of both psycho-pharmacologic agents in the pediatric population as well as non-pharmacological therapies to support the child and family.


Elective Month

The Consultation-Liaison Psychiatry fellowship allows the fellow to design with the Program Director an elective month to pursue a clinical and/or research interest they would like more exposure to. This may include experience in various sub-specialty clinics to include the in-patient pain service and out-patient behavioral pain clinic, the various neurology clinics to include, Epilepsy, Movement Disorders, and ALS. Other elective rotations may include the Bariatric and Metabolic Weight Loss Center, and Left Ventricular Assist Device Program, among others. In addition, the fellow will attend the interdisciplinary team meetings of these programs to discuss patients and to enhance their skills in working as part of an sub-specialty integrated team.


Consultation-Liaison Psychology Service

Fellows will participate in a cognitive behavioral therapy (CBT) rotation on the C-L Psychology service, with exposure to third wave CBT modalities including mindfulness, Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT).  This rotation will focus on diagnostic evaluation using a CBT based case formulation approach and brief psychotherapy for medically hospitalized patients.   There are opportunities to carry a short term outpatient CBT case, based on the fellow's interests.  Through this rotation, the fellow will be able to understand and apply biopsychosocial theory where the fellow can incorporate biological, genetic, medical, individual, personality, situational, and environmental factors in their care formulations.  The fellow will learn how to implement guided discovery, Socratic questioning, reflective listening and summarizing.  The fellow will become proficient in developing a collaborative-empirical approach to a therapeutic alliance.  There will be ample opportunity to practice the components of CBT by discoing patient's automatic thoughts, implementing behavioral strategies such as behavioral activation, pleasant activities, relaxation, distraction and applying evidence based cognitive behavioral therapies.


Neurology Consultation Service

Fellows complete a one-month rotation on the Stony Brook University Neurology consultation service, aimed to strengthen their skills in neurological assessment and differential diagnoses.  Common clinical problems fellows encounter include delirium, suspected seizures, headaches, new onset focal weakness or sensory loss, dementia, and other chronic neurological illnesses such as Parkinson's disease and multiple sclerosis. Through exposure to this diverse patient population with a vast array of neurological disorders, fellows will sharpen their clinical skills in neurological examination, neuroanatomical localization, cognitive assessment and the interpretation of neuroimaging. 


Liaison to the Renal Transplant Service

Fellows will have the opportunity to collaborate closely with the Kidney Transplantation Service at Stony Brook, which is in the top 20% of programs nationally by patient volume.  Fellows will perform outpatient evaluations of patients seeking living and deceased kidney transplants in addition to screenings of individuals seeking to provide altruistic kidney donation.  The fellow will participate in monthly meetings with the kidney transplant team to discuss any potential barriers for patient listing and ways to maximize a patient's candidacy for transplantation. Fellows will learn how to assess and provide recommendations for caring for patients with a variety of pathologies including affective disorders, psychosis, substance abuse, cognitive disorders, personality disorders, and non adherence in this medically complex population.


Consultation for Outpatient OBGYN Services

Fellows will have an elective opportunity to rotate in the outpatient Obstetrics and Gynecology clinics at Stony Brook University.  This rotation is aimed at enhancing proficiency in assessment of the peripartum population.  Fellows will gain experience in managing a wide array of conditions such as postpartum depression, peripartum OCD and anxiety, substance use disorders, and other mental health issues related to pregnancy.  The fellow will gain comprehensive knowledge about managing the peripartum population through psychopharmacological approaches, psychotherapeutic resources and will enhance their skills in treating patients through inter professional collaboration with the OBGYN team.