Clinical Experience Rotation
The training-based experience involves the provision of psychological services to a range of medical services across this tertiary care center and its clinics. Staff and trainees are responsible for providing psychological assessments, interventions, and consultations for patients with a variety of acute and chronic medical problems. Fellows provide bedside services to patients in the hospital setting and also provide outpatient evaluation and longer-term assessment services. Patients range in age from 17-100 on this service.
Further, a wide range of patient diagnoses and referral questions are presented. As a large component of this experience, fellows provide psychological consultation to a variety of medical teams, and learn to work collaboratively and efficiently with a number of different medical staff including physicians, nurses, rehabilitation therapists, nutritionists, pharmacists, social workers and pastoral care providers.
Over 160 new referrals are received per month, and thus, fellows develop an appreciation for the important role of psychology in assisting in the treatment of a multitude of patient diagnoses.
Fellows will spend approximately 80 percent of their time on the inpatient service. As a secondary rotation (20 percent of their time), fellows will have the opportunity to focus on specialty areas in health psychology. The determination of this rotation will be based upon each fellow’s stated interest and training background, availability of the rotation in any given training year, and the approval of the Director of Training. Within the Medical-Surgical service, fellows will have the opportunity to work in the following:
Primary Track (80 percent time)
- Primary Track-Adult Hospital-Based Service: The Health Psychology service provides bedside assessment and intervention to patients referred by the medical-surgical services across the hospital. Referrals are made with the expectation that we will provide timely recommendations and treat as appropriate. Fellows will learn to provide same day assessments relevant to the referral question and will become skilled in a variety of assessment techniques and modalities. Also on this rotation, and somewhat unusual for many other consultation-liaison services, the fellow will have the opportunity to provide ongoing interventions with the patient during their hospital stay. They will learn to provide brief, solution-focused and supportive psychotherapy with patients and families while they are in the hospital. Consultation with medical and allied health staff is also a very large component of this experience.
Additional specialized focus areas within the Medical-Surgical Service:
- Burn Service: UW Burn Service houses an eight-bed acute care service for burn patients. There is also an outpatient Burn clinic for those patients who have been discharged from the hospital and require continued medical care. The Health Psychology service provides assessment and intervention services for adult and pediatric Burn patients. Specific skills developed include trauma screening, pain management, and adaptation to loss and body image change. One of the postdoctoral fellows takes a psychology “lead” position on the Burn Team, attending weekly multidisciplinary rounds and assisting with patient coping.
- Palliative Care Service: The Health Psychology service provides consultation to the multidisciplinary palliative care treatment team, who works directly with inpatients at end-of-life or with symptom management needs. This includes providing consultation for ethical dilemmas and clinical decision-making that occurs when working with patients at end-of-life. Intervention with dying patients and their families is also a part of this experience. The training experience for an interested fellow also includes didactics in palliative care. Any fellows interested in active involvement in the palliative care service can do so for approximately 2-3 hours per week.
- Organ Transplant Evaluation Service: The Health Psychology service provides pre-surgical evaluation for potential organ recipients on the cardiology, pulmonary, kidney and liver transplant services. These include clinical interviews with potential recipients and their support persons and psychological testing. Fellows also provide pre-surgical evaluation to the living kidney and liver donor programs. Typically, fellows can expect to perform 2-3 evaluations per month.
- Acute Care for the Elderly Service (ACE): Fellows can choose to provide consultation to this multidisciplinary treatment team focused on comprehensive treatment planning for geriatric patients. Consultation questions include decisional capacity assessment, safety evaluation and dementia/delirium/depression work-up. Fellows attend morning rounds, work with patients and families, and provide consultation to treatment teams.
- Neurology and Neurosurgery Service: Fellows can choose to attend Neurology/Neurosurgery rounds and take a psychology lead on this multidisciplinary treatment team. Patients seen include those who have suffered stroke, undergone resection of brain tumors, or are being treated for seizure disorder. Patients diagnosed with conversion disorder can also be seen while a member of this treatment team.
- Vascular Surgery: Fellows can choose to attend Vascular Surgery rounds on a weekly basis, and tend to work with the patients who are undergoing planned amputation as a result of vascular disease. Fellows engage in walking rounds and also attend weekly conferences on this service.
In addition to receiving a broad range of experience, fellows can attempt to seek experiences emphasizing specific patient populations depending upon specific interests. In the past, fellows have chosen to gain additional specialized experience in Family Medicine and Hematology services. The hospital setting is very receptive to any fellow interested in a certain area of training.
Adult Specialty Services
Each fellow will spend approximately 20% of their time in a specialty clinic in health psychology. In the past, the possible options have included UW Carbone Cancer Center, UW Health at The American Center Weight Management program and the Outpatient Health Psychology Clinic. Site availability and fellow interest will determine the rotation for each fellow.
- Each fellow is supervised by at least two licensed psychologists.
- The Director of Postdoctoral Training oversees all supervision. Fellows receive a minimum of two hours of formal supervision per week.
- Ongoing, informal supervision is available throughout every day.
- Fellows are formally evaluated on a quarterly basis using the Minnesota Supervisory Inventory from the QAI Systems. The fellowship program is overseen by the Director of Postdoctoral Training at UW Hospitals and Clinics, a full-time licensed staff psychologist whose responsibility it is to ensure that training needs are being met.
- The Director of Postdoctoral Training is responsible for the recruitment and selection of fellows, and provides direction to and oversees the training faculty with regard to their involvement in the fellowship program.
- Fellows are required to maintain records of their clinical activities, and these records are reviewed by the Director of Training to ensure a breadth of experience during the fellowship year. These records include the number of patient contact hours, the settings in which clinical services are provided, the type of psychological assessments and interventions provided and the fellows’ exposure to diversity in patient cultures.
- Fellows are asked to provide feedback and to evaluate their supervisors, training experiences and the overall fellowship program throughout the year. An exit interview is performed by the Director of Postdoctoral training and by the Health Psychology administrator with each fellow at the end of the year.
- Fellows also have the opportunity to provide supervision (under supervision) to practicum students who rotate through University Hospital when practicum students are available. There is also the opportunity to provide training to medical residents and other allied health staff on an as requested basis.