Fellowship in Psychosomatic Medicine

Consultation-Liaison Psychiatry (also known as Psychosomatic Medicine) involves collaborating with general practitioners in caring for patients who have simultaneously occurring psychiatric and general medical conditions. Our program at Mount Sinai Beth Israel has trained more than 60 fellows, many of whom have taken on nationwide leadership roles in Consultation-Liaison psychiatry.

Mount Sinai Beth Israel (MSBI) is a 350-bed teaching hospital that has been serving New York City for the past century. We have an academic affiliation with the Icahn School of Medicine at Mount Sinai, and we are a clinical campus for the medical students' rotations. The Consultation-Liaison division began in the 1960s, and our one-year fellowship was established in 1986—one of the first in the nation to receive accreditation from the American Council on Graduate Medical Education (ACGME). Dr. Seema Quraishi, the current Program Director, and Dr. Carmen Casasnovas, the Assistant Program Director, are both graduates of the fellowship.

Each year the Fellowship trains 2 fellows for a 12 month period.  The Fellowship at MSBI provides an exposure to diverse clinical settings to enhance the Psychosomatic Medicine training experience.  Fellows develop a solid fund of knowledge and clinic skill throughout the year allowing them to progress toward key positions in the field.  The Fellowship also focuses on creating a strong research foundation.  MSBI Psychosomatic Medicine Fellows have had numerous presentations at the Academy of Psychosomatic Medicine Annual Meeting, the American Psychiatric Association Annual Meeting, among others. 

The training consists of several year-long activities:

  1. Clinical activities (inpatient and outpatient)
  2. Liaison activities and work with multidisciplinary teams
  3. Didactics and supervision
  4. Teaching and supervision of residents, medical students, and non-medical staff
  5. Administrative duties
  6. Academic projects and research
  7. Participation in the Education and Quality Improvement Committees

How to Apply

To be considered for this fellowship, you must have graduated from an ACGME-accredited psychiatry residency program and have passed Step 3 of the USMLE. International medical graduates must have a valid ECFMG certificate for a visa. Candidates must take the General Psychiatry Boards during this fellowship if they are not board-certified. Eligible candidates must also commit to taking the Psychosomatic Subspecialty Boards.

To apply, please send an application, three letters of reference, and a personal statement to seema.quraishi@mountsinai.org. The fellowship match number is 1470409F0. This program begins on July 1 and lasts for one year. Candidates are encouraged to submit applications starting in July prior to the year they wish to begin, and interviews will begin in August.

Clinical Rotations  

Inpatient Consultations
MSBI sees an average of 160 consultation requests per month, and fellows are assigned approximately four consults per week. Over the course of the year, fellows see a wide range of patients with varying diagnoses and degrees of difficulty from MSBI and New York Eye and Ear Infirmary. They receive daily individual supervision from Drs. Quraishi, Khan, and Casasnovas.  As they progress, fellows take on greater responsibilities: they lead rounds and case conferences, and take an administrative role in running the Consultation-Liaison service.

Institute for Advanced Medicine: The Peter Krueger Clinic
This is a required part-time, year-long outpatient rotation staffed by Dr. Ashley, with expertise in caring for patients with HIV. Fellows work as part of a multidisciplinary team, and follow outpatients under the supervision of the Attending physicians. Educational activities include weekly supervision, HIV rounds, and an HIV Journal Club. The fellows participate weekly in multidisciplinary mental health care team meetings and case presentations with psychologists, social workers, care coordinators, and nursing staff.  

Transplant Service at Mount Sinai Hospital
This is a required part-time rotation with a consult psychiatrist on the transplant service at Mount Sinai Hospital to learn about evaluations of transplant candidates pre- and post-transplant as well as participate in multidisciplinary discussion of transplant cases.

Sidney Hillman Family Practice
Fellows are required to spend a half day per week for six months at the Sidney Hillman Family Practice Clinic. Goldie Alfasi, PhD, a senior psychologist from the Department of Family Medicine will provide direct supervision to the fellows as they use an integrated care model emphasizing teamwork and shared expertise with the family medicine residents and interns. Fellows are exposed to common psychiatric problems seen among medically ill outpatients and collaborate with the primary physician to evaluate of these problems and establish an appropriate diagnostic and treatment plan. Additionally, the fellow gains training and hands-on experience in precepting Family Medicine residents in the management of patients in the outpatient medical clinic.

Outpatient Oncology
Fellows are required to spend a half day a week for four months at an outpatient Oncology Center where they see patients in conjunction with Dr. Khan. Fellows learn about issues related to being diagnosed, treated for, and living with cancer; and about psychiatric disorders as they present in cancer patients. The Attending gives eight psycho-oncology lectures and uses case vignettes with questions.  Fellows also learn about pain and insomnia management.

Outpatient Psychotherapy
Fellows follow medical outpatients for psychotherapy. Therapeutic issues may involve adjustment to medical illness, how it impacts family or loved ones, existential issues, how to disclose to others and when, how to interact effectively with the medical team. Patients may be audio- or videotaped, which will be reviewed during supervision.

Ethics
Fellows will have the opportunity of participating in ethics consults on the inpatient medical floor.

Palliative Care Rounds Liaison
Each week fellows will attend a multidisciplinary conference held by the Division of Palliative Care. The meeting is attended by Palliative Care Attendings and fellows, chaplains and chaplaincy students, social workers, music therapists and music therapy students. Palliative Care Fellows and Attendings present cases to address complex psychosocial issues. Discussions can include how to manage difficult patient and family situations, physician and other team members' emotional response to their work, patients and death, education in psychopharmacology or psychodynamics, patient and family coping with illness and death.

Integrated Care
Fellows will participate in a weekly conference call with the Phillips Ambulatory Care Center discussing patients enrolled in the Depression Care Management Program, which is based on the AIMS model for collaborative care.

Electives
Electives may be arranged part-time in areas of particular interest to the fellow.

Didactics  

General Consultation-Liaison Psychiatry Seminar
There are several formal didactics. The first is a 22-week course including guest lecturers to complement our own faculty. The areas covered in this course include delirium, neuropsychiatry of HIV/AIDS, psycho-oncology, psychiatric aspects of liver transplant, death/palliative care, integrated care, somatic symptom disorders, pain evaluation and management, cross cultural issues, and more.

Seminar with Dr. Wallack: Introduction to Advanced C-L
The fellows spend 8 weeks reviewing classic papers from the Psychosomatic Medicine literature on topics such as coping and adaptation to medical illness, the approach to managing the difficult patient on the medical wards or working as a liaison to a medical or surgical team.

Fellows' Seminar
There is also a year-long, weekly Fellows' Seminar with didactics on advanced topics in Psychosomatic Medicine. Topics include severe drug reactions, pain management, and a review of CL aspects of cardiac, renal, endocrine, gastrointestinal and other areas. Current text books, current and classic papers are read. Journal Club meets monthly to critically evaluate recently published studies.

Journal Clubs
There is a bi-weekly journal club led by the fellows where residents and fellows present articles of interest in Psychosomatic Medicine. There is also a weekly journal club centered on the care of patients with HIV. Journal articles, relevant chapters on the psychiatric care of patients with HIV are read and discussed

Case Conferences
There is a weekly case conference that focuses on patients in the hospital. Each week, patients with diverse diagnoses and problems are evaluated. The conference is led by the senior faculty or by visiting Attendings with different expertise. PGY2 Psychiatry Residents, medical students, Family Medicine Residents, and the entire CL faculty participate. The Attending interviews the patient and the interview is followed by a group discussion of the issues raised by the patient's case. Later in the year the fellows will interview the patient and lead the group discussion. Fellows learn how to teach in the case conference format, gain skills in interviewing in front of a group, and understand how and what to teach trainees of different educational levels.

Research

Research and Academic Project Meeting
Fellows meet weekly with the faculty to work on academic projects for various meetings and for the fellows' grand rounds presentation in April. Each year the Division has had numerous presentations at the Academy of Psychosomatic Medicine Annual Meeting and the American Psychiatric Association Annual Meeting. Fellows create research projects, learn basics of research design, how to run a literature search, write abstracts, create posters, workshops and present in the Grand Rounds format.Fellows attend the Annual Meeting of the Academy of Psychosomatic Medicine (APM) in November each year, and are encouraged to join the APM.

Research and Academic Projects
Fellows are required to participate in academic projects. They may join ongoing projects within the division, or develop their own project often based on clinical data or on complicated clinical cases. Past projects included "The Management of an Acutely Manic Patient with Brugada Pattern: a case report," Cannabinoid Hyperemesis Syndrome: 19 Year-old Female with Cannabis Dependence, Cyclical Vomiting, and Compulsive Bathing," "A Case Report of Megaloblastic Madness" and "Documentation of Risk Factors for Cardiac Arrhythmias in the Treatment of Delirium with Neuroleptics," Fellows work on a joint research /academic project that will be presented at Grand Rounds and submitted to the Academy of Psychosomatics Annual Meeting (APM). Each year fellows have had a number of presentations at the APM. Fellows are encouraged to write up their findings for publication.

Teaching and Administrative duties

Teaching and Supervision of Residents and Medical Students
Fellows serve as the primary supervisor for family medicine third year residents who rotate through Consultation-Liaison as part of their training. Fellows also supervise PGY-2 psychiatry residents and third and fourth year medical students. Fellows teach in journal club, seminars, formal lectures, rounds and in the case conference format mentioned earlier. Formal lectures for medical students on topics such as delirium or depression are arranged during the year.

Administrative Duties and Committees
The fellows spend six months coordinating the consult service under the supervision of the Attendings. This involves working with non-psychiatric physicians, triaging of consultation requests being called in, assigning them to residents and staff, and working closely with the program assistant who maintains the patient log and database. Fellows learn about the financial aspects of the C-L service and about billing for consultations, and clinical information systems. This includes learning proper diagnostic and CPT code documentation, as well as the process of working with Medicare, Medicaid, and other third party payers. Fellows participate in weekly Division Staff Meetings where they learn about how the Division interfaces with the larger Psychiatry Department and the Medical Center. Fellows are members of the Psychosomatic Medicine Fellowship Graduate Medical Education Committee. They participate in educational program development, evaluation and improvement. They are integral members of the selection committee for new fellows. Fellows are part of the C-L Division Quality Improvement Committee and work on projects to improve patient care.

Support

We prioritize fostering a pleasant and collegial working environment, and any concerns are taken seriously. The full-time faculty supervises all clinical, teaching, administrative, liaison, and academic activities. The fellows meet daily with their supervisor for individual supervision on their cases.  

Benefits
MSBI supports a generous package of benefits for trainees and staff. The Fellowship stipend is described on the GME website, and housing is usually available at attractive rates. MSBI has an excellent full-service medical library, the Seymour J. Phillips Library, located on the 12th floor of Fierman Hall. Fellows also have online access to the Levy Library at the Mount Sinai School of Medicine. Fellows have their own office with computer access to the hospital electronic medical record, PRISM, EPIC, and EMSTAT and may search the electronic databases available through the library (OVID, and PsychLit, Cochrane, etc.), and request papers. Papers typically arrive via email within 24 hours. Up-to-Date, Lexi-Comp and other clinical information sources are available via the hospital intranet and there is VPN remote-access.

This fellowship is accredited by the Accreditation Council for Graduate Medical Education.