Psychiatry in the Medical Setting Residency Track

Most patients with psychiatric disorders seek care in non-psychiatric medical and surgical settings, where their mental health problems frequently go unrecognized and untreated. In fact the primary care system has been called the "de facto" mental health system of the United States since over half of patients with psychiatric disorders only receive mental health care within this system of care. Psychiatric conditions such as depression, anxiety, and personality disorders may lead to costly medical workups, difficulties engaging in medical or surgical treatment, and poor health outcomes of patients' comorbid medical illnesses. For instance patients with depression and either heart disease or diabetes have increased medical symptom burden, additive functional impairment, poor adherence to medical regimens (such as following diet, cessation of smoking and taking medication as prescribed) and at least 2-fold higher rates of mortality. Furthermore, psychiatric conditions may mimic medical conditions because of this association with medical symptoms such as headache and fatigue, and many medical conditions have associated psychiatric symptoms, such as mood changes, anxiety, cognitive impairment, and psychosis. Psychiatrists able to work at the psychiatry-medicine interface and collaborate with medical and surgical colleagues can make a significant difference in the care and outcomes of these patients. Moreover, because patients in primary care and medical systems are often seen at early stages of mental illness, enhanced accuracy of diagnosis and quality of mental health care may prevent long-term disability from developing.

The Psychiatry in the Medical Setting Track has as its goal preparing residents for academic careers focusing on clinical work, research, and teaching at the psychiatry-medicine interface, including consultation-liaison psychiatry, geriatric psychiatry, and research in psychiatric health services and care delivery. This four-year track provides residents with opportunities for enhanced clinical, research, and mentorship experiences working clinically and doing research at the interface of medicine and psychiatry. Residents in this pathway can select clinical rotations providing psychiatry consultations within primary care (e.g., family medicine, general internal medicine, women's health) and medical/surgical specialty (e.g. heart disease, cancer, diabetes, transplants, maternal/infant care & high-risk Ob/Gyn, neurology, international refugee, HIV/AIDS) and geriatric clinics. In these clinical rotations, residents will be supervised by highly experienced psychiatric faculty who are experts in consultation-liaison and geriatric psychiatry who also have psychiatry consultation liaison positions within these medical clinics.. Beginning with up to 3 months in the PGY-2 year, and continuing with more longitudinal time (up to half time) in years 3 and 4, residents will have the opportunity to work with highly experienced mentors to participate in research at the interface of psychiatry and medicine. Residents will have the opportunity to participate in a weekly research "works-in-progress" conference and to have regular meetings with a research mentor, as well as designing and completing a research project and publishing manuscripts.

Residents in the Psychiatry in the Medical Setting Track will have a high likelihood of being accepted to one of four fellowship programs in the Department of Psychiatry and Behavioral Sciences at the University of Washington after completion of their psychiatry residency. These include two one-year ACGME-accredited clinical fellowship programs in Psychosomatic Medicine and Geriatric Psychiatry, as well as two 2-year research training fellowships funded by the National Institute of Mental Health (NIMH): a fellowship in Primary Care-Psychiatry or a fellowship in Geriatric Mental Health Services Research. These two research fellowships include two years of funding, completion of an MPH degree in the UW School of Public Health or other appropriate research methods training, participation in ongoing research at the interface of psychiatry, medicine, or geriatrics, and development of an independent research project.