C-L “How To” Guides

• Concise educational materials related to common C-L topics, created by the ACLP Residency Education Subcommittee. Specific guides include:
  • Doing a Consult
  • Acute Agitation
  • Alcohol Withdrawal
  • Buprenorphine microinduction
  • Catatonia
  • Clozapine
  • Creating a Behavioral Plan
  • Death and Dying
  • Delirium
  • Demoralization
  • Depression
  • Medication Syndromes
  • Microaggressions
  • Opioid Use Disorder
  • Perinatal Psychiatry
  • Psychopharmacology after Bariatric Surgery
  • QTc Prolongation
  • Suicide Risk Assessment
  • Transplantation

ACLP Webinars

• Case conferences providing trainees an opportunity to learn more about C-L psychiatry through interesting case presentations, moderated by leaders in the field.

ACLP Podcast

• Episodes covering C-L clinical updates, new research, and interviews with leaders in the field.

Annual Meeting Content

• Selected recorded content from the 2021 ACLP Annual Meeting, along with an annotated guide to these sessions. Sessions were selected by members of various ACLP Education Committee subgroups based on relevance to students and residents. Please click here.Recommendations about didactic content from the 2022 and 2023 meetings are also available.

Bibliography

• For Medical Student Learners and Teachers in C-L
  • Key articles on C-L topics relevant to students, compiled by the Medical Student Education Subcommittee.
• Quarterly Annotations
  • Commentary on recent journal articles relevant to C-L psychiatry, updated quarterly by the ACLP Guidelines & Evidence-Based Medicine Subcommittee.
• Journal of the Academy of Consultation-Liaison Psychiatry (JACLP)
  • The official journal of the ACLP, with a new issue published every two months. Access is free to ACLP members!

Recommended External Websites

• Psychiatry Student Interest Group Network (PsychSIGN)
  • A national network for medical students interested in psychiatry.
• Visiting Student Learning Opportunities (VSLO)
  • A compilation of resources from the Association of American Medical Colleges (AAMC) regarding short-term learning opportunities for medical students and public health students in locations outside of their home institutions (“away rotations”).
• Medical student resources from the American Psychiatric Association (APA)
  • Information on residency applications and psychiatry as a career, with links to opportunities for summer programs
• Association of Directors of Medical Student Education in Psychiatry (ADMSEP) Clinical Simulation Initiative eModules
  • A repository of interactive eModules on various topics in psychiatry, including the psychiatric interview and the mental status exam.
• MedEdPORTAL: the Journal of Teaching and Learning Resources
  • An open-access journal of teaching and learning resources in the health professions published by the Association of American Medical Colleges (AAMC), in partnership with the American Dental Education Association.

There are many opportunities for students to be involved in the ACLP, including:

Joining the ACLP

• Membership is currently free to students and includes free annual meeting registration, access to a variety of member resources on the ACLP web site, and full access to the Journal of the Academy of Consultation-Liaison Psychiatry.
• Student members are eligible to join any ACLP Special Interest Group (SIG) or Forum and can apply to any of the ACLP Committees or Subcommittees (with applications open to members each summer). Each year, the ACLP Medical Student Education Subcommittee has a membership spot specifically reserved for a student member.

Attending an ACLP Annual Meeting

• Each year, the ACLP holds a national meeting in November. Students are welcome and encouraged to attend! Information on future and past meetings can be found here.

• The Medical Student Education Subcommittee provides student conference attendees with student-specific information prior the meeting and invites students to attend each year’s Trainee Mixer for a networking event specifically designed for students, residents, and fellows.
• Beyond attending the meeting’s academic and networking sessions, students are encouraged to submit their work to be featured in the conference. The submission deadline typically falls in late March or early April and is open to both members and non-members.

Joining the ACLP Mentorship Program

• This is a program designed for both trainees and early career psychiatrists to connect with more senior C-L psychiatrists for mentorship. This program is open to both members and non-members.

What is consultation-liaison psychiatry?
Consultation-liaison (C-L) psychiatry is a subspecialty within psychiatry that involves the interface between psychiatry and other medical specialties. A C-L psychiatrist may work in the inpatient medical setting, the emergency medical setting, or the outpatient medical setting. In each, the C-L psychiatrist provides direct patient care and/or collaborates with other medical specialists as they care for patients. Training in C-L begins in psychiatry residency, when every resident must complete a C-L rotation. Individuals can then pursue a one-year fellowship in C-L psychiatry and subsequently pursue board-certification in C-L psychiatry through the American Board of Psychiatry and Neurology (ABPN).

If you are interested in psychiatry but want to keep up your knowledge of medicine and surgery, C-L psychiatry may be the career for you. See this presentation from the APA. See also this presentation about the special connection between C-L psychiatry and medical practice.

How is C-L psychiatry different from psychosomatic medicine?
Whereas C-L psychiatry was the term used to describe the field throughout much of the twentieth century, “psychosomatic medicine” was the officially approved name of the subspecialty when it was first recognized by the American Board of Medical Specialties (ABMS) in 2003. The name of the subspecialty was changed to consultation-liaison psychiatry in 2018 in part to address frequent misunderstanding by other physicians and the public regarding the meaning of the term psychosomatic.

What patient populations do C-L psychiatrists serve?
C-L psychiatrists serve patients of all ages from diverse demographic, cultural, and psychosocial backgrounds with complex medical, surgical, neurologic, and obstetric conditions.  C-L psychiatrists frequently work as inpatient consultants with patients and families on general medical and surgical units, care for outpatients in outpatient specialty medical clinics, and provide collaborative and integrated care in partnership with primary care providers and other medical specialties. 

The breadth and medical complexity of populations served by C-L requires expertise in managing behavioral syndromes that are directly caused by medical problems, as well as the physical and emotional difficulties that arise in patients coping with life changing illnesses.  C-L psychiatrists serve patients across the lifespan, developing expertise in managing delirium and other neurocognitive problems, risk assessment, psychopharmacology, pain, addiction, forensic issues, end-of-life care, and the psychiatric sequelae of medical disorders. C-L psychiatrists advocate for high quality, integrated care and help develop ongoing treatment plans for patients with psychiatric needs at hospital discharge and across outpatient levels of care.

What does the liaison component of consultation-liaison mean?
The liaison component speaks to a C-L psychiatrist’s work providing consultation and education for the patients of teams specializing in organ transplantation, cardiac care, critical care, cancer, burns, women’s health, infectious diseases, neurologic illness, brain injuries, trauma, and many other general medical and surgical problems.  As a liaison, the C-L psychiatrist bridges gaps in communication and understanding among patients, clinicians, administrators, and other staff. C-L psychiatrists are often involved in cases with medicolegal, ethical, or system-level implications.

How do I learn more about C-L Psychiatry? What if my medical school doesn’t have C-L electives? (Insert Picture 3)
The first and most straightforward step is through your institution. Find out whether the Department(s) of Psychiatry that your medical school is affiliated with has a Consultation-Liaison Service. Ask to meet with faculty members who are involved in those clinical and academic areas to learn more about the subspecialty.

Some medical school psychiatry clerkships include exposure to C-L psychiatry; some also offer medical student electives in C-L for those who have already completed a clerkship in psychiatry. The best way to find out about such electives is to go to the medical student webpage for any program that you might be interested in or which you are considering for residency to and look for a link to electives for visiting medical students. A list of all U.S. C-L Fellowship programs is located in the Fellowship section of the ACLP website. Many of these programs host electives for medical students through their affiliated medical schools. Please also feel free to contact one of our Medical Student Education Committee members directly for advice or assistance.

If your institution does not have an active C-L service or Division (or even if it does and you’re curious about experiencing other institutions), consider signing up for an “away elective” in C-L. To find out about electives at institutions other than your own, go to VSLO (see above).

Get involved at the local, regional, national, and international level! Browse the websites for some of the major psychiatric organizations like the American Psychiatric Association (APA) and the main C-L organizations such as the Academy of Consultation-Liaison Psychiatry (ACLP) or European Association of Psychosomatic Medicine (EAPM). Look for medical student memberships (often for reduced rates), conferences to attend, awards to apply for, and mentorship programs.

Utilize student-focused organizations. Consider joining PsychSIGN, a national psychiatry interest group with regional chapters, which will give you access to numerous opportunities to learn more about careers in psychiatry, through informal gatherings, activities at larger conferences, networking, and more. Membership is free!

The Accreditation Council for Graduate Medical Education (ACGME) requires that every general psychiatry residency training program provide a resident experience in C-L psychiatry including at least two months full-time (or equivalent) in which residents consult under supervision to other medical and surgical services.

For medical students with an interest in C-L, it can be helpful to ask during residency interviews about each program’s C-L experience for its residents.

What is the day-to-day life of a C-L fellow?
The C-L fellowship is a one-year program.  Most of the time is spent performing consultations in a general medical hospital.  A trainee who completes a C-L fellowship will not only learn the skillsets needed to adequately identify and treat psychiatric symptoms in medically ill patients but will also be able to identify how those psychiatric symptoms may affect the patient’s medical care.  Fellows rotate in a variety of subspecialty clinics such as the options described below (transplant, psycho-oncology, cardiology, etc.).

What’s the difference between C-L Psychiatry fellowship and other combined medicine-psychiatry residency programs?
While many combined residency training programs may provide exposure to each type of discipline in their own respective setting, C-L psychiatry focuses on the integration of the disciplines with an emphasis on how mental health may be affecting a patient’s physical health and vice versa.  For medical students interested in both psychiatry and another medical subspecialty, there are several training programs that provide dual and even triple board certification. The type of program has its own time span, however the amount of time spent in each specialty—while generally equal—may differ based on the institution. Among these are the following:

• Internal Medicine – Psychiatry Residency: These programs are 5 years with equal exposure to both fields.  Trainees who complete this type of residency are eligible for both Internal Medicine and Psychiatry board certification.  There are currently 15 institutions that offer this type of combined specialty track training.
• Family Medicine – Psychiatry Residency: These programs also span 5 years with equal amounts of training in both fields.  Trainees who complete this type of residency are eligible for both Family Medicine and Psychiatry board certification.  There are currently 6 institutions that offer this type of combined specialty track training.
• Pediatrics – Psychiatry – Child & Adolescent Psychiatry Triple Board Program: This is a combined training program that spans 5 years.  At the end of residency, trainees are eligible for board certification in Pediatrics, Psychiatry and Child and Adolescent Psychiatry.  There are currently 10 institutions that offer this type of combined specialty track training. 
• Neurology – Psychiatry Residency: This is a combined training program that spans 6 years. At the end of residency, trainees are eligible for board certification in Neurology and Psychiatry. Currently there are 4 institutions that offer this type of combined training.

Additional information about combined and alternative pathway programs is available from the American Board of Psychiatry and Neurology here and the Association of Medicine and Psychiatry here.

A psychiatrist who is board certified in C-L has many career options, spanning clinical, academic, and administrative positions across multiple practice settings.

The C-L psychiatrist in subspeciality care:  C-L psychiatrists develop close working relationships with clinicians from different departments or divisions, often focusing on a certain specialty or subset of medical conditions. For example, a psycho-oncologist works closely with a cancer treatment team (medical oncology, radiation oncology, social work) to deliver psychiatric care. Other common subspecialties are HIV psychiatry, transplant psychiatry, cardiovascular psychiatry, women’s mental health, ICU-psychiatry, and neuropsychiatry.

The C-L psychiatrist in a general hospital:  The general hospital C-L psychiatrist performs psychiatric consultations on patients admitted to the various services in the hospital (internal medicine, surgery, pediatrics, etc.). In addition, the C-L psychiatrist may serve as the psychiatric liaison to a specific clinical program or programs.

The psychiatrist in a collaborative care model:  The C-L psychiatrist may provide psychiatric consultations and oversight of a large medical setting, such as an outpatient medical clinic. In this position, the psychiatrist may perform consultations on patients where psychiatric evaluation is needed, listen to case presentations and offer suggestions to the patients’ primary care clinicians on how to manage clinical concerns, and provide education to the program staff about psychiatric illness and behavioral disorders.

Outpatient psychiatrist:  The C-L psychiatrist may have an outpatient practice treating patients with complex medical conditions.

Hospital administrator:  The C-L psychiatrist, through close involvement in several clinical and hospital-wide activities, may assume an administrative role, running programs, serving on executive committees, or providing other forms of leadership within hospitals or other organizations.

Educator:  Though the C-L psychiatrist naturally serves as an educator in each of the above practice settings, the C-L psychiatrist is also in a unique position to take on a formal role as an educator at the level of the hospital or medical college.

Researcher:  The C-L psychiatrist is uniquely positioned to investigate research questions occurring at the intersection of mental health and non-psychiatric medical illness.

Hear C-L psychiatrists speak about their interest in the field here.