Training Methods: Health Psychology Post-Doctoral Fellowship Program

Training methods for the University of Wisconsin Hospital and Clinics Health Psychology Post-Doctoral Fellowship Program include the following:

University of Wisconsin Hospital and Clinics (Medical-Surgical Care):

The UW Hospital and Clinics hospital-based medical-surgical rotation involves the provision of psychological services to a range of medical-surgical services across this tertiary care center and its clinics. Staff and trainees on this service 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 (physicians; nurses; rehab therapists; nutritionists; pharmacists; social workers; pastoral care providers).

Over 120 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 can also participate in program development or in research activities relevant to medical-surgical issues. For instance, recent fellows have been involved in research on quality of life of organ donors, assessing outcomes and consumer satisfaction, and have developed assessment and treatment protocols for various patient populations within the hospital and in the outpatient clinics.

Within this rotation, fellows can chose to focus in several specified training areas:

Burn Service

The UW Burn Service houses an 8-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. Health Psychology provides protocol assessment and intervention services for all adult and pediatric burn patients. Specific skills developed include trauma screening, pain management, and adaptation to loss and body image change. Consultation to the multidisciplinary Burn Team and attendance at weekly case rounds is also a large component of the experience.

Sleep Disorders Clinic

Fellows can conduct psychological assessment and intervention to outpatients referred by the Sleep Disorders Clinic. Typically, these include patients with insomnia, sleep apnea, and neuropathic movement disorders. A sleep assessment, recommendations, and follow up for any interventions are provided to the referring physician. Patients are provided with outpatient sleep hygiene education, cognitive-behavioral therapy, family/marital psychotherapy, and/or other appropriate psychological services related to sleep disorders.

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.

Organ Transplant Evaluation Service

The Health Psychology service provides pre-surgical evaluation for potential organ recipients and donors on the cardio-pulmonary, kidney, and liver transplant services. These include clinical interviews with potential recipients and donors, and objective psychological testing. The psychologist also serves as a member of the pre-surgical multidisciplinary evaluation team.

Consultation-Liaison

The Health Psychology service provides bedside assessment and intervention to patients referred by the medical-surgical services within the hospital. These include patients on the following services:

• Neurology
• Cardiology
• Family Practice
• General Surgery
• Oncology Surgery
• Trauma Life Center
• Trauma Surgery
• Orthopedics
• Geriatrics
• Renal
• Organ Transplant
• Gastroenterology
• Pulmonary

Typically, psychological services are requested when patients are struggling to adjust to a particular medical situation, or have experienced a significant physical loss, or are noncompliant with treatment recommendations. All trauma patients are referred for a Health Psychology assessment, as part of the hospital protocol as well. Referrals are made with the expectation that we will provide timely recommendations and treat as appropriate.

Fellows will learn to provide prompt and efficient 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. They will learn to provide brief, solution-focused and supportive psychotherapy with patients and families while they are in the hospital.

Consultation with nursing and medical staff is also a very large component of this experience. There is also opportunity to see patients for any long-term interventions to assist with issues such as coping or compliance as outpatients through the various medical and surgical clinics.

Decisional Capacity Evaluation

Fellows will have the opportunity to develop competence in the assessment of patients' capacity to meaningfully participate in health care decisions. As a function of this training, fellows will receive didactic background into the forensic issues underlying capacity evaluations, Power of Attorney, and guardianship. Fellows also develop skill in assessing capacity of patients across the medical center, and rendering recommendations to the treatment provider.

Clinical Rotation:

• Access Community Health Centers (Primary Care)
  
  The Primary Care Behavioral Health Service provides integrated mental and behavioral health care service to outpatients of the Access Community Health Centers. The behavioral health trainee works alongside the medical team of family practice physicians and physician assistants to provide both curbside consultation and direct patient care in the primary care setting.
  
  This model of care uses a functional assessment of the patients' needs and efforts to cope and provides behavioral change strategies to improve those coping efforts. The model also seeks to increase the level of care provided by the primary care provider through curbside consultation. As such, fellows are challenged to raise their competencies in the full range of mental disorders, medically-related behavioral health issues, and psychopharmacology. Fellows will receive exposure to direct patient care in the Primary Care Behavioral Health (PCBH) model.
   

  Supervision in this model is fashioned after the medical model (resident training) involving shadowing and reverse shadowing and collaborative work with a supervising psychologist in real-time. Trainees learn to report on patients efficiently, sharpening communication skills as well as case conceptualization skills in brief patient encounters. The pace of work mimics the generally fast pace of primary care.
   

• Supervision
  
  Each fellow is supervised by one or more senior faculty members associated with their primary rotations. Every primary rotation supervisor is a psychologist with license to practice in the State of Wisconsin who also has a minimum of three years post-licensure experience. Fellows receive a minimum of two hours of supervision with this supervisor per week, although there is ample opportunity for informal supervision as well.
  
  Fellows are evaluated by these primary supervisors on a quarterly basis utilizing the Minnesota Supervisory Inventory from the QAI Systems. In addition to supervision by their primary supervisors, fellows can receive additional supervision and guidance from adjunct supervisors in particular training sites. The use of live or audiotaped supervision is strongly supported.
  
  The fellowship program is overseen by the Director of Postdoctoral Training at UW Hospital and Clinics, a full-time 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. Fellows have regular informal interaction with the Director of Postdoctoral Training, but also meet individually on a scheduled quarterly basis for monitoring and evaluation.
  
  Fellows are required to maintain records of their clinical activities, and these records are reviewed and held 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, rotation experiences, and the overall fellowship program throughout the year. An exit interview is performed by the Director of Postdoctoral training with each fellow at the end of the year. Fellows also provide written evaluations of the program at the end of the year.
  
  Fellows also have the opportunity to provide supervision (under supervision) to practicum students who rotate through the American Family Children's Hospital and Access Community Health Centers.