Curriculum

The Adult Inpatient Consultation-Liaison Psychiatry Service performs consultations for the entirety of University Hospital (UH), the 550-bed main hospital of Michigan Medicine.  UH encompasses multiple medical, surgical, and neurological units, as well as 5 separate intensive care units including trauma-burn, neurocritical care, cardiac, medical and surgical.  Additionally, the service provides consults to inpatients in the Frankel Cardiovascular Center, a 48-bed facility with complex intensive care and moderate care patients.  Finally, the service consults on patients admitted to the 50-bed obstetrical floor of VonVoigtlander Women’s Hospital, and adults over the age of 25 admitted to C.S. Mott Children’s Hospital.  Mott houses an adult oncology/BMT floor.  A new inpatient facility called The Kahn Pavilion will open in late 2025, and add beds for neurological, cardiac, and surgical specialties.

These clinical settings care for some of the most severely ill patients in the state, and include oncologic and transplant patients.  Consults are requested for a variety of reasons including delirium, agitation, capacity, primary mental illness, depression, anxiety, acute stress disorder, and safety assessments to name a few.  There is a separate Psychiatric Emergency Services that performs evaluations for patients in the Emergency Department.

The Service consists of two teams, each led by one faculty attending, with one social worker per team.  There are typically 2-4 PGY2 psychiatry residents, 1 PGY4 psychiatry resident, 2-3 medical students, one nurse practitioner, and sometimes a neurology resident.  There are 2 part-time health psychologists, and a clinical nurse specialist who supports nurses on the non-psychiatric floors. The fellow may take cases on their own early in the year, but later progresses to supervising resident and medical student cases and running one of the consult teams. 

The Ann Arbor Veteran’s Hospital has 105 acute care beds, and an additional 40 bed community living center.  Fellows provide consults to patients admitted to the hospital and living center, and take an active role in leading the consult team, as well as doing extensive teaching with University of Michigan medical students and a PGY-1 psychiatry resident.  The AAVA has general care beds as well as intensive care units. 

This service performs consults on patients under the age of 25 in Mott Children’s Hospital.  Team members include child-adolescent psychiatry trained faculty, child psychiatry fellows, and a variety of other multidisciplinary team members.  This service gives the fellow more intensive exposure to inpatients with developmental disorders, eating disorders, somatic symptom disorders, among other diagnoses.

A separate inpatient consultation-liaison transplant service is run by CLP board-certified faculty.  The fellow can rotate on the inpatient consultation service and combine with outpatient transplant clinics during the week.  Pre-transplant evaluations are done in both settings, in collaboration with social work and psychology.  Post-transplant patients can be followed closely on the consultation service to manage delirium and other post-transplant neuropsychiatric issues.  Post-transplant patients are also followed in clinic.  Fellows participate as well in multidisciplinary transplant meetings.

Fellows can rotate on these services either at Michigan Medicine or the Ann Arbor VA.  At Michigan Medicine, fellows attend at least 2 mornings per week of ECT cases and do some inpatient and outpatient consultations.  At Michigan Medicine, they can qualify for an ECT certification letter if completing certain requirements.  Emphasis on ECT in the medically ill, including those admitted to medical services with diagnoses like NMS and catatonia is given.

Run primarily by addiction medicine providers, this inpatient consultation service sees hospitalized patients with a variety of substance use disorders, with the main focus on management of opioid use disorders in complex medically ill patients.  Some CL Psychiatry faculty attend on this service, and the fellow gets exposure to MOUD and the comorbid management of pain in substance use disorders.

The general inpatient psychiatry consult service sees pregnant and post-partum patients admitted to the hospital.   The fellow may also participate in 2 separate outpatient clinics for one or month blocks to get additional exposure to Reproductive Psychiatry. 

These include: 

1. The Perinatal and Reproductive Psychiatry clinic through the Department of Psychiatry, staffed by dedicated reproductive psychiatry faculty
2. The Partnering for the Future Clinic, a clinic co-located in the obstetrical clinics, with a focus on substance use in pregnancy and higher risk psychiatric populations

This innovative clinic was one of the first in the country to co-locate psychiatry in a hepatology clinic, with the goal to treat patients with liver disease from alcohol use disorder and comorbid mental health conditions, with the hope of intervening to prevent the need for liver transplant. 

This is a multidisciplinary clinic started by a partnership between neurology and psychiatry, with patients seen by neurology, psychiatry, psychology, and social work during one clinic visit and a final meeting with the entire team and patient at the end of the assessment.  Fellows gain experience in talking to patients about PNES and learning techniques from the manualized therapy done in the clinic.

CL Psychiatry Fellows work with palliative medicine attendings and fellows on primarily a hospital-based consultation service.  Psychiatry fellows gain skill in symptom management of pain, fatigue, and other conditions in patients with severe medical illness, particularly oncologic patients, and also get more training in goals of care discussions.

While rotating on other services, or as a separate month, fellows can rotate in specialty neurology clinics such as cognitive disorders, movement disorders, and epilepsy.   Fellows gain experience in assessing and treating psychiatric comorbidities in these neurologic conditions and learning how primary psychiatric conditions/ medications exacerbate neurologic symptoms.

Fellows can rotate in this outpatient-based program with psychiatrists, psychologists, and social workers in treating teens and young adults with disordered eating.  For fellows with more interest in this area, they can also work with the Adolescent Medicine consult team at C.S. Mott Children’s Hospital.

Fellows work with a psychiatry attending and collaborative care case manager in managing a panel of primary care patients, tracking metrics and providing guidance and education to primary care providers. 

Co-located in the Infectious Disease HIV clinic, the fellow works with a psychiatry faculty member in managing common psychiatric comorbidities and ensuring safe use of psychotropic medications along with the patient’s antiretroviral regimen.