Psychosomatic Medicine Fellowship

Program History

The OHSU Psychosomatic Medicine Fellowship Program is funded by the Department of Veterans Affairs and is directed by Todd Eisenberg, M.D. The program has received full accreditation by the Accreditation Council for Graduate Medical Education (ACGME). Most members of the combined Oregon Health & Science University (OHSU)/Portland VA Medical Center Psychosomatic Medicine faculty have American Board of Psychiatry and Neurology subspecialty certification in Psychosomatic Medicine or dual Medicine-Psychiatry Board Certification. Several faculty members are core investigators of the VA Health Services Research & Development funded Center for the Study of Chronic Comorbid Mental and Physical Disorders.

Overall Goals and Plan of the Psychosomatic Medicine Fellowship

Goal 1. Balance and breadth of clinical experience

The fellowship is one-year in duration and at the PGY-5 level. We provide a balanced experience in Psychosomatic Medicine, with opportunities for the development of clinical, teaching and research skills. Clinical skills are developed in both ambulatory and acute care settings.  In these settings, Fellows may provide consultation to medical colleagues as well as assume continuous care of outpatients. The curriculum, which includes supervised clinical experiences and formal didactic and participatory conferences, allows the Fellow to gain the knowledge, skills, and practical experience necessary to provide expert psychiatric care to patients with comorbid and complex medical and surgical problems and to consult effectively to medical colleagues. We complement the Fellow’s predominantly male VA patient exposure with the addition of female patients seen at OHSU. By the end of the fellowship, each resident will be prepared for the subspecialty board examination in Psychosomatic Medicine.

Goal 2: Meaningful research opportunities

Psychosomatic Medicine residents will have a predominantly clinical experience which meets the requirements set by the ACGME for completing an accredited Psychosomatic Medicine Program, and will be prepared for the board subspecialty examination. Additionally, Fellows are provided with one-half day per week to work on a scholarly project.  Fellows are required to spend at least 6 months on this scholarly project, but have the option of extending the duration of the project for the entire 12 months of the Fellowship.  Abundant research opportunities exist and may include participation in an established research study, initiating a focused project, the scholarly review of a topic, or coursework through the Human Investigations Program (HIP) at OHSU. The HIP, funded through the National Center of Research Resources and sponsored by the School of Medicine, Portland VAMC, and Divisions and Departments at OHSU, provides a curriculum targeted to medical or dental residents and fellows, and faculty of the medical, nursing and dental schools who are interested in developing research skills in human investigations. A non-degree track allows enrollment in individual courses.

A comprehensive, sequential, faculty-supported and supervised approach to research training includes:

• Exposure to basic research concepts, discussions with the various researchers, site visits to laboratories, theme selection, critical literature review and development of hypotheses.
• Project design, protocol preparation, solicitation of peer review, revision, and approval by research and human subjects review committee.
• Project implementation, data collection, analysis, and interpretation

It is hoped that residents who participate in research for 6 months will be able to contribute to a manuscript for peer-review publication. For residents participating for 12 months, it is hoped that findings will be presented at a regional or national meeting and that a peer-review manuscript will be under review or in press by the end of the fellowship.

Outstanding active research programs exist in the areas of:

• Health Services
• • Detection and treatment of mental disorders in primary care
  • Chronic pain
  • Epidemiology of comorbid disorders
  • Suicidal ideation in health care settings
  • Decision-making capacity
• Dementias
• Schizophrenia and End-of-Life Care
• Ethics
• Substance Use Disorders
• Parkinson’s Disease
• Psychiatric Aspects of End-of-Life Care
• Telemental health

VA Training Facilities

The Portland VA Medical Center is one of the best-equipped academic general hospitals in the VA system. Wards, clinics, offices, conferences rooms, laboratories and equipment are first rate. Outstanding clinical and research staff in psychiatry, medicine and neurology are closely allied with their counterparts at OHSU, physically located just one-quarter mile away. The two institutions are joined by an enclosed sky bridge, making the trip between the two institutions even more convenient. The hospital’s catchment area includes metropolitan Portland (population 1.5 million and growing rapidly) and a large rural area with another one million.

Clinical Program

The Portland VAMC Mental Health Division is a major academic service, with 29 staff psychiatrists, all with faculty appointments at OHSU. There are 18 General Psychiatry Residency positions (fully integrated within a total OHSU-VA program of 32 positions), two geropsychiatry fellowship positions and two addictions fellowship positions. We have 21 acute psychiatry beds, and mental health clinics have over 40,000 visits annually. Telemedicine is increasingly being used to treat Veterans living in rural areas. There is an active Psychiatry Consultation Service that consults to a full range of inpatient medical and surgical services including a dialysis unit, and also conducts transplant evaluations. A Palliative Care Consultation team is also available. We have developed an active outpatient psychiatric consultation service, located on-site in most of the primary care clinics. In these programs, we have close working relationships with primary care clinicians and OHSU Medicine residents who have continuity clinics in these settings. We have an active Geriatric Psychiatry Clinic, Dementia Clinic and Geriatric Medicine Assessment Clinic. At the Vancouver, Washington site (just across the Columbia River from Portland) there is an 80-bed teaching Nursing Skilled Care Unit (NSCU). We have a close, congenial relationship with Neurology and several Psychosomatic Medicine faculty members have ongoing collaborations with the Portland VA Parkinson’s Disease Research and Education Center (PADREC) and Multiple Sclerosis Center of Excellence. A Center of Excellence in Epilepsy has recently been funded.

Teaching Opportunities:

• Internal Medicine Residents and Staff: Reciprocal teaching opportunities occur during the outpatient and inpatient consultation rotations, in specialty elective rotations, and in seminars. Opportunities for teaching diverse groups of health professionals exist through VAMC-based consortium programs (VA, OHSU and Portland State University) supported by the USPHS Bureau of Health Professions to develop faculty and train health professionals throughout the state.
• Medical Students: Opportunities exist to teach medical students individually and in small groups.
• Psychiatry Residents:  Fellows assume a leadership role while rotating on the inpatient consultation services at both the PVAMC and OHSU.

OHSU Training Facilities

The Psychiatry Department houses several nationally prominent academic research and training programs. Most notable are programs on the Biology of Affective Disorders, Psychopharmacology, Psychiatric Epidemiology, and community and social psychiatry (trans-cultural, forensic and public psychiatry).

The Ambulatory Medicine/Psychiatry Service is a half-day per week that provides outpatient psychiatric evaluation and treatment to patients with complex medical and surgical problems. Psychosomatic Medicine Fellows work along side OHSU Medicine Residents. The Geriatric Psychiatry Clinic evaluates and treats a broad range of demented and nondemented elderly women and men. An Electroconvulsive Therapy service administers between 60 and 80 treatments per month. The Public Psychiatry Program is a unique program which links the Department with the State Mental Health Division in a variety of teaching, research and administrative enterprises.

There are efforts underway in the Division to further integrate mental health services into primary medical care services. The Biomedical Information Communication Center combines traditional library and computing services, biomedical communications, and medical informatics research, and is supervised by Dr. Douglas, Chief of Informatics at the Portland VAMC.

Finally, the Center for the Ethics in Health Care is funded by grants from several private foundations and has an interdisciplinary faculty (OHSU and VA). The program currently focuses on four areas: education, research, patient consultation, and health policy development. Dr. Ganzini, Psychosomatic Medicine faculty member and Director of the Portland VA Center for the Study of Chronic Comorbid Mental and Physical Disorders, is a Senior Scholar at the Ethics Center. She supervises educational and research opportunities in ethics and end-of-life care.