Table of Contents - Academy of Psychosomatic Medicine

linguistic proficiencies. Issues included the “organic-functional”
dichotomy in the context of culture, end of life decisions
across cultures, capacity determination in a cultural context,
family communication patterns and the cultural aspects of
the doctor-patient relationship. Considerations of culture add
to the complexity of the biopsychosocial formulation inherent
in C-L psychiatry, in a way that is unique in the psychiatric
training experience.
References
Fung K, et. Al. An integrative approach to cultural competence
in the psychiatric curriculum, Academic Psychiatry,
32:4 July-August 2008
Weiss Roberts L, et al. When providers and patients come
from different backgrounds: perceived value of additional
training on ethical care practices. Transcultural Psychiatry,
45(4) December 2008
75. Accessible, Beneficial & Consistent
Learning: The Beginning of Quality Care
Presenting Author: Kristin Somers, MD
Co-Authors: Pamela Netzel, MD, Kemuel Philbrick, MD,
FAPM
Purpose: An essential prerequisite for quality care in psychosomatic
medicine is laying a foundation of effective
teaching, practical clinical experience, and demonstrable
competency during training. These elements may be difficult
to forge when residents are supervised by rotating faculty,
serve in diverse clinical settings, and rarely complete formal
evaluations of their knowledge base. We describe the construction
of a web-based curriculum for psychosomatic medicine
that addresses these needs.
Methods: An internal website was built with five principal
components: 1) fundamental factual, scientific content on
key topical areas arranged in user-friendly slideshow summaries
and with links to relevant reference material; 2) resource
material germane to the ‘art’ of consultation psychiatry,
e.g., interviewing tips, frequently encountered personality
traits and challenges; 3) selected advanced articles and
resources for the returning senior resident and/or fellow, including
material on teaching and evaluating; 4) selections
from non-medical literature that provide a unique, affectivelyinformed,
window on issues commonly encountered in psychosomatic
medicine, e.g., the passage from Tolstoy’s Anna
Karenina describing her feelings and thoughts prior to her
suicide attempt; and, 5) case-vignettes and questions designed
to aid the trainee in preparing for certification exams.
Results: Trainees and faculty commonly rotate at irregular
intervals and for variable durations to the consultation
service; a well-ordered delineation of core topics appended
by easily accessible, consistent didactic material frees the
faculty and trainee to use available time to efficiently review
the fundamentals of psychosomatic medicine. Whatever
the level of training, educational needs are served by the
breadth and depth of available material. Trainees who take
initiative for self-assessment can gauge their progress using
the board-style knowledge appraisal tools. Institutional
software options may vary; ideally, trainees will have access
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to a personalized record that enables tracking which topical
areas they have already covered.
Conclusion: Construction of an easily accessed, systematic
summary of essential knowledge augmented by learning
tools that engage the trainee will facilitate ‘point-of-need’
learning on psychosomatic medicine services and help ensure
delivery of quality care.
References: Novack DH: Realizing Engel’s vision: psychosomatic
medicine and the education of physician-healers.
Psychosomatic Medicine. 65(6):925-30, 2003 Nov-Dec.
76. Constant Observation for Delirious
Patients in the General Hospital: Allocation of
Resources and its Implications for Quality of
Care
Presenting Author: Lisa Seyfried, MD
Co-Author: Helen Kales, MD
Background: A frequent clinical tension between psychiatric
consultation-liaison (CL) and medical-surgical services is
over the need for constant observation for delirious patients.
Purpose: To identify patient characteristics contributing to
the recommendation for constant observation of delirious patients
in the general hospital.
Methods: In response to an adverse event, we conducted
a retrospective chart review of all consults to the CL service
at the University of Michigan Hospital occurring during
the month of the event. Using an electronic medical record
search engine (EMERSE), we identified all patients diagnosed
with delirium by the consult service. Information extracted
from the charts was examined qualitatively to determine
themes pertaining to the use of CO.
Results: During the study month, the CL service saw 115
new consults. Of those, 34 (30%) were diagnosed with delirium.
Of those, the CL service specifically recommended
CO for 11 patients (32% of delirious patients or 10% of total
consults). Factors associated with CO were documented behavioural
problems (such as pulling lines, getting out of bed,
physical aggression, etc) and “agitation” in general. Factors
associated with no recommendation for CO include features
more consistent with hypoactive delirium. There was no
documentation regarding the discontinuation of CO in any of
the 11 cases.
Conclusion: Delirium is a major reason for psychiatric consults
and a significant proportion of delirium consults may
need constant observation due to hazardous behaviours.
Liaison with medical-surgical services may be enhanced by
informing such discussion with a clearer understanding of
the need for such services.