To the Editor: Psychiatry residents’ clinical experiences in primary care settings have historically focused on either the trainee delivering primary care services as an intern rotating on family or internal medicine, or the trainee performing ambulatory psychiatry consultations as a senior resident (1, 2). Collaborative care is a well-studied model of integrated psychiatric and primary care that can effectively treat some psychiatric disorders, such as depression, commonly encountered in primary care settings (3).

Collaborative care interventions are population-based, highlighting screening and case-identification, with the goal of increasing the total number of people exposed to evidenced-based psychiatric treatment. Collaborative care uses a team of psychiatrists, primary care physicians, and care managers to manage a clinic-wide population of patients, and a patient registry to track outcomes. The collaborative care psychiatrist becomes involved in the care of more patients than he or she would be involved with in the traditional consultation model (4). The clinical work in collaborative care differs from the clinical work performed in traditional primary care-based ambulatory psychiatric consultations (2, 5). Also, collaborative care embraces measurement-based care with tools such as the Patient Health Questionairre-9 (PHQ-9) (5). Additional details of collaborative care are described in a review article (5).

To find published reports in English of any resident rotations in collaborative care, we searched PubMed, using the following term combinations in September 2011: collaborative care, AND resident education, education, resident, elective, rotation. Our search yielded no publications describing resident rotations in collaborative care models.

We created a year-long, longitudinal elective in collaborative care for one PGY-4 resident at Mount Sinai School of Medicine in New York City during the 2011–2012 academic year. The resident aimed to learn one model of collaborative care—IMPACT (6)—and the associated skill-set, including ambulatory consultation and supervision skills, techniques in team work, the use of standardized rating scales, and the leadership and communication skills specific to one geriatric primary care setting. The IMPACT model of collaborative care focuses on the recognition and treatment of late-life depression.

Each week, the resident directly cared for patients, supervised the care manager, and attended IMPACT team meetings. The resident spent ½ day per week doing ambulatory psychiatric consultations and long-term psychiatric care for some patients in the geriatrics primary care clinic. Caring directly for patients in this clinic helped the resident learn the day-to-day functioning of the clinic, meet the clinic staff and physicians (which aided coordination of care), and further develop clinical skills in the treatment of geriatric patients. Also, the resident met with the collaborative care team weekly for 1 hour to assess the progress of the collaborative care implementation project and troubleshoot problems. The resident and attending psychiatrist co-supervised a depression care specialist for 1 hour weekly. Depression care specialist supervision by a psychiatrist is a key component in successful collaborative care programs (3, 6). It is notable that this resident’s elective co-occurred with implementation of collaborative care in the medical center’s geriatrics clinic, making it possible for the resident to observe and participate in project implementation. For example, the resident helped prepare and participated in the training and introduction of the collaborative care model to other trainees and geriatrics faculty. Part of the rotation involved preparing reports for, and sitting in on meetings with, members of the foundation who funded IMPACT implementation at the institution. Scholarly work was also expected. The resident and attending physician developed a poster presentation for a national meeting.

To our knowledge, this is the first description of a resident rotation in collaborative care. The future clinical responsibilities of many psychiatrists may involve integrated care work. Through electives in well-studied models, such as collaborative care, we hope that more residents will have the opportunity to learn the skills needed to deliver integrated services.