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Training Psychiatry Residents as Consultants in Primary Care Settings

Dr. Cowley is Professor and Director, Psychiatry Residency Program, Dr. Katon is Professor and Vice Chair for Health Services Research, and Dr. Veith is Professor and Chair, Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle, Washington. Address reprint requests to: Deborah S. Cowley, M.D., Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195-6560. e-mail: dcowley{at}u.washington.edu

Patients seen in primary care medical settings often have psychiatric disorders that often go undetected by their primary care physicians. It is important that psychiatry residents be trained in the specific skills necessary to work as consultants in primary care settings. The authors describe 2 years of primary care consultation–liaison rotation experience for 4th-year psychiatry residents (16 rotations, one-half day per week for 12 months or 1 day per week for 6 months). Residents' evaluations of their experience were generally positive. The presence of a supervising attending psychiatrist who worked in the same clinic resulted in higher satisfaction and effectiveness ratings. Other issues identified by residents included need for specific preparation for working in such settings, frequent misunderstanding of the psychiatry resident's role by primary care providers, and the difficulty of establishing relationships and communicating with multiple clinic providers. Authors discuss modifications of this rotation and recommendations for the establishment of similar rotations elsewhere.

Key Words: Primary Care • Consulting Psychiatry

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