Division of Consultation/Liaison Psychiatry
The Consultation-Liaison Division (CLD) is the fourth largest division in the Department of Psychiatry.We focus on the relationship amongst psychological, biological, and social factors in the expression of symptoms in medical/surgical illness. This Division’s mandate is to provide consultation to patients and liaise with their treatment teams, to optimize the bio-psycho-social care of patients. We also train students in the psychiatric care of patients with medical, surgical, and somatic symptom disorders; develop and promote research; establish and communicate standards of care; and provide continuing education in the interface between psychiatry and physical health.
The CLD draws the attention of physicians and members of the community to the often undetected and untreated psychiatric morbidity and psychosocial distress in medically and surgically ill populations, and enhances the services and treatment available for such problems. The CLD is based at several general hospitals, rehabilitative institutes, and one paediatric hospital, with additional research staff located at other institutions and universities.
CL staff are frequently embedded in non-psychiatric settings such as intensive care units, cancer centres, dialysis units and Rehab centers. The CLD therefore serves as a professional and academic home within the Department of Psychiatry for its far-flung members.
Administratively, there is a Divisional steering committee that meets quarterly, with open membership to any Divisional member, but standing representation from each teaching site, the resident body, and a Status-Only representative. This committee disseminates information, plans Divisional activities and debates any issues brought forward by divisional members.
Specific roles include:
- Bob Maunder: Divisional Research Director
- Marta Novak: International Relationships Representative
- Raed Hawa: Undergraduate Education Lead
- Adrienne Tan: Fellowship Coordinator
- Jon Hunter: Post Graduate and Core Curriculum Lead
- Jeanette Villapando: Administrative Support
The CLD is notable for the educational scholarship of its members. For instance, the Robin Hunter Prize for Postgraduate Teaching has been won more times by members of the CLD than any other Division.
For more information about the Consultation Liaison Division, please contact Division Director Dr. Jon Hunter.
Third year clinical clerks rotate through C-L services at the general hospitals, typically spending 3 weeks as junior members of a CL team. These students learn fundamentals such as the recognition and management of delirium, or how to improve coping with difficult circumstances. However, they are also exposed to aspects of psychiatric care that will impact on their future practice regardless of specialty. These include optimizing doctor-patient communication, understanding the role of interpersonal relationships in medicine, and how to apply strategies for appreciating and managing one’s own reactions to challenges in patient care. Opportunities exist in the CLD for selective and elective medical students to be involved in inpatient and outpatient settings.
A core CL rotation is mandatory for psychiatric residents. It comes late in postgraduate training and functions as an integrative opportunity to practice as consultants, collaborators and advocates, as well as medical experts. The CLD redesigned the core curriculum into monthly day-long “mini-conferences”, organized around fundamental clinical presentations such as ‘the confused patient’, a change that has since been adopted by other divisions.
Senior selectives also occur within the CLD, as PGY-5’s seek out substantial local expertise in not only clinically based C-L psychiatry, but eating disorders, transplant psychiatry, psycho-nephrology, and a large variety of other subspecialties.
The CLD is a sought after placement for both research and clinical fellows. Adrienne Tan and the UHN CL team have taken on the primary responsibility for organizing a 2 year structured fellowship for international medical graduates, which is consistently filled and highly regarded. Graduates can also create fellowships specific to their interests and training needs, for instance, training in the psychiatry of bariatric surgery, or psycho oncology. Integration with the Medical Psychiatry Alliance can also occur.
Continuing Professional and Practice Development CPPD
Divisional members are active participants in numerous national and international conferences providing exemplary continuing education to colleagues around the world. As examples, Marta Novak has been a founder of the European Association of Psychosomatic Medicine, the central CL organization in Europe, and has actively recruited many Divisional members to academic work within that organization. Sanjeev Sockalingam is the CPPD Director for the University of Toronto Department of Psychiatry, Vice-Chair of the Council for C-L Psychiatry at the American Psychiatric Association, and Conference Chair for the Canadian Psychiatric Association. He also has a leadership role on the Medical Psychiatry Alliance.
Divisional members are frequently Fellows of the Academy of Psychosomatic Medicine, and/or active in the Canadian Academy of Psychosomatic Medicine, the Academy of Psychosomatic Medicine, the American Psychosomatic Society, Canadian Association of Psychosocial Oncology, and the International Society of Psychosocial Oncology.