Division of Consultation/Liaison Psychiatry
The Consultation-Liaison Division (CLD) is the third largest division in the Department of Psychiatry in terms of number of all faculty by division and the second largest in terms of number of status only faculty. We focus on the relationship amongst psychological, biological, and social factors in the expression of symptoms in medical/surgical illness. We also see the role of the C/L psychiatrist to facilitate comprehensive treatment approaches within a system of care and to enhance communication among disciplines and across divisions in health care systems. The 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.
CL staff are frequently embedded in non-psychiatric settings such as intensive care units, dialysis and transplant units, and cancer centres. 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.
The CLD is notable for the educational scholarship and leadership of its members and many members are international leaders in their research domains.
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. 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.