Journal Article Annotations
2025, 1st Quarter

Education

Annotations by Jai Gandhi, MD
March, 2025

2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry.

PUBLICATION #1 — Education

2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry.

Scott R Beach, Carrie L Ernst, David C Fipps, Thomas M Soeprono, Mallika Lavakumar, Samuel P Greenstein, Thomas W Heinrich, Ann C Schwartz.

Abstract: J Acad Consult Liaison Psychiatry. 2025 Jan-Feb;66(1):80-89. doi: 10.1016/j.jaclp.2024.11.001. Epub 2024 Nov 10.

Background:
Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade.

Objective:
These recommendations are intended to guide residency program directors toward optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship.

Methods:
We convened a workgroup of 8 Academy of Consultation-Liaison Psychiatry members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the Academy of Consultation-Liaison Psychiatry Executive Council and conducted via a three-stage iterative process.

Results:
Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervision, formal curriculum and evaluations, and elective experiences. Residents must spend sufficient time on CLP rotations to achieve relevant milestones. Given that consultants are expected to offer unique insight, the ideal placement of core CLP rotations comes at a time in residency where residents are able to provide expert opinion and lead teams. Faculty expertise in CLP and availability to provide direct supervision and oversight to trainees are essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training.

Conclusions:
Establishing a strong CLP foundation for all residents is essential for ensuring competency in providing psychiatric care for medically complex patients and collaborating with our colleagues in other specialties, as well as fostering trainee interest in pursuing a career in CLP.

Keywords:
consultation-liaison psychiatry; education; residency.

Annotation

The finding:
This article updates the 2014 ACLP recommendations for C-L psychiatry training in psychiatry residency, providing 34 recommendations. Particular highlights include the placement of the core C-L psychiatry experience in the second half of training (i.e. PGY3 or PGY4 years), full time faculty for core C-L psychiatry rotations (or at least for a full block), and a ratio of one faculty FTE (full-time equivalent) for 1.5-2.0 resident FTE.

Strength and weaknesses:
The greatest weakness of this publication is the limited eight person expert consensus utilized in developing the recommendations, and the lack of consideration of current psychiatry resident, or C-L psychiatry fellow, perspectives. Nonetheless, the use of an anonymous survey to elicit perspectives on current guidelines, and requiring 75% agreement to qualify for consensus provides reassurance on the rigor of the process.

Relevance:
As the approach to psychiatry residency training continues to change, alongside the implementation of competency based medical education, these recommendations will be invaluable in considering how, and in what ways, C-L psychiatry training can be positioned through the postgraduate training years. The article provides an opportunity for every C-L psychiatrist associated with an academic institution to advocate for the use of these guidelines for the C-L psychiatry rotations they supervise. Many psychiatry residency programs will face numerous challenges in implementing these recommendations in full, though these provide clear guidance on an educational model each program should strive toward.