The UC Davis Medical Center Inpatient Psychosomatic Medicine Service is a required 50% rotation, one full-day and three half days.  The CL Service is staffed by two faculty psychiatrists and a clinical nurse specialist.  Each attending psychiatrist directly supervises the clinical work of one fellow, evaluating the same patient together or sequentially, discussing the findings, and arriving at a well-considered diagnosis and treatment plan.  Cases are discussed at morning rounds, and residents are encouraged to review relevant literature.  The patient socio-demographic and payer mix is diverse.  There are between 1200 and 1300 new cases annually.  The average age is 50; 50% male/50% female.  Diagnoses:  40% mood disorder, 30% cognitive disorder, 20 substance use disorder.  The typical daily census is 20 cases.  The average caseload for the PSM fellow is six or seven cases.  The fellow is primarily responsible for supervision of students, PGY-1 evaluation, interface with PSM faculty, liaison with medical/surgical services, discharge aftercare arrangements, decision to commit unstable patients, advice regarding psychiatric evaluation, management, disposition.  The fellow begins the interview, is joined by faculty for part of the interview, discussing the case privately with the faculty, and then discusses options with the referring physician and patient (where appropriate) over the last 5-10 minutes.  Follow-up support is provided on evaluation and treatment.  Daily supervision includes l l/2 hour of rounds with faculty and additional case-specific supervision.  Neurology PGY-4 rotators (maximum of one) present three to four months per year and are integrated into the team.

The Telemedicine Clinic is required and is a part-time rotation, two half days a week throughout the year.  There are two faculty psychiatrists. Educational activities involve patients/families, PCPs medical students, and residents.  The fellow will teach patients and PCPs about their illness and treatments through:  discussion; live demonstration of web sites; referral to books and additional web sites; and other services that may be of use to them.  The fellow could also do grand rounds for the CHT by interactive video to multiple sites using a bridge such that all sites are interactive.  Faculty can moderate the discussion as applicable.  The fellow will teach medical students and residents through individual cases about interviewing, diagnosis, treatment, consultation to primary care and rural health.  The fellow will attend in a 5-part Telepsychiatry Curriculum.  Clinical population:  Age:  47% of the population is between 18 and 30; 50% of the population is between 36 and 65; 51% of the population is female; 49% is male.  Socio-demographics: 53% of the population is covered by MediCal or Medicare; 41% managed care; 6% of the population are either indigent, self-pay or other.  Patient diagnoses include:  Mood disorders, 51%; Adjustment Disorder, 22%; Anxiety Disorders, 11%; Psychotic Disorder, 4%; Substance Disorder, 3%; other, 9%. Fellows complete two evaluations and two follow-up patients per clinic.  As this service is consultation, there is not an ongoing caseload but there may be patients referred for re-consultation. On-site, case-based supervision is provided with presence for each patient.

Internal Medicine Consultation Liaison Clinic -  A Psychosomatic Medicine faculty member supervises each case seen by the fellow for diagnosis/treatment.  The faculty member advises the fellow in the relevant interface between medical and psychiatric illness presentations. Clinical population:  The patient mix is older adults, both sexes, numerous cultural backgrounds, all with chronic illness. The fellow sees patients established in the Internal Medicine clinic who have co-morbid psychiatric illness, evaluating and advising the primary care physician regarding management.  The typical census is four cases per day.  Same day supervision is provided by the on-site  Psychosomatic Medicine faculty member daily.   Scheduled supervision:  On-site, case based supervision with presence for each patient.

The UC Davis Medical Center Gastric Bypass Clinic is an elective rotation, one half day a week throughout the year.  The GI surgery service has a dedicated psychiatrist who is a faculty member on the psychosomatic medicine service.  There is a monthly conference on the psychological aspects of obesity and psychiatric aspects of gastric bypass surgery. The patient population is predominantly female (70%) with a range of psychiatric diagnoses including affective, substance abuse, anxiety, and eating disorders.  The average caseload is 2 patient evaluations a week for gastric bypass surgery and 1-2 follow-ups per week for postoperative patients.  The fellow functions as a primary consultant to the service with principal responsibility for his or her patients. The attending psychiatrist provides supervision directly on-site.  There is a minimum of one hour of supervision weekly. There are no other mental health services rotating to the GI Surgery clinic.  There are medical students and GI surgery residents and attendings who see patients in the clinic at the same time as the psychiatrists.  There is a full-time GI surgery social worker and dietician who consult to the service and work closely with the psychiatrist and fellow.  There is also a weekly GI surgery support group for post-surgery patients led by the social worker that the fellow can electively co-facilitate.  There are opportunities for collaborative research with the attending psychiatrist on gastric bypass patients.  UC Davis is a participating site in the LABS (Longitudinal Assessment of Bariatric Surgery) program.

The UC Davis Medical Center Transplant Service is an elective rotation, approximately one half to one day a week throughout the year. The Transplant Service has a dedicated transplant psychiatrist who is a faculty member on the psychosomatic medicine service. There is a monthly transplant journal club and a four (4)  hour seminar series on transplant psychiatry. The UCDMC Transplant Service includes liver, kidney, pancreas and lung transplant patients.  All patients receive a psychosocial evaluation from a social worker prior to transplant and nearly half of the liver transplant patients and all of the lung transplant patients also receive a psychiatric evaluation prior to transplant. Transplant patients with psychiatric illness either pre- (once listed) or post-transplant are evaluated and treated by the transplant psychiatrist. The average caseload is 2 pre-transplant evaluations weekly and 1-2 follow-ups a week for treatment.  The fellow functions as a primary consultant to the service with principal responsibility for his or her patients.  He or she will also sit on the Liver and Kidney Transplant Committees, which meet one hour a week. The transplant psychiatrist provides one hour of supervision every week and also serves on the Liver and Kidney Transplant Committee with the fellow. There are no other mental health services rotating to the transplant patients, though there are 2 full-time social workers who provide all initial psychosocial assessments to the Transplant Service.  There are transplant surgeons, surgical residents, gastroenterologists, hepatologists, nephrologists, and occasional medical students on the transplant service. The psychiatrists work closely with the transplant social workers and nurses to address psychiatric assessment and treatment issues with the transplant patients.  There is an annual UCDMC Transplant CME Conference which the fellow can attend.  There are opportunities for collaborative research with the transplant psychiatrist and gastroenterology attendings on the service.