Clinical Training Experience

Consultation-Liaison Psychiatry Service at Stanford University Medical Center – Inpatient Service

The inpatient Consultation-Liaison Psychiatry (CLP) Service provides consultation throughout the hospital’s 23 medical/surgical units for the management of psychiatric conditions arising within the context of medical and surgical conditions, including the critical care units, cancer center, and organ transplantation. The service consists of a full time CLP attending physicians, 1–2 CLP fellows, 2 – 3 PGY2 psychiatry residents, 0 – 2 internal medicine or neurology residents, and 0 – 2 medical students. Fellows learn to evaluate patients and provide a wide range of treatment recommendations, including pharmacotherapy, hypnosis, cognitive-behavioral management plans, brief supportive psychotherapy, alterations in the milieu, meetings with family or members of support system and recommend interventions by other disciplines such as neurology, social work, the spiritual care, or rehabilitation services. Fellows provide on-going supportive psychotherapy and family counseling, and may arrange and chair, focused, multidisciplinary staff conferences to deal with difficult management problems. They learn to communicate clearly, orally and in writing to medical and surgical colleagues and develop liaison relationships with other departments. They also participate in competency and conservatorship proceedings, as well as in initiating and extending psychiatric holds.

In addition to direct patient care, the fellow is heavily involved in educational activities on the service, providing teaching and peer supervision to other trainees on the team (medical students, residents). 

Service Director: Jose Maldonado, MD, FACLP, FACFE.
 

Critical Care Psychiatry [CCP] Service

The rotation’s purpose is to introduce trainees to the diagnosis and management of neuropsychiatric syndromes associated with critical care illness and/or its treatment. Most disorders encountered during this rotation are those associated with acute severe medical disorders (e.g., pneumonia, myocardial infarctions), acute and chronic end organ failure, acute trauma, and immediate post-operative states. The service consists of a full time CLP attending physicians, one CCP fellow, 1 – 2 PGY2 psychiatry residents, 0 – 2 internal medicine or neurology residents, 0 – 1 Critical Care Medicine fellow, and 0 – 2 medical students. The most common diagnoses trainees will be exposed to in this environment include delirium, post-operative neuro cognitive syndrome, post-traumatic stress disorder, and traumatic brain injury. Fellows will rotate through Stanford’s ten (10) specialized critical care units. This is a required rotation. Beginning with the 2023-2024 academic year, CLP fellows with special interest will be able participate in a subspecialty CCU concentration/ track.

Service Director: Jose Maldonado, MD, FACLP, FACFE.

** Note:  Subject to change; will be adjusted to account for liaison meetings, alternative clinical experiences
 

Consultation–Liaison Psychiatry (CLP) Evaluation & Continuity Clinic

The Consultation–Liaison Psychiatry (CLP) Evaluation & Continuity Clinic specializes in the diagnosis and treatment of psychiatric syndromes associated with medical and surgical conditions and their treatment. The clinic provides assessment and management of the major psychiatric disorders encountered in the medical/surgical patients including Adjustment Disorders, Anxiety Disorders (e.g., Panic Disorder, Post-Traumatic Stress Disorder), Mood Disorders (e.g. Major Depression), Cognitive Impairment Disorders (e.g. Delirium, Dementia), Psychotic Disorders, and Somatic symptom disorders, using combined psychopharmacology and psychotherapy. The clinic also provides pre-organ transplant psychiatric evaluation and post-transplant psychiatric follow-ups for various organ transplant services at SHC. 

Clinic Director: Yelizaveta Sher, MD, FACLP.
 

HIV Psychiatry Clinic

The Stanford Positive Care Program serves approximately 2000 HIV+ patients in two multidisciplinary clinics located in Atherton and San Jose. The Consultation-Liaison Psychiatry Fellow will become experienced in the evaluation and treatment of new and returning patients for a wide variety of conditions, including HIV-Associated Neurocognitive Disorder (HAND), substance abuse (predominately methamphetamine), and neuropsychiatric presentations of opportunistic infections, sexually transmitted diseases, and side effects of antiretroviral medications. Approximately thirty percent of the patients positive for Hepatitis C, management of which involves close psychiatric assessment and treatment. Fellows will also become familiar with the latest treatments for HIV/AIDS, Hepatitis C, and the management of drug-drug interactions. Previous fellows have elected to participate more extensively in community activities, including HIV/AIDS support groups, research, and educational programs (e.g., telemedicine consultations and webinars for primary care providers). 

Clinic Director: Lawrence McGlynn, MD.
 

GI Behavioral Medicine

The GI Behavioral Medicine Rotation provides fellows with focused experience in the psychiatric care of patients with complex gastrointestinal conditions, in collaboration with the Digestive Health Center at Stanford. Fellows will primarily conduct initial psychiatric assessments in the outpatient GI Behavioral Medicine Clinic, with opportunities for longitudinal follow-up when clinically appropriate. Common referrals include patients with disorders of gut-brain interaction, disordered eating, chronic nausea, and abdominal pain. The rotation includes weekly interdisciplinary case discussions with a GI psychologist, LCSW, and gastroenterology providers, where topics such as neuromodulator use, diagnostic clarification, and behavioral health referral pathways are explored. Fellows also contribute to a psychiatric e-consultation service supporting GI providers, with a focus on psychopharmacology and drug-drug interactions. Optional opportunities include participation in monthly multidisciplinary care conferences, inpatient GI psychiatry consultations, and shadowing experiences in GI Nutrition, biofeedback, or motility testing clinics.

Clinic Director: Dany Lamothe, MD
 

 Integrated Behavioral Health

The Integrated Behavioral Health (IBH) Service offers fellows the opportunity to engage in a collaborative care model embedded within Stanford’s primary care clinics, including locations at Stanford Medical Center, Los Altos, and Portola Valley. Working alongside primary care physicians, social workers, care managers, and nursing staff, fellows serve as psychiatric consultants supporting the identification, assessment, and management of mental health conditions in medically complex patients. The core of the rotation is based at Stanford Internal Medicine – East (SIME), a continuity clinic for internal medicine residents. Fellows proactively screen the daily schedule, formulate tailored interview strategies for primary care providers, and provide real-time consultation to residents and attendings. Emphasis is placed on education, patient-centered communication, clinical case formulation, and evidence-based treatment planning. Additional opportunities include registry reviews, collaboration with behavioral care managers, participation in co-visits, and optional exposure to other IBH sites and system models. Fellows also work with the Stanford Coordinated Care Program in a unique IBH model to provide psychiatric care for patients with complex/chronic medical conditions.

Director of Education: Matthew Gunther, MD, MA; Psychiatric Director for Integrated Behavioral Health: Mira Zein, MD, MPH

Abdominal Transplantation Psychiatry Service

Fellows will get experience working with organ transplant services participating in pre-transplant psychiatric evaluation, screening of prospective living donors, post-transplant management of psychiatric complications, and inpatient consults of abdominal transplantation (i.e., liver, kidney, pancreas, small intestine) patients. 

Service Director: Filza Hussain, MD, FACLP.
 

Thoracic Transplantation Psychiatry Service

This clinical rotation provides a variety of outpatient and in-patient experiences. This service provides primary consultation to the Heart and Vascular Clinics (e.g., General Cardiology, Adult Congenital Heart Program, Amyloid Center, Cardiac Arrhythmia Service). In Addition, this team serves as primary consultant to the Heart Failure and Cardiomyopathy Clinic, the Heart Transplant Program, and the Mechanical Circulatory Support Program. In that capacity, we perform pre-transplant/pre-LVAD evaluations, as well as provide support to heart/LVAD post-transplant patients. 

Service Director: Yelizaveta Sher, MD, FACLP.
 

Cystic Fibrosis/Pulmonary Medicine Psychiatry

This clinical rotation takes advantage of a new embedded clinic developed by Dr. Sher, a recognized expert in the psychiatric aspects of Cystic Fibrosis. This clinic provides trainees with an opportunity to be exposed to the psychosocial aspects of a chronic medical illness process (including end stages) with significant mental health sequelae. 

Service Director: Yelizaveta Sher, MD, FACLP.
 

Hospice & Palliative Care Medicine

This rotation is an immersion experience with the palliative medicine team. The Stanford University Hospice and Palliative Medicine Fellowship is the oldest training program in the nation. This rotation takes place at Stanford Health Care, where specialized palliative care is available through inpatient consultation teams. During this rotation, fellows participate in the activities common to a Palliative Care Service, including symptom management; discussion and planning for care options; how best to support patients and families with stress associated with illness.

Service Director: Rebecca Sands, MD, Clinical Associate Professor of Medicine; Clinical Section Chief of Palliative Care at Stanford University  
 

Psycho-oncology Service

Consultation-Liaison Psychiatry Fellows have an opportunity to rotate on the Comprehensive Cancer Center (CCC) Psycho-Oncology Service. The exact duration of the elective and time invested is to be determined based on programmatic needs and fellow’s preferences.

During the course of this rotation Consultation-Liaison Psychiatry Fellows will learn to assess psychiatric symptoms and psychological distress and coping mechanisms in patients at various stages of a cancer diagnosis, including: diagnosis, treatment, and remission/survivorship or terminal disease; develop proficiency in using psychiatric medications in the context of various cancer treatments (e.g., chemotherapy, radiation therapy, surgery, bone marrow transplantation); develop competency in providing various form of psychotherapy (e.g., supportive, cognitive behavioral, couples/family, and end of life/existential) and dealing with family dynamics, grief, and countertransference amongst medical staff; and gain experience working in a multi-disciplinary setting (i.e. oncologists, nurses, social workers, chaplains) and utilizing liaison skills. 

Service Director: Sheila Lahijani, MD, FACLP.