Clinical Training Experience

Stanford University Medical Center

The Stanford University Medical Center is comprised of three world-renowned institutions: Stanford Hospital & Clinics, which includes the Comprehensive Cancer Center; the Stanford University School of Medicine, the oldest medical school in the Western United States; and Lucile Packard Children's Hospital, an adjacent pediatric teaching hospital providing general acute and tertiary care.

Stanford Hospital & Clinics (SHC) is a 600-bed general medical and surgical facility with over 26,000 admissions a year. Stanford is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. In November of 2019 we inaugurated our new hospital building equipped with innovative facilities to combine superb clinical care, world-class research, and Stanford University’s groundbreaking education programs. The new, four towers, seven-story facility, houses a new Trauma Center and Emergency Department, and an enhanced capacity for patient care with 20 additional state-of-the-art operating rooms, state of the art radiology and imaging services, and a rapidly expanding world-class cancer center.

Stanford Health Care's renowned Stanford Hospital has again been recognized as one of the nation's premier hospitals by U.S. News & World Report, earning a spot on its national Honor Roll. As in previous years, U.S. News & World Report gathered and analyzed data for more than 4,500 medical centers. Stanford Health Care is among the top 10 hospitals in the nation, according to the U.S. News & World Report’s 2022-2023 Best Hospitals rankings.

The hospital was named in the top three in California and the best in the San Jose metropolitan area. For the eighth consecutive year, Stanford Hospital was included in the honor roll, which recognizes the 20 best-performing hospitals nationwide for a variety of medical specialties, procedures, and conditions. Stanford Health Care’s strong showing reflects expertise in numerous specialties and complex procedures. It was recognized as No. 1 in the country for ear, nose and throat, and it earned top-10 rankings for cardiology and heart surgery as well as obstetrics and gynecology.

In addition to the required rotations, the fellow spends half day a week, on average, in up to three sub-specialty rotations. Available rotations include: Neurocritical Care, HIV/AIDS Clinic, Women Wellness Clinic, Pain Service, Palliative Care Service at the Palo Alto VAHCS, Transplant programs, Pulmonary Clinic; GI Clinic, Psycho-oncology, and Clinical Research.

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). This is a required rotation.

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.
 

Neuro-Critical Care Medicine [NCC] Rotation

This rotation is an immersion experience into the world of Neurocritical Care Service. It also serves as a great refresher of basic neurological anatomy and physiology; presentation and management of acute neurological disorders (e.g., stroke, epilepsy, traumatic brain injury). This is a required rotation; with extra time allowed as elective rotation time.

Service Director: Anna Finley, MD (Neuro-Critical Care)

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. This is a required rotation.

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). This is an elective rotation.

Clinic Director: Lawrence McGlynn, MD.

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. This is an elective rotation.

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. This is an elective rotation.

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. This is an elective rotation.

Service Director: Yelizaveta Sher, MD, FACLP.
 

Hospice & Palliative Care Medicine

This rotation is an immersion experience into the world of the Palo Alto-VA, In-patient Palliative Care Unit; a specialized, inter-professional unit caring for medically complex patients who are seriously ill. The Stanford University Hospice and Palliative Medicine Fellowship is the oldest training program in the nation. We were also the first program in the nation to be funded by the Department of Veterans Affairs. This rotation takes place at the Palo Alto – Veterans Administration Health Care System, where specialized palliative care is available through inpatient consultation teams at the Palo Alto–VA. 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. This is a required rotation.

Service Director: VJ Periyakoil, MD, Professor of Medicine; Associate Dean of Research (Geriatrics and Palliative Care), Founding Director, the Stanford Hospice & Palliative Care Program
 

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. This is an elective rotation. Beginning with the 2023-2024 academic year, CLP fellows with special interest will be able participate in a subspecialty Psycho-oncology concentration/ track.

Service Director: Sheila Lahijani, MD, FACLP.