REQUIRED ROTATIONS

*Supervisors are noted in (parentheses) 

            1. Adult Psychiatry Inpatient Unit: It is clear mental health care in the US is moving away from inpatient facilities for all but the most severely impaired patients.  However there is still an need for acute, short-stay units for crisis stabilization, with day patient units then used to care for those who no longer need inpatient, but do need intensive outpatient care. 

            This is a new and very modern 22-bed teaching unit, where front-line care is provided by third-year WVU medical clerkship students, non-medical graduate students, and psychiatry residents, with the support of WVU School of Medicine Faculty.  The patient population includes many diagnostic categories, but highlights management of acute problems in a short period of time.  Special care is offered for patients with medical problems or chemical dependency.  Day patients receive the core of the inpatient day, but return home in the evening.  Each patient is randomly assigned to a treatment team comprised of a medical student, a psychiatric resident, a nurse and at times a non-medical graduate student.  The team follows the patient throughout the inpatient stay. 

            Psychology interns have access to all inpatient records, and are expected to note their observations, impressions and recommendations in patient charts.  During inpatient interns attend medical student lectures daily, as well as grand rounds and various other seminars. There is therefore a good deal of  didactic and tutorial teaching provided to a variety of trainees on this service. The inpatient rotation is required and full-time for 6 weeks (Wilhelm) 

            Emergency Department: As part of the Inpatient Rotation, interns work in the Emergency Department (ED). Behavioral Medicine and Psychiatry is on call to the busy General Division ED at all times.  When a patient has an emotional or behavioral problem, an on-call third year medical student and psychiatric resident is consulted to the ED to evaluate the individual and suggest an intervention plan.  Psychology interns take ED call with residents for a 24-hour period several times during the inpatient rotation.  During this time they function as medical students with resident colleagues.  They may clinically evaluate and plan for as many as 12 ED patients in a 24-hour period.  Scrubs and sleeping quarters are available for interns in the evening, although sleeping through a call night is unusual.  This is excellent crisis intervention experience, and draws on the intern’s flexibility and resourcefulness. (Faculty as assigned). 

            2. WVU Outpatient Psychiatry Service: This is a busy training clinic where patients of all ages enter through referral from inpatient, from other parts of the hospital, through physician and community referral, or by self-referral. Doctoral interns function as staff during this rotation.  They can follow former inpatients, select cases from the ED crisis service, and do scheduled intakes.  Faculty members of all disciplines welcome doing co-therapy with psychology interns, both for initial intakes and also longer term case management and psychotherapy.  Interns are required to carry a modest caseload, but the focus of the clinic is teaching, not service.  The outpatient clinic does not need intern labor to function. Therefore, students and their supervisors can select cases, which are best suited to fill the intern’s clinical experience gaps.            

            All therapeutic modalities are encouraged in this setting, and interns are often consulted by other staff regarding advice in areas of the intern’s particular interest and expertise.  Conversely, interns are expected to explore new clinical techniques to insure their time in the outpatient department is one of training and not merely service.  On outpatient, interns may choose to work with children, adults, families and groups.  Again, the problem is tailored to the needs of the student as much as possible, and faculty members involved with specific areas are available for supervision and guidance.  (Cloonan, Linton, Wilhelm).  

            Outpatient Electives:  In addition to work in the Behavioral Medicine Outpatient Clinic, interns can take a number of outpatient electives, which are targeted learning experiences available to those who wish to develop special expertise.  The time commitment is typically about 4 hours per week, which is applied to the required outpatient hours. Current Outpatient Electives are: 

            3. Consultation/Liaison Service:  Physicians on other medical services often consult Behavioral Medicine regarding their patients who are having behavioral or emotional problems. Typical referrals are for depression, anxiety, pain control, substance abuse, competency determination, family crises, and adjustment to trauma. C/L Team trainees (residents, psychology interns) make first contact with the patient, and perform an initial assessment.  The case is then presented to attending staff and the team for review.  Each patient is then revisited during teaching rounds led by a faculty member.  The rotation on C/L presumes only basic competence in traditional clinical skills. Exposure to the role of the psychologist in general medical settings is the primary goal of the C/L Team, and experience with the interdisciplinary team forms the core of the rotation. 

            Interns interact daily with physicians, nurses and other hospital personnel.  They may do liaison activities such as consultation with the Renal Dialysis or Transplant programs, the Trauma Center and intensive care units, Medical Rehabilitation, Cancer Center and the Heart Institute.  Primary to this service is a development of a sense of the health delivery system, and assigned readings supplement experiential aspects of the rotation. This is a full-time rotation, but interns are “eased” into this busy service for the first few weeks. Consults are assigned with concern for the intern’s level of experience, and while previous work in health psychology may help, it is not necessary. (Linton, Wilhelm, Wright). 

            4. Assessment Service:  In order to integrate psychological assessment with the other duties performed by a psychologist, and to expose the intern to a variety of approaches to psychological evaluation, the psychological assessment rotation will consist of a requirement to perform 10 psychological assessments over the course of the year.  The assessments are not designed to be hard labor, but will be very flexible and designed to reflect the interest of the intern as well as address any deficits in skills.  Factors included in the assessment process may include: researching relevant clinical issues, clarification of referral questions, patient interviewing techniques, test selection and interpretation, report writing and patient feedback.  Although a psychometrician is available to administer tests, in order to gain experience interns may elect to perform their own testing.  The intern may choose to evaluation any combination of adults or children, psychiatric or non-psychiatric medical patients, the chemically dependent, etc.  Evaluations may include IQ testing, assessment of developmental disabilities or ADHD, pain management evaluations, personality testing, or development of proficiencies with new techniques.  The intern will develop an individualized plan with the guidance of the director of the psychological assessment service, which will require flexibility over the course of the year (DiPino).

OPTIONAL ROTATIONS

As mentioned earlier, in addition to required experiences, interns may design a program from the list of optional rotations.  This is done by consulting with supervising faculty of the desired rotations.  Interns do not need to “compete” with one another for these settings, and it is no problem if everyone wants some and not others.  Interns do not need to choose optional rotations in advance, since informed choices can only be made after interns are here for a while and get to know the programs and supervisors.  Some optional rotations can be done part-time, so interns can be involved in several at once.

Managing several assignments at one time is consistent with the demands on professional psychologists in health care settings, and is a valuable learning experience.  Transition from one rotation to another is designed to be smooth so little time is wasted. 

The Following Rotations Are Optional for Psychology Interns: 

            1. CAMC Family Resource Center (FRC):  Located on the Women and Children’s Campus, the FRC is a full service outpatient mental health facility serving adults, children, adolescents, couples and families. Clients are treated for a wide range of problems including depressive disorders, anxiety disorders, eating disorders, domestic violence, and bereavement. The FRC also provides consultation to Women and Children’s Hospital on the inpatient units as well as outpatient clinic settings. Interns can work with individuals, couples and families, or they can co-lead ongoing DBT groups. Consultation opportunities include pediatric oncology, and working with patients with encephalitis, diabetes, and other chronic and acute illnesses. Experiences in infertility consultation and evaluation are anticipated  (Walker-Matthews, Weir).

            2. CAMC Cardiac Rehabilitation: Is a multidisciplinary program within the large and active Heart Institute, consisting of four phases from acute to long-term follow-up of patients who have experienced cardiac events.  Interns can be involved in psychological consultations to cardiac care inpatients, individual therapy with outpatients in the rehabilitation program, group therapy focused on various mental health issues related to cardiac problems, consultation with other medical staff, and research on psychosocial outcomes following interventions for cardiac events. (Chelf, Sirbu). 

            3. CAMC Cancer Center: Located on the Memorial Campus, the Cancer Center is a rapidly growing inpatient and outpatient referral center for the southern region of the state.  On this service interns will be introduced to the fields of oncology and hematology, and participate in-patient and family assessment and treatment as part of an inter-disciplinary team.  This rotation can also provide fertile ground for the development and implementation of new research proposals.  Interns may also provide in-service training and support for Cancer Center staff.  Some outpatient work at the Cancer Center can count for outpatient requirement. (Barton) 

            4. WVU Department of Family Medicine: Psychology faculty coordinate the behavioral science component for the Family Medicine residency training program.  This provides a unique opportunity for interns to participate in program development in primary care health psychology.  Interns can round with family physicians, provide consultation to them about psychological issues in patients, and participate in didactic presentations for residents.  In addition to the Charleston Area clinics, rotations in two rural primary care settings can be arranged. The rotation is tailored to the interests of the intern as much as possible. (Fields) 

            5. WVU Child and Adolescent Psychiatry:  Interns may spend two or more months in Child and Adolescent Psychiatry, working with a child psychologist, a social worker/family therapist, child psychiatrists, and psychiatry residents.  Patients range in age from 2-17 years and present with a variety of emotional/behavioral disorders and issues.  Interns may receive training in parent-child interaction therapy, family therapy, and cognitive-behavioral approaches to intervention.  Pediatrics consultation and monthly didactics are included in the rotation. (Cloonan) 

            6. WVU Psychological Assessment Laboratory:  This provides an opportunity for additional assessment experience for the interns.  While the primary focus of the rotation is typically neuropsychological in nature, the Psychological Assessment Service provides the entire medical center with evaluations, and the opportunity exists to arrange other assessment experiences.  Relations with neurology, neurosurgery and physical medicine are excellent, and assessment experiences can also be arranged through special clinics or upon referral for clinical problems of interest to the intern.  Testing is done primarily by psychometric staff, but interns may administer some or all of their own testing to develop and sharpen assessment skills (DiPino, other staff as assigned).

            7. Medical Rehabilitation Center: The CAMC Rehabilitation Center is located on the General Division Campus.  It is a modern, 40-bed facility, and treats patients suffering the effects of spinal cord injury, CVA (stroke), closed head injury, amputation, and other acute problems requiring rehabilitation services.  The intern participates as a team member under supervision doing clinical assessments, providing individual and family treatment from ICU through acute care, through rehabilitation to discharge,  and attending regular patient staffings and conferences.  (Linton) 

             8. Critical Incident Stress Management (CISM) Team. The Department is the lead mental health agency for response to critical incident stress in emergency responders. in southern West Virginia.  Team membership requires specific in-house training, as well as time in the field responding with emergency services personnel.  The request for stress management service occurs unpredictably throughout the year around the region, so this is not a rotation with clear time boundaries.  Debriefings and educational workshops are usually done in the early evening or weekends. (Linton)

 9. Independent Research: In addition to time made available during the other rotations of the internship, interns may elect to take a month to focus upon a particular research project.  Such a project might be carried out alone, or in collaboration with others in the Department. Doctoral dissertations do not qualify unless data are being collected on site. (Various faculty)

            10. Rural Schools Resiliency Project: This is an opportunity to be involved in a collaborative grant funded effort among WVU School of Medicine, the Lincoln Co. Board of Education, the WVU Extension and local non-profit agencies.  Interns spend about 20 hours per month for three months on this rotation, based in a rural county southwest of Charleston.  With a member of the collaborative, interns primarily co-facilitate a secondary prevention program for at-risk rural youth.  Interns may also conduct research, work with school personnel or offer training to local parents and professionals.