European guidelines for training in consultation–liaison psychiatry and psychosomatics: Report of the EACLPP Workgroup on Training in Consultation–Liaison Psychiatry and Psychosomatics

Abstract

Objective: The European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) has organized a workgroup to establish consensus on the contents and organization of training in consultation-liaison (C-L) for psychiatric and psychosomatic residents. Methods: Initially, a survey among experts has been conducted to assess the status quo of training in C-L in different European countries. In several consensus meetings, the workgroup discussed aims, core contents, and organizational issues of standards of training in C-L. Twenty C-L specialists in 14 European countries participated in a Delphi procedure answering a detailed consensus checklist, which included different topics under discussion. Results: Consensus on the following issues has been obtained: (1) all residents in psychiatry or psychosomatics should be exposed to C-L work as part of their clinical experience; (2) a minimum of 6 months of full-time (or equivalent part-time) rotation to a C-L department should take place on the second part of residency; (3) advanced training should last for at least 12 months; (4) supervision of trainees should be clearly defined and organized; and (5) trainees should acquire knowledge and skills on the following: (a) assessment and management of psychiatric and psychosomatic disorders or situations (e.g., suicide/self-harm, somatization, chronic pain and psychiatric disorders, and abnormal illness behavior in somatically ill patients); (b) crisis intervention and psychotherapy methods appropriate for medically ill patients; (c) psychopharmacology in physically ill patients; (d) communication with severely ill patients and dying patients, as well as with medical staff; (e) promotion of coordination of care for complex patients across several disciplines; and (f) organization of C-L service in relation to general hospital and/or primary care. In addition, the workgroup elaborated recommendations on the form of training and on assessment of competency. Conclusion: This document is a first step towards establishing recognized training in C-L psychiatry and psychosomatics across the European Union. D

A proposal of basic guidelines for training in psychosomatic and liaison psychiatry in Spanish psychiatry training programs

“…Learning spaces 6,12,19,34 Malcolm Knowles introduced the term "andragogy" defining it as "the art and science of helping adults learn". Andragogy is based on five assumptions about how adults learn and their attitude and motivation for learning (Table 4) 35 .…”

“…In USA psychosomatic medicine has been recognized as a Psychiatry subspecialty 4 , with its own "board examination" and certification. In 2007 Creed and Sollner 12 published the excellent European guidelines for training in consultation-Liaison Psychiatry and Psychosomatic, that have helped us to elaborate this proposal, with whom we would like to open discussions over the education in this subspecialty in our country.…”

The Role of Psychosomatic Medicine in Global Health Care

“…For psychiatrists who seek board certification in psychosomatic medicine, at least 1 year of additional fellowship training is required. Often, in addition to inpatient consultation work, advanced trainees see patients in embedded outpatient primary care and specialty clinics that emphasize a more collaborative approach to mental health [24,25].…”

“…Other specific skills of psychosomatic medicine practitioners include assessment of medical decision-making capacity; evaluation and management of chronic pain, neuropsychiatric disorders, and somatoform disorders; and pharmacologic and nonpharmacologic interventions for emotional and/or behavioral symptoms in the setting of medical comorbidities [26]. Psychosomatic medicine psychiatrists freely share basic clinical approaches with general practitioners and other allied health professionals, aiming to build their capacity to recognize and treat common mental disorders in primary care settings [24,25]. They may participate in interdisciplinary rounds made up of medical and psychiatric providers, in which they are wellpositioned to identify the primary treatment team's emotional responses and help other team members guard against burnout.…”

Consultation-Liaison Psychiatry in the General Hospital: the Experience of UK, Italy, and Japan

“…Also, good evidence exists on the role and characterization of CLP in terms of types of diagnostic and management problems encountered by psychiatric consultants in the medical and surgical divisions of a general hospital. Standard textbook and practical manuals are available [e.g., [4][5][6], and guidelines have been developed over the last 15 years by institutions and psychiatric societies [7][8][9][10]. A robust scientific literature has also increased, with many dedicated journals in the field (e.g., Psychotherapy and Psychosomatics, Journal of Psychosomatic Research, Psychosomatics, General Hospital Psychiatry).…”