xxAACP Newsletter, Volume 11, Number 2, Spring 1997
Community Psychiatry Fellowship Begins in Maryland
It is expected that graduates of the Fellowship will be qualified to become Directors or Clinical Directors of community services, or of services systems, and will be experts in the development, implementation, and evaluation of mental health programs. The Fellowship program will provide experiences in an existing well organized system of care, with many unique and innovative programs and close links to city and state programs. Our geographic closeness to state and national government agencies will also be utilized to enhance the Fellowship experience.
The key word in the Fellowship will be "leadership". This leadership training will be accomplished by a combination of in depth, supervised exerience in a clinical setting, and non-clinical experiences which provide an in depth look at the system at all levels (program, local, citywide, state and national). We feel that this combination is necessary, since a leader in community psychiatry must be able to appreciate clinical needs on a micro level, while also understanding how the program level relates to and is influenced by the larger system of care. The Fellow will have experiences in clinical work, administration, research, program evaluation, and the politics of service delivery. A mentorship model will be the primary mode of teaching.
The Fellowship will be a well organized and well planned academic experience, and will not be simply an advanced clinical placement. The difference from a PGY-IV elective will be the level of clinical and administrative responsiblity (a "junior attending" role). The expectation to examine in depth the operations of the core clinical program to which the Fellow is assigned, the expectation to explore first hand and to understand in some detail the workings of the larger system, and the expectation for a scholarly paper focused on community psychiatry will be part of the experience.
A key organizing issue for the Fellowship is the examination of the boundaries in the service system (e.g., inpatient/outpatient; mental health/substance abuse programs; somatic/psychiatric illness programs' "traditional"/rehabilitation programs; administrative/clinical roles; physician/other staff roles; etc.).
About 60% of the Fellow's time will be in clinical work and clinical administration. This year long "core placement" will be in an assertive community treatment team, or a service with equal community integration potential. An academic affiliation of the core placement is a plus, but it will not be a strictly academically based program. The Fellow will carry a relatively small caseload (as compared to a non-trainee), but service delivery per se or development of the Fellow as a "specialist" in a particular type of service is not the goal of the Fellowship. The Fellow will spend 20-25 hours per week at the core clinical program, in both clinical and non-clinical work.
The Fellow will be expected to go to essentially all meetings attended by the Medical Director, and a certain number of meetings attended by the Program Director. After each meeting, the Fellow will be debriefed by the Director or Medical Director. The Fellow will be involved with discussions on budgeting, human resources, program development, quality management, etc. Problem areas will be discussed with the Fellow present. The Fellow should see the "trade offs" which go into decisions.
The Fellow will have clinical responsiblity from the start of the year, but as the year progresses, it will be important for the Fellow to have some responsiblity in running the program (e.g., be placed "in charge" with supervision of running some staff meetings, of developing a plan for the budget, or writing part of the annual report, etc.). The goal is to produce a person who is comfortable with clinical administration.
About 20% of time will be devoted to an "academic project", which will lead to a publication in a refereed journal. This might be a research project, a program evaluation project, a scholarly review of the literature with examples from the Fellow's experience in the Fellowship, or other projects approved by the Director of the Fellowship Program. A specific topical area (theme) will be chosen, with the academic project relating to that theme. Themes will be system oriented (rather than clinically oriented). The result will be presented at a Department of Psychiatry Grand Rounds and/or at an APA meeting.
About 20% of time will be devoted to other experiences, designed to let the Fellow become familiar with as much of the system as it practical and pursue individual community psychiatry interests. This will include extended visits to State and Federal agencies, and other local and area service programs (particularly those which are unique or innovative).
Supervision will be provided by John A. Talbot, MD, Chairman of Psychiatry; James W. Thompson, MD, MPH, Fellowship Director; and Fred Osher, MD, Director of Community Psychiatry. In addition, there are many community psychiatrists on the UMAB (University of Maryland at Baltimore) faculty who are available for mentorship and supervision. Didactics will be via assigned readings and discussions of those readings with mentors.
Potential Fellows should contact:
James W. Thompson, MD, MPH
Director
Community Psychiatry Fellowship
University of Maryland
Department of Psychiatry
645 W. Redwood Street
Baltimore, MD 21201
(410) 706-8149
E-Mail Dr. Thompson at jthompso@umpsy.ab.umd.edu
Back to Spring 1997 Table of Contents