MCW APP Psychiatry and Mental Health Fellowship

Duration: 2-3 days per week, lasting 2.5-3 months

Access Clinic/Infectious Disease
Fellows will split their time between seeing patients virtually with their preceptor at the Infectious Diseases Clinic and staffing the Access Clinic at the Tosa Health Center. The Infectious Diseases Clinic provides comprehensive care for HIV clients including psychiatric and psychotherapy services. Housed within this clinic is the Inclusion Clinic. The Inclusion Clinic provides comprehensive services for clients of the LGBTQA+ community including psychiatric and psychotherapy services.

Fellows will also have the opportunity to see patients independently in consultation with their preceptor while staffing the Access Clinic at the Tosa Health Center. The Access Clinic was established to increase access to mental and behavioral health services for underserved populations.

Child and Adolescent
Under the supervision of the preceptor, the fellow will evaluate and treat patients for psychopharmacologic care in an outpatient setting. Patient ages will vary from preschool age through young adulthood. Possible diagnoses include (but are not limited to) ADHD, Anxiety disorders, Mood Disorders developmental disorders, and behavioral disorders. Commonly, patients have co-morbid medical conditions. Fellows will also have a variety of shadow experiences scheduled throughout the rotation which may include: outpatient psychiatry clinic with a child and adolescent psychiatrist, adolescent medicine outpatient clinic (eating disorder intakes), neuropsychological testing, chronic pain/ headache clinic, sleep medicine clinic, epilepsy monitoring unit, and inpatient pediatric psychiatry consultation-liaison service.

Fellow/learner will practice integrating the DSM-5 criteria into interview assessment and diagnosis; practice/refine interview skills, practice biopsychosocial formulation, integrate differential diagnoses, learn/refine psychopharmacology and practice suicide/homicide and non-suicidal self-injury assessments.

Student Mental Health
APP learners will spend 2-3 months at Marquette University Counseling Center. At the Marquette University Counseling Center (MUCC) fellows/students will learn to evaluate and treat patients in an outpatient mental health clinical setting.

Typical learner schedule:

• Week #1: Shadow and scribe all clinic appointments.
• Week #2: Scribe and begin sharing patient interview, assessment, and treatment planning with preceptor.
• Week #3: Lead interviews, assess and treat with preceptor. Share scribing notes with preceptor.
• Week #4+: Lead interviews, assess, treat with preceptor, and scribe note.

Fellow/learner will practice integrating the DSM-5 criteria into interview assessment and diagnosis; practice/refine interview skills, practice biopsychosocial formulation, integrate differential diagnoses, learn/refine psychopharmacology and practice suicide/homicide and non-suicidal self-injury assessments. Common diagnoses seen at MUCC are:

• Major Depressive Disorder
• Persistent Depressive Disorder
• Cyclothymic Disorder
• Bipolar 1 & 2
• Seasonal Affective Disorder
• Generalized Anxiety Disorder
• Social Anxiety Disorder
• Panic Disorder
• Obsessive Compulsive Disorder
• Post-Traumatic Stress Disorder
• Acute Stress Disorder
• Adjustment Disorder
• Disordered Eating (Review DSM5 by type)

Higher Level of Care
APP Fellows will spend 6-8 weeks on the adult residential depression unit and 6-8 weeks on the child/adolescent residential OCD/anxiety unit. They may also get the opportunity to staff the adult and child inpatient units.

During the Higher Level of Care rotation, fellows will learn to evaluate and treat patients admitted for residential and inpatient treatment. Fellows will learn how to monitor patients’ status daily including psychiatric, medical, legal, and social/placement issues; learn how to address changes in status and adapt treatment plans accordingly; and learn how to document need for continued hospitalization.

Duration: 1-1.5 days per week lasting 2.5-3 months

Child Development
Under the supervision or the preceptor, fellows will learn to diagnose and provide treatment recommendations for the following conditions:

• Developmental delays including delayed development in speech, language, motor skills, and thinking ability
• Cognitive delays
• Learning disorders including dyslexia, writing difficulties, math disorders, and other school-related learning problems
• Attention and behavioral disorders including attention-deficit/hyperactivity disorder and associated conditions including oppositional-defiant behavior, conduct problems, and adjustment and anxiety disorders
• Language and communication disorders
• Autism Spectrum Disorder
• Selective mutism
• Psychological and developmental concerns secondary to trauma

Community Outpatient
Fellows will work with their preceptors at the North Hills Health Center seeing adult patients in an outpatient setting. Common diagnoses seen include mood disorders, anxiety disorders, psychotic disorders, personality disorders, neurodevelopmental disorders etc. Fellows will learn to evaluate, document, and create treatment plans for adults seen in the community for outpatient services.

Geropsychiatry
Fellows will see patients in the Geriatric Psychiatry Clinic at the Froedtert North Hills Health Center. The natural process of ageing can be associated with many conditions that change your general health, physical functioning, psychological health, cognition, and lifestyle. Fellows will work in an interdisciplinary team to make accurate diagnoses and to coordinate appropriate treatment in caring for the needs of older adults. The Geriatric Psychiatry Clinic specializes in disorders such as Alzheimer's dementia, delirium, other conditions that affect memory and the ability to function in daily activities of life and late-life depression and anxiety.

Perinatal
The fellow will have the opportunity to learn to manage reproductive-aged women, both during pregnancy and up to 12 months post-partum to provide consultation, manage psychotropic agents during pregnancy and lactation, and provide liaison to their OB providers.

Poison Center
The medical toxicology rotation accepts learners from multiple disciplines. Historically, this has included medical students, pharmacy students and residents, medical residents from multiple specialties (including emergency medicine, psychiatry), psychiatric nurse practitioners, and pediatrics EM fellows. Additionally, there is an ACGME Toxicology fellowship. Learners will participate in Poison Center Rounds, phone and bedside consultation, and poison center didactics.

Fellows will be assigned to 2 elective rotations based on their interest:

• Complex Intervention Unit
• Consult Liaison
• Integrated Behavioral Health
• Mental Health PHP and Substance Use IOP
• Psycho-oncology