Curriculum

There are three rotations during the fellowship. Each is approximately four months in duration. Fellows rotate through each rotation during the fellowship year with one fellow assigned to one rotation, and all fellows complete all three rotations.

1. Family Medicine
2. Internal Medicine/OB
3. Hospital Consultation-Liaison

Family Medicine: East Flint Campus Rotation

While working on the East Flint Campus Rotation, the fellow will have the opportunity to function as a health psychologist within a family medicine training practice. There are numerous opportunities to acquire and polish clinical health psychology skills during this rotation. One of the central components of the fellowship program is medical education. Fellows are involved in designing and implementing the behavioral sciences curriculum for the family medicine residency program and in shadowing medical visits to promote learning about communication, time efficiency, and overall good patient care. Fellows also gain clinical health psychology skills and assist residents in learning about the psychosocial aspects of family medicine through several behavioral clinics including an Integrated Primary Care Clinic, an ADHD assessment clinic, and a lifestyle change clinic.

Integrated Primary Care (IPC)

Our main approach to reaching our patients' immediate health needs and to providing medical education for family medicine physicians, who learn along with the psychology fellow, in IPC. Through focused psychological evaluation and treatment, the psychology fellow addresses a variety of presenting problems common to the primary care medical setting including mental health concerns, such as generalized anxiety, panic disorder, and major depression, as well as common behavioral medicine concerns such as medication adherence, emotional adjustment to new medical diagnosis/physical pain/physical injury etc., and other clinical health psychology related concerns, such as coping with chronic medical conditions. The fellow position is primarily IPC in nature, operating out of the medical preceptor's office or resident physician work stations. We respond to respond to calls for Behavioral Medicine consultation from any of our 40+ physician colleagues in the primary care clinic. To a lesser extent, the fellow maintains 5 hours per week for scheduled psychotherapy appointments, which are short-term in nature. We typically only provide psychotherapy services for mild-moderate severity levels, while referring more severe cases out to our local community psychiatric/mental health centers. Resident physicians may observe some of these IPC evaluations and treatment sessions (based on resident’s availability/rotation) to learn how to integrate some of these skills into their practice. This training opportunity aims to prepare health psychologists to function effectively in an outpatient medical setting as well as in medical residency training settings.

ADHD Assessment Clinic

This is a twice monthly clinic where children and adolescents identified as possibly having ADHD are provided a screening evaluation that includes clinical interviewing, psychological assessment materials, and a physical exam conducted by the family medicine resident. The fellow is responsible for teaching the residents how to conduct a clinical interview, how to interpret results from a psychological behavior index, identifying possible differential diagnoses, and providing relevant and timely feedback and recommendations to the parents.

Lifestyle Change Clinic

This is a weekly clinic run by the psychology fellow and 1-2 family medicine residents that aims to assist patients identified by their primary care physician as needing assistance with weight management, smoking cessation, or increasing physical activity. The fellow assists the residents in learning motivational interviewing strategies for health behavior change and dealing with ambivalence according to the transtheoretical model of stages of change.

Internal Medicine & OB/GYN - Downtown Flint Campus

The psychology fellow at the Genesys Downtown Flint Health Center is an integrated member of the internal medicine and obstetrics-gynecology treatment teams. This setting is a busy academic ambulatory practice in which approximately 10,000 patient visits occur each year. These visits occur in the internal medicine residency program, the obstetric-gynecology residency program, the podiatry residency program, the general surgery program, and the behavioral science psychology program.

The main focus of this rotation is to continue to refine medical education skills in a setting requiring a higher level of autonomy, while also providing clinical consultation to the primary care ambulatory practices. Fellows participate in the following teaching activities:

• Shadowing internal medicine and OB-GYN residents to provide feedback about both clinical content related to psychology, but also strategies to improve doctor-patient relationships, advanced counseling skills, and time efficiency.
• Videorecording internal medicine and OB-GYN residents co-jointly with physician faculty to improve residents’ skills
• Designing curriculum to improve the patient experience and physician skills and confidence
• Precepting clinical cases with physicians

Clinically, the psychology fellow provides a variety of services to our patient population. Fellows typically carry a caseload of approximately 20-25 patients, with approximately 10 clinical contact hours per week. Many of these encounters are traditional psychotherapy cases, but approximately 25-50% of them are triage primary care appointments. These triage services use an integrated primary care psychology approach. Fellows typically treat patients collaboratively with their physician health care provider. Presenting concerns mirror a primary care practice. They can include:

• adjustment to medical illness
• health related behavior
• Gut directed hypnotherapy for GI related conditions
• neuropsychological screening
• treatment of uncomplicated depression
• panic disorder assessment and treatment
• chronic pain
• substance abuse
• trauma

Hospital C-L Rotation

The psychology fellow on the consultation-liaison rotation manages the psychology consult service at Genesys Health Park providing inpatient psychological services. The psychology consult service responds to requests for consults, assessing mental health problems among admitted patients on the general floor and providing treatment recommendations to the medical team regarding patient needs.

Commonly encountered referral questions include:

• assessment and treatment of anxiety and depression
• pain assessment and management
• capacity for medical decision-making

We also provide follow-up services to patients as needed, such as relaxation training, pain management, and behavioral activation.

We work closely with the family practice and internal medicine teams, including residents and attendings, regarding patient care.

Other responsibilities include completing pre-surgical psychological evaluations for bariatric surgery center at Genesys and providing behavioral medicine lectures within the hospital to various groups of residents and medical students. The psychology fellow works closely with a psychology faculty member, who provides supervision and didactic training covering topics pertinent to psychologists working in inpatient settings.

Populations Served

As typical of primary care and hospital-based services, fellows work with patients across the age spectrum ranging from childhood to geriatrics. Most patients seen by fellows in the hospital setting are adult or geriatric, while in primary care there is greater opportunity to work with children and adolescents. From an SES standpoint, the EFC and DFHC settings serve a primarily medically underserved, lower SES patient population, while the hospital-based service includes a higher SES population with higher rates of private and Medicare insurance coverage. Both the EFC and DFHC settings are located within urban environments in the Greater Flint Community, and have patient populations comprised ethnically/racially of White (72.5%), Black (20.2%), Hispanic (3.1%), Mixed (2.7%), Asian (1%), and other (0.5%). Fellows routinely work with first generation immigrants, patients with disabilities, and LGBTQ individuals.