(APPIC/NMS program code = 161914)
For 2024-2025 the behavioral medicine track will accept six residents. All residents will receive extensive training in behavioral medicine within medical/surgical and medical rehabilitation settings. In addition, all residents in the Behavioral Medicine track will have at least some exposure to basic neuropsychological principles and assessment. Previous neuropsychology experience is not required for the Behavioral Medicine track.
Please note that while Behavioral Medicine residents receive some limited exposure to neuropsychological screening and assessment, those wishing for a more intensive neuropsychology training experience should consider the Rehabilitation Neuropsychology track.
- University of Washington Medical Center (UWMC)
- Harborview Medical Center (HMC)
Rotations and Training Sites
All psychology residents complete three, 4-month rotations during the training year. Some of these 4-month rotations may include multiple training sites or clinical services. A description of Behavioral Medicine clinical service sites is below.
- Jeanne Hoffman, PhD, ABPP-RP (inpatient consultations and outpatient rehabilitation)
- Ivan Molton, PhD, (inpatient rehabilitation)
- Nick Dasher, PhD
- Tracy Herring, PhD
- Jed McGiffin, PhD
- Myron (Moe) Goldberg, PhD, ABPP-CN, (Director, Neuro Rehabilitation Program & Neuropsychology Service)
The Behavioral Medicine rotation at UWMC provides an array of clinical experiences to train clinical psychologists within a multidisciplinary team framework in a medical setting. Psychology residents will have opportunities to work with physicians, nurses, speech pathologists, physical therapists, occupational therapists, vocational counselors, therapeutic recreation therapists, and social workers, from within the medical center as well as from the community in developing collaboratively and implementing treatment plans. Psychology is an integral part of the medical team. Our patients are diverse in terms of medical conditions and problems, ethnic and socioeconomic backgrounds, and ages. Psychology residents will have an opportunity to evaluate and treat patients with a variety of presenting medical conditions, including spinal cord injury, brain injury due to trauma stroke, tumor, aneurysm, hemorrhage, hypoxia, etc., multiple sclerosis; muscular dystrophy, post-polio syndrome, amyotrophic lateral sclerosis, cancer, and large organ transplant (heart, lung, and liver). The rotation provides a mix of inpatient and outpatient psychological assessment and treatment opportunities.
The training model emphasizes empirically supported scientist-practitioner approach to assessment and treatment. Psychology residents learn to function as an integral member of an interdisciplinary rehabilitation team. Psychology residents cover 2 teams on the acute inpatient rehabilitation unit and follow up to 8 outpatients in the rehabilitation clinic. Occasionally residents will have an opportunity to assist with the inpatient consultation-liaison service. Typical patients present with need for assessment of psychological and/or neuropsychological functioning, identification of patient and family concerns, development and implementation of appropriate treatment programs, and mobilization of resources to integrate the patient into the community. Psychology residents are involved in a range of clinical activities, including psychological assessment; utilization of assessment findings in inpatient and outpatient rehabilitation treatment planning; development of behavioral programs; consultation to team members and community agencies; case management of patients; and provision of individual and family therapy. All residents will receive training in conducting and utilizing findings from brief inpatient neuropsychological evaluations.
Participation in weekly rounds and team/family conferences is an important part of the psychology residents’ experience. There is also the opportunity to observe or participate in outpatient treatment groups. Psychology residents who are involved in the behavioral medicine rotation participate in a monthly rehabilitation psychology journal club. Psychology residents also have opportunities to attend the Department of Rehabilitation Medicine’s Grand Rounds which occurs twice per month and covers various rehabilitation topics, many of which are of interest to residents.
Expectations of Psychology Residents
Behavioral Medicine residents participate in all aspects of the training experiences listed above and can typically expect to follow 4 to 8 inpatient cases, and 6 to 8 outpatient cases weekly. By the end of the rotation, psychology residents are expected to:
- have an understanding of a psychologist’s role on an interdisciplinary rehabilitation team
- demonstrate an increased awareness of and ability to assess the emotional, behavioral, and cognitive sequelae of various traumatic and chronic medical conditions
- have a fundamental understanding of the functional implications of neurocognitive screens
- recommend and implement basic therapeutic interventions with patients and their families
- apply ethical and legal principles to practice
- have an awareness of personal strengths and limitations as they relate to providing psychological services to this population
Psychology residents will have an orientation session with tours of the facility. Residents will then have an opportunity to accompany and observe the supervising psychologist(s) performing clinical work. Residents will then have opportunities to see patients with direct observation and supervision provided. The eventual goal is for psychology residents to work fairly independently with patients and to move towards a co-treatment model. Psychology residents are provided with examples of psychological /neuropsychological evaluation reports, progress notes, and other written communications as models. Residents have access to a training manual and numerous articles and books to supplement their learning experiences. Psychology residents participate in weekly scheduled individual supervision as well as weekly group supervision. Residents have additional opportunities for contact and supervision with the supervisors during weekly rounds and conferences. Residents are encouraged to drop by or page the supervisors with day-to-day questions concerning patients. Supervision is provided by the attending psychologists, and additional supervision may be provided by the post-doctoral fellow.
Evaluation of Psychology Residents
Supervisors provide frequent, ongoing feedback on the psychology resident’s performance throughout the rotation. Residents and supervisors discuss the resident’s progress and training needs at the mid-rotation point. Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site.
- Jeffrey Sherman, PhD, (Consults)
- Shelley Wiechman, PhD (Burns, Pediatrics)
- Dawn Ehde, PhD (CORP neuropsychology)
- Katie Wright, PhD (Madison Clinic, Inpatient Rehabilitation, and Inpatient Consultation Service)
- Carlene Deits-Lebehn, PhD
- Jake Bentley, PhD
- Gina Formea, PhD, ABPP-CN (CORP neuropsychology)
- Charles Bombardier, PhD, ABPP-RP (Inpatient rehabilitation)
- Amy Starosta, PhD (Inpatient rehabilitation)
- Arjun Bhalla, PhD (Acute Pain Consultation)
- Akansha Vaswani-Bye, PhD
- Felicia Mata Greve, PhD
- Lindsey Knowles, PhD
- Joel Peterman, PhD
General Rotation Description & Patient Demographics
Behavioral Medicine rotations provide training in medical psychology and rehabilitation psychology and operate within several areas of the medical center and related clinics: Inpatient Rehabilitation (Bombardier, Knowles, Starosta, Wright), Comprehensive Outpatient Rehabilitation Program (Formea, Ehde and multiple faculty), Inpatient Consultation Service (Sherman, Wright, Mata-Greve), Burn Unit (Wiechman, Bentley), Pediatric and Burn Clinics (Wiechman), Acute Pain Service (Bhalla) and Madison Clinic (Vaswani-Bye). These rotations are described in greater detail below, after the rotations have been described more generally. An important aspect of these rotations is understanding the role of clinical psychologists within an interdisciplinary team framework and within a health care delivery system. Psychology residents work with multidisciplinary teams that include physicians, nurses, speech pathologists, physical therapists, occupational therapists, social workers, and vocational counselors. This site provides abundant opportunities to apply psychological principles in a medical setting with patients experiencing a variety of acute and chronic medical and surgical conditions.
Patients are commonly admitted to HMC due to trauma or acute illness. Psychology residents typically work with patients who have sustained traumatic brain injury, cerebral vascular accidents, spinal cord injuries, severe burn injuries, and multiple traumas. Patients come from diverse backgrounds in terms of ethnicity, socioeconomic status, and geographical location. The Burn Unit provides residents with extensive experience in pediatric consultation and liaison. Psychology residents have a shared, on-site office space with computers, printers, phones, and voice mail provided.
Training Experiences & Treatment Modalities
The mission of the psychologists at the Harborview Medical Center (HMC) rotation is to provide primary psychological care for inpatients on the Rehabilitation Medicine and Burn Units as well as patients followed by the Outpatient Rehabilitation Medicine Service. Also, consultations are provided for inpatients on Neurosurgery, Orthopedic Surgery, Neurology, General Medicine, General Surgery, and all Intensive Care Units at HMC. Psychology residents on the HMC Behavioral Medicine rotation therefore are exposed to a wide variety of consultation and liaison experiences and learn to work on interdisciplinary medical teams in both inpatient and outpatient settings.
Harborview Medical Center is a Regional Level I Trauma Center serving five states with a highly diverse patient mix. Psychologists play a prominent role in the care of these patients. This site provides a unique opportunity to work with a multiethnic patient population and to obtain training from psychologists who regularly integrate clinical and research activities. It also gives the experience of providing psychological services in a fast-paced, intense, but extremely collegial environment.
Psychology residents work closely with a variety of medical and adjunctive medical disciplines such as physical therapy, occupational therapy, speech pathology, nursing, social work, rehabilitation counseling, and therapeutic recreation. Surgery and rehabilitation medicine physicians are our two most prominent medical colleagues. HMC rehabilitation psychologists must rely on treatment modalities that fit well into the trauma setting. As such, there is a heavy emphasis on consultation/liaison, brief psychotherapy, and focused assessment. Behavioral and cognitive-behavioral frameworks are used frequently. More traditional psychotherapy is practiced through the outpatient rehabilitation and burn clinics as well. Training in hypnosis for pain control and motivational interviewing for substance abuse and treatment adherence is available. The psychologists often rely on a systems approach in which the patient is evaluated and treated within the context of the interdisciplinary health care team and family. Assessing and treating team behaviors is often essential to assisting the patient.
Behavioral Medicine residents at HMC rehabilitation first undergo a group orientation session with tours of the facility. Residents then accompany and observe an attending psychologist doing clinical work. Based on the residents’ level of comfort they are then provided with the opportunity to see patients under visual supervision. As the comfort level of residents’ further progresses, supervision increasingly takes the form of co-treatment or face-to-face review of cases. Residents meet with attending psychologists for individual supervision on a weekly basis. Group supervision meetings are held on a weekly basis as well. All residents attend the weekly neuropsychology case-based seminar. Generally there is a minimum of two hours of individual supervision a week, and in addition psychology residents are encouraged to page the supervisors with time-urgent questions about patient management. A psychology resident handbook is provided that contains extensive reading materials pertaining to the patient populations served and resident clinical responsibilities. Model reports, structured evaluation formats and practical clinical care guidelines are also included. Psychology residents typically attend multidisciplinary Rehabilitation and Burn Unit rounds, thereby becoming familiar with the work of other professionals. They continue to attend the regular internship didactics through this rotation as well as specialized seminars on topics of specific importance to residents (e.g., acute pain/stress management techniques, hypnosis for pain and stress, introductions to spinal cord injury, traumatic brain injury, and burn injury as well as sessions on working with interpreters, with multi-ethnic populations, and with medical teams).
Rotations at Harboview Medical Center
Inpatient Consultation Liaison Service, Burn Unit and Pediatrics Service
Behavioral Medicine residents on this service are actively involved in a thriving psychology consultation service that provides treatment for the majority of the services in a regional, level 1 trauma center. About one third of consultation referrals are to the Burn Unit, which is world famous and provides interdisciplinary care on an inpatient and outpatient basis. Frequent clinical issues include facilitating adjustment to burn injuries, managing acute pain, assessing for reactions to trauma, and behavioral management. One third of the patient population on the Burn Unit is pediatric and residents are given the opportunity to work with children. Training with hypnosis and other acute pain and stress management techniques is available and often emphasized on this service. The other two thirds of consultation referrals are to nearly every unit in the hospital including Neurosurgery, Neurology, Orthopedics, Medicine, Surgery units and every ICU in the hospital. Clinical work with such patients often involves assessment and treatment after multiple traumas. This service differs from Psychiatry Consultation/Liaison in that the emphasis is on adjustment to physical trauma and brief psychotherapy as opposed to Psychiatry’s emphasis on suicide assessment, treatment of psychosis, and pharmacologic treatments.
The Inpatient C&L service and Burn/Pediatric services differ enough so that residents can rotate through both and receive different types of training.
HMC Inpatient Rehabilitation
On the inpatient rehabilitation rotation, residents become core members of a multidisciplinary rehabilitation team made up of physicians, nurses, PTs, OTs, SLPs, and others. They learn to engage with racially, ethnically, socioeconomically, and language-diverse medical patients recovering from recent trauma or illness. They will perform biopsychosocial assessments, and lead efforts to manage psychiatric disorders, substance abuse disorders, adherence to treatment issues, and adjustment to disability as well as acute and chronic pain, stress, and insomnia. Residents learn about common cognitive, behavioral, and psychological conditions associated with traumatic injuries such as brain injury and spinal cord injury as well as neurological conditions such as stroke and aneurysms. They learn how to adapt evidence-based treatments for the above conditions to the inpatient rehabilitation setting. They gain experience working on multidisciplinary teams, co-treating patients with rehabilitation colleagues, and working with and through team members to help patients, their loved ones, and rehabilitation team members cope more effectively with the rehabilitation process. Residents may participate in interpreting and reporting on results from a brief neuropsychological testing battery administered by a dedicated psychometrist and supervised by Drs. Peterman, Goldberg, or Dasher.
The Madison Clinic
The Madison Clinic is an outpatient clinic located near Harborview Medical Center that provides medical care and social services for persons living with HIV/AIDS regardless of sexual orientation, race, or ability to pay. Each patient has a primary care provider who organizes services required. Care at the Madison Clinic is interdisciplinary. Mental health services are provided by psychologists and psychiatrists. Other providers include nurses, pharmacists, nutritionists, social workers, and other specialists. Psychology residents will function as part of this interdisciplinary team to provide assessment and treatment for a broad range of disorders found in patients living with HIV/AIDS such as depression, anxiety, PTSD, and neurocognitive impairments as well as issues related to adjustment to chronic illness and adherence to medical recommendations.
HMC Outpatient Burn Clinic
Patients who are discharged from our inpatient burn unit continue to get care from our outpatient burn clinic often for at least two years after discharge. Much like the inpatient burn unit, it serves the surrounding five state region as the only verified burn center in the region. The clinic also accepts referrals for patients not treated on the inpatient burn unit. The Outpatient burn clinic served 2457 patients (both adults and children) this past fiscal year. Given the multitude of issues that burn survivors face, including ongoing pain, high rates of depression, PTSD and body image concerns, the psychologist is a valued member of the multidisciplinary team. The psychologist screens every patient during their clinic appointment, in conjunction with the medical team. Longer interventions are conducted on those patients who screen positive for psychological issues. Training opportunities include the opportunity to conduct brief screens and consult with the larger medical team, as well as providing evidence-based interventions targeted at managing distress (PTSD, depression, sleep disturbance) and adjustment to injury. Finally, trainees get to see the full spectrum of recovery from a serious injury when they can follow a patient from the ICU to the acute floor and on to the outpatient burn clinic.
HMC Comprehensive Outpatient Rehabilitation Program (CORP)
The CORP program does not represent a stand-alone rotation. Rather, all Behavioral Medicine residents at HMC treat CORP patients. The resident case load of CORP patients depends on their other clinical responsibilities. Within CORP, residents will similarly function as an integral member of an interdisciplinary outpatient rehabilitation medical team that serves outpatients with neurological conditions (brain injury, stroke, spinal cord injury), chronic pain, and other medical/surgical conditions such as amputations. Residents provide a range of psychological services including psychological assessment, consultation, and psychotherapy. Psychotherapy is typically short-term (4-12 sessions) and problem focused. Residents work with the family as well as the patient, consult to team members and community agencies, and utilize neuropsychological test results in treatment planning. Interested residents also have the opportunity to receive training in comprehensive outpatient neuropsychological assessment.
HMC Acute Pain Service
The Acute Pain Service (APS) is a specialty consultation-liaison service staffed within the hospital to assist primary teams in managing the needs of patients who have difficulty achieving adequate pain control with traditional methods and require adjunctive and multimodal pain relief through analgesics (ketamine, lidocaine, opioids, gabapentin, acetaminophen, nonsteroidal anti-inflammatory drugs) and nerve catheters (peripheral, epidural). The focus of APS is to stabilize patients’ acute exacerbations of pain, typically post-injury and/or surgery (both emergent and elective). APS consists of anesthesiologists, advanced practice providers, pharmacy, rehabilitation psychology, spiritual care, and on some occasions, acupuncture. Psychology supports patient’s pain management through patient-facing assessment and psychological interventions, and consultation with APS, primary teams, and other staff and providers. Many patients seen by the service have a history of opioid use and/or chronic pain. Emphasis is often placed on management of pain and substance use disorders to promote overall health and engagement of patients during hospitalization.
Within each 4-month rotation residents are typically assigned to two clinical services simultaneously to provide a diverse training experience that includes both inpatient and outpatient training throughout the year. The table below presents rotation combinations that are illustrative. The exact combinations and percent commitment may vary by year. Rotations are arbitrarily labeled A-F.
|Rotation A||Rotation B||Rotation C||Rotation D||Rotation E||Rotation F|
|Inpatient Rehab (80%)||C&L Service (80%)||Burn Unit C&L (80%)||C&L Service (20%)||C&L Service (10%)||Acute Pain Service (80%)|
|CORP (20%)||CORP (20%)||Peds & Burns Clinics (20%)||CORP
(& optional NP) (80%)
|Madison Clinic (70%)
General Resident Expectations & Supervision
HMC rehabilitation psychologists seek to train residents in a scientist/practitioner model. In addition, psychology residents learn to provide assessments and treatment within a primarily medical/surgical context. Thus, our objective is that residents are comfortable in acute medical settings in general, as well as rehabilitation and burn unit placements specifically. General skills that are taught during these rotations include clinical assessment of people with acquired physical and cognitive disabilities, DSM-5 diagnosis, behavioral management, hypnosis for pain control, brief interventions for psychological distress related to medical conditions/grief, brief interventions for substance abuse problems, working with adult and pediatric patients with burns, and working with families of people who have had trauma or disability.
Residents provide an initial comprehensive psychological evaluation on each of their rehabilitation patients. Clinical responsibilities with such patients include seeing the inpatients at least once a week and combining their input with those of a multidisciplinary team during weekly rounds. Psychology residents are also expected to attend the burn unit psychosocial rounds each Monday morning and to respond to whatever consults are generated during those rounds. After evaluating patients with burns, residents then report to the general medical team rounds held once or twice weekly on the burn unit. Simlarly, residents on the Inpatient Rehabilitation Unit attend team meetings up to three mornings per week and one Patient/Family and Treatment Team Meeting one afternoon per week.
Psychology residents also provide consults on several different floors throughout the hospital. Residents generally carry a caseload of 8-12 outpatient patients and see about six outpatients per week, attend outpatient team rounds, collaborate with multidisciplinary team, and participate in groups. Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site. Residents and supervisors exchange verbal feedback at the mid-rotation point. Written and verbal feedback is exchanged at the end of the rotation. In addition, residents are provided with feedback throughout the rotation based on observations of treatment, as well as participation in multidisciplinary team rounds. Training is provided by attending psychologists (faculty within the Department of Rehabilitation Medicine) and, frequently, one or two postdoctoral fellows. At least two hours of individual supervision per week is provided by psychology faculty, with additional supervision offered on an as-needed basis. One hour per week of group supervision is required. The neuropsychology faculty holds a weekly neuropsychology/rehab psychology seminar for all residents.