Abstract Introduction Determining the optimal timing and structure for a core residency rotation in consultation-liaison psychiatry (CLP) remains a key challenge for program directors and rotation leaders. Previous surveys have been conducted regarding these questions and guidelines from national organizations have been issued, but practices remain varied among institutions. Methods We conducted a narrative review of the literature related to the timing of CLP rotations and generated consensus recommendations based on our experience as program directors, rotation leaders, and residents. Results Explicit goals of CLP training in residency include identifying and treating psychiatric manifestation of medical illness and communicating effectively with primary teams. Implicit goals of training may include conflict management, limit setting and “thinking dirty.” Discussion Though CLP rotations earlier in residency often create a better fit within the overarching curriculum and allow for generating early interest in the field, significant amounts of supervision are required and consultees may look to attendings as the primary consultant. Conversely, while later rotations are sometimes challenging to structure with other outpatient responsibilities, they allow for greater autonomy and may map better onto the informal curriculum. A hybrid model, with training spread across multiple years, is another approach that may mitigate some of the disadvantages of confining CL training to a single year. Conclusions Compelling arguments can be made for placing the core CLP rotation in PGY-2 or -3 or using a hybrid model. Regardless of placement, program directors and rotation leaders should be mindful of tailoring the rotation to the trainees’ developmental stage.

中文翻译：

---

优化适合度：以住院医师精神病学咨询联络轮换为目标进行不同级别的培训


摘要 简介 确定咨询联络精神病学 (CLP) 核心住院医师轮换的最佳时机和结构仍然是项目主管和轮换领导者面临的主要挑战。此前已经针对这些问题进行过调查，国家组织也发布了指导方针，但各机构的做法仍然存在差异。方法 我们对与 CLP 轮换时间相关的文献进行了叙述性回顾，并根据我们作为项目主管、轮换领导者和住院医师的经验提出了共识建议。结果 CLP 住院医师培训的明确目标包括识别和治疗内科疾病的精神表现以及与基层团队的有效沟通。培训的隐性目标可能包括冲突管理、限制设定和“肮脏思维”。讨论 尽管 CLP 住院医师早期的轮换通常能够更好地适应总体课程，并能够尽早产生对该领域的兴趣，但需要大量的监督，并且咨询者可能会将主治医师视为主要顾问。相反，虽然后来的轮换有时很难与其他门诊职责一起构建，但它们允许更大的自主权，并且可以更好地映射到非正式课程。混合模型是另一种方法，训练分布在多年内，可以减轻将 CL 训练限制在一年内的一些缺点。结论 对于将核心 CLP 轮换置于 PGY-2 或 -3 或使用混合模型，可以提出令人信服的论据。无论安排如何，项目主管和轮换领导者都应注意根据学员的发展阶段调整轮换。