Psychosomatics 2019:-:-–- ª 2019 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.
Review Article
Advancing the Mission of Consultation-Liaison
Psychiatry Through Innovation in Teaching
Patrick A. Ho, M.D., Christina Girgis, M.D., James K. Rustad, M.D., Douglas Noordsy, M.D.,
Theodore A. Stern, M.D.
Background: Consultation-liaison (C-L) psychiatry,
similar to other medical specialties, relies on the educa-
tion of students, residents, fellows, and life-long learners
for growth of the field. C-L psychiatry is unique as it
exists at the intersection of psychiatry with other medical
subspecialties. Traditional teaching methods have been
used in C-L psychiatry programs for more than 50 years,
while technology has recently advanced as available
resources and the learning styles of today’s learners have
evolved. A growing number of younger trainees are
taking advantage of new ways to learn. Objectives: We
sought to examine both traditional and novel teaching
methodologies and how each of these educational meth-
odologies fits within adult learning theory and in the
context of how digital natives learn about C-L psychia-
try. Methods: In this narrative review, we drew upon the
experiences of the authors as both life-long learners and
Key words: consultation-liaison psychiatry, research, teaching, education, technology
INTRODUCTION
Consultation-liaison (C-L) psychiatry, similar to other
medical specialties, relies on the education of students,
residents, fellows, and life-long learners for the growth of
the field. C-L psychiatry, however, is unique among
subspecialties of medicine, as it exists at the interface of
psychiatry, general medicine, surgery, neurology, ob-
stetrics/gynecology, and also pediatrics.1 Figure 1
graphically depicts clinical scenarios within C-L psy-
chiatry that provide a context for teaching opportunities.
For more than 50 years, most C-L psychiatry
programs have used time-honored teaching methods
(for example, didactic lectures, case-based rounds,
Psychosomatics -:-, - 2019
educators. We then reviewed the literature pertaining
to teaching methods that have been used in C-L
psychiatry as well as emerging methods that could
potentially be used in C-L psychiatry. Results: C-L
psychiatry has used traditional teaching methods such as
readings, didactic lectures, case-based rounds, and
problem-based learning. Novel teaching methodologies
such as teaching rotations, simulations, social media,
podcasts, movie clubs, and the use of mobile tablet
computers have been used in general psychiatry and
other medical specialties, while literature specific to C-L
psychiatry was sparse. Conclusions: Opportunities
abound to make use of new teaching methodologies
and technologies to appeal to future generations of
C-L psychiatrists.
(Psychosomatics 2019; -:-–-)
Received June 11, 2019; revised July 17, 2019; accepted July 19, 2019.
From the Department of Psychiatry (P.A.H., J.K.R., D.N.), Geisel
School of Medicine at Dartmouth, Lebanon, NH; Dartmouth-Hitch-
cock Leadership Preventive Medicine Residency Program (P.A.H.),
Lebanon, NH; Dartmouth-Hitchcock Psychiatry Residency Program
(P.A.H.), Lebanon, NH; Mental Health Service Line (C.G.), Edward
Hines Junior VA Hospital, Hines, IL; Department of Psychiatry (C.G.),
Loyola University Chicago Stritch School of Medicine, Maywood, IL;
Department of Mental Health and Behavioral Sciences (J.K.R., D.N.),
White River Junction VA Medical Center, White River Junction, VT;
Department of Psychiatry (T.A.S.), Massachusetts General Hospital and
Harvard Medical School, Boston, MA. Send correspondence and reprint
requests to Patrick A. Ho, MD, Dartmouth-Hitchcock Medical Center,
Department of Psychiatry, 1 Medical Center Drive, Lebanon NH 03756;
e-mail: patrick.a.ho@hitchcock.org
ª 2019 Academy of Consultation-Liaison Psychiatry. Published
by Elsevier Inc. All rights reserved.
www.psychosomaticsjournal.org 1
Advancing C-L Psychiatry Through Teaching
FIGURE 1. Clinical Scenarios That Serve as Teaching Opportunities Within C-L Psychiatry and Across Disciplines.
readings [from journal articles or C-L textbooks], and
apprentice-style teaching at the bedside).2 With each of
these approaches, the educator is typically an attending
physician. In more recent times, however, technology
has advanced, while available resources and the
learning styles of today’s learners have evolved. As a
result, a growing number of younger trainees are taking
advantage of new ways to learn and to teach (e.g., with
simulations, communication apps, social media,
problem-based learning [PBL]) within C-L psychiatry
and across specialties. Consequently, we sought to
examine how each of these educational methodologies
fits within adult learning theory and in the context of
how digital natives can learn about C-L psychiatry.
2 www.psychosomaticsjournal.org
HOW HAS C-L PSYCHIATRY BEEN TAUGHT?
To understand how C-L psychiatry has been taught and
how it has evolved, we sought to understand how
teaching methodologies have been used. Since William
Osler,3 widely recognized as the father of modern
medicine, led the medical service at the Johns Hopkins
Hospital, the field of medicine has used an apprentice-
ship model, in which senior physicians have been
responsible for educating their junior colleagues.
Trainees have learned by observing senior physicians,
with senior physicians serving as role models for delivery
of clinical care; with time and experience, trainees were
granted more autonomy and eventually were responsible
Psychosomatics -:-, - 2019

for teaching other learners. In medical education, this
model has been widely known as “see one, do one, teach
one.” For many years, this model has been applied in
many medical fields from surgery4 to psychiatry.5
Reading textbooks has been an important part of
medical education, predating Osler’s The Principles and
Practice of Medicine6 first published in 1892. The
advent of peer-reviewed journal articles, and now
search engines, for example, PubMed, has allowed for
an unprecedented sharing of knowledge about medi-
cine, and these readings serve an important function for
sharing knowledge in the field of C-L psychiatry.7 As
C-L psychiatry has grown as a subspecialty of psychi-
atry, more and more works pertinent to the field of C-L
psychiatry have been published. To assist learners of
C-L psychiatry, attempts have been made to compile
pertinent works into annotated bibliographies. One
such attempt at Massachusetts General Hospital8
compiled 129 works and was aimed at developing an
academic curriculum. Case reports are another excel-
lent and educational way to communicate new findings9
and have added to what has been available in previous
annotated bibliographies. Similar to other medical
subspecialties, C-L psychiatry has an academy, with a
journal that provides educational content for practi-
tioners of the field.10
Teaching rounds in conjunction with bedside teach-
ing have long been a mainstay of academic C-L psychi-
atry.11 These rounds generally involve the presentation of
a case by trainees with a discussion that focuses on the
biological, psychological, and social factors affecting the
patient so that a deeper understanding will be gained and
evaluation and treatment options reviewed. More
generally, teaching rounds provide a valuable opportu-
nity to learn how to develop a case formulation and to
hone the skill of a consultant through effective commu-
nication with other services. However, as C-L psychiatry
is practiced at the interface of other specialties, conflicts
between the consulting primary team and C-L psychiatry
consultants sometimes arise.12 Teaching rounds provide
a valuable opportunity for trainees to learn how to
manage such conflicts. Furthermore, bedside teaching
during rounds is often invaluable. Teaching at the
bedside provides the opportunity for clinician-educators
to observe their trainees’ interactions with patients (and
vice versa) and to have trainees observe their teachers
conducting interviews or examinations. Care at the
bedside represents the optimal location for trainees to
observe, learn, and practice interviewing skills and
Psychosomatics -:-, - 2019
Ho et al.
techniques, as well as strategies for patient and family
education, shared decision-making, approaches to the
physical examination, bedside manner, and the use of
rating scales and screening tools.
Early iterations of formal educational methodolo-
gies in C-L psychiatry have mirrored those within other
fields of medicine. C-L psychiatry embraced problem-
based learning13 in the 1990s to harness and stream-
line learning in the apprenticeship-based model of
medicine. PBL was innovative at the time of its devel-
opment. PBL was contrasted with standard didactic
teaching, as the topic to be learned would typically be
identified by the student rather than by the teacher, and
the subject matter would focus on a clinical problem.
Small-group discussions were also used. Over the last
30 years, PBL has been a constructive teaching method
on C-L psychiatry14 services as it has provided effi-
ciency through a forum for active problem solving on
inpatient C-L services.
ADULT LEARNING THEORY
In the 1970s, Knowles15 defined adult learning theory
as “the art and science of helping adults learn.” Adult
learning theory has guided strategies for teaching about
C-L psychiatry. As such, an understanding of adult
learning theory is critical to the understanding of the
evolution of learning in C-L psychiatry. Adult learning
theory is based on several underlying assumptions
(Table 1). Adults are presumed to have a more mature
self-concept (or set of beliefs about oneself), and they
prefer to take part in directing their own learning.
Another assumption is that adults have a bevy of
learning experiences on which to draw, and thus, they
respond well to personalized approaches to education.
A third assumption is that adults have a readiness to
learn as they understand the value of education and
that concepts can be applied to real-world scenarios.
The next assumption is that adult learners look for, and
respond best to, practical and problem-oriented ways to
learn. The final assumption is that adults are driven by
TABLE 1. Assumptions of Adult Learning Theory
 There is an advanced self-concept
 There are past learning experiences
 There is a readiness to learn
 There are practical reasons to learn
 Adults are driven by intrinsic motivation
www.psychosomaticsjournal.org 3
Advancing C-L Psychiatry Through Teaching

and respond better to intrinsic motivation rather than year psychiatry residents taught, supervised, provided
by extrinsic motivation. When driven by intrinsic rather feedback for, and organized a didactic curriculum for
than extrinsic motivation, it makes sense that educa- more junior residents. This rotation allowed residents
tional outcomes would be better. to improve teaching skills under attending supervision.
These principles illustrate the importance of un- The process motivated and challenged the learners to
derstanding and using new teaching methods. To consolidate knowledge and demonstrate mastery to
continue to appeal to the adult learner, teachers of C-L teach it to others. Theory suggests that the process of
psychiatry should understand and leverage adult teaching what one knows to another person requires
learning theory. cognitive manipulation of the material in a way that
supports deeper learning. Participating in this type of a
NEW FRONTIERS IN C-L PSYCHIATRY rotation also provides an opportunity for professional
EDUCATION growth for the teacher, and it may incite a passion for
the topics presented to the learner.
As the technology and information available to teach-
ers and learners of C-L psychiatry have advanced, the Simulations
techniques that teachers use to educate their students
have improved. As adults tend to prefer to direct their C-L psychiatrists are often consulted when patients
own learning, the use of new technologies and meth- become acutely agitated. In this crucial moment, it is
odologies that make it easier to learn is attractive. In important that C-L psychiatrists be well prepared to
addition, clinical scenarios often make use of technol- respond effectively to this situation. As caring for an
ogy, so it is important to incorporate technology into acutely agitated patient can be one of the most anxiety-
learning to facilitate a familiar connection between provoking clinical scenarios that a psychiatrist can face,
education and application to real-world scenarios. In simulations,17–19 both with simulated patients in a
the field of C-L psychiatry, teaching rotations, simula- simulation center or in role playing scenarios with the
tions, and social media have been used to incorporate team, have become a key method in which trainees learn.
new methodologies into education (Table 2). Simulation offers several advantages. Simulations occur
in a controlled environment in which it is safe to make
Teaching Rotations mistakes and to learn from them. They also provide an
opportunity for teachers to observe and to evaluate
Teaching rotations, in which a trainee teaches more
trainees in a standardized fashion. Through the hands-
junior trainees or medical students, have developed into
on learning experience simulations provide, trainees
one of the newer methods of teaching psychiatry. In one
can gain confidence while dealing with clinical scenarios
novel approach, a teaching rotation was implemented
that may otherwise have provoked anxiety. In the case of
for second-year psychiatry residents in an academic
agitated patients, simulation has been shown to be
teaching hospital setting.16 In the first and only pub-
significantly more effective than didactic education only.
lished report of such rounds, to our knowledge, second-
In one study, residents who trained using simulated
patients showed significantly greater improvement in
TABLE 2. Traditional and Novel Teaching Approaches
knowledge and performance.18 In another study using
Traditional approaches Novel approaches
simulated patients, participating psychiatry residents
Readings (including those Teaching rotations reported increases in self-assessed knowledge.19
from annotated bibliographies) (i.e., trainees as instructors)
Textbooks Simulations
In addition to clinical scenarios, simulations have
Journal articles Social media also been used to practice transitions of care.17 Also
Case-based rounding Closed physician groups referred to as “warm handoffs” or “sign-outs,” in-person
Bedside teaching Live and prerecorded videos
transitions of care from one physician or team to
Didactic lectures Scheduled chats
Grand rounds Podcasts another are an integral part of patient care. Inadequate
Journal clubs Movie clubs transitions of care can have negative consequences for
Problem-based learning Mobile tablet computers patient care, and many psychiatry programs do not have
(including those with
pre-loaded content) established protocols for transition of care.20 A simu-
lated scenario could provide an opportunity to assess

4 www.psychosomaticsjournal.org Psychosomatics -:-, - 2019


how well a trainee who is transferring care can provide a
concise summary of important information relevant to
patient care and how well the accepting trainee un-
derstands this information and asks questions pertinent
to anticipated challenges.
The word “simulation” naturally evokes mental
imagery of technology-based platforms or simulated
patients, but simulation can be used to teach C-L psy-
chiatry in other ways. One example is the use of a
“general practitioner letter” (GP letter)-simulated sce-
nario.21 GP letters have recently been used as a focused
simulated scenario to teach the liaison part of C-L
psychiatry. This involves 2 students pairing up to gather
a psychiatric history on a patient. One student will then
send a brief letter to the “GP” outlining a case
formulation as well as a treatment plan. The student
simulating the role of the GP will then review the letter
and ask for clarification, if needed. This is one way in
which the complexities of dyadic communication be-
tween a consultant and a consulting physician can be
practiced. This method highlights the role of a patient’s
GP in their longitudinal care, while giving students an
opportunity to refine their skills at digesting and orga-
nizing information and communicating it effectively.
Social Media
Social media is another emerging tool in medical edu-
cation that, as with any new technology or new tool, is
likely (at least initially) to be met with healthy skepti-
cism or even overt resistance. Today’s citizens and
learners, however, have embraced it as a part of life,
while today’s learners have embraced social media as a
learning tool. Social media includes the use of software
applications in which users can share information with
other users in real time. In 2019, 79% of the United
States population had a social media account, with the
most popular being Facebook.22 Other examples
include Twitter, YouTube, or Instagram. Use of these
applications among physicians is high. As reported by
one study in 2011,23 an estimated 72% of physicians
used social media, while a more recent study from
201724 estimated that 88% of physicians and nurses
used social media. Other fields of medicine, such as
emergency medicine,25 have tapped well-known plat-
forms (particularly Twitter) to deliver high-yield
educational concepts on a regular basis.
A previous focus in the literature has been on using
social media ethically, professionally, and responsibly
Psychosomatics -:-, - 2019
Ho et al.
as a physician, particularly when interacting with pa-
tients. Similarly, with the new ways that social media is
being used for education, there is a need to consider
patient privacy when discussing particular cases. More
recently, a body of evidence has developed regarding
the use of social media to teach psychiatry; however,
evidence on specific use patterns specific to C-L psy-
chiatry is lacking.26,27 In 2015, a systematic review that
focused on the use of social media in psychiatric edu-
cation28 examined 6 articles that met the authors’ in-
clusion criteria; these 6 articles focused primarily on the
risks of social media in psychiatric education (while not
providing any insight into potential opportunities that
social media provides in the teaching of psychiatry).
Since then, another study looked at the use of Twitter
to enhance the education of psychiatry residents29 at an
academic medical center. The residents were encour-
aged to follow the department’s Twitter account, which
tweeted links to journal articles, take home points from
formal residency learning activities, and references to
psychiatry in the context of current events. As a result
of this intervention, the percentage of participants using
Twitter for medical education and the percentage of
participants having a Twitter account saw statistically
significant increases, while the percentage of partici-
pants using Twitter saw an increase which was not
statistically significant. A significant increase in the
proportion of participants who used other forms of
social media for medical education was also noted.
Facebook has been another platform embraced by
physicians of all specialties,30–33 including psychia-
trists,34,35 thousands of whom have joined and partici-
pated in closed Facebook groups. The group feature on
Facebook has allowed physicians to form closed online
communities in which they can communicate with one
another in a virtual, but private, space. Psychiatry
Network,36 one such group formed in 2016, is now
comprised of nearly 10,000 members. Within this group,
psychiatrists and psychiatry residents can connect with
one another to discuss professional as well as clinical
topics and to learn from one another. The group also
hosts formal educational opportunities for members
using Facebook Live Videos to review various clinical
topics and journal articles (including C-L themes),
allowing members to obtain free Continuing Medical
Education credits for watching the videos. Facebook
also provides the ability to upload documents, so all
varieties of files (including articles and presentations) are
shared to the group by individual members.
www.psychosomaticsjournal.org 5
Advancing C-L Psychiatry Through Teaching

As much of the population receives information training. Although no studies have examined their use
from social media,26 these platforms may provide an specifically in psychiatry or C-L psychiatry, mobile
opportunity for psychiatrists to educate the public— computing devices create many new opportunities for
and each other—on mental health topics. With wider delivering, teaching, and learning C-L psychiatry.
use and acceptance of the value of social media in the
teaching of psychiatry, it is important to think about
WHAT IS IN STORE FOR C-L PSYCHIATRY?
how it can be used to meet trainee competencies set by
accreditation bodies. A recent work by Zalpuri et al.37
Over the past decade, recruitment of medical students
has designed a competency-based framework, which
into psychiatry residency programs has been quite
creates an approach to the use of social media to teach
challenging. After an alarmingly low rate of only 3.9%
psychiatry; this aligns with the Accreditation Council
of graduating US medical students chose to enter psy-
for Graduate Medical Education competencies for
chiatry in 2012,41 the numbers have steadily risen to 5%
trainees. This framework creates social media subtopics
of graduating US medical students choosing to train in
within the 6 Accreditation Council for Graduate
psychiatry in 2016. This improvement coincided with
Medical Education core competencies of patient care,
the number of residency positions in the US increasing
interpersonal and communication skills, professional-
(at first steadily, then more rapidly; Figure 2) from 1091
ism, systems-based practice, practice-based learning
in 2010 to 1740 in 2019. In addition to the increase in
and improvement, and medical knowledge. It is also
available positions, the proportion of positions filled
outlined how a trainee would demonstrate progression
through the match has generally increased from 96.7%
through milestones in each of these subtopics
in 2012 to 98.9% in 2019 (Figure 2).42,43 While these
throughout training.
improvements are encouraging for psychiatry, it is
important to consider whether recruitment into C-L
Mobile Computing Devices psychiatry has lagged behind the relative “boom” for
general psychiatry since 2012.
Finally, as broadband technology has developed, new
As mentioned by Brenner et al.,42 the challenges
software allows information to be accessed and
that psychiatry has faced in recruitment are not
consumed in innovative ways. New hardware devices,
restricted to the United States. Other countries have
such as mobile tablet computers (e.g., iPads) and smart
been able to leverage developing educational techniques
phones, provide a portable and easy way to consume
to increase interest in psychiatry. India has successfully
the plethora of resources available today, and research
used an electronic journal club44 as well as a psychiatry
is beginning to develop for their use in graduate medical
movie club45 to educate psychiatrists and increase in-
education.38 For example, the use of mobile tablet
terest in psychiatry within their country. In Canada,
computers in medical education provides an opportu-
psychiatry residents from the University of Toronto
nity to tailor a curriculum to the preferences of students
(Ontario, Canada) created an educational psychiatry
and even to assist those with visual impairment.38 In a
podcast for medical learners in which they pick a
study including all residents across one institution, the
common psychiatric condition and discuss its diagnosis
use of mobile tablet computers was found to increase
or management with a staff member from the Depart-
the proportion of residents accessing patient charts on
ment of Psychiatry.46 This is an important time for
mobile devices and also increased the use of mobile
enterprising C-L psychiatrists to leverage the lessons
devices to explain diagnoses to patients.39 This points
learned from both new and developing teaching
to an opportunity to incorporate mobile devices into
methods to increase interest in the field.
the training of C-L psychiatrists. Finally, secure video
technologies are increasingly being used to make
consultation available to patients in underserved areas DISCUSSION
and are now expanding to mobile platforms such as VA
Video Connect.40 As C-L psychiatrists could eventually Many large technology companies and numerous start-
use this technology to play a larger role in caring for the ups are seeking to develop digital interventions in psy-
underserved, it would be helpful for trainees to gain chiatry, mental health, and education. The American
exposure to new technologies during the course of Psychiatric Association’s Psychiatry Innovation Lab

6 www.psychosomaticsjournal.org Psychosomatics -:-, - 2019


FIGURE 2. US Postgraduate Year-1 Psychiatry Positions Filled and Unfilled by Year.
1800
1700
1600
1500
1400
30
1300
1200
1330
1100 16 29 38
1075 1068 1080
1000
2010 2011 2012 2013
Filled Positions
and Stanford University’s Brainstorm Laboratory for
Brain Health Innovation and Entrepreneurship repre-
sent explicit efforts to stimulate technologic innovation
in psychiatry.47 As technology advances, the field of C-
L psychiatry has great opportunities to leverage this
technology into novel teaching methods. Evidence in C-
L psychiatry is likely to build as the field begins to use
innovative teaching techniques (e.g., teaching rotations,
simulations) and technologies (e.g., social media, mo-
bile devices). Within social media, technology has led to
the advent of learning psychiatry through interfaces
such as podcasts, YouTube videos, and specialty-based
closed Facebook groups. These new modalities allow
C-L trainees as well as established psychiatrists to
engage and contribute to their own ongoing learning in
ways that have previously been impossible. New
hardware, such as mobile computing devices, also
demonstrates exciting and untapped potential, such as
earlier (and portable) exposure to compelling physical
findings of neuropsychiatric conditions (e.g., asterixis in
hepatic encephalopathy, posturing in catatonia, and
multifocal myoclonus in delirium) and expanded po-
tential for observation of clinical interactions. At this
time, there is little evidence exploring the use of these
methods in C-L psychiatry. To our knowledge, this is
the first narrative review on these methods that exam-
ines their applicability to C-L psychiatry. Future
studies should focus on the efficacy of these novel
Psychosomatics -:-, - 2019
Ho et al.
20
16
4
11 1720
14
31
1540
1491
1373
1339
1291
2014 2015 2016 2017 2018 2019
Unfilled Positions
teaching modalities in C-L psychiatry. It is important to
note that these new opportunities also create novel
challenges that should be considered, such as privacy
concerns with mobile recording devices and use of
video content that includes patient images.
PBL has long been an important part of education
in C-L psychiatry and persists despite the development
of newer and more novel teaching modalities. Suc-
cessful implementation of PBL on C-L psychiatry ser-
vices continues48 to be documented in the literature,
perhaps because of its self-directed nature and the
broad array of forms in which information can now be
delivered. In this sense, novel teaching modalities in
C-L psychiatry can be used within a PBL framework.
Increased acceptance of PBL coincides with a focus
on the principles of adult learning theory in education.
In addition to an understanding of adult learning the-
ory, it is important to understand the different styles by
which adults learn. These “primary learning styles”49
are visual, auditory, and kinesthetic. In practice, adult
learners typically have a style by which they learn best,
and learners can use any or all of the different styles.2
Knowledge of these learning styles allows teachers to
parsimoniously use different teaching modalities that
would work best with a learner’s strengths. For
example, visual learners may learn best using social
media or readings. Auditory learners may learn best
with podcasts or traditional lectures. Simulations or
www.psychosomaticsjournal.org 7
Advancing C-L Psychiatry Through Teaching
teaching rotations may work best with kinesthetic
learners. Many of the newer approaches to the teaching
of C-L psychiatry harness a more active learning
approach,50 which engages learners on a higher level of
thinking that can garner more interest, better engage-
ment, and a deeper understanding of C-L psychiatry.
Throughout this review, we have outlined some of
the teaching methodologies that have been used in C-L
psychiatry and also discussed more novel methodolo-
gies. Although more traditional methods may still be in
use today, novel methodologies are becoming more
commonplace. While evidence in C-L psychiatry for
teaching rotations and simulations continues to develop,
evidence for other methodologies is beginning to grow
stronger in other medical fields, including general psy-
chiatry. Although an evidence base for social media and
mobile computing devices has not yet developed in C-L
psychiatry, the applicability is clear. This review has
shown that while many teaching methodologies might
be used in C-L psychiatry, evidence is sparse. Evidence
specific to C-L psychiatry should be built over time.
CONCLUSION
C-L psychiatry is being taught to learners in multiple
ways, and a multimodal approach to C-L education has
been emphasized in the past.51 As technology pro-
gresses, new teaching methodologies that tap these
technological advances are being developed at a rapid
rate. Future studies should explore these new method-
ologies (and their applicability to C-L psychiatry) in
References
1. Querques J, Stern TA: Approach to psychiatric consultations in
the general hospital. In: Stern TA, Freudenreich O, Smith FA,
Fricchione GL, Rosenbaum JF, (eds) Massachusetts General
Hospital Handbook of General Hospital Psychiatry, 7th ed.
Philadelphia, Pennsylvania: Elsevier; 2017. p. 2–14
2. Lokko HN, Gatchel JR, Becker MA, Stern TA: The art
and science of learning, teaching, and delivering feedback
in psychosomatic medicine. Psychosomatics 2016; 57:31–40
3. Dornan T: Osler, Flexner, apprenticeship and ‘the new
medical education’. J R Soc Med 2005; 98:91–95
4. Kotsis SV, Chung KC: Application of the “see one, do one,
teach one” concept in surgical training. Plast Reconstr Surg
2013; 131:1194–1201
5. Gorrindo T, Beresin EV: Is “See one, do one, teach one”
Dead? Implications for the professionalization of medical
educators in the twenty-first century. Acad Psychiatry 2015;
39:613–614
8 www.psychosomaticsjournal.org
further detail. An up-to-date knowledge base regarding
innovations in educational methods, paired with a
willingness to embrace emerging technologies, will help
C-L psychiatrists advance the work of the Academy of
Consultation-Liaison Psychiatry’s stated mission state-
ment forward: “the advancement of medical science,
education, and health care for persons with comorbid
psychiatric and general medical conditions.”52
Continuing to research and develop strategies that
can be tailored and personalized to educate trainees
with appropriate safeguards may spark interest in the
field and assist with recruitment and career develop-
ment. Opportunities abound to make use of new
teaching methodologies and technologies to appeal to
future generations of C-L psychiatrists.
Conflicts of Interest: Dr. Girgis reports receiving
personal fees from Psychiatry Network LLC, during the
conduct of the study and outside the submitted work. Dr.
Stern is an employee of the Academy of Consultation-
Liaison Psychiatry and has received royalties from
Elsevier and the Massachusetts General Hospital Psy-
chiatry Academy outside the submitted work. Drs. Ho,
Rustad, and Noordsy report no conflicts of interest
related to the subject of this article and no proprietary or
commercial interest in any product mentioned or concept
discussed in this article. Drs. Girgis, Rustad, and
Noordsy are employed by the US Department of Vet-
erans Affairs; the opinions expressed in this manuscript
belong to the authors and do not reflect those of the US
Department of Veterans Affairs.
6. Osler W: The principles and practice of medicine. New York
and London: Appleton and Company; 1893
7. Nisavic M, Shuster JL, Gitlin D, Worley L, Stern TA:
Readings on psychosomatic medicine: survey of resources for
trainees. Psychosomatics 2015; 56:319–328
8. Cremens MC, Calabrese LV, Shuster JL Jr, Stern TA: The
Massachusetts General Hospital annotated bibliography. For
residents training in consultation-liaison psychiatry. Psycho-
somatics 1995; 36:217–235
9. Cromwell JC, Stern TA: Publishing case reports: educational
strategies and content recommendations. Psychosomatics
2019; 60:361–364
10. Taylor JB, Stern TA: Meeting its mission: does Psychoso-
matics align with the mission of its parent organization, the
academy of psychosomatic medicine? Psychosomatics 2017;
58:375–385
11. Wei MH, Querques J, Stern TA: Teaching trainees about the
practice of consultation-liaison psychiatry in the general
hospital. Psychiatr Clin North Am 2011; 34:689–707
Psychosomatics -:-, - 2019

12. Taylor JB, Stern TA: Conflicts between consultants and
consultees: causes, consequences, and corrective actions.
Psychosomatics 2013; 54:479–483
13. Schmidt HG: Foundations of problem-based learning: some
explanatory notes. Med Educ 1993; 27:422–432
14. Yates WR, Gerdes TT: Problem-based learning in consulta-
tion psychiatry. Gen Hosp Psychiatry 1996; 18:139–144
15. Knowles MS: The adult learner: A neglected species (building
blocks of human potential). Houston, TX: Gulf Publishing;
1990
16. Vestal HS, Sidelnik SA, Marcovitz D, Huffman J: A novel
resident-as-teacher rotation for second-year psychiatry resi-
dents. Acad Psychiatry 2016; 40:389–390
17. Pheister M, Stagno S, Cotes R, et al: Simulated patients and
scenarios to assess and teach psychiatry residents. Acad
Psychiatry 2017; 41:114–117
18. Vestal HS, Sowden G, Nejad S, et al: Simulation-based
training for residents in the management of acute agitation: a
cluster randomized controlled trial. Acad Psychiatry 2017;
41:62–67
19. Zigman D, Young M, Chalk C: Using simulation to train
junior psychiatry residents to work with agitated patients: a
pilot study. Acad Psychiatry 2013; 37:38–41
20. Bowes MR, Santiago PN, Hepps JH, Hershey BR, Yu CE:
Using I-PASS in psychiatry residency transitions of care.
Acad Psychiatry 2018; 42:534–537
21. Castle D, Sanci L, Hamilton B, Couper J: Teaching psychi-
atry to undergraduates: peer-peer learning using a “GP
letter”. Acad Psychiatry 2014; 38:433–437
22. Clement J: Percentage of U.S. population with a social
media profile from 2008 to 2019. 2019. Available from:
https://www.statista.com/statistics/273476/percentage-of-us-
population-with-a-social-network-profile/
23. UBM Medica: HCPs & Social Media. UBM Medica In-
sights. 2011. Available from: http://marketing-images.
ubmmedica.com/Insights/2011/HCPs_and_Social_Media.
pdf. [Accessed 16 May 2019]
24. Surani Z, Hirani R, Elias A, et al: Social media usage among
health care providers. BMC Res Notes 2017; 10:654
25. Bahner DP, Adkins E, Patel N, Donley C, Nagel R,
Kman NE: How we use social media to supplement a novel
curriculum in medical education. Med Teach 2012; 34:439–444
26. Peek HS, Richards M, Muir O, Chan SR, Caton M,
MacMillan C: Blogging and social media for mental health
education and advocacy: a review for psychiatrists. Curr
Psychiatry Rep 2015; 17:88
27. Sabin JE, Harland JC: Professional ethics for digital age
psychiatry: boundaries, privacy, and communication. Curr
Psychiatry Rep 2017; 19:55
28. O’Hagan TS, Roy D, Anton B, Chisolm MS: Social
media use in psychiatric graduate medical education: where
we are and the places we could go. Acad Psychiatry 2016;
40:131–135
29. Walsh AL, Peters ME, Saralkar RL, Chisolm MS: Psychiatry
residents integrating social media (PRISM): using Twitter in
graduate medical education. Acad Psychiatry 2019; 43:319–
323
Psychosomatics -:-, - 2019
Ho et al.
30. Jones LB, Mallin EA: Dr. MILK: support program for
physician mothers. Breastfeed Med 2013; 8:330–332
31. Gonzalez RS, Amer SM, Yahia NB, et al: Facebook discussion
groups provide a robust worldwide platform for free pathology
education. Arch Pathol Lab Med 2017; 141:690–695
32. Bittner JG 4th, Logghe HJ, Kane ED, et al: A Society of
Gastrointestinal and Endoscopic Surgeons (SAGES) statement
on closed social media (Facebook(R)) groups for clinical edu-
cation and consultation: issues of informed consent, patient
privacy, and surgeon protection. Surg Endosc 2019; 33:1–7
33. Shillcutt SK, Silver JK: Social media and advancement of
women physicians. N Engl J Med 2018; 378:2342–2345
34. Aboueid L: ‘Connecting’ with social media. Psychiatry
News [Internet]. 2017. Available from: https://psychnews.
psychiatryonline.org/doi/full/10.1176/appi.pn.2017.7a16
35. Zagorski N: Online networks allow psychiatrists to connect
on patient, personal issues. Psychiatry News [Internet].
Psychiatric News, American Psychiatric Association; 2017.
Available from: https://psychnews.psychiatryonline.org/doi/
full/10.1176/appi.pn.2017.3a19
36. Psychiatry Network. 2016. Available from: https://facebook.
com/groups/psychnetwork
37. Zalpuri I, Liu HY, Stubbe D, Wrzosek M, Sadhu J, Hilty D:
Social media and networking competencies for psychiatric
education: skills, teaching methods, and implications. Acad
Psychiatry 2018; 42:808–817
38. Patel S, Burke-Gaffney A: The value of mobile tablet com-
puters (iPads) in the undergraduate medical curriculum. Adv
Med Educ Pract 2018; 9:567–570
39. Dupaix J, Chen JJ, Chun MB, Belcher GF, Cheng Y,
Atkinson R: The effect of mobile tablet computer (iPad)
implementation on graduate medical education at a multi-
specialty residency institution. Hawaii J Med Public Health
2016; 75:190–195
40. Hale A, Haverhals LM, Manheim C, Levy C: Vet connect: a
quality improvement program to provide telehealth subspe-
cialty care for Veterans residing in VA-contracted commu-
nity nursing homes. Geriatrics (Basel) 2018; 3
41. Verduin ML: Improving the recruitment of medical students
into psychiatry. Acad Psychiatry 2017; 41:207–212
42. Brenner AM, Balon R, Coverdale JH, et al: Psychiatry
workforce and psychiatry recruitment: two intertwined
challenges. Acad Psychiatry 2017; 41:202–206
43. National Resident Matching Program: Report Archives.
2019. Available from: http://www.nrmp.org/report-archives/
44. Sathyanarayana Rao TS, Andrade C: Initiative for capacity
building in academic psychiatry in India: the E-Journal Club
of the Indian Psychiatric Society. Indian J Psychiatry 2015;
57:115–116
45. Kalra G: Psychiatry movie club: a novel way to teach psy-
chiatry. Indian J Psychiatry 2011; 53:258–260
46. PsychEd Podcast. 2017. Available from: https://www.
psychedpodcast.org/
47. American Psychiatric Association: 2019 Psychiatry
Innovation Lab. 2019. Available from: https://www.
psychiatry.org/psychiatrists/education/mental-health-innovation-
zone/psychiatry-innovation-lab
www.psychosomaticsjournal.org 9
Advancing C-L Psychiatry Through Teaching
48. Bright RP, Krahn L: Value-added education: enhancing
learning on the psychiatry inpatient consultation service.
Acad Psychiatry 2015; 39:212–214
49. Pashler H, McDaniel M, Rohrer D, Bjork R: Learning styles:
concepts and evidence. Psychol Sci Public Interest 2008;
9:105–119
50. Tabrizi S, Rideout G: Active Learning: Using Bloom’s Taxon-
omy to Support Critical Pedagogy. IJCDSE 2017; 8(3):3202–3209
10 www.psychosomaticsjournal.org
51. Heinrich TW, Schwartz AC, Zimbrean PC, et al: Rec-
ommendations for training psychiatry residents in
psychosomatic medicine. Psychosomatics 2014; 55:438–
449
52. Academy of Consultation-Liaison Psychiatry: ACLP
Vision, Mission, & Bylaws. 2018. Available from:
https://www.clpsychiatry.org/about-aclp/vision-mission-
bylaws/
Psychosomatics -:-, - 2019