The Foundation for a Rewarding Career
The foundation for a rewarding career in the field of psychiatry and behavioral health includes extensive exposure to the diagnosis, management and investigation of a diverse patient population with both simple and complex cases, individualized advisement from an outstanding faculty that will guide you in treatment approaches and problem-solving and myriad opportunities to contribute to the advancement of the field through research.
Forensic Psychiatry Fellowship
Combining psychiatry and the law, fellows learn in conjunction with Ohio’s only maximum security forensic hospital, Twin Valley Behavioral Healthcare, and at Nationwide Children’s Hospital. In both jail and hospital settings, fellows aid in the evaluation of defendants’ competency and sanity at the time of the act.
Expect to provide inpatient and outpatient treatment for those in the maximum security forensic unit, and outpatient treatment for mentally ill offenders who have worked their way through the hospital system. Your juvenile offender evaluations will concern bind-over to adult court and recommendations to the court for treatment. Civil cases include fitness for duty, disability, malpractice and consults to other physicians on challenging patients. Additionally, there are opportunities for interested fellows to become involved in advocacy and policy matters at the State level through the Ohio Department of Mental Health.
Psychosomatic Medicine Fellowship
As a psychosomatic medicine fellow, you will actively consult with teams specializing in transplantation, cardiothoracic/critical care, oncology/hematology, burn, pre-, peri- and postpartum care, infectious disease, rheumatology, endocrinology, neurological and psychological rehabilitation services (e.g., head trauma, stroke), dialysis and postoperative wards. Fellows will rotate at The Ohio State University Wexner Medical Center as a member of the inpatient consultation-liaison psychiatry service as well as in outpatient psychosomatic subspecialty clinics.
In addition to the common psychiatric conditions seen in non-hospital settings, you will become adept at the diagnosis and management of delirium, chronic pain, capacity issues, end-of-life care and psychiatric sequelae of medical disorders. Fellows will also be involved in the disposition of patients with psychiatric needs, including substance-related impairment, and transfer to psychiatric settings upon medical stabilization. Fellows will work under the supervision of a faculty supervisor and are active with instructing residents and medical students on the service. In addition, fellows will provide oversight and leadership to residents with less experience rotating on the consultation service. Fellows will be highly interactive in communicating with other services and have responsibilities with ensuring communications are successful.
When you select the Integrated Psychiatry Clinic at Nationwide Children’s Hospital as a portion of your longitudinal outpatient clinical experiences, you will have the chance to deliver direct patient care to those with chronic biopsychosocial illnesses that originate in childhood, including cystic fibrosis and sickle cell anemia, under the supervision of a board-certified psychosomatic medicine psychiatrist.
Psychosocial Oncology Fellowship
To prepare you to provide transdisciplinary care for patients with chronic or life-limiting illness, this fellowship for psychologists combines psychosocial oncology training with palliative care specialization to provide you with specific expertise in symptom management and end-of-life care.
Your involvement in the outpatient Psychosocial Oncology Clinic and consultation within a specific oncology clinic enrich your education with a diverse array of clinical experiences. Fellows have the opportunity to work with patients and families at various phases of their cancer journey from the point of diagnosis to the end of life. Many of these patients and their family members experience depression, anxiety, psychosocial distress and anticipatory grief, while others have a history of post-traumatic stress or other mental health concerns.
Fellows complete rotations in consultation-liaison, hospice and bereavement care and palliative medicine, with other elective rotations. You also provide education to patients and staff members on the psychosocial aspects of cancer care.
In research, you will be assisted to develop manuscripts through the Psychosocial Oncology Research Program and may also engage in research with oncologists at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. You will take part in psychosocial oncology grand rounds and research team meetings, and are expected to complete at least two manuscripts per year.
Goals and Objectives
A fellow trained in Psychosocial Oncology will be able to:
- Differentially diagnose psychological disorders in the context of chronic and terminal medical illness.
- Develop a comprehensive biopsychosocial case formulation and treatment plan including patient and family physical, psychological, social/practical and spiritual concerns.
- Apply empirically supported psychological treatment techniques including cognitive behavioral therapy, acceptance and commitment therapy, cognitive processing therapy, dialectical behavior therapy, dignity therapy, existential psychotherapy and grief counseling.
- Describe the prognosis and the most frequent psychosocial problems encountered by patients with brain, head and neck, colorectal, endocrine, pancreatic, esophageal, lung, gynecologic and breast cancers, as well as sarcoma and melanoma.
- Address patient and family distress including anticipatory grief, functional decline, sense of burden, fears of recurrence, disease progression and dying, caregiver stress and end of life preparation.
- Utilize standardized clinical outcomes assessment tools for psychological treatment.
- Perform a comprehensive pain and/or symptom (e.g., fatigue, dyspnea, insomnia) assessment including the use of standardized symptom management measures.
- Provide empirically supported non-pharmacologic symptom management (e.g., cognitive therapy for pain, cognitive-behavioral therapy for insomnia, activity pacing for fatigue).
- Assess opioid risk status and recommend appropriate harm reduction strategies to reduce patient, family, and provider harm from pain medication misuse, particularly for patients with addiction histories or active substance abuse problems.
- Complete and document basic mental status evaluation including brief neuro-cognitive assessment when indicated.
- Demonstrate skill in performing suicide risk assessment and management.
- Demonstrate competence in advance care planning with patients and families.
- Recognize and describe the signs/symptoms of imminent death and the typical trajectories to death for various diseases.
- Discuss with patients and families the role of appetite loss during terminal illness.
- Describe key differences between hospice and palliative care and describe how and when to utilize each.
- Distinguish normal grief from complicated grief, post-traumatic stress, and depression and provide empirically supported grief support.
- Effectively utilize medical system resources to meet patient/family needs.
- Demonstrate compliance with billing/tracking patient care practices and develop an understanding of third-party payer systems for mental health care.
- Demonstrate clinical research competence as it applies to research design, methods, data management, applied statistics, research presentation, manuscript development and basic skills in grant preparation.
- Actively identify and apply self-care strategies including regular attendance at case conferences, communication seminar, clinical supervision and other self-reflective and educational activities to prevent burnout and maintain professionalism.
Curriculum and Rotations
Fellows will complete a combination of didactics, supervised clinical rotations, team discussions, case conferences, individual readings, individual supervision, teaching and research projects and presentations.
Psychosocial Oncology Grand Rounds (monthly). Psychosocial oncology grand rounds will provide fellows with the opportunity to learn new clinical skills and techniques for providing psychosocial care to cancer patients from a panel of interdisciplinary providers including social work, psychology, chaplaincy, mental health nursing, children’s programs and bereavement specialists. Topics covered in these sessions are consistent with the Psychosocial Oncology Core Curriculum of the American Psychosocial Oncology Society.
Psychosocial Oncology Case Conference (monthly). Fellows will participate in the Psychosocial Oncology Case Conference attended by psychologists, licensed independent social workers, art and music therapists and professional chaplains. At this conference, fellows will have the opportunity to discuss complex patient care issues, evaluate their current approach to treatment with specific clients, examine issues of transference and counter-transference and gain support and assistance from other multidisciplinary providers in the development of psychosocial plans of care. We also discuss methods of managing provider burnout and other professional development issues at this conference.
Psychosocial Oncology Seminar/Journal Club (monthly). This group educational session focuses on learning about new techniques for diagnosing and managing psychosocial challenges for cancer patients. Fellows are expected to facilitate one session each year.
Communication Seminar (monthly). During their second year, fellows will participate in the Palliative Medicine communication seminar taught by Drs. Jillian Gustin and Sharla Wells-Di Gregorio. Topics covered include patient-centered communication, shared decision-making, managing anticipatory grief and uncertainty, managing depression, demoralization and desires for hastened death, managing anxiety about disease progression and recurrence, understanding hope as a clinical entity, motivational interviewing and de-escalation and mindfulness.
Psychiatry Grand Rounds (weekly). Fellows are expected to attend weekly psychiatry grand rounds, which include a variety of national and local speakers focused on topics in the field of psychiatry and behavioral health. The focus is on innovations in research and patient care in the field of psychiatry and behavioral health.
Palliative Medicine Grand Rounds (monthly). During the second year, fellows will attend palliative medicine grand rounds to learn more about evidence-based symptom management, current research in palliative medicine and other topics relevant to caring for patients at the end of life. Recent topics include preparedness planning for LVAD, palliative withdrawal of mechanical ventilation and other support measures, caring for minority patients in hospice and palliative care and the psychological impact of family witnessed resuscitation.
Other Relevant Coursework. With instructor permission, fellows can take courses offered as part of the Residency Program in the Department of Psychiatry and Behavioral Health, such as Addiction Psychiatry, Emergency Psychiatry, Ethics and Psychopharmacology.
Supervised Clinical Rotations
Outpatient Psychosocial Oncology Clinic (two years). The fellow will spend two years in the outpatient Psychosocial Oncology Clinic working with Sharla Wells-Di Gregorio, PhD, and other members of the Psychosocial Oncology and Supportive Care teams. During this outpatient training experience, fellows will broaden their medical and psychological knowledge including diagnosis and treatment of psychological disorders in the context of serious medical illness. The fellow will learn to complete comprehensive biopsychosocial assessment and to consult and refer to other providers to assist with the biopsychosocial care plan. The fellow will also learn key concepts in symptom assessment and management, including psycho-educational and non-pharmacologic techniques for symptom management. This setting also provides experiences for honing suicide risk management skills, as many patients seen in this setting have cancer, chronic pain and financial stress, increasing suicide risk. They will also learn to do opioid risk assessment and to use harm reduction methods in this setting.
Fellows will provide treatment for patients who have a history of trauma affecting coping with cancer. Fellows will also learn skills to assist with advance care planning to help patients and family members take care of essential business at the end of life. The fellow will work with patients and/or family members in the outpatient setting throughout their fellowship to provide long-term management for patient and families living with advanced disease.
Inpatient Consultation-Liaison Psychiatry (one month). The fellow will complete a one-month part-time rotation with David Kasick, MD, and the C-L Psychiatry Service at the beginning of his or her fellowship. This experience will allow the fellow to better understand the role of a psychiatric/psychological consultant to medical services, learn legal regulations regarding voluntary and involuntary commitment, perform capacity assessments, identify risk factors for suicidal or homicidal behavior and develop a working familiarity with psychopharmacologic treatment of psychiatric disorders seen commonly among medical inpatients. The fellow will provide the team with assessment and non-pharmacologic/behavioral management services. This rotation will also provide the fellow with the opportunity to become familiar with the system of inpatient medical care.
Oncology Clinic Consultation (1.5 years). During the second six months of Year 1 and all of Year 2, the fellow will spend one day serving as a consultant in an oncology clinic, where they will be the primary provider for psychological services. During this experience, fellows will develop expertise regarding a specific type of cancer and hone their brief assessment and intervention skills. The fellow will also provide education to the team regarding distress screening and the psychotherapeutic management of patients via consultation and presentation to the team. He or she will assist the team to manage urgent psychiatric issues and will coordinate ongoing psychological care for patients and family members when indicated.
Hospice and Bereavement Services (one month, Kobacker House). During the second year, the fellow will complete a one-month rotation in a hospice setting. They will learn about the terminal phase of disease and signs and symptoms of impending death. They will learn about symptom management, nutrition and hydration and financial preparation for the end of life. They will assess patients and family members’ pre-death needs and determine the degree of risk for complicated grief. Fellows will learn to distinguish normal grief from complicated grief, post-traumatic stress and depression.
Inpatient Palliative Medicine (one/two months). Also during the second year, the fellow will complete a one- to two-month rotation in inpatient palliative medicine. The fellow will round with the Palliative Care teams in Cardiology, General Medicine and the James Cancer Hospital and Solove Research Institute. Fellows will hone their non-pharmacologic symptom management skills and will assist patients and families faced with imminent death, particularly assisting patients regarding communicating with young children. Fellows will have the opportunity to collaborate closely with physicians and nurses working in intensive care. They will observe family meetings and have the opportunity to learn more about communication at the end of life. They will be exposed more broadly to a variety of disease states beyond cancer to complement their behavioral medicine experience. In both settings, the fellow will be available to provide psychodiagnostic evaluation in the context of complex medical illness, mental status evaluation, brief neurocognitive screening and brief medical interventions.
Fellows have a variety of teaching opportunities, including informal teaching of hospice and palliative medicine physician fellows and other staff members in outpatient clinic about psychosocial contributions to health and illness, empirically supported psychological interventions and about educational and community resources that may benefit their patients and families. The Psychosocial Oncology Fellow will be responsible for supervising undergraduate students participating in the Psychosocial Oncology Research Program. The fellow will also be responsible for two to four case presentations at the monthly Psychosocial Oncology Case Conference and Seminar per year and one presentation at the monthly Psychosocial Oncology Grand Rounds during the fellow's second year.
Other teaching opportunities include teaching techniques such as motivational interviewing or relaxation strategies for various oncology nursing and administrative units. The fellow will also teach quarterly for JamesCare for Life on topics such as depression, anxiety and insomnia and lead programs or groups based on fellow interest and programmatic needs.
Fellows have access to an extensive library of empirical articles focused on psychosocial oncology, palliative medicine, communication and end of life. Ohio State has 21 campus libraries, including the Health Sciences Library, which supports The Ohio State University Wexner Medical Center. The Psychosocial Oncology Resource Library has an extensive array of patient handouts and protocols, which you will have access to beyond fellowship. Statistical consultation is available via both the Ohio State Center for Biostatistics as well as the Department of Psychology Quantitative Program. Research support is also available at the Center for Clinical and Translational Science.
A designated comprehensive cancer center, the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute has Shared Resources for research support. In general, Ohio State is a resource-rich institution with collaborations possible across a wide range of training programs, in addition to an Office of Postdoctoral Research to support postdoctoral fellows within the College of Medicine.
Our fellowship program is structured around six core competencies. At the completion of training, fellows will demonstrate competency in:
Patient Care: Assessment and Treatment
- Perform a comprehensive psychological assessment including medical history, symptom review, mental status exam, health behavior history, social history, psychiatric history, spiritual history, substance abuse history and comprehensive family history necessary for a biopsychosocial case formulation and generation of a treatment plan.
- Generate a comprehensive, focused and practical differential diagnosis, including a differential diagnosis of possible physical, social, cultural and environmental causes of the specific psychological presentation.
- Understand the contribution of other treatments (e.g., chemotherapies), substance use (e.g., intoxication and withdrawal) and disease states (e.g., thyroid dysfunction, hypercalcemia) to the differential diagnosis of psychiatric disorders and recognize and utilize consultation and laboratory pathways for narrowing the differential diagnosis.
- Develop knowledge and utilization of standardized assessment tools, questionnaires and psychological and neuropsychological testing to clarify the diagnostic impression and determine the severity of patient symptoms and impairment.
- Perform a competent assessment of patient dangerousness with regard to suicide and violent behaviors based on interview assessment and an understanding of critical risk factors.
- Monitor patient progress in treatment including patient safety, symptoms and adverse medication effects in order to make necessary referrals and consultations with other providers.
- Formulate a comprehensive bio-psychosocial diagnostic impression and productively present and discuss it with the patient and family.
- Document and record information relevant to the initial assessment and subsequent patient contacts in a timely and coherent manner in IHIS (Integrated Healthcare Information System).
- Provide up to date and accurate disorder specific education to patients and families.
- Provide information to patients and families about treatment options in light of the existing evidence base.
- Develop an effective and practical treatment plan in partnership with the patient and family that addresses the relevant biopsychosocial needs of the patient and family.
- Demonstrate competence in the selection of psychotherapeutic interventions appropriate for patient diagnosis, level of impairment, individual and family characteristics and preferences.
Medical and Psychological Knowledge
- Understanding and familiarity with modern psychiatric classification, particularly DSM-5 diagnostic criteria.
- Understanding and familiarity with common comorbid medical and neurological conditions (e.g., hyperthyroidism) and the differential diagnosis of common and/or serious psychiatric presentations (e.g., depression, delirium, dementia), as well as the impact of substances of abuse.
- Knowledge of clinically relevant anatomy.
- Knowledge of clinically relevant epidemiology and risk factors for suicide and violence.
- Basic familiarity with symptoms, diagnosis and management of medical conditions commonly encountered in oncology and palliative medicine (e.g., HIV/AIDS, heart failure, sickle cell disease).
- Familiarity with psychoactive medications relevant to the treatment of psychiatric disorders including indication, effective doses, contraindications and side effects.
- Understanding and familiarity with evidence-based psychotherapies and non-pharmacologic interventions for psychiatric disorders and physical symptoms.
- Knowledge and familiarity with standardized psychological assessment tools and questionnaires.
- Ability to establish rapport and to develop a therapeutic alliance with patients and families.
- Ability to function effectively as a consultant in a general medical setting and in hospice.
- Ability to interact effectively and respectfully with individuals from diverse cultural and socioeconomic backgrounds.
- Ability to maintain good relationships with other staff.
- Ability to work as a member of a multidisciplinary team.
- Awareness of and ability to manage transference and countertransference issues.
- Ability to advocate for patient and family to get needs met.
- Ability to communicate effectively verbally and in writing with patients, families, co-workers and referral sources.
- Receptiveness to feedback and constructive criticism.
- Ability to teach and supervise as indicated by teaching evaluations.
- Respect for patients, families and co-workers, including cultural and socioeconomic differences.
- Responsible attitudes and behaviors regarding care documentation, patient care and effective relations with colleagues.
- Professional appearance and demeanor.
- Initiative/interest in work.
- Sensitivity to diversity in patients, families, and coworkers and their needs.
- Effective and responsible use of supervision.
- Promptness and attention to time management.
- Understand and appreciate professional ethical standards of conduct.
- Respect for patient confidentiality.
- Maintain comprehensive and timely IHIS documentation.
- Understand how to ethically and appropriately transfer responsibility for patient care and conclude a therapy relationship.
- Knowledge and use of the psychological/psychiatric and general medical scientific literature and application to patient care.
- Ability to evaluate own strengths and deficiencies related to patient care practices.
- Utilize quality improvement to improve practice.
- Ability to incorporate constructive feedback from supervisors, co-workers, patients and families.
- Ability to regularly set learning and improvement goals and structure and follow-through with learning activities.
- Ability to advocate for quality patient care via systems.
- Appropriate consultation and referral to ancillary staff.
- Effective resource management.
- Awareness of the larger context of care and the healthcare system.
- A basic understanding of third party payment.
- Ability to understand and follow relevant county, state, federal and professional regulations.
- Ability to understand and address relevant forensic issues such as voluntary and involuntary psychiatric admission, informed consent in clinical and research settings, patient competency and child custody and family welfare.
- Reporting of child and older adult maltreatment.
- Development of treatment plans that address patient/family needs and limitations (transportation, appointments, caregiver needs).
Specific Competency Areas
The competency areas for training in psychosocial oncology were developed by the American Psychosocial Oncology Society and represent a formal approach to educating oncologists, psychiatrists, psychologists, nurses and social workers on the psychological and behavioral dimensions of cancer. At the completion of training, fellows will demonstrate knowledge and/or skills in these areas:
- Cancer Basics
- Business of Psychosocial Oncology
- Psychological/Emotional Aspects of Cancer
- Sexuality and Cancer
- Spiritual/Religious/Existential Concerns
- Social/Practical Challenges of Cancer
- Cognitive Challenges
- Managing Physical Symptoms
- Psychosocial Screening and Assessment
- Psychosocial Oncology Treatment
The competency areas for training in palliative care were developed by the National Consensus Project for Quality Palliative Care. At the completion of training, fellows will demonstrate knowledge and/or skills in these areas:
- Structure and processes of care
- Physical aspects of care
- Psychological and psychiatric aspects of care
- Social aspects of care
- Spiritual, religious and existential aspects of care
- Cultural aspects of care
- Care of the imminently dying patient
- Ethical and legal aspects of care
Pain Medicine Fellowship
We offer two pain medicine fellowships each year to train physicians to understand and help patients manage acute and chronic non-malignant pain and acute and chronic cancer pain. A 12-month program (July 1 to June 30), fully accredited by the Accreditation Council for Graduate Medical Education, consists of four rotations with neurology, psychiatry, palliative medicine and either physical medicine and rehabilitation (PM&R) or anesthesiology.
Most training takes place in the OSU Comprehensive Spine Center, in collaboration with orthopedics, neurology, anesthesiology and physical medicine and rehabilitation. More than 4,500 patients are evaluated annually, with all surgical procedures performed here. Learn more.
Sleep Medicine Fellowship
We accept two fellows each year to this ACGME-accredited program in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine. You’ll study at four locations (including a 14-bed accredited sleep center) with six sleep medicine faculty physicians and other faculty who see sleep patients as part of their practice and participate in our program as well.
You will also have opportunities to participate in clinical or bench research in your area of interest. Learn more.
Community Psychiatry Fellowship
The Department of Psychiatry and Behavioral Health has one-year Public and Community Psychiatry Fellowship, which is a collaborative program between The Ohio State University Wexner Medical Center and Case Western Reserve University (CWRU). Drawing from a network of more than 20 community mental health agencies in the greater Cleveland area, fellows devote up to four days a week to clinical work, a half-day per week for program development or administrative work at one or two host sites and a half-day per week of didactics.
Each fellow works with faculty to match their site placement with their career interests. Popular areas of interest include homelessness, serious and persistent mental illnesses, forensics, substance abuse, state hospitalization, veteran affairs and other treatment programs funded by county or state mental health boards. As an alternative to local sites in Cuyahoga and neighboring Northeast Ohio counties, fellows may choose to arrange a placement in several areas throughout the state of Ohio, including Akron, Cincinnati, Columbus, Dayton and Toledo.