The Behavioral Medicine Track offers a variety of training experiences that address the relationship between psychological functioning and physical health. These rotations involve multi-disciplinary training in a variety of in- and outpatient settings with both civilian and veteran populations in specialty and primary care settings. The patient populations seen in these rotations is quite diverse, as are the service settings.
Clinical experiences are geared toward the delivery of multi-disciplinary services to patients with a variety of general medical issues and chronic illnesses. Interns work in a number of different clinics and facilities at MUSC, providing one-on-one and group-level patient care, as well as consultation services to a variety of medical specialties. Interns will gain fluency in a range of services including but not limited to interviewing, assessment, psychological testing, individual psychotherapy, consultation, applied physiology, treatment planning, and oral and written communication with multi-disciplinary providers. The three major service settings for this rotation are described below.
Interns see patients for individual psychotherapy geared toward helping them manage chronic medical conditions and associated psychosocial complications. The clinic has relationships with a number of medical specialties and departments at MUSC, and we provide comprehensive psychosocial services for patients with problems such as chronic pain, irritable bowel syndrome, pancreatitis, headache, sleep problems, hypertension, Crohn's disease, fibromyalgia, non-epileptic event disorder, conversion disorder, diabetes, and many others. Additionally, interns provide services for improving health behaviors, including weight management related to bariatric surgery and smoking cessation. Interns will get hands-on experience in multidisciplinary treatment, providing cognitive psychotherapy, biofeedback, behavioral therapy, hypnosis, and integrative psychotherapeutic approaches. Interns are expected to communicate relevant treatment-planning information to a variety of providers including physicians, physician assistants, nurses, and nurse- practitioners.
Interns conduct comprehensive evaluations and offer outpatient psychotherapy services for patients that are being considered for heart, liver, kidney, lung, and auto-islet cell transplantation. Interns will administer neuropsychological, cognitive, and personality screening, make referrals for further comprehensive psychological testing if indicated, make recommendations about the appropriateness of patients for surgery, and assess ability to process and manage post-operative medical recommendations.
Interns conduct comprehensive evaluations and offer outpatient psychotherapy services for patients who are gastric bypass, sleeve gastrectomy, or laproscopic adjustable gastric band surgery candidates. Interns will administer neuropsychological, cognitive, and personality screening, make referrals for further comprehensive psychological testing if indicated, make recommendations about the appropriateness of patients for surgery, and assess ability to process and manage post-operative medical and dietary recommendations.
The intern will also follow patients for psychotherapy pre- and post-surgery (transplant and/or bariatric). These services are highly respected by the referring medical teams, who contact us frequently regarding our treatment to optimize surgical outcomes. By the end of the rotation, the intern will be able to:
Interns and psychiatry residents on the consult-liaison service meet with faculty weekly to discuss issues relevant to clinical service provision for patients with chronic illnesses. Clinicians from a variety of disciplines present lectures on diverse topics relevant to behavioral medicine.
MUSC Institute of Psychiatry, Division of Bio-Behavioral Medicine
This rotation provides training experiences in three specialty clinics within the VAMC Behavioral Medicine Service. These clinics are briefly described below.
Interns work closely with an interdisciplinary team (e.g., anesthesiology, psychology, nursing, pharmacy, and psychiatry) in the assessment and treatment of veterans referred with a variety of chronic pain complaints.
Interns provide services within the VA’s weight management program. They will work with a multidisciplinary team to engage patients in motivational enhancement strategies to address health behavior change and weight loss strategies.
Interns provide individual therapy to veterans with chronic medical conditions that might include: chronic pain, diabetes, sleep disorders, and pulmonary disease. Referrals to this clinic are made from clinics throughout the VA and interns gain experience in working with health care providers from a variety of disciplines and specialties.
After completing the VA Behavioral Medicine Rotation, the intern will be able to:
Ralph H. Johnson VA Medical Center
Family Medicine is unique among medical specialties in that it integrates care for people of all ages, genders, and states of health. Family Medicine encompasses prevention activities as well as the treatment of a broad range of acute and chronic illnesses. The approach of family physicians is evidence-based and incorporates biological, psychological, social/cultural, and spiritual aspects. Family physicians serve as guides and advocates for their patients within the broader healthcare system. Family doctors are also specifically trained and skilled with regard to interdisciplinary practice and particularly place a high degree of value on the contributions of clinical and counseling psychologists towards their patient’s well-being and overall health.
The Behavioral Health Consultation Clinic (BHCC) provides participating psychology interns with opportunities to work primarily within two outpatient Family Medicine clinics (Ellis Oaks faculty practice and Trident Family Health residency practice). Patients are referred by their treating physician for assistance with diagnostic assessment as well as time-limited evidence-based psychological interventions (generally 6 sessions or less). Typical presenting problems include: ADHD, depressive disorders, anxiety disorders, insomnia, pain management, tobacco abuse, alcohol abuse, and adjustment issues. Psychology interns will have ample opportunity to collaborate with referring physicians (both faculty and resident physicians) with regard to patient care.
Psychology interns will learn to effectively utilize both clinical interview as well as brief self-report measures to succinctly and accurately assess the mental health/behavioral needs of their patients (at baseline and across time). Interns will also learn to effectively and succinctly communicate their clinical findings and treatment plans to patients as well as referring physicians (both verbally and in writing). Given the central nature of the doctor-patient relationship in primary care practice, emphasis will be placed on developing knowledge and skill for managing the doctor-patient relationship to support optimal patient health and well-being. The psychology intern will become familiar with a variety of evidence-based psychological treatments (generally behavioral and cognitive behavioral) for the effective management of specific presenting conditions.
Of note, many patients being referred to the BHCC will be taking psychotropic medication. Some patients may have medication changes (including starting a new psychotropic medication) occur while participating in BHCC services. Other patients will prefer to address their presenting issues without the use of psychotropic medication. So, in addition to developing knowledge and skill regarding brief evidence-based psychological assessment and treatment approaches, the psychology intern will also become familiar with evidence-based biological approaches for addressing patient complaints. In all cases, consideration of patient preferences, evidence-based practice, and collaboration amongst treatment professionals will be combined to determine the optimal clinical approach for each patient.
After completing the BHCC rotation, interns will be able to:
Department of Family Medicine Ellis Oaks (Faculty) Clinic (James Island)
Trident Family Health (Residencey) Clinic (North Charleston
John R. Freedy, M.D., Ph.D., professor of Family Medicine
Interns provide psychological services for patients (and families of patients) who are being treated through the MUSC Hollings Cancer Center, the only NCI Designated Cancer in South Carolina. The intern provides consultation services for the various oncological treatment teams and sees individual patients for psychotherapeutic management of cancer-related psychosocial issues (including disease management, pain management, and end-of-life issues) and co-morbid psychiatric disorders. Interns also provide psychological assessment services to assist in the multi-disciplinary determination of eligibility for bone marrow or stem cell transplantation.
By the end of the rotation, the intern will be able to:
Hollings Cancer Center, MUSC
The Telehealth Resilience and Recovery Program is a multi-disciplinary experience that provides an opportunity to work with children and adults who experienced traumatic injury. Once enrolled in our service via our level-1 trauma center, these patients are monitored for emotional recovery and offered mental health assessment and treatment as needed. PTSD and depression are prevalent in this population. Interns provide psychoeducation in our acute care setting, assist patients in remote monitoring of emotional recovery, and conduct telehealth-based assessment and treatment for patients who develop PTSD or depression. Exposure-based treatments, behavioral activation, and other best practice interventions are used most often.
The intern functions as an integral part of the treatment team and is involved in every aspect of patient care. Specifically, the intern participates in assessment and diagnosis of PTSD, depression, and other psychological conditions using a multi-dimensional assessment approach, and then implements individual and family behavioral treatment approaches, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), and stress management techniques, as indicated. Interns also gain an understanding of systemic issues related to continuity of care and interdisciplinary management of clinical cases. Participating interns may be involved in pilot studies and clinical trials, if appropriate, and programmatic development of the telehealth service for trauma patients.
(Note: This rotation is considered both a Behavioral Medicine and Traumatic Stress track rotation.)
At the end of the rotation, interns will be able to:
MUSC Emergency Department and Department of Psychiatry
Clinical experiences are geared toward the delivery of psychological services to patients who smoke and have a variety of medical issues and chronic illnesses. Interns work in an outpatient clinic at Hollings Cancer Center and in all inpatient hospitals at MUSC (Main Hospital, Ashley River Tower Hospital, Institute of Psychiatry, and Children’s Hospital), providing one-on-one patient care.
Interns see patients for individual psychotherapy geared toward helping them change their tobacco use and manage chronic medical and psychiatric problems and associated psychosocial complications. Although our primary charge is for cancer patients treated at Hollings, patients from a variety of other clinics are seen (e.g., cardiology, pulmonology, etc.). Patients are seen in our dedicated clinic space and the medical floors and in infusion settings. In addition to tobacco treatment, interns provide services for improving other psychological issues (e.g., depression). Interns will get hands-on experience in multidisciplinary treatment, providing motivational interviewing and cognitive behavioral psychotherapy. Interns are expected to communicate relevant treatment-planning information to a variety of medical disciplines including physicians, physician-assistants, nurses, and nurse-practitioners.
Interns conduct brief evaluations and psychotherapeutic interventions for admitted inpatients for all patients in our hospitals. Interns administer interventions to both patients and their family members, including the parents of children admitted to our Children’s Hospital.
By the end of the rotation, the intern will be able to:
Hollings Cancer Center, MUSC
The MUSC Weight Management Center is a multidisciplinary center that offers a full range of evidence-based weight management programs to the greater Charleston community. We are staffed with psychologists, registered dietitians, exercise physiologists, physicians, and a registered nurse. Interns interested in the assessment and treatment of overweight and obese patients will have a variety of clinical, research, and teaching opportunities while on our clinical rotation. Specifically, our interns conduct in-person psychological screenings of new/potential patients, deliver evidence-based treatment protocols to patients in our various programs (both individual and group formats), regularly discuss patients with the multidisciplinary staff, and oversee/manage an individual caseload of patients.
After completing the Weight Management Center rotation, interns will be able to:
Weight Management Center, MUSC
Pat O’Neil, Ph.D., professor
Patients present with very high levels of trauma exposure, co-morbid psychiatric disorders, and either documented histories of substance abuse or high risk for substance use problems. The patient population is racially and ethnically diverse, with high levels of socioeconomic disadvantage (as reflected by self-reported income level). There is a high need for integrated medical and behavioral health care, but at present, the only services available are brief, supportive counseling and medication management provided by a consulting psychiatrist. Social workers and/or OB/GYN physicians screen patients during intake visits and check-up appointments, and those showing signs or reporting symptoms of ongoing psychiatric disturbance are referred to Dr. Guille for further evaluation.
Interns will screen patients for the presence of psychiatric (depression, anxiety, bipolar disorder, PTSD) symptoms and substance abuse risk behaviors, and report findings back to a multi-disciplinary staffing conference that includes both OB/GYN, psychiatry, and clinical psychology professionals. The team will make a determination about the type of services recommended for the patient. These may include counseling around adherence for general health, prenatal dietary and lifestyle management, brief interventions to decrease alcohol and illicit substance consumption, and stress management, as well as more involved and longer-term psychotherapeutic interventions to reduce symptoms of depression, anxiety, PTSD, and chronic substance misuse.
At the end of the rotation, interns will be able to:
MUSC Outpatient OB/Gyn Clinic