Medpsych Clinical Experiences

Interns in the med/health area practice in a consult liaison model. This means that rather than doing an in depth rotation for an entire quarter, interns are able to work with all populations and supervisors throughout the year. For example on a Tuesday, an intern might assess a pain patient in the morning and head over to the sleep disorders clinic in the afternoon. Or on a Thursday, an intern might evaluate a transplant patient in the morning and a GI Oncology patient in the afternoon, with a quick trip up for an inpatient neurotrauma consult in between. Interns partner with the faculty to create the schedule each day; this allows for more flexibility in creating your own training program and having the experiences you want throughout the year.

Assessment of Solid Organ and Bone Marrow Transplantation

Supervisor:  Glenn Ashkanazi, Ph.D.

The Internship experience in Transplant provides interns with opportunities to conduct semi-structured interviews with adults with a wide variety of disorders that require transplantation of either bone marrow (in the case of blood-based cancers), or solid organs (heart, lung, liver, kidney-pancreas), for survival or improvement in quality of life. Assessment can be conducted on either inpatients or outpatients. Patients are routinely evaluated pre-transplant for a variety of psycho-social issues including the presence of psychopathology, adherence/compliance issues, substance abuse, coping skills, support system adequacy, Quality of Life, risk-benefit analysis, etc. The assessment of these patients also includes some Psychological testing using a variety of instruments including, but not limited to, the Million Behavioral Medicine Diagnostic, the SF-36, beck Depression Inventory, etc.

Assessment of Chronic Pain/GI/Chronic Illness

Supervisor:  Lori B. Waxenberg, Ph.D., ABPP

Interns have the opportunity to work with patients who have a variety of pain conditions including back pain, limb pain, facial pain, fibromyalgia, abdominal pain, lupus, etc. Interns are also able to conduct pre-surgical evaluations for candidates for a spinal cord stimulator. Assessments are outpatient and conducted in the Psychology clinic. Interns conduct semi-structured interviews to evaluate pain/illness history and experience, interaction of pain and mood, substance abuse and psychosocial history. Psychological testing involves the administration of several paper and pencil measures such as the McGill Pain Questionnaire, the Coping Strategies Questionnaire revised, the Pain Anxiety Symptom Scale, the Pain Disability Inventory and the SF-36. Patients are often referred for treatment and interns have the opportunity to continue working with a particular patient they assess in order to provide evidence based CBT and/or ACT interventions in therapy.

Bariatric Pre-Surgical Assessment

Supervisor: Dr. Allison Holgerson

Interns on the Bariatric Surgery rotation will participate in pre-surgical evaluations of adolescents and adults seeking surgical weight loss. All patients are referred from the UF Health Weight Loss Surgery Center. Patients are also occasionally referred from regional bariatric program. Psychological evaluations are conducted outpatient and are part of a more comprehensive assessment process involving the bariatric surgeons, cardiology, endocrinology, neurology/sleep medicine, and nutrition. Psychological evaluations involve medical chart review, a semi-structured interview, and self-report measures of mood, disordered eating behaviors, and cognitive and behavioral factors associated with weight management. As part of the evaluation process interns will also participate in brief and focused problem-solving of goals for behavioral modification of health behaviors. Psychosocial results and recommendations are integrated into a report that is shared with the bariatric surgical team and used to inform the team’s decision to proceed with surgery. Patients seeking surgical weight loss commonly present with substantial comorbid medical conditions (e.g., diabetes, obstructive sleep apnea, thyroid disorder, GERD, cardiovascular disease), maladaptive health behaviors (binge eating, substance use, medical non-adherence), and may also present with significant psychological concerns (e.g., depression, anxiety, poor coping). Therefore, in addition to psychosocial evaluations, interns will also have the opportunity to pick-up cases for therapy with patients who present with potential contraindications for surgical weight-loss. Interns also have the opportunity to work with a multidisciplinary team and most commonly work in collaboration with the team’s registered dietitian.

Behavioral Sleep Medicine

Supervisor:  Jessica Payne-Murphy, Ph.D.

A rotation experience in the Insomnia & Behavioral Sleep Medicine Clinic provides interns with opportunities to conduct diagnostic interviews and deliver short-term interventions to adult outpatients with a wide variety of sleep disorders (e.g., insomnia, sleep apnea, delayed sleep phase syndrome, shift work, hypnotic dependence). Interns will also become familiar with a variety of behavioral sleep interventions (sleep hygiene, stimulus control & sleep restriction). The clinic receives referrals from UF’s accredited Sleep Disorder Center as well as regional psychiatrists, neurologists, and internal medicine physicians.

Neurotrauma Service

Supervisor:  Robert Guenther, Ph.D., ABPP

Florida is unusual in that psychological services are mandated by state statute for all neurotrauma patients admitted to state-accredited code one neurotrauma centers. For this reason, we are able to provide our trainees with the rare experience of being intimately involved in the care of acute hospital inpatients with brain and spinal cord injuries. Trainees are able to observe and provide services to these patients and their family members. Many of the patients are initially in coma and/or medically deeply sedated, while others are able to interact with us. Most patients recover sufficiently to begin to interact with staff prior to their discharge. We know of no other setting outside Florida where psychologists are core members of the acute care neurotrauma service. Thus, our trainees frequently acquire an experience from this rotation which few other psychologists can claim. These services consist of completing an initial evaluation of the patient.  The initial evaluation typically includes a clinical interview those patients able to participle and/or family members and a neurocognitive evaluation of the patient. We then provide ongoing services in the form of brief periodic neurobehavioral status examinations, provision of emotional support to patients, and provision of educational and emotional support services to family members. We document only in EPIC, the electronic medical record.

This is a true interprofessional training experience wherein trainees are able to interact with all the members of the care team informally as well as formally. We see our patients every few days during their acute hospital stay. Some patients will return for follow-up neuropsychological evaluations following a sufficient period of time to allow for some neurological stability. Some patients may also be referred to us for cognitive rehabilitation services. Graduate students and interns who are comfortable with independent operation on the service can acquire their own caseloads and follow their patients during their hospital stays. Graduate students are encouraged to consider completing an advanced practicum on the neurotrauma service.

Psycho-Oncology Assessment

Supervisor:  Deidre B. Pereira, Ph.D.

Interns on this rotation conduct psychological evaluations on oncology outpatients and inpatients referred for a wide variety of adjustment, anxiety, behavioral, and mood concerns. Evaluations are typically comprised of a 60 minute diagnostic interview with the patient (and family/caregivers, as appropriate) and brief self-report psychological testing. Patients are predominantly referred by UF Health providers for the assessment and treatment of a wide range of psychopathology, including adjustment disorders, anxiety, delirium, depression, end-of-life issues, personality disorders, serious premorbid psychopathology, suicidality, and treatment nonadherence. Common referral sources include the Breast Center, ENT (Division of Head and Neck Surgery), Gastrointestinal Oncology, Gynecologic Oncology, Hematology/Oncology (Medical Oncology), Internal Medicine, Neurosurgery (Neuro-Oncology), Radiation Oncology, Psychiatry, Patient and Family Services, and Surgical Oncology. In addition, interns perform routine psychological evaluations on the following: (a) patients with hematologic malignancies being evaluated for hematopoietic stem cell transplant (in conjunction with the Transplant Service), (b) patients being evaluated by the Breast Center for contralateral/bilateral prophylactic mastectomy for the reduction of breast cancer risk, and (c) patients presenting for care within the UF Health Cancer Center’s Multidisciplinary Gastrointestinal Oncology Clinic.

Women’s Health and Infertility Assessment

Supervisor: Patricia E. Durning, Ph.D.

Interns have the opportunity to work alongside Dr. Durning in an outpatient Reproductive Endocrinology and Infertility clinic, seeing all the cases she sees.  As a member of the infertility group, Dr. Durning sees all couples or individuals preparing for in vitro fertilization (IVF) as well as all individuals involved in third party reproduction (i.e., oocyte donor candidates, recipients of donor sperm or oocytes, and gestational host surrogacy candidates and commissioning couples) for psychological consultation that includes a brief psychosocial interview and psychoeducation.  Interns will also have the opportunity to see patients referred through Obstetrics and Gynecology for psychological assessment and treatment for a range of difficulties, including prenatal anxiety, post-partum depression, and more general psychological difficulties.

Sample med-health intern schedule

*Interns maintain an ongoing caseload of adult and child treatment cases that are obtained through the Psychology Clinic outpatient and inpatient services. Interns are encouraged to carry a diverse caseload in terms of demographics, presenting problems and clinical supervisors. Interns typically carry a caseload of 5-7 patients at a time, aiming for 4 contacts per week.