Continuity of Care Experiences
An important part of the training experience in the family medicine/psychiatry residency program is continuity of care. In order to achieve expertise in both family medicine and in psychiatry, as well as integrate these specialties, residents in the combined program have several longitudinal continuity experiences that span the entire curriculum.
During the first year, FMP residents have a weekly family medicine continuity clinic during family medicine rotations. During the second year, FMP residents have their weekly family medicine continuity clinic all year, and they also begin a weekly continuity clinic in the Family Medicine Psychiatry Clinic. Spanning across part of the third and fourth years of training, FMP residents have a full year of outpatient psychiatry continuity clinical experiences, while simultaneously maintaining their other continuity clinics. Residents maintain their weekly family medicine and weekly Family Medicine Psychiatry continuity clinics until they complete their residency training.
Family Medicine Clinic
The Family Medicine Clinic at UI Hospitals and Clinics is a full spectrum family practice clinic that serves the University of Iowa community, Iowa City, and neighboring communities. Patients range from newborn to older adult, and everyone in between. The clinic provides care to a wide variety of people, including people with a range of public and private health insurance plans, people who speak a range of international languages, college students, university staff, retirees, disabled persons, people with complex chronic health needs, people for whom prevention is the primary health issue, people who live in town and people who live in nearby rural communities. Residents, under the supervision of faculty physicians, see their own patients alongside family medicine faculty who are seeing their own patients. In this clinic, residents gain experience and expertise in providing primary care to children and adults, including obstetrical care and office procedures. Residents provide preventive health care, acute care services with a same-day access clinic, and chronic disease management. The clinic also has a care management program (CoMeBeh=Collaborative Medical and Behavioral Health) for patients with chronic physical and mental health conditions, or alcohol misuse. The clinic’s electronic medical record (EMR), Epic, is entirely integrated with the UIHC EMR. Lab and radiology services, as well as some point of care testing, are available on-site.
Family Medicine Psychiatry Clinic
The Family Medicine Psychiatry (FMP) Clinic is an outpatient mental health clinic, located within the Family Medicine Clinic. Patients are seen by residents in the family medicine/psychiatry combined program, who are supervised by Dr. Alison Lynch and Dr. Michelle Weckmann, both dually-trained and board certified family physicians/psychiatrists, and graduates of the UIHC family medicine/psychiatry residency program. The clinic provides single visit consultation as well as diagnostic assessment and ongoing psychiatric outpatient care. Starting in their second year of training, FMP residents gain experience providing psychopharmacologic management, as well as behavioral and psychotherapy management of mental health conditions. When possible, recommendations for management are sent to the referring primary care provider so the patient can continue follow up in the family medicine clinic with their regular doctor, which also gives the FMP residents the opportunity to develop an expertise in serving as a consultant psychiatrist to their family physician peers. Co-location allows us to provide easy access for clinicians working in the Family Medicine Clinic to obtain both formal and informal (“curbside”) psychiatric consultation. FMP residents maintain a weekly continuity clinic in the FMP Clinic for 4 years, until they complete their training.
Starting in the middle of the third year, FMP residents begin their year-long outpatient psychiatry training experience. During this year, residents spend time each week in the UIHC Adult Psychiatry Clinic, the Iowa City Veterans Affairs Psychiatry Clinic, and the Mid-Eastern Iowa Community Mental Health Center. These clinics allow residents to learn about and provide care to a wide range of people with diverse mental health needs, and they also gain experience learning to work in different settings with different resources. In each of these clinics, residents provide care to their patients under the supervision of faculty psychiatrists from the UIHC Department of Psychiatry.
Another component of the outpatient psychiatry year is resident psychotherapy training. Throughout the residency training program, resident didactics include instruction on various aspects of psychotherapy and its role in mental health treatment. During the outpatient psychiatry year, residents have a weekly psychotherapy clinic where they provide psychotherapy under the direct supervision of their psychotherapy supervisor. They also have regular supervision time where they meet one-on-one with their supervisor to review cases. Supervisors are faculty in the Department of Psychiatry. Among the supervisors, there is a wide range of psychotherapy expertise, ranging from cognitive behavior therapy, interpersonal psychotherapy, motivational interviewing, dialectical behavior therapy, psychodynamic psychotherapy, acceptance and commitment therapy, to mentalization therapy. This spectrum allows residents to gain exposure to a variety of psychotherapy techniques and perspectives during their training. Residents typically follow 2-5 psychotherapy patients at a time, with appointments generally occurring weekly or biweekly.
Residents maintain their continuity clinics in Family Medicine and Family Medicine Psychiatry during the outpatient psychiatry year.