consultation–liaison psychiatry: a new psychiatric subspecialty in switzerland
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Journal of Psychosomatic Research 71 (2011) 429–430
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Journal of Psychosomatic Research
Consultation–Liaison Psychiatry: A new psychiatric subspecialty in Switzerland
Dan Georgescu a, Alexandre Berney b,⁎a Department of Geriatric Psychiatry, Königsfelden Psychiatric Hospital, Brugg, Switzerlandb Consultation–Liaison Psychiatry, Lausanne University Hospital, Switzerland
⁎ Corresponding author.E-mail address: [email protected] (A. Bern
0022-3999/$ – see front matter © 2011 Elsevier Inc. Aldoi:10.1016/j.jpsychores.2011.06.004
a r t i c l e i n f othe USA. Based on the advocacy and the curriculum developed by theSSCLP, C–L psychiatry was quite rapidly recognized as a subspecialty by
Article history:
Received 10 June 2011Accepted 14 June 2011Keywords:Consultation–liaison psychiatry
the Swiss Medical Chamber in 2008, thus being the second approvedsubspecialty field of adult psychiatry after old age psychiatry (2005).The C–L training program became effective in 2010.
The new subspecialty was designated ‘C–L Psychiatry’, which waspreferred to the term ‘Psychosomatic Medicine’ in use in the USA.Indeed, psychosomatic medicine is seen as a discipline studying the
leading to a proficiency certificate.
Although psychiatry has a long tradition in Switzerland, C–Lpsychiatry is a newcomer. The continuous reduction in recent years ofthe number of beds in psychiatric hospitals favored the development ofC–L services. The results of a survey of C–L psychiatry showed that inSwitzerland C–L services are provided in general hospitals, even in thesmall and rural ones [1]. An important step was achieved recently withthe recognition of C–L psychiatry as a subspecialty of adult psychiatry.The following summarizes some of the milestones of this process.
In1931, thefirst training requirements for the specialty of psychiatrywere given out by the Swiss Medical Chamber. The revision of 1964stipulated a psychotherapeutic training for obtaining the title ofpsychiatry specialist. In 1985, psychosomatic medicine and C–Lpsychiatry were introduced into the psychiatric training curriculum[2]. The 1998 revision defined for the first time the knowledge, skills,and attitudes the resident should acquire during the facultative rotationto C–L psychiatry.
In parallel, a first loose gathering of Swiss C–L psychiatrists started in1990 in the form of a study group. In 2001, the Swiss Society ofConsultation–Liaison Psychiatry (SSCLP) was established. In thefollowing year, the SSCLP was adopted as an affiliate society by theSwiss Society of Psychiatry and Psychotherapy (SSPP). In 2004, theexecutive board of the SSCLP concluded to seek the recognition of C–Lpsychiatry as a subspecialty. The development of Swiss C–L trainingrequirements for general psychiatry residents as well as for C–Lpsychiatry candidates has been influenced by international develop-ments, such as the recommendations made by the UEMS, the WPA andthe EACLPP [3–5], and by the official recognition of the subspecialty in
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relationship between biological, social, and psychological factorsdetermining health and illness and the official denomination‘Psychosomatic and Psychosocial Medicine’ designates in Switzerlandan area of advanced training open to all medical specialists and
The C–L subspecialty training program [6] stipulates a minimum of2 years full-time work (or equivalent part-time) at an accredited C–Ltraining center. In addition to residency goals, fellows in C–Lsubspecialty should deepen and expand their knowledge and skillsin several areas of clinical interventions.
The C–L subspecialty candidates have to perform during theirtraining a minimum of 300 written and supervised referrals as well asat least 10 interdisciplinary team-counseling sessions in a generalhospital or nursing home setting. In addition to tutorials, supervision,journal clubs and case conferences locally offered by the C–Ldepartments, trainees in subspecialty have to attend at least 40 h oftheoretical training. The theoretical course covers main contents suchas models in C–L psychiatry, psychopharmacology and psychotherapyin the C–L context, as well as topics related to specific consultations ordisorders (e.g. neuropsychiatry, oncology, transplantation, painpatients, eating disorders, and substance abuse). The course iscentrally provided by the SSCLP and evaluated by the trainees. Aminimum of 120 h of individual or group supervision offered by atleast two certified C–L psychiatrists — one of them not serving in thedepartment — is required. Learning outcome and competencyassessment include a learning objectives based evaluation by thetutors and an examination consisting of a thesis (or a publishedpaper) and an oral examination. The curriculum comprises also adefinition of C–L psychiatry and a profile of the contemporary SwissC–L psychiatrists.
A special feature of Swiss training programs is the procedure ofaccreditation of training institutions. In psychiatry, the curriculumrevisionof 1954has seen the implementation of this accreditation. Sincethen, setting standards for training institutions to ensure that candidateswill obtain the required training is one of the main aims of the trainingprogram. These standards have a strong influence on the developmentof psychiatric services [2]. For instance, the implementation of old age
430 D. Georgescu, A. Berney / Journal of Psychosomatic Research 71 (2011) 429–430
psychiatry curriculum led to the spread of memory clinics all over thecountry. Currently, 25C–L services of varying sizes are recognized by theFMH as places of residency and fellowship in C–L psychiatry, each withan a priori specified period of recognized training.
Summing up, it can be said that in Switzerland internationalrecommendations on C–L training [3–5,7] have been implemented toa large extent. The implementation of the training program favors thedevelopment of C–L services and of the SSCLP. Besides the educationalactivities — such as organizing and administering of courses andexams or accrediting of training centers — the SSCLP organizesnational and regional symposia, publishes a newsletter 2–3 times peryear and has a website (www.ssclp.ch), in German and French.
References
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[2] Georgescu D. Weiterbildung in Konsiliarpsychiatrie in der Schweiz – Blick zurücknach vorn. Psychosom Konsiliarpsychiatr 2007;1:209–15.
[3] UEMS Section for Psychiatry/European Board of Psychiatry. Charter on training ofmedical specialists in the EU (Chapter 6): requirements for the specialty ofpsychiatry. at http://www.uemspsychiatry.org/board/reports/Chapter6-11.10.03.pdf 2003 (accessed March 2011).
[4] World Psychiatric Association. WPA institutional program on the core trainingcurriculum for psychiatry. Yokohama: WPA; 2002.
[5] Söllner W, Creed F. European guidelines for training in consultation–liaisonpsychiatry and psychosomatics: report of the EACLPP Workgroup on Training inConsultation–Liaison Psychiatry and Psychosomatics. J Psychosom Res 2007;62:501–9.
[6] Foederatio Medicorum Helveticorum (FMH). Facharzt für Psychiatrie und Psy-chotherapie. at http://www.fmh.ch/files/pdf4/psychiatrie_version_internet_d.pdf 2009 (accessed March 2011).
[7] UEMSEuropeanBoardofPsychiatry. Consultation–LiaisonPsychiatry inEurope. athttp://www.uemspsychiatry.org/board/reports/2009-Oct-CL%20Psychiatry%20in%20Europe.pdf 2009 (accessed March 2011).