OCD and Anxiety
According to Mental Health America, eating disorders may occur with a wide range of other mental health conditions, including anxiety disorders, depression and other mood disorders, posttraumatic stress disorder (PTSD) and substance use disorders. Because these conditions are commonly co-occurring, psychiatrists will likely have a patient who has an eating disorder at some point in their career, regardless of discipline.
Over the past four years, the eating disorder inpatient unit at Rogers Memorial Hospital–Oconomowoc has accepted four to six Medical College of Wisconsin residents for four-week elective rotations. In psychiatry, residency programs are four-year commitments. In July 2015, the Medical College approached Rogers to create a more formal agreement allowing eight residents each year to participate in a required eating disorder rotation at Rogers during the residents’ third year of training.
Mara Pheister, MD, director of residency education in psychiatry at the Medical College of Wisconsin, says the relationship benefited both parties. “We found Rogers’ eating disorder unit to be very unique and one that we don’t have any experience with in our program, so that seemed to be something that would work well for both Rogers and the Medical College,” she says.
A recent graduate of the Medical College residency program was also coming on board at Rogers. “It was helpful that Dr. Elizabeth Hamlin, an adult psychiatrist here at Rogers-Oconomowoc, was also joining our team right as she was finishing up her own residency,” adds Brad Smith, MD, medical director of eating disorder services. “She was interested in helping train the residents and we knew she would be well-versed with the program. It all just came together at the right time.”
Even though the residents are only at Rogers for a few weeks, they gain a large amount of experience. “Our residents primarily work on the eating disorder inpatient unit because there is a higher flow of patients than in our lower levels of care, which creates more learning opportunities,” says Dr. Smith.
“The inpatient unit is also a familiar level of care for psychiatry residents, who typically come to us with extensive experience in various inpatient psychiatry settings,” he says. “They are very accustomed to the general work flow and demands of an inpatient setting, and now get to experience how to provide treatment for individuals with eating disorders in that level of care.” The psychiatry residents also gain experience in the residential level of care which is less familiar to them.
Residents are evaluated on their performance on the unit by Dr. Smith and Dr. Hamlin. “Each resident is assigned four to six patients to follow closely and keep the same normal routine that an attending psychiatrist would,” says Dr. Smith. “That includes labs, charting, vitals, medications and reviewing what has happened with each patient over the last 24 hours with Dr. Hamlin.”
Not every resident will treat eating disorders in their professional career. “Even if the residents aren’t planning on going into eating disorder work, we hope they have a positive experience with us and may find another area of psychiatry they would like to practice at Rogers,” says Dr. Smith. “They get an opportunity to see a very structured way of delivering cognitive behavioral therapy (CBT) and experience a private hospital setting, which may be different than their other experiences.”
“It’s a great setting to learn and increase their understanding about how exposure and response prevention (ERP) works in eating disorders treatment,” adds Dr. Hamlin. “Our treatment also has a strong focus on experiential therapy.”
Overall, the program helps residents become more familiar with the very best of the community’s resources. “The majority of our residents stay in the Milwaukee area to practice, so it’s important for them to have working knowledge of the different treatment options and systems that are available in our area,” says Dr. Pheister. “Each system participating in the program has different strengths, so it’s especially helpful for the residents to learn in the different areas of expertise at each location.”
But what do the residents think about the program? “Since the residency program at Rogers is still new, we’ve only had about six residents rotate through so far, but the response has been very positive,” says Dr. Pheister.
Marc Gunderson, MD, a current resident with the Medical College, is among those who value their residency program at Rogers. “I have a new appreciation for the pathology and comorbidities associated with eating disorders,” he says. “I have a better sense of what treatment for these patients involves and will be better able to assess whether a patient requires an increased level of treatment.”
The challenging experience helps residents prepare for conditions they will likely encounter. “This is a pathology we get little exposure to on many of our other rotations,” says Dr. Gunderson. “Eating disorders are complex and often comorbid with other disorders, which makes for multi-faceted treatment.”
Dr. Hamlin explains that the residents are educationally prepared, but have not had much previous experience working with patients with eating disorders. “All the residents know how to talk to patients and handle medications, but not all know eating disorder pathology or how to approach patients separately from their disorder,” says Dr. Hamlin. “They’re surprised about the variety in each patient’s eating disorder. Each disorder is as different as each person.”
In a world where face-to-face psychiatry is getting harder to find, the additional time spent with psychiatry residents most importantly helps patients. “They feel good that someone is learning from their journey with an eating disorder and they really benefit from the extra one-on-one time with another clinician,” says Dr. Hamlin.
Rogers partners with various universities, colleges and professional organizations to offer graduate placements and practicums in multiple disciplines throughout the system.