Curriculum

Fellows participate in weekly, shared didactics with Addiction Medicine fellows. Didactic lecturers include faculty from both Addiction Psychiatry and Addiction Medicine and are specifically designed so interaction and feedback from various specialties can be assimilated for the most complete perspective both diagnostically and from a training and treatment view.

Rotation site: William S. Middleton Memorial Veterans Hospital

Rotation length: 10% FTE

The VA Psychotherapy rotation provides intensive psychotherapy training and experience utilizing evidence-based psychotherapy methods to treat addictive disorders. Fellows learn to facilitate group therapies. Fellows also work with families and patients to enhance participation in community supports.

Rotation site: UW Health

Rotation length: 2.5% FTE

In the UW HIV Clinic, fellows work with the UW Health HIV Care & Prevention Program to provide information, treatment, and care for patients living with HIV/AIDS, regardless of ability to pay or insurance status. Fellows follow referred patients to address substance use issues and comorbid mental health and chronic pain conditions.

Fellows participate in multiple rotations:

Rotation site: UnityPoint Health-Meriter

Rotation length: 10% FTE

On the UPH-Meriter Consults rotation, fellows work with an interdisciplinary team to provide addiction psychiatry/medicine consultation to patients. This rotation provides an important opportunity for exposure to both substance use in pregnancy and neonatal abstinence syndrome in an acute setting. Fellows conduct comprehensive assessments of patients admitted to Meriter’s inpatient units, including the psychiatric unit, with substance use disorders and comorbid conditions.

Rotation site: UW Health

Rotation length: 5% FTE

On the UW Consults rotation, fellows work with the UW Health Consultation Service to provide interdisciplinary addiction consultation services for hospitalized patients. Fellows participate in initial evaluations and treatment plan formulation and have ample opportunities to assess patients in acute withdrawal (primarily alcohol and opioids). Fellows participate in post-discharge treatment planning for patients with active substance use disorders, thus developing familiarity with community treatment resources and formulation of community-based treatment planning and care coordination.

Rotation site: William S. Middleton Memorial Veterans Hospital

Rotation length: 2.5% FTE

In the VA ADTP Intake Clinic, fellows evaluate and consult on patients referred from a variety of sources including: community services, general psychiatrists, primary care physicians, and the entire range of VA providers. Fellows conduct comprehensive assessments of patients with addiction disorders and other comorbid psychiatric conditions. Fellows learn how to determine placement at the appropriate levels of care in the VA system. Fellows coordinate care with a team of addiction therapists, pharmacists, nursing staff, and other prescribers including physicians and nurse practitioners.

Rotation site: William S. Middleton Memorial Veterans Hospital

Rotation length: 2.5% FTE

In the VA Integrated Care Clinic, fellows work with The Primary Care – Mental Health Integration (PC-MHI) service to provide care for veterans’ mental health conditions in the primary care setting. A primary focus of the experience is communication and function as a member of an interdisciplinary team consisting of pharmacists, social workers, psychiatrists, and psychologists. Clinical activities for fellows include brief problem-focused assessments in PC-MHI, depression and alcohol use disorder care management, panel management, and medication management visits with a focus on behavior change and Motivational Interviewing.

Rotation site: Addiction Services and Pharmacotherapy (ASAP)

Rotation length: 2.5% FTE

Addiction Services and Pharmacotherapy (ASAP) is a full-service medication-assisted treatment (MAT) program with a strong counseling emphasis for patients with opioid use disorders. ASAP individualizes treatment to each patient and utilizes all FDA approved MAT treatments including: methadone, buprenorphine, and naltrexone.

Fellows participate in multiple rotations:

Rotation site: UnityPoint Health-Meriter

Rotation length: 10% FTE

In the UPH-Meriter Outpatient and Suboxone Clinic, fellows see a diverse array of patients, including young adults and those with a variety of insurances (including BadgerCare and Medicare). Fellows conduct intake assessments and medication management with brief psychotherapy appointments, while referring to therapy services as appropriate.

Rotation site: UW Health

Rotation length: 5% FTE

In the UW Outpatient Clinic, fellows rotate at the UW Health Behavioral Health and Recovery Clinic, an academic teaching clinic with a patient population generally similar to that seen in private practice. Most patients have co-occurring substance use disorders and psychiatric disorders. Fellows observe patient visits with addiction psychiatrists and Master’s level therapists. Fellows build their own caseload by completing initial intake evaluations. Fellows integrate pharmacologic treatment and psychotherapeutic techniques (e.g. Motivational Enhancement, 12-Step Facilitation, and Cognitive Behavioral Therapy) into follow-up visits. When possible, fellows are engaged in evaluation and treatment of adolescents and young adults with substance use issues, including evaluation, case management, and individual/family therapy.

Rotation site: William S. Middleton Memorial Veterans Hospital

Rotation length: 35% FTE

The VA Outpatient Clinic provides fellows’ core outpatient experience and is scheduled throughout the entire fellowship. Fellows provide longitudinal care to patients with substance use disorders and comorbid psychiatric disorders. Fellows assume the lead role as patients’ primary addiction psychiatry provider, with the physician supervisor retaining ultimate responsibility and accountability for patient care decisions. Fellows provide pharmacologic and psychotherapeutic treatment of substance use disorders as well as comorbid psychiatric disorders in patient appointments. Fellows utilize evidence-based psychotherapeutic techniques, including: 12-Step Facilitation, Motivational Enhancement Therapy, and Cognitive Behavioral Therapy.

Rotation site: William S. Middleton Memorial Veterans Hospital

Rotation length: 2.5% FTE

In the VA Suboxone Clinic, fellows work as a member of a multidisciplinary team of social workers, nurse practitioners, and physicians to evaluate and treat veterans with opioid use disorders. Fellows assess veterans for opioid use disorder, perform suboxone inductions, order and evaluate labs, and provide ongoing treatment of these veterans in their VA Outpatient Clinic. Fellows also work with, teach, and supervise psychiatry residents who also rotate through this clinic.

Fellows are required to complete a quality improvement project during their one-year fellowship. Fellows have protected time to work on these efforts and have access to faculty mentors to help them develop and implement a project. Most years fellows choose processes related to improvement in access or safety of patients, often at the VA Hospital, but opportunities for a QI project may also be found with other training sites. Examples of recent fellows’ work in quality improvement include: using VA dashboards to look at the number of veterans who continue opioid antagonist therapy overtime for opioid use disorder.

Rotation site: ARC Community Services, Inc.

Rotation length: 2.5% FTE

ARC Community Services, Inc. provides trauma-informed, intensive outpatient program (IOP)-level care to a diverse array of women, including pregnant women and women with infants and young children. Patients are ethnically and geographically diverse, and many patients are from rural communities in Wisconsin with patterns of substance use disorders that are less common in the Madison area.

Rotation site: William S. Middleton Memorial Veterans Hospital

Rotation length: 2.5% FTE

In the VA Pain Clinic, fellows work on a multidisciplinary consultation service. Disciplines present in the clinic include rehab medicine, neurology, OT/wellness, psychology, nursing, and pharmacy. Fellows participate in preparation and chart review, assessment in the visit, team-based consultation and treatment planning, and communication of recommendations to patients living with chronic pain. There is ongoing education on the biopsychosocial model of chronic pain with a focus on how to communicate this to patients in order to promote self-management.