Continuing Education in Integrated Care: A Perspective From an Early Career Psychiatrist

“To build a workforce equipped to provide effective mental health care in primary care and other settings, we have to think beyond traditional training programs like residencies and fellowships. In this issue’s column, we gain firsthand insight into the innovative, employment-friendly Community-Based Integrated Care Fellowship funded by the Washington state legislature that is bringing integrated care skills to psychiatrists already in practice.” —Jürgen Unützer, M.D., M.P.H.

My first job out of residency included building a vision for psychiatric services across multiple settings that included a collaborative care program. A question about collaborative care during my interview with Island Hospital in Anacortes, Wash., quickly grew into a full-fledged implementation project, which was daunting as an early career psychiatrist! When an opportunity presented itself to continue training as I started my full-time job, I jumped at the chance. Education and support from expert faculty as I built a program from scratch in my first years of practice? Yes, please!

I began the Community-Based Integrated Care Fellowship at the University of Washington in March 2017 as part of the first cohort, a group of psychiatric advanced practice registered nurses and psychiatrists from throughout Washington. As expected, I expanded my knowledge in primary care psychiatry and had excellent support in building our program. The real gems, however, were the unexpected learnings and growth that occurred over the fellowship year.

• Confidence: My confidence has increased, and I’ve been empowered by my involvement with the fellowship. Although the didactic content was critical in helping me implement my own collaborative care program, especially knowing the research base and familiarity with logistics like liability and documentation, I appreciated the genuine connections I made with a talented group of health care professionals throughout the state. Observing fellowship faculty advocate for resources and time needed to implement integrated care, I developed a level of comfort in this skill, and I have been humbled in how supportive my organization has been in response.

• Realistic lifelong learning: The program’s structure was a blend of online and in-person content, making it very accessible. Completing the recommended three hours of online didactics a week amid a busy outpatient practice with a toddler and another child on the way forced me to keep the work within these boundaries. I was amazed how this made me focus on relevant information and created a great foundation for lifelong learning. The 100+ CME hours was icing on the cake.

• Enjoyable quality improvement (QI): Through a required QI project, I became much more familiar with the QI process and how to apply it to even small changes. I found myself creating small, personal QI projects to test changes in my workflow (does a new template improve efficiency?) or even in my personal life (can a timer help toddler bedtime?). It introduced a new level of flexibility in my approach to new projects. The process of planning a change, trying something, having to adjust, and trying again feels productive and satisfying instead of overwhelming. What a gift!

• Concrete resources: I developed a database of knowledge and resources applicable to integrated care. Projects like creating an elevator pitch or public speaking practice have been directly relevant to my implementation project. I have saved time by pulling from things I either developed or started during the fellowship, always a win.

The fellowship training in integrated care I received was excellent because it allowed me to develop my expertise, implement a quality program across multiple settings, anticipate challenges, and become more confident in my abilities both for myself and for my leadership team. All of this I was expecting. The personal growth I experienced was more of a surprise and, for me, an invaluable outcome that nurtured my first two years of practice and home life. It is something I have wholeheartedly recommended to colleagues. Through developing similar programs throughout the country or in other specialty areas, we may well be able to increase access to effective mental health care and support professional development for psychiatrists in any phase of their career with the same intervention. Win-win-win! ■