Clinical Experience and Opportunities

Goals and Major Objectives

1. Knowledge
   1. Sex and gender differences
      1. To understand empirical gender differences in prevalence and expressions of psychopathology.
      2. To understand biological influences on gender differences in both normal and pathological states, including sexual dimorphism in the brain and in brain development.
      3. To understand sociocultural influences on gender differences in both normal and pathological states.
      4. To understand gender differences in pharmacotherapy, including pharmacokinetics, pharmacodynamics, treatment response, side effect profiles, interactions with endogenous and exogenous hormones, psychological reactions to pharmacotherapy, and adherence to treatment.
   2. Reproductive cycle effects
      1. To understand the influence of the female reproductive cycle on psychiatric disorders, including biological and psychological effects of puberty, the menstrual cycle, pregnancy, the postpartum period, and perimenopause.
      2. To understand both normal and psychopathological reactions to reproductive-related interventions, such as hysterectomy, treatment for gynecologic cancers, and infertility interventions.
   3. Effects of gender-influenced trauma
      1. To understand the spectrum of responses to childhood physical and sexual abuse.
      2. To recognize the signs of, and understand the dilemmas faced by, women subjected to current domestic violence, rape, and sexual harassment. 
   4. Interviewing skills
      1. To demonstrate competence in interviewing patients with sensitivity to gender-specific communication styles.
      2. To demonstrate competence in eliciting sexual and reproductive histories.
      3. To develop interview techniques which elicit information about past and current traumatic events, such as sexual abuse, physical abuse, and domestic violence, without overly suggestive comments or "leading" questions.
   5. Diagnostic and assessment skills
      1. To incorporate an understanding of biological and cultural gender differences into diagnostic assessment of women patients.
      2. To incorporate assessment of central issues such as family context, parenting capability, family planning needs, and primary women’s health care needs into psychiatric assessments.
      3. To conduct physical examinations that include aspects of screening that are particularly important for women -- e.g. pelvic examinations, skin examinations for bruises.
2. Treatment skills
   1. To demonstrate an ability to modify pharmacotherapy based on pregnancy, lactation, the menstrual cycle, menopause, exogenous hormones, and gender differences in pharmacokinetics.
   2. To incorporate knowledge of normal and pathological psychological reactions to reproductive events (e.g. pregnancy, menopause) into psychotherapeutic interventions.
   3. To learn how to modify electroconvulsive therapy techniques during pregnancy and lactation.
   4. To recognize gender-specific issues in psychotherapy.
   5. To learn psychotherapeutic techniques effective for treating short and long term sequelae of trauma, including sexual abuse, sexual assault, physical abuse, domestic violence, and perinatal loss.
   6. To learn the indications for various types of psychosocial rehabilitation pertinent to women with major mental illness, including parenting rehabilitation strategies and sexuality education.
3. Attitudes
   1. To demonstrate sensitivity to gender role stereotypes and their influences on diagnosis and treatment.
   2. To recognize one’s own values regarding gender roles, including any beliefs that may interfere with one’s ability to respect and empathize with patients' choices.
   3. To develop a collaborative approach to mental health problems in women, working with patients, family members, other health professionals, child welfare staff and significant others to collectively improve problems.
   4. To develop an appreciation and keen awareness of social, cultural, logistical and economic barriers to mental health care access for women.

Description of Teaching/Learning Activities Clinical training experiences:

Most of the clinical training will take place within the Women's Mental Health Program of the University of Illinois Chicago (UIC) Department of Psychiatry. The Women's Mental Health Program provides mental health services for women with reproductive and gender-related problems, such as premenstrual dysphoria, pregnancy-related mental illness, parenting problems, perimenopausal mood disorders, eating disorders, and post-traumatic stress disorders.

Specific clinical sites within the UIC Women's Mental Health Program include:

Eating Disorders Clinic:
A clinic offering comprehensive and integrated services for women with eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder (compulsive overeating).

Women’s Clinic:
A general outpatient clinic for women with gender or reproductive-related psychiatric or psychological symptoms.

Women’s Consultation Service:
A team that offers psychiatric consultation to outside departments or agencies, including prenatal clinics, an addiction treatment program for pregnant women, and obstetric/gynecologic inpatients.

Women’s Inpatient Treatment Service:
A hospital service for women with major mental illness who are having a crisis or an acute exacerbation of a psychiatric illness.

Didactic training experiences:
The primary didactic teaching for the fellowship consists of:

• Women’s Mental Health Seminar: A lecture series covering key women’s mental health issues
• Women’s Mental Health Tutorial: Trainees are presented with case summaries illustrating various aspects of women’s mental health. Each trainee is given a question about the case to research. Trainees then present their conclusions to one another, and discuss the case in light of the research. A faculty member helps guide the research and discussion.
• Department of Psychiatry Grand Rounds: Fellows can attend all presentations, and give one Grand Rounds presentation on a women’s mental health topic during the fellowship.

Scholarly activities:

Fellows are encouraged to participate in some research or scholarly activity related to women's mental health. This could consist, for example, of a written case report and literature review, co-authoring a book chapter or journal article, reviewing a journal article submitted for publication, assisting in an ongoing research project, or conducting an independent research project under supervision. Those fellows anticipating a career in academic psychiatry will be encouraged to submit a paper for publication and/or present at a regional or national conference. Fellows may also participate in the UIC Perinatal Mental Health Project, a statewide project that includes educating and consulting to other health care providers; designing, implementing and evaluating innovative models of perinatal mental health care; and designing and evaluating self-care tools for pregnant and postpartum women.

Core reading materials:

A set of core textbooks are used for the fellowship, and are supplemented by journal articles and book chapters. Fellows also expand their reading beyond these core materials to areas that interest them or are pertinent to their clinical work and research.

Current core texts include:

• Frank E, ed: Gender and its Effects on Psychopathology. Washington, DC: American Psychiatric Press, 2000
• Kornstein SG, Clayton A, Monti DA, eds: Women’s Mental Health. New York: Guilford Press, 2002
• Romans SE, Seeman MV: Women’s Mental Health: A Life-Cycle Approach. Philadelphia: Lippincott Williams & Wilkins, 2006
• Steiner M, Eriksson E, Yonkers KA: Mood Disorders in Women. Blackwell, 2000
• Steiner M, Koren G: Gender Specific Psychopharmacology. J. A. Major, 2003
• Stotland NL, Stewart DE, eds: Psychological Aspects of Women’s Health Care: The Interface Between Psychiatry and Obstetrics and Gynecology, Second Edition. Washington, DC:
• American Psychiatric Press, 2001

Relationship between program activities and objectives

The core of this specialty training fellowship is direct patient contact with supervision from faculty members with expertise in various aspects of women’s mental health. The amount of time spent in different clinical services within the program can vary, depending on the specific educational objectives of individual fellows.

Facilities and Other Resources

The Women’s Mental Health Program is based on the third floor of the Neuropsychiatric Institute of the University of Illinois Chicago. Fellows have a private office in the Women’s Clinic, which includes full clinic facilities (waiting area, reception desk, fax machine, copier, etc.) Fellows have a computer with Internet access and e-mail. They have access to a well-stocked medical library and a video library. They have access to the resources of the Center of Excellence for Women’s Health.

Evaluation Plan

Fellow evaluation:

Fellows are evaluated twice a year (December and June) by faculty. Prior to each evaluation period, an evaluation form is sent to all of the fellows' clinical supervisors, research mentors and seminar leaders. Fellows have the opportunity to comment on their perspectives about the evaluations. The spirit of these evaluations is to note strengths and weaknesses and to formulate constructive plans for expansion, improvement, and meeting fellows' career goals.

Program evaluation:

• Ratings of each clinical site, supervisor and didactic course by fellows.
• Periodic (every 2-3 years) review of the program by the WMH teaching faculty.
• External review by the Director of Residency Training.

When problems, unanticipated logistical complications, or weaknesses are identified based on any of the above evaluation methods, relevant faculty will convene to study the problem and initiate improvements.