Eating Disorder Residential and Partial Hospitalization Rotation at McCallum Place Eating Disorders Treatment Center

Rotation Director: Ginger Nicol, MD

Rotation Faculty: Kim McCallum, MD; Monica Bishop, MD; and Brooke Ayden, MD

Rotation Coordinator: Dawn Slechta

Length of Fellow Rotation: 10-12 weeks

Time of Fellow Rotation:  First year

Location:
McCallum Place Eating Disorders Treatment Center
231 W. Lockwood Ave. Suite 200
St. Louis, MO 63119
(314) 968-1900

Goal
To provide first-year CAP fellows with an in-depth exposure to the evaluative and treatment modalities used in residential and partial hospitalization of children, adolescents, and young adults with eating disorders.

Objectives
To develop competence in the following areas

Patient Care

The fellow will learn the provision of clinical care at McCallum Place. The nature of patient care at McCallum Place is inter-disciplinary and includes individual, group, and family therapy; treatment of medical comorbidities by primary care, psychopharmacology, and psychotherapy by a psychiatrist; meal planning and weight restoration/weight loss by a registered dietitian; and academic assessment and planning by on-site teachers.

  • Assessing patients admitted from outside hospitals or outpatient care settings
  • Conducting patient and family-centered evaluations of severe Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and comorbid medical and psychiatric disorders
  • Observing and interpreting family relationships and their pertinence to the patient’s presenting problems
  • Appreciating the role of the family in the assessment and treatment regardless of the age of the patient
  • Producing differential diagnosis and dynamic case formulation of psychiatric symptomatology and appreciating the importance of biologic, psychologic, and socio-cultural aspects of symptoms
  • Becoming familiar with developmentally appropriate, evidence-based psychopharmacological and psychotherapeutic approaches in the treatment of severe eating disorders
  • Understanding behavior modification and level systems in treatment
  • Understanding group dynamics and group therapy structure
  • Planning dispositions for return to an outpatient or less restrictive care system

Medical Knowledge

The fellow will gain medical knowledge through a combination of supervised clinical activities, mandatory divisional didactics, and supervised reading of the pertinent related literature.

  • Knowing the strengths and limitations of the current DSM diagnostic criteria
  • Understanding the developmentally and age-appropriate use of laboratory testing and medical workup
  • Understanding the appropriate use of adjunct medical consultation
  • Familiarity with evaluation and treatment of common medical comorbidities in eating disorders in youth.

 Practice-Based Learning

In addition to supervised clinical activities and self-initiated and suggested readings, the fellow will participate in supervision including 1:1 supervision by faculty at McCallum Place and other divisional supervision including individual and team supervision.

  • Continuing to appraise oneself of current knowledge concerning the pathogenesis and etiology of eating disorders by reading and searching scientific literature on specific topics related to eating disorder etiology, pathophysiology, diagnosis, and treatment
  • Becoming familiar with the appropriate use of medical and psychological testing in eating disorder patients
  • Gaining experience delivering evidence-based psychotherapies for eating disorders including family and group therapies
  • Appreciating historical, cultural, legal, and ethical aspects of eating disorder treatment
  • Engage in guided readings on etiology, epidemiology, and theoretical issues and, with supervision, will engage in literature searches to understand evidence-based treatments relevant to patient care.
  • Engage in independent literature searches and reviews regarding evidence-based treatments and also engage in literature reviews regarding etiology, epidemiology, and theoretical issues as they apply to patient care

 Professionalism

The fellow will demonstrate sensitivity and compassion to children, adolescents, young adults, and their families/caretakers affected by serious eating disorders and will continue to develop relationships with other professionals or professionals in training including supervisors, colleagues, students, and allied professionals.

  • Developing intra-professionally by managing their own emotional reactions to severe psychopathology
  • Demonstrating the ability to function as a cooperative member of a multi-disciplinary therapeutic team
  • Demonstrating a commitment to continued professional development
  • Managing medical and psychiatric issues independently with attending supervision and managing their schedules independently by working with McCallum Place staff to schedule intake assessments and patient appointments as fits their clinical hours at McCallum Place
  • Interact with families and outpatient providers to coordinate care and disposition planning, and engage in weekly family contact to provide psychoeducation and family-based psychotherapy techniques.

Interpersonal/Communication Skills

  • Effectively communicate with patients, their families, and all other members of the treatment team
  • Conducting developmentally appropriate interview techniques as well as a comprehensive mental status examination
  • Talking with and obtaining a history from patients, family members, and all others involved in the caretaking system of the patient (outside providers, DFS social worker, teacher, etc.)
  • Presenting cases succinctly and accurately

System-Based Care

  • Understanding the roles of other mental health and medical professionals including psychotherapists, nursing staff, dietitians, educational therapists, activity (yoga, dance) therapists, etc.
  • Appropriately interact with family/caregivers and social and legal agencies in the management of child/adolescent eating disorders


Measurement of Objectives

  • Standard program evaluations
  • Multisource feedback
  • Clinical skills examinations

Description of Rotation & Clinical Activities

  • CAP weekly hours: 2 half days and 3 full days (including Saturday depending on SLCH call) = 32 hours/week average
  • PGY-2 weekly hours: 5 full days (including Saturday) = 40 hours/week average

The McCallum Place Eating Disorder Treatment Center exposes residents to a range of medical and psychiatric severity across the spectrum of eating disorders, to the evaluation and management of potentially life-threatening medical comorbidities, and to psychiatric comorbidities. Residents are also exposed to the full range of treatment modalities used to treat inpatients including pharmacotherapy, behavior modification, family therapy, group therapy, milieu therapy, activity therapy, and supported eating and meal regulation.


Weekly schedule

This rotation averages 25-35 hours per week. Time is divided as such:

Follow 10 patients, 2 teams (CAP)

  • Description: 15-20 minute visit plus documentation = 30-45 minutes depending on family involvement, one visit per week; participate in family meetings, up to three per week (60 minutes)
  • Max hours/week: 5-8

Perform all child/adolescent intakes + staff with attending (may sometimes have late-age adolescents or young college-age adults)

  • Description: 60-minute visit, plus holding note and dictation = 90 minutes per intake, 2-4 per week, max of 2 per day during full days and 1 per day during half days.
  • Max hours/week: 3-6

Attend Weekly team staffing (2.5 hours/week/team)

  • Description: Discussion of all patients with attending, RD, and therapist
  • Max hours/week: 5

Weekly supervision with supervising attending 

  • Description: Discuss difficult cases, guided review of literature
  • Max hours/week: 1+

Attend weekly Drs. Meeting when possible

  • Description: 12:30-1:30 Fridays
  • Max hours/week: 1*

Weekly supervision with Dr. McCallum  (when available)

  • Description: Review evidence-based treatments, neurobiology of EDs, case discussion
  • Max hours/week: 1

Outpatient ED Clinic with Dr. Nicol on Fridays

  • Description: Perform initial assessments (1-2) and follow-up visits (2-3)
  • Max hours/week: 4 hours for half-day, 7 hours for full day depending on rotation assignments

Attend Meal Therapy Training once during rotation

  • Description: 9-2 every third Thursday of the month
  • Max hours/week: 1 (averages to this but 5 hours all at once)

Attend Family Day

  • Description: Third Saturday of the month; OPTIONAL didactic presentation in the morning and/or run a group session in the afternoon (8 hours in person, 2 hours preparation)
  • Max hours/week: 1 (averages to this but 5-8 hours total)

Total Hours Per Week: 22-32

*Optional, patient care needs supersede attendance

+May overlap with staffing