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
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.