Consultation-liaison psychiatry, often abbreviated CLP, sits at the intersection of psychiatry and the rest of medicine. Its practitioners evaluate and manage psychiatric conditions in patients who are primarily receiving medical or surgical care, addressing problems such as delirium, dementia with behavioral disturbances, decision-making capacity, and the psychological dimensions of serious illness. Because these issues arise in virtually every corner of the hospital, exposure to CLP during medical school can benefit future clinicians well beyond those who choose psychiatry as a career. Prior research has suggested that medical student rotations in consultation-liaison psychiatry correlate with increased interest in psychiatry careers and with greater psychiatric knowledge among students pursuing other specialties, making the quality and availability of these experiences a matter of broad educational significance.

The historical context makes the new survey particularly notable. The last broad survey of consultation-liaison undergraduate education in the United States was published in 1976, when 83 percent of programs offered CLP experiences ranging from single-digit seminars or consultations to multiple weeks of clinical CLP. A UK study from 1983 found that only one school in twenty-five offered formal clinical psychosomatic medicine or CLP experience, although many taught related didactic content. A Canadian survey published in 1984 showed that fewer than 10 percent of students were assigned primarily to CLP settings during their psychiatry clerkship. With comparable data from the United States and elsewhere remaining sparse in the decades since, the authors of the new study set out to characterize current CLP undergraduate opportunities and identify strategies to strengthen student education.

To do so, the research team designed a survey for psychiatry clerkship directors covering clerkship structure, class size, faculty characteristics, and affiliated CLP fellowships and electives. The instrument also assessed the scope of each school’s CLP didactic topics, perceived barriers to expanding CLP training, attitudes toward student exposure, and interest in centralized resources. It combined multiple-choice questions with Likert scales and was distributed in 2024 through the listserv of the Association of Directors of Medical Student Education in Psychiatry, which included 56 self-identified clerkship directors. To broaden participation, the survey was redistributed in 2025 using publicly available email addresses of clerkship directors and associate staff. The team sought contact information for the 200 medical schools operating in summer 2024, identified from the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine, and located addresses for 148 of them. Because listserv membership was anonymous, the investigators could not determine whether these schools overlapped with those reached in the first round. The survey closed automatically for respondents who reported having already completed it, and all responses were anonymous, with the project approved by the VA Boston Research and Development Committee and data managed through REDCap electronic capture tools hosted at the Veterans Health Administration.

The final sample comprised 54 of the 200 existing medical schools, a response rate of 27 percent. Responding schools were predominantly allopathic at 91 percent, and all US Census Bureau geographic regions and all quartiles of medical school class size were represented. Twelve respondents, or 22 percent, had formal CLP training or board certification, while 42 schools, or 78 percent, had at least one CLP-trained faculty member. Nineteen schools, or 35 percent, had an affiliated CLP fellowship. These institutional characteristics matter because faculty expertise and fellowship infrastructure are closely tied to the depth and breadth of the educational experiences a school can offer its students.

The headline finding is that consultation-liaison psychiatry is broadly represented in the clerkship landscape. Forty-nine of the 54 responding schools, or 91 percent, offered CLP core clerkship options. Inpatient CLP was the most common format, offered by 96 percent of those 49 schools, while outpatient CLP was the least frequent, offered by only 20 percent. Yet availability did not translate into universal participation. Among schools offering CLP clerkship options, the proportion of students actually participating in a CLP experience ranged from just 7.5 percent to 100 percent of each class, meaning that at many institutions the majority of students complete their psychiatry training without direct clinical exposure to the subspecialty.

Didactic teaching showed a similar pattern of uneven coverage. Across all 54 responding schools, the most frequently taught CLP topics were delirium at 87 percent, dementia with behavioral disturbances at 70 percent, and capacity assessment at 59 percent. At the other end of the spectrum, psycho-oncology was taught at only 5.6 percent of schools and transplant psychiatry at just 3.7 percent. These low figures are striking given that delirium, capacity evaluation, and the psychiatric dimensions of cancer care and organ transplantation are relevant to nearly every specialty a medical student might enter, from surgery to oncology to internal medicine. Even the most common topics were not universally taught, leaving room for improvement in core content that applies across the hospital.

The survey also probed the barriers standing in the way of expanded CLP education. The top identified obstacles were lack of dedicated CLP services, cited by 33 percent of respondents, lack of institutional support, cited by 26 percent, and insufficient CLP faculty, also cited by 26 percent. When asked to rate the number of CLP opportunities at their schools on a scale from far too few to far too many, 43 percent of respondents felt their schools had too few clinical opportunities and 39 percent felt there were too few CLP didactics. At the same time, 63 percent of respondents agreed with the statement that all medical students should have clinical exposure to CLP. The authors suggest that this variation in opinion reflects the identified institutional limitations as well as the opportunity cost that universal CLP rotations could impose by limiting student exposure to other areas of psychiatry.

Perhaps the most actionable finding concerns what educators want next. The preferred strategies to enhance CLP student exposure were centralized online didactics, favored by 70 percent of respondents, and CLP student handouts, favored by 80 percent. These handouts are described as printable, student-level educational guides summarizing key CLP topics or offering tips on how to contribute to a CLP team. The authors note that this enthusiasm for shared resources is intuitive given reported shortages in both faculty and specific didactic topics. If it is not feasible for every student to rotate clinically in CLP, or for each school to provide specialized didactics on its own, increased online resources could help fill the educational gap. Some centralized materials already exist, including resources on the Academy of Consultation-Liaison Psychiatry website and the ADMSEP Clinical Simulation Initiative modules, but the survey results suggest substantial interest in developing and more widely distributing student-level CLP content.

The study’s limitations warrant careful interpretation. With a response rate of 27 percent, the authors suspect their results overrepresent consultation-liaison psychiatrists or educators with preexisting enthusiasm for CLP, since such individuals would presumably be more inclined to open and complete a survey on the topic. Without information on which schools responded, it is difficult to quantify these potential biases, and didactics taught outside of psychiatry, such as a delirium lecture embedded in the surgery curriculum, may not have been captured by respondents. Even so, the survey provides unique and updated information on a question left unanswered since the mid-1970s. Its central message is clear: not all medical students receive clinical exposure to consultation-liaison psychiatry, meaningful barriers stand in the way of expanding that exposure, and there is a strong, documented desire among clerkship leaders for centralized, student-level resources that could bring this medically integrated field to every future physician, regardless of the specialty they ultimately choose.

Subject of Research: A national survey of US psychiatry clerkship directors on medical student education experiences in consultation-liaison psychiatry.

Article Title: Current Medical Student Education Experiences in Consultation-Liaison Psychiatry: A Survey of US Psychiatry Clerkship Directors

Article References: Kao, L. E., Shenai, N., Zabinski, J. S., Sarin, A., Topor, D. R., & Kasick, D. (2026). Current Medical Student Education Experiences in Consultation-Liaison Psychiatry: A Survey of US Psychiatry Clerkship Directors. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02433-6

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02433-6

Keywords: consultation-liaison psychiatry, medical education, psychiatry clerkship, clerkship directors, undergraduate medical education, survey research, delirium, capacity assessment, ADMSEP, Academic Psychiatry, psychosomatic medicine, curriculum design

The clinical journey began with what appeared to be a straightforward gastroenterological workup. Chronic diarrhea, hyperpigmentation, edema, and peripheral neuropathy are classic hallmarks of chronic arsenic toxicity, a condition that remains endemic in parts of the world where groundwater contamination is prevalent. But this patient had no environmental exposure to speak of. The turning point came when clinicians pieced together her medication history: she had been persistently self-administering bisacodyl, a stimulant laxative, along with a traditional Chinese medicine known as the Bezoar Antidotal Pill. Laboratory analysis revealed that the pill contained microquantities of arsenic trioxide and arsenic pentoxide—two toxic arsenic compounds. Taken repeatedly over time, these small doses accumulated, producing the insidious poisoning that had finally driven her to seek care.

The motivation behind this dangerous regimen was the first psychiatric thread in the case. During a consultation-liaison psychiatry assessment, specialists diagnosed anorexia nervosa on the basis of the patient’s excessive preoccupation with weight and her deliberate use of laxatives and arsenic-laced pills to shed pounds. Anorexia nervosa is among the most lethal psychiatric disorders, and its hallmark features—intense fear of weight gain, distorted body image, and restrictive or purging behaviors—often drive patients toward increasingly hazardous methods of weight control. The use of toxic traditional medicines for slimming purposes is a documented but underrecognized phenomenon, particularly in regions where such remedies are widely available and perceived as natural or safe. In this patient, that perception collided catastrophically with the biological reality of cumulative arsenic toxicity.

Yet one aspect of her presentation did not fit the anorexia nervosa picture. Despite her skin darkening, diarrhea, and neurological symptoms—signs that any reasonable observer would find alarming—the patient had delayed seeking medical care for a remarkably long time. She only presented to the hospital when she became convinced that her physical condition was genuinely life-threatening. This pattern of self-neglect sat uneasily beside the intense body preoccupation characteristic of anorexia nervosa, which typically involves heightened, not diminished, attention to bodily signals. The discrepancy puzzled the liaison psychiatry team and prompted a deeper biopsychosocial interview, a decision that would prove decisive for both diagnosis and treatment planning.

That deeper interview revealed a history of post-traumatic stress disorder, and with it, the missing piece of the diagnostic puzzle. The researchers propose that the patient’s delayed presentation was a combined effect of two distinct psychological mechanisms: the denial commonly seen in anorexia nervosa, which minimizes the severity of physical harm, and the generalized avoidance that defines PTSD, which drives patients away from medical settings, memories, and anything reminiscent of past trauma. Rather than one disorder explaining the delay, the two conditions appeared to act synergistically, with PTSD exacerbating the pre-existing anorexia-related postponement of care. This formulation transformed a confusing clinical contradiction into a coherent biopsychosocial narrative, and it illustrates why single-diagnosis thinking can fail catastrophically in complex patients.

The comorbidity of eating disorders and post-traumatic stress disorder is well documented in the psychiatric literature, though it remains underdiagnosed in routine practice. Epidemiological studies have repeatedly shown that individuals with eating disorders report elevated rates of traumatic exposure and PTSD compared with the general population, and that trauma histories are associated with earlier onset, greater severity, and poorer outcomes in eating pathology. Shared mechanisms have been proposed, including emotion dysregulation, dissociation, and the use of eating behaviors as a means of coping with trauma-related distress. For some patients, controlling food and body weight becomes a maladaptive strategy for managing overwhelming internal states—a dynamic that may have been operating in this case, where weight loss efforts escalated to the point of self-poisoning.

The treatment implications of such comorbidity are substantial. The authors review current thinking on managing eating disorders and PTSD concurrently, noting that addressing one condition in isolation risks undermining progress on the other. In a liaison psychiatry setting, where psychiatric consultants work alongside medical teams, the challenge is compounded by the physical consequences of the eating disorder and, in this case, the toxic effects of arsenic. Chronic arsenic poisoning requires cessation of exposure and careful medical management of gastrointestinal, dermatological, and neurological complications, while the psychiatric conditions demand structured psychotherapy, nutritional rehabilitation, and attention to trauma-related symptoms. Coordinating these strands of care requires a team-based approach and a high index of suspicion for hidden psychiatric drivers of medical presentations.

The case also carries a broader public health message about traditional medicines. The Bezoar Antidotal Pill, a classical remedy, contains trace amounts of arsenic compounds that are generally harmless in occasional, properly dosed use but dangerous with persistent self-administration. Because patients often do not regard traditional preparations as medications, they may fail to disclose them during clinical interviews, leaving physicians blind to a critical source of toxicity. The authors’ report underscores the importance of explicitly asking about all supplements, herbal products, and traditional remedies—particularly in patients with unexplained multisystem symptoms such as hyperpigmentation, diarrhea, edema, and peripheral neuropathy, which together should always raise the question of chronic heavy metal exposure.

Ultimately, this report stands as a rare and instructive example of diagnostic medicine at its most demanding. A single patient carried three interacting conditions—an eating disorder that drove her toward toxic weight-loss agents, a trauma disorder that kept her away from help, and a heavy metal poisoning that was the direct consequence of both. The authors argue that recognizing the interplay among these conditions was essential to making her clinical picture rational and to planning meaningful treatment. For clinicians, the lesson is that puzzling inconsistencies in a patient’s story are often signals to look deeper rather than artifacts to dismiss. For the public, it is a sobering reminder that remedies marketed as natural can carry lethal doses, and that the pursuit of thinness, when entangled with untreated trauma, can push individuals into territory where the line between self-treatment and self-harm disappears entirely.

Subject of Research: A case report of co-occurring anorexia nervosa, PTSD, and chronic arsenic poisoning from arsenic-containing traditional medicine used for weight loss.

Article Title: Post-traumatic stress disorder and anorexia nervosa in a patient with chronic arsenic poisoning: a case report and review of literature

Article References: Ma, D., Xie, Y., Wang, Q., Tang, H., Fang, X., Cao, J., & Wei, J. (2026). Post-traumatic stress disorder and anorexia nervosa in a patient with chronic arsenic poisoning: a case report and review of literature. Discover Mental Health. https://doi.org/10.1007/s44192-026-00599-x

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00599-x

Keywords: anorexia nervosa, post-traumatic stress disorder, chronic arsenic poisoning, eating disorders, consultation-liaison psychiatry, traditional Chinese medicine, delayed medical seeking, comorbidity, heavy metal toxicity, biopsychosocial interview, weight loss, case report

That moment of misdirection, described by Dr. Danilo Rojas-Velasquez of Harvard Medical School and Beth Israel Deaconess Medical Center in a new viewpoint article published in Academic Psychiatry, sits at the heart of an argument that is gaining urgency across academic medicine: the language clinicians write into charts is not a neutral record but a durable force that shapes how every subsequent clinician perceives a patient. Psychiatry, a chart-heavy specialty in which practitioners learn to scan prior notes for buzzwords that key early hypotheses, is particularly exposed. Words travel with patients across years of records, and the language chosen by one team determines how the next team imagines the person in the bed.

Clinical medicine has already made a deliberate effort to soften the edges of its vocabulary. Undomiciled has largely replaced homeless, non-adherent has supplanted non-compliant, and declined is preferred to refused. These substitutions reflect a genuine ethical awareness that stigmatizing descriptors can follow patients for decades. But Rojas-Velasquez argues that such lexical swaps can function as a kind of hygiene that leaves the underlying clinical gaze unchanged. A patient called non-adherent by a frustrated team is not necessarily better understood than one called non-compliant; the person is simply described in the currently sanctioned vocabulary. The deeper issue is not which words are approved but what those words do once they are placed in a chart and begin to circulate.

The empirical evidence behind this concern is substantial. A growing body of research documents that stigmatizing language in the medical record measurably alters downstream clinical decisions, including pain management and the intensity of diagnostic workups. Studies have found that descriptors such as pleasant and cooperative are applied unevenly across patient race, meaning that the chart itself can become a vector for the transmission of bias. Physician use of stigmatizing language in patient records has been documented systematically in large-scale analyses, and researchers have shown that negative framing in one note propagates into the impressions formed by later readers. Yet documentation is still often treated as a matter of mechanics: billing compliance, problem-list hygiene, and the architecture of the assessment and plan. The ethics of clinical language, what a clinician is actually doing to a patient when writing about them, has remained a hidden curriculum, absorbed by osmosis from whichever notes a trainee happens to read.

Into this landscape, ambient scribes and large language model-assisted documentation are arriving faster than the educational infrastructure can adapt. Randomized trials of ambient AI scribes in clinical practice are already underway, and health systems are deploying the tools at scale. The technical mechanism of concern is subtle but consequential: AI tools inherit and polish the linguistic conventions of their training data, which means that stigmatizing patterns already present in charts are being laundered into outputs that feel more authoritative precisely because they are fluent. A trainee who might once have written that a patient seems frustrated may now sign a note describing him as hostile and uncooperative simply because that is what the model produced. Fluency, in this context, is not accuracy; it is a cosmetic upgrade applied to inherited bias.

There is also an educational cost. Historically, the note has been the place where clinical formulation happens. Writing was thinking, and the attending’s question of why a trainee described a patient in a particular way was a teaching moment built directly into the workflow. When the note arrives pre-formed by an algorithm, that moment is structurally removed unless educators deliberately rebuild it. The formulation step, in which a clinician weighs observations, considers alternative explanations, and commits to a reasoned characterization of the patient, is being quietly absorbed by the model. What remains for the trainee is verification, which is a fundamentally different and far less formative cognitive task.

In response, the article proposes three practical steps for teaching note writing in the age of AI. The first is to teach note-reading before note-writing. On a rotation, a resident might review prior documentation, name the impression those notes created, and then compare that impression with what actually emerges at the bedside. The point is not to grade the prior note or its author but to make the chart’s authorial power visible before the resident adds to it. This exercise converts an invisible influence into an object of explicit study, allowing trainees to feel firsthand how a one-line summary can pre-load an entire clinical encounter with assumptions.

The second step is to build a next-reader pause into supervision. Before signing a note, the trainee considers how it would read to a covering clinician at three in the morning, to the patient with portal access, and to a family member reviewing the chart. Open Notes initiatives and patient-facing documentation have already shifted the audience for clinical writing; patients can now read the words written about them, and imagining these readers helps residents notice attributions and tones of voice that would otherwise pass unexamined. Qualitative work on patient-centered documentation in the era of open notes suggests that this kind of deliberate audience-awareness changes how clinicians draft, encouraging precision and fairness over shorthand judgment.

The third step treats the editing of AI-drafted notes as genuine clinical work rather than clerical review. If formulation is being absorbed by the model, the trainee’s task is not merely to check grammar or fill gaps but to interrogate what the draft has already decided: where observations have hardened into character judgments, where hedge words have drifted toward unwarranted certainty, and where descriptors would not survive the next-reader test. The article suggests a weekly note rounds, in which a team reviews and revises an anonymized AI-drafted note together, turning a hidden judgment back into a shared teaching moment. In this arrangement, the AI draft becomes a specimen to be dissected rather than a product to be signed, restoring the pedagogical function that automation threatened to erase.

The chart remains one of the few places in medicine where a patient is constructed in their absence, by people with power over them, in language they have historically been unable to see. Open Notes is changing the last part of that sentence, and ambient AI is changing the second, but the construction itself endures, and arguably matters more now than it did when notes lived in locked basements. Consultation-liaison psychiatrists, who live in other clinicians’ notes before they ever meet their patients, are unusually positioned to notice this dynamic. They watch language do its quiet work, and they write notes that will in turn shape how the next team thinks. Whether the current generation of trainees inherits a thoughtful relationship to that responsibility, or simply a more polished vocabulary applied at greater speed, will depend in large part on how medical educators decide to teach it. The stakes are not stylistic. They concern who patients become on paper before anyone meets them in person, and whether the accelerating machinery of AI-assisted documentation amplifies clinical understanding or merely automates its failures.

Subject of Research: Teaching ethical clinical documentation and note-writing skills to psychiatry trainees in the era of AI-assisted medical records

Article Title: Teaching Note Writing in the Age of AI: Three Practical Steps

Article References: Rojas-Velasquez, D. (2026). Teaching Note Writing in the Age of AI: Three Practical Steps. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02434-5

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02434-5

Keywords: clinical documentation, artificial intelligence, psychiatry education, stigmatizing language, medical records, ambient AI scribes, large language models, Open Notes, clinical formulation, medical bias, consultation-liaison psychiatry, graduate medical education