Medical Psychiatry: Comprehensive Update Conference 2025

September 18, 2025 to September 21, 2025

Overview


Please Note: This program will be held Virtually via Zoom Video Livestream. All program times listed are in Eastern Daylight Time 

  

Mass General Brigham’s Medical Psychiatry: Comprehensive Update conference is becoming a leading venue for showcasing advances in the application of medical psychiatry. The 2025 course will be held virtually over four days: Thursday, September 18th, through Sunday, September 21st, 2025.

Medical Psychiatry, or Consultation Liaison Psychiatry (CL), is an exciting and rapidly growing field that is at the forefront of integrated medical and psychiatric practice in both the general hospital and outpatient settings. Providers specialize in the treatment of acute psychiatric disorders, including those at the interface of medicine and psychiatry, such as delirium, catatonia, neurocognitive disorders, and complications of psychiatric illness or interventions. There is a focus on the evaluation and comprehensive treatments, including psychopharmacologic and psychological therapies of patients with neuropsychiatric symptoms that may result from medical, surgical, gynecologic, and oncologic illness, as well as patients with primary psychiatric illness complicated by medical disease.

This course is designed to enhance participants' knowledge and skills for diagnostic workup and treatment of patients suffering from both psychiatric and medical disorders. Course material will review cutting-edge clinical research, evidence-based interventions, and practical guidelines for clinicians and trainees. The course content will include the process of psychiatric assessment and consultation in the medical setting, including novel deliveries of care, management of challenging psychiatric presentations in the inpatient, emergency, and outpatient settings, treatment of substance use in the medical setting, and non-pharmacological interventions.

There will also be the opportunity to discuss the psychiatric impact and management of patients in specialty settings, including burn/trauma, neuropsychiatry, addiction, critical care, cardiology, oncology, transplant, women's mental health, and other areas. This course also provides an opportunity for a comprehensive review before the American Board of Psychiatry and Neurology specialty board exams, which are being held later this year. Learners will benefit from a variety of educational formats, including lectures, case discussions, question and answer sessions, and an electronic syllabus.


Pricing

MDs/Doctoral-Level Professionals

Early Bird Special (on or before August 1, 2025): $800 
Regular Registration (after August 1, 2025): $1000

RN/APRN, PAs, Psychologists, Social Workers, and Other Allied Health Professionals:

Early Bird Special (on or before August 1, 2025): $640
Regular Registration (after August 1, 2025): $800

Residents/Fellows/Students/Interns:

Early Bird Special (on or before August 1, 2025): $480
Regular Registration (after August 1, 2025): $600

Group discounts are available upon request


Before You Register: Important Notice

You must create a free account through the MGH Psychiatry Academy to register for this event. MGH Psychiatry Academy accounts are not limited to MGH employees. We welcome attendees from around the world and from any organization. 


E-Syllabus

We provide all attendees with completely free access to all slide presentations in digital PDF format prior to the conference. This is an environmentally friendly alternative and helps keep costs lower for all attendees. The e-syllabus will be available for 30 days after the conference. 


Cancellation Policy

A refund minus a $100.00 administrative fee will be issued for refund requests received by August 29, 2025. Payments made may not be applied to future conferences or other educational activities. There are no exceptions to these policies.

Target Audience

This course is targeted to Specialty Physicians, Physicians Assistants, Nurse Practitioners, Psychologists, and Primary Care Physicians.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe best practices in providing psychiatric consultation in medical and surgical settings.
  • Analyze the components of psychosocial formulation and apply them to complex clinical cases.
  • Discuss ethical and legal considerations relevant to capacity assessments in hospitalized patients.
  • Select and utilize evidence-based strategies for managing agitation in medically ill patients.
  • Identify and explain key features of catatonia, neuroleptic malignant syndrome, and serotonin syndrome.
  • Apply structured approaches to assess suicide risk in patients with and without co-occurring medical illness.
  • Critique system-level and clinical challenges related to emergency department psychiatric boarding.
  • Describe management strategies for behavioral dysregulation in developmentally delayed youth.
  • Interpret ECGs in psychiatric patients and assess the risk of QTc prolongation associated with psychotropic medications.
  • Explain psychiatric care considerations in intensive care and critical care environments.
  • Discuss the pathophysiology of delirium and demonstrate prevention and treatment strategies.
  • Assess the psychiatric and medical dimensions of eating disorders in hospitalized patients.
  • Design and apply safe, evidence-based treatment plans for perinatal mental health and substance use disorders.
  • Prepare comprehensive psychiatric evaluations for organ transplant candidates.
  • Use integrated psychiatric approaches in the management of chronic illness, pain, and addiction.
  • Identify and explain neuropsychiatric symptoms related to HIV, autoimmune, endocrine, and oncologic conditions.
  • Explain the bidirectional relationship between psychiatric disorders and gastrointestinal diseases, and apply integrated management strategies to improve outcomes in patients.
  • Discuss ethical, legal, and clinical considerations related to physician-assisted death, and apply best practices for psychiatric evaluation and support of patients at the end of life.
  • Describe neuropsychiatric manifestations of dementia and revise treatment plans based on disease stage.
  • Identify neuropsychiatric presentations associated with epilepsy and stroke and apply treatment strategies in medical settings.
  • Critique diagnostic approaches to functional neurological disorders and design interdisciplinary treatment plans.

Accreditation

 

In support of improving patient care, MGH Institute of Health Professions is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

26.25 Physicians

MGH Institute of Health Professions designates this live activity for a maximum of 26.25 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.

26.25 Physician Associates/Assistants

MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 26.25 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

26.25 Nursing

MGH Institute of Health Professions designates this activity for 26.25 contact hours for nurses. The American Academy of Nurse Practitioners Certification Board (AANPCB) accepts credit from organizations accredited by the ACCME and ANCC.

26.25 Psychologists

Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibly for the content of the programs. MGH Institute of Health Professions designates this activity for 26.25 credits.

26.25 IPCE Credit

This activity was planned by and for the healthcare team, and learners will receive 26.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

Course summary
Available credit: 
  • 26.25 AMA PRA Category 1 Credit™

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of McLean Hospital and Massachusetts General Hospital. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians.

    McLean Hospital designates this Live activity for a maximum of 26.25 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  • 26.25 Nursing Contact Hours

    Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.

    This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 26.25 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.

  • 26.25 Participation

    This course allows other providers to claim a Participation Certificate upon successful completion of this course.

    Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.

  • 26.25 Psychologists CE Credit

    The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content.

    This offering meets the criteria for 26.25 Continuing Education (CE) credits per presentation for psychologists.

Registration opens: 
03/01/2025
Course closes: 
09/21/2025
Event starts: 
09/18/2025 - 8:45am EDT
Event ends: 
09/21/2025 - 3:50pm EDT
Cost:
$800.00
Rating: 
0

Program

DAY 1 - Thursday, September 18, 2025

8:45-8:50 AM

Welcome & Introductory Remarks
Adrienne Taylor, MD, Sejal Shah, MD, Heidi Holiver, NP and David Silbersweig, MD

8:50-9:00 AM

Chair's Welcome: Consultation Liaison Psychiatry and It's Value

9:00-9:45 AM

Psychiatric Consultation in the Medical/Surgical Setting: The Art of the Consult

Dave Gitlin, MD

9:45-10:30 AM

Applying Psychosocial Formulation and Intervention in Complex Clinical Settings
Michelle Jacobo, PhD

10:30-11:00 AM

Difficult Capacity Assessments: Ethical and Legal Considerations
Jhilam Biswas, MD

11:00-11:15 AM

Panel Discussion - Q&A

11:15-11:30 AM

Break

11:30 AM-12:15 PM

Management of Agitation in the Medical Setting
Naomi Schmelzer, MD

12:15-1:15 PM

Psychiatric Emergencies: Catatonia, NMS, Serotonin Syndrome
Nathan Praschan, MD, MPH

1:15-1:30 PM

Panel Discussion - Q&A

1:30-2:30 PM

Lunch

2:30-3:00 PM

Acute Psychiatric Management and ED Boarding
Sejal Shah, MD

3:00-4:00 PM

Suicide Risk Assessment
Heidi Holiver, NP

4:00-4:45 PM

Management of Behavioral Outbursts in Developmentally Delayed Children, Adolescents, and Young Adults in the Hospital Setting
TBA

4:45-5:00 PM

Panel Discussion - Q&A

5:00-5:05 PM

Closing Remarks

DAY 2 - Friday, September 19, 2025

8:55-9:00 AM

Welcome & Introductory Remarks

9:00-9:30 AM

ECG Interpretation for the CL Psychiatrist

Christopher Celano, MD

9:30-10:00 AM

QTc Prolongation: Overview of Medications

Scott Beach, MD

10:00-10:30 AM

QTc Prolongation: Risk Stratification and Mitigation for Challenging Clinical Cases
Margo Funk, MD, MA

10:30-10:45 AM

Panel Discussion - Q&A

10:45-11:00 AM

Break

11:00-11:30 AM

Critical Care Psychiatry
Maureen Cassady, MD

11:30 AM-12:15 PM

Delirium: Pathophysiology, Prevention and Treatment
TBA

12:15-12:30 PM

Panel Discussion - Q&A

12:30-1:30 PM

Lunch

1:30-2:15 PM

Pharmacological Considerations in Pregnancy
Polina Teslyar, MD

2:15-3:00 PM

Medically Unstable Eating Disorder
TBD

3:00-3:15 PM

Panel Discussion - Q&A

3:15-4:00 PM

Management of Substance Use Disorders in Pregnancy
TBA

4:00-4:45 PM

PMDD/Menopause

Hadine Joffe, MD, MSc

4:45-5:00 PM

Panel Discussion - Q&A

5:00-5:05 PM

Closing Remarks

DAY 3 - Saturday, September 20, 2025

8:55-9:00 AM

Welcome & Introductory Remarks

9:00-9:45 AM

Comprehensive Evaluation and Assessment of Transplant
Fremonta Meyer, MD

9:45-10:15 AM

Care of Complicated Burn and Trauma Patient
Adrienne Taylor, MD

10:15-10:45 AM

Trauma-Informed Care in the Hospital Setting
Nomi Levy-Carrick, MD, MPhil

10:45-11:00 AM

Panel Discussion - Q&A

11:00-11:15 AM

Break

11:15-11:45 PM

Management of Substance Use Disorders in the Medical Setting
TBA

11:45 AM-12:15 PM

Interface of Pain and Addiction in CL
Claire Twark, MD

12:15-12:45 PM

Counseling around the Use of Medical Cannabis
Roxanne Sholevar, MD

12:45-1:00 PM

Panel Discussion - Q&A

1:00-2:00 PM

Lunch

2:00-2:45 PM

Psycho-Oncology Primer
Carlos Fernandez-Robles, MD, MBA

2:45-3:15 PM

Management at the End of Life
TBA

3:15-3:45 PM

Neurocognitive Effects from Chemotherapy
TBA

3:45-4:15 PM

Medical Aid in Dying
John Peteet, MD

4:15-4:30 PM

Panel Discussion - Q&A

4:30-4:35 PM

Closing Remarks

DAY 4 - Sunday, September 21, 2025

8:55-9:00 AM

Welcome & Introductory Remarks

9:00-9:30 AM

Psychiatric Disorders in Gastrointestinal Diseases
Ashwini Nadkarni, MD

9:30-10:15 AM

Endocrine and Metabolic Disorders: A Medical Psychiatry Focus
Catherine Gonzalez, MD

10:15-10:30 AM

Panel Discussion - Q&A

10:30-10:45 AM

Break

10:45-11:30 AM

Inflammation, Autoimmune Disorders and Psychiatric Illness
Rishab Gupta, MD

11:30 AM-12:15 PM

Neuropsychiatric Manifestations and Pharmacologic Considerations in HIV and other Infectious Disorders
John Grimaldi, MD

12:15-12:30 PM

Panel Discussion - Q&A

12:30-1:30 PM

Lunch

1:30-2:15 PM

Neurocognitive Impairment and Dementia: Clinical Principles and Bedside Assessment
TBA

2:15-2:45 PM

Epilepsy and Stroke
TBA

2:45-3:15 PM

Neuropsychiatry of Movement Disorders
Stanley Lyndon, MD

3:15-3:45 PM

Functional Neurologic and Somatoform Disorders: Assessment and Management
TBA

3:45-4:00 PM

Panel Discussion - Q&A

4:00-4:10 PM

Closing Remarks
Adrienne Taylor, MD and Sejal Shah, MD

Faculty

Faculty

Medical Psychiatry: Comprehensive Update features Harvard Medical School faculty and prominent experts and leaders in their field. The course is led by:

   

Adrienne Taylor, MD, BWH Psychiatry

 Associate Director, BWH Division of Medical Psychiatry

  

Sejal Shah, MD, BWH Psychiatry

Chief, Division of Medical Psychiatry, Department of Psychiatry, Brigham and Women's Hospital  
Associate Vice Chair, Clinical Consultation Services, Department of Psychiatry, Brigham and Women’s Hospital
Assistant Professor of Psychiatry, Harvard Medical School


 

David Silbersweig, MD, Chairman Emeritus, BWH Psychiatry

Chairman Emeritus, Department of Psychiatry  
Brigham and Women’s Hospital
Stanley Cobb Professor of Psychiatry

 

Heidi (Boland) Holiver, DNP, MS, BWH Division of Medical Psychiatry

Psychiatric/Mental Health Nurse Practitioner
Brigham and Women's Hospital
Psychiatry Department

Speakers:

       

Gaston Baslet, MD

Neuropsychiatry, Bruce W. Carter VA Medical Center, Miami, FL
Associate Professor of Psychiatry, Boston, MA

       

Scott Beach, MD, MGH Psychiatry

Psychiatrist, MGH Acute Psychiatric and Psychiatric Consultation Service
Associate Professor of Psychiatry, Harvard Medical School

 

Jhilam Biswas, MD, BWH Psychiatry

Director, Psychiatry, Law, and Society Program
Co-director, Harvard Mass General Brigham Forensic Psychiatry Fellowship
Consult Liaison Psychiatry Clinical Lead, Forensic Psychiatry
Mass General Brigham Academic Medical Center
Instructor Part-Time, Harvard Medical School

 

Maureen Cassady, MD, BWH Psychiatry

Instructor in Psychiatry, Harvard Medical School 
Associate Psychiatrist, Brigham and Women’s Hospital 

 

Christopher Celano, MD, MGH Psychiatry

Associate Director, Cardiac Psychiatry Research Program, MGH
Associate Professor, Harvard Medical School

Carlos Fernandez-Robles, MD, MBA, BWH Psychiatry

Chief Of Psychiatry, Brigham and Women’s Faulkner Hospital 
Vice-Chair BWFH, Brigham and Women’s Hospital 
Assistant Professor of Psychiatry, Harvard Medical School

  

Margo Funk, MD, MA, BWH Psychiatry

Director, Cardiovascular Psychiatry Program
Director, BWH-HMS Psychiatry Residency Training Program
Brigham and Women’s Hospital

Dave Gitlin, MD, BWH Psychiatry

Attending Psychiatrist
Brigham and Women's Hospital
Assistant Professor of Psychiatry

 

Catherine Gonzalez, MD, BWH Psychiatry

Director of Geriatric Psychiatry, Brigham & Women's Hospital
Medical Director of Faculty, Trainee & Employee Mental Health, Brigham & Women's Hospital
Assistant Professor of Psychiatry, Harvard Medical School

 

John Grimaldi, MD, BWH Psychiatry

Associate Medical Director, Brigham Psychiatric Specialties
Assistant Professor of Psychiatry, Harvard Medical School

Rishab Gupta, MD, BWH Psychiatry

Associate Psychiatrist, Brigham and Women's Faulkner Hospital
Staff Neuropsychiatrist, Center for Brain/Mind Medicine, Brigham and Women's Hospital
Instructor in Psychiatry, Harvard Medical School

Michelle Jacobo, PhD, Dana-Farber Cancer Institute

Hadine Joffe, MD, MSc, BWH Psychiatry

Paula A. Johnson, Professor of Psychiatry in the Field of Women's Health  
Harvard Medical School
Executive Director, Mary Horrigan Connors Center for Women's Health 
Department of Psychiatry
Brigham and Women’s Hospital
Dept. of Supportive Oncology / Breast Cancer Program
Dana-Farber Cancer Institute
Connors Center / WHARP Research  

Nomi  C Levy-Carrick, MD, MPhil, BWH Psychiatry

Vice Chair, Clinical Services, Mass General Brigham AMC Department of Psychiatry
Medical Director, Critical Illness Recovery Program
Co-Chair, BWH Trauma-Informed Care Learning Collaborative
Assistant Professor of Psychiatry, Harvard Medical School

Stanley Lyndon, MD
Co-Director | Center for Brain/Mind Medicine
Medical Director | Division of Neuropsychiatry
Neuropsychiatry Lead | Division of Medical Psychiatry
Director of Education | TMS | Center for Brain Circuit Therapeutics
Co-Director | Behavioral Neurology and Neuropsychiatry Fellowship Program
Brigham and Women’s Hospital | Harvard Medical School

Scott McGinnis, MD, BWH Psychiatry

Fremonta Meyer, MD, Dana Farber Cancer Insitute

Director, Transplant Psychiatry Services, BWH
Director, Medical Student Education in Psychiatry, BWH/HMS
Assistant Professor of Psychiatry, HMS 

Damien Miran, MD, Dana Farber Cancer Institute

Clinical Director, DFCI Inpatient Psychiatry Consult Service
Department of Supportive Oncology
Dana-Farber Cancer Institute

Ashwini Nadkarni, MD, BWH Psychiatry

Assistant Professor of Psychiatry, Harvard Medical School
Interim Vice Chair, Faculty Affairs, Department of Psychiatry, BWH
Associate Medical Director, Brigham Psychiatric Specialties

 

John Peteet, MD, Dana-Farber Cancer Institute

Associate Professor of Psychiatry, Harvard Medical School
Affiliated with Brigham and Women’s Hospital and Dana-Farber Cancer Institute

Nathan Praschan, MD, MPH, BWH Psychiatry

Associate Neuropsychiatrist, Brigham and Women's Hospital
Associate Co-Director, Brigham and Women's Hospital Fellowship in Behavioral Neurology and Neuropsychiatry
Director, Advanced Consult-Liaison Psychiatry Clerkship, Harvard Medical School

 

Zachary Sager, MD, Dana-Farber Cancer Institute

 

Naomi A, Schmelzer, MD, BWH Psychiatry

Director of Medical Psychiatry | Department of Psychiatry | Brigham and Women’s Faulkner Hospital

 

Roxanne Sholevar, MD, Dana-Farber Cancer Institute

Staff Psychiatrist, Department of Supportive Oncology, Dana-Farber Cancer Institute
Instructor in Psychiatry, Harvard Medical School

 

Joji Suzuki, MD, BWH Psychiatry

Polina Teslyar, MD, BWH Psychiatry

Director, Women's Mental Health and Reproductive Psychiatry Fellowship, Department of Psychiatry, Brigham & Women's Hospital
Instructor, Harvard Medical School

Claire Twark, MD, BWH Psychiatry

Daniel Weisholtz, MD, BWH Psychiatry

Associate Neurologist, BWH/MGB
Assistant Professor of Neurology, HMS

Course Reviewers:

Susan Sprich, PhD, APA Content Reviewer

Aaron R. Hoffman, DO, MPH, CME Content Reviewer

Jane Davis, CRNP, DNP, Nurse Content Reviewer

CE Information

Available Credit

  • 26.25 AMA PRA Category 1 Credit™

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of McLean Hospital and Massachusetts General Hospital. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians.

    McLean Hospital designates this Live activity for a maximum of 26.25 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  • 26.25 Nursing Contact Hours

    Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.

    This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 26.25 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.

  • 26.25 Participation

    This course allows other providers to claim a Participation Certificate upon successful completion of this course.

    Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.

  • 26.25 Psychologists CE Credit

    The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content.

    This offering meets the criteria for 26.25 Continuing Education (CE) credits per presentation for psychologists.

Register/Take course

Price

Cost:
$800.00
Please login or register to take this course.

Course Directors/Planners

Adrienne Taylor, MD

Sejal Shah, MD

David Silbersweig, MD

Heidi Holiver, DNP

Required Hardware/software

Hardware/Software Specifications

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, and Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration

Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
Internet Connection: 1 Mbps or higher

Minimum Requirements

Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit