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Psychiatry Residency Training Program
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Residency Policies & Procedures
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The Department of Psychiatry faculty is responsible for ensuring that residents proceed through their educational/training program in a satisfactory manner. Assessment of clinical skills and competence should reflect a gradual and steady maturation with each rotation and new level of training. Residents should meet competency requirements for knowledge, patient care, problem-based learning, professionalism, interpersonal communication, systems-based practice, and specific psychotherapies in a manner appropriate for their level of training and consistent with the department's standards. Residents who, for whatever reason, are not making satisfactory progress, need to be informed of this promptly. Similarly, residents who demonstrate exceptional abilities should receive appropriate and timely praise.

I. Mechanisms for Evaluation

  1. Clinical Rotations

    Faculty should provide specific, informative, and constructive feedback to residents under their supervision during clinical encounters and throughout clinical rotations. For rotations of two months or longer, a midpoint evaluation should occur during a scheduled meeting. At the conclusion of each rotation, a written evaluation should be completed and reviewed with the resident in a scheduled meeting. Completed evaluation forms should be completed in a timely manner and forwarded to the program director so that they can be reviewed to assure that residents are progressing in a satisfactory manner.

  2. Didactics and Seminars

    Residents are expected to attend 85% of didactic and required seminar sessions (with the exception of sessions when they are on vacation, on other leave, or post-call). Teaching faculty should inform the resident in a timely manner of any concerns regarding attendance or performance in the class or seminar. At the conclusion of each required psychotherapy seminar, a written evaluation should be completed and reviewed with the resident in a scheduled meeting. Completed evaluations should be forwarded to the program director.

  3. Written and Oral Examinations

    Each year, all PGY-2 through PGY-4 residents take the annual American College of Psychiatrists Psychiatry Resident In-Training Examination (PRITE), a written, multiple-choice examination. Each resident also completes an oral "Mock Board" examination in each of the PGY-2 through PGY-4 years. The examining faculty member grades the resident's performance as "Pass", "Fail", or "Conditional" for his/her level of training. Each resident must pass at least one oral examination during the PGY-3 or PGY-4 year in order to graduate from the training program. Residents failing the examination in both PGY-3 and PGY-4 years will be offered a re-examination. Results of the PRITE and the annual oral examination are incorporated with written evaluations from attending supervisors to form an overall composite assessment of the resident's knowledge and skills.

  4. Departmental Review

    Twice a year, resident performance is reviewed with the training director or designee (preceptor) in a scheduled meeting with the resident. Written documentation of the review is maintained by the program director in the resident's permanent file.

II. Management of Problems

Evaluation of resident performance includes clinical competence, professional attitudes, and humanistic qualities. Each of these areas requires continuous improvement, commitment, and self-monitoring. Notable incidents of concern or praise should be channeled to a central authority and integrated into a composite assessment. The site's Assistant Training Director and then the Residency Training Director are the points of contact.
If problems arise, the program director should assess the quality of performance over time, the presence of temporary life crises, the educational responsiveness of the resident, and the impact of the resident on the program. The program director may notify or request assistance for remediation from the faculty preceptor, department Chair, members of the Resident Education Steering Committee, and/or the entire department faculty or an appropriate mental health specialist. Upon notification of a problem in cognitive, clinical, or interpersonal performance, the training director will decide whether the problem can be addressed through the normal evaluation process and/or informal measures or whether it requires a formal intervention and specific remediation program. The program director may use the category focus of concern for serious issues requiring remediation and the category probation for very serious issues that might lead to a failure to renew a resident's appointment or termination for cause.

III. Focus of Concern

Concerns may arise over clinical performance, following departmental policy or procedures, academic performance, documentation, interpersonal skills, professional and ethical conduct, or other features that negatively impact an individual's ability to carry out his/her duties. In determining that a trainee is a focus of concern, the supervising faculty should expect that the problem can be corrected immediately or within a defined period of time. A written notice of deficiency and corrective plan should be developed by the program director in consultation with the resident's preceptor and with support and concurrence from other faculty as needed. The elements of the written plan should include the following:

    1. Clear statement and analysis of the problem.
    2. Supportive and/or corrective intervention.
    3. A monitoring mechanism including a definite statement of the time at which re-evaluation will occur.
    4. Consequences if corrective action is not achieved.

This focus of concern documentation will be given to the individual and will not normally be considered part of the trainee's permanent file. However, it can be made part of the file at the discretion of the program director if complete remediation is not achieved. If the problem has been satisfactorily remedied at the time of re-evaluation, the documentation regarding focus of concern may be removed from the resident's permanent file.

IV. Probation

Probation may be designated because of significant deficits in a trainee's clinical or academic performance, professional and ethical conduct, or interpersonal skills; failure to fully remediate a focus of concern; a second incident directly following a focus of concern remediation effort; or other serious and persistent issues that negatively impact a trainee's ability to carry out his/her duties. In placing a trainee on probation, a written notice of deficiencies and corrective plan will be developed by the program director in consultation with the resident's preceptor and other relevant faculty. The written plan will have the following elements:

    1. Clear statement and analysis of the problem.
    2. Supportive and/or corrective action.
    3. A monitoring mechanism including a definite statement of the time at which re-evaluation will occur.
    4. Consequences if corrective action is not achieved.

The documentation of probation will become part of the trainee's permanent file and may be disclosed to other agencies or persons when the individual seeks hospital privileges or licensure or if the individual continues in graduate medical education in a different program. Re-evaluation to remove probation status will be made by the program director and other relevant faculty as designated in the written statement. Failure to achieve corrective action may result in extension of probation, non-renewal of appointment, or termination for cause. Procedures for non-renewal of appointment or termination for cause are specified in the individual's Residency Position Appointment. If a trainee is on focus of concern or probation status at the time of the annual review of all residents for reappointment, the Department may elect not to renew the resident's appointment until the designated time at which the resident's progress is re-evaluated, as designated in the written focus of concern or probation plan. The resident will be notified by the standard reappointment date that the decision about reappointment is being deferred.

(Approved by the RESC on March 13, 2002 and the Chair, Department of Psychiatry & Behavioral Sciences, on March 20, 2002.)

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Psychiatry Residency Training Program
1959 NE Pacific Street, Box 356560
Seattle, WA 98195-6560