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Psychiatry Residency Training Program
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Residency Policies & Procedures
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Supervision is designed to help residents to learn the principles and practice of Psychiatry. Residents are supervised throughout residency, as part of every clinical experience. Beginning residents have close, daily supervision. As residents progress through the residency, they will generally be supervised less closely and less frequently. Residents will be given increasing responsibility for patient care, in a graduated manner, appropriate to their level of training and skills. In addition, senior residents are expected to supervise junior residents (with attending backup) during training call. The program's policies regarding supervision are outlined in the Supervision Policy. The following Expectations Regarding Supervision constitutes an addendum to the Supervision Policy and covers more detailed and specific requirements for types of supervision at each PGY level, as well as general expectations regarding supervisory relationships in our residency program.

Overview of Specific, Required Types of Supervision by PG-year:

PGY-1 year

  • Daily supervision with inpatient Psychiatry attending on rounds
  • During Psychiatry rotations, one hour a week of supervision with the inpatient attending (apart from rounds)
  • One hour per week "off ward" supervision (on Psychiatry rotations) with a faculty member other than your inpatient attending. You can use this time to present and discuss cases, work on case formulation, interview patients with your supervisor, review literature, etc.
  • Back up attending supervision when on call (please see below for guidelines about when to contact your on-call backup attending)

PGY-2 year

  • Daily supervision with inpatient/consult/ER attending on rounds
  • One hour a week of supervision with inpatient/consult/ER attending (apart from rounds)
  • One hour per week of psychotherapy supervision (assigned)
  • Caseload supervision in clinic (i.e. supervision of your patient caseload by an on-site faculty member responsible for the patient care you provide)
  • Back up attending supervision when on call

PGY-3 year

  • Daily supervision with inpatient/consult/ER attending, as relevant
  • One hour/week of supervision with inpatient/consult/ER attending (apart from rounds), as relevant
  • Caseload supervision in every clinic (one hour per clinic day; may be in team/group format)
  • At least two hours per week of psychotherapy supervision
  • Back up attending supervision during clinic days and when on call

PGY-4 year

  • Caseload supervision in every clinic (one hour per clinic day)
  • At least two hours per week of psychotherapy supervision
  • Back up attending supervision during clinic days and when on call

Expectations Regarding Supervision
Interactions between residents and supervising faculty attendings are governed by the following principles:

  • interactions between residents and attendings are expected to be respectful, collegial, and focused on the common goal of excellent patient care
  • a resident should, at all times, have direct access (in person or by telephone) to a faculty attending
  • when the attending is on vacation or otherwise unavailable, a specific covering attending will be designated
  • a faculty attending on the clinical service in which patient care takes place is designated as the supervising attending and has the ultimate clinical and legal responsibility for the care provided, although the resident is encouraged (and may be required) to also consult with other clinical or regular faculty supervisors
  • residents will present new cases to the attending on daily rounds on the inpatient, emergency, and consultation-liaison psychiatry services. On outpatient rotations, the resident will present new cases to the attending (caseload supervisor) as soon as possible, and definitely within two weeks, and will provide regular updates for ongoing cases (monthly, or whenever the patient is seen if this is less often than monthly)
  • residents on Psychiatry services (i.e. not on Medicine, Pediatrics, or Neurology) will have at least two hours of individual supervision per week (including individual supervision with the inpatient/consult/ER attending, "off ward" supervision, psychotherapy supervision, and/or outpatient caseload supervision, as appropriate: see overview by PG-year, above)
  • as a teacher, the supervisor/attending is expected to provide the resident with information, guidance, and choices in patient care. The attending/supervisor needs to keep abreast of clinical issues on the service or with the resident's patient caseload, and supervision needs to be sufficiently close to allow him/her to notice problems
  • the attending/supervisor needs to monitor the resident's performance and give regular, constructive feedback. The attending/supervisor determines how closely the resident needs to be supervised and how much reporting he/she expects from a particular resident, depending on the resident's level of training, experience, and skills. The resident is expected to be open to learning, willing to consult, and prepared to fully inform the attending/supervisor about all patient care issues. It is strongly recommended that the expectations, terms, and goals of the supervisory agreement be made explicit in a collegial discussion between the attending/supervisor and the resident at the beginning of the supervisory relationship
  • as outlined in the Supervision Policy, the supervising attending needs to be informed by the resident: a) when the patient's condition deteriorates unexpectedly; b) when additional information puts the working diagnosis in doubt or questions the treatment plan; c) when information is obtained that raises concerns regarding the patient's risk for self-harm or harm to others; d) when the patient or family members disagree with the treatment plan; e) when there are serious disagreements or conflicts within the treatment team or with other services or providers; f) when decisions need to be made that have major clinical or legal implications, such as decisions not to hospitalize suicidal or homicidal patients
  • as outlined in the Supervision Policy, during on-call or night float duty, the resident will notify the on-call attending when: a) the resident has any questions or concerns about the patient or the care provided; b) when patients decide to leave AMA; c) when the resident intends not to hospitalize a patient seen in the ER who has expressed ideas of self-harm or harm to others; d) when the resident intends to turn down a request for admission; e) when the resident plans to send home from the ER a patient who has had a rapidly deteriorating clinical course (e.g. recent onset of mania, anorexia with significant recent weight loss). The resident will also call the on-call attending to review all consults.

Any resident or supervisor who feels uncomfortable with any supervision relationship, for whatever reason, should consult the Residency Director, Associate Residency Director, and/or Chief Resident at the clinical site for help and advice.


(Approved by the RESC on June 14, 2012.)

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