Residency Policies & Procedures
V. CLINICAL ROTATIONS
GOALS AND OBJECTIVES FOR COMMUNITY PSYCHIATRY ROTATIONS
Goal: The goal of community psychiatry rotations is to
teach and provide supervised clinical experience in the comprehensive,
integrated care of patients with severe and persistent mental illness
in the community mental health system, including diagnostic assessment,
formulation of a treatment plan, provision of psychotherapy and/or psychopharmacologic
treatment as indicated, and working as an effective member of the multidisciplinary
Supervision: Each resident must receive a minimum of one
hour of direct supervision per day (or 30 minutes per half-day), and must
have direct access (in person or by telephone) to a supervising attending
at all times.
On completing the community psychiatry rotation, the resident is expected
to be able to:
1. Patient Care
- Perform adequate psychiatric diagnostic interviews, including establishing
rapport, eliciting important clinical information, and assessing emergent
issues (e.g. suicidality, homicidality).
- Include in the assessment developmental, psychodynamic, cognitive,
sociocultural, and other biopsychosocial factors contributing to the
presenting symptoms and important in treatment planning.
- Make appropriate multiaxial DSM-IV diagnoses.
- Develop individualized treatment plans, integrating medication, different
forms of psychotherapy, and community support resources as appropriate.
- Manage chronic psychiatric disorders over time, including the use
of medications, crisis intervention, patient education, and psychotherapy,
to maximize patient function and minimize the need for hospitalization.
- Use appropriate laboratory, neuropsychological, and other testing
in diagnosis and treatment.
- Use collateral information (e.g. from family members, caretakers,
other treatment providers, past treatment records) in assessment and
treatment, and display understanding of associated issues of confidentiality
and informed consent.
- Set appropriate goals for treatment, incorporating the patient's
- Demonstrate effective coordination of care with other members of
the treatment team, synthesizing their input in your assessments and
treatment planning. Attend team meetings where appropriate
- Display appropriate knowledge of treatment guidelines, best clinical
practices, and clinical pathways that can be used to guide treatment
planning. The resident should recognize both the importance and limitations
of published research and treatment guidelines in selecting treatment
interventions for particular patients.
- Demonstrate an understanding of the larger system in which the community
mental health center exists, including the effects of ITA laws, funding
3. Practice-Based Learning and Improvement
- Locate and critically appraise scientific literature relevant to
- Regularly use information technology in the service of patient care.
- Participate in practice-based improvement activities (e.g. improving
the resident's practice as a result of supervision and/or reading,;
case conferences; M&M-type case reviews; quality improvement projects)
4. Interpersonal and Communication Skills
- Engage patients in treatment; maintain a basic therapeutic alliance
throughout the duration of treatment.
- Engage patients around issues related to their recovery, addressing
their concerns in a holistic manner, instilling hope, and discussing
their own goals for treatment.
- Recognize the resident's own characteristic responses to patients
("countertransference") and the effects of these responses on treatment.
- Work effectively as part of a multidisciplinary outpatient team,
collaborating with other mental health providers involved in the care
of the patient (e.g. case managers, psychologists, social workers, nurses).
- Demonstrate respect for others, compassion.
- Demonstrate reliable attendance and appropriate professional attire.
- Demonstrate integrity, accountability, and an ethical approach to
outpatient treatment (e.g. maintaining professional boundaries, obtaining
informed consent for treatment).
- Demonstrate understanding of patients and their illnesses in a sociocultural
context, including displaying sensitivity to patients' culture, ethnicity,
age, gender, socioeconomic status, sexual minority status, and/or disabilities.
- Demonstrate concise, accurate, and timely record keeping.
6. Systems-Based Practice
- Provide clinically appropriate and cost effective care.
- Make appropriate referrals for further medical or surgical evaluation,
or for different levels of psychiatric care.
- Make appropriate referrals for optimal utilization of resources available
in the community mental health center.
- Appropriately advocate for quality patient care; help patients with
- Interact effectively with primary care providers and third party payers.
- Display effective team leadership skills, including the ability to
triage, prioritize tasks, and delegate work as appropriate.
8. Educational Attitudes
- Display openness to supervision; accept constructive criticism.
- Seek direction when appropriate; demonstrate eagerness to learn.