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Psychiatry Residency Training Program
 
  Applicants Department GME Office Home School of Medicine UW UWHA

Residency Policies & Procedures
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V. CLINICAL ROTATIONS

GOALS AND OBJECTIVES FOR INPATIENT PSYCHIATRY ROTATIONS
ADVANCED LEVEL (PGY-2 OR LAST 3-4 MONTHS)

Goal:  The goal of inpatient psychiatry rotations is to provide supervised clinical experience and instruction in the assessment, diagnosis, and treatment of psychiatric inpatients with a variety of conditions. A further goal of inpatient psychiatry rotations at the advanced level is to have the resident lead the inpatient team, under the supervision of his/her attending.

Supervision: Each resident must receive a minimum of two hours of direct supervision per week, at least one of which is individual, and must have direct access (in person or by telephone) to a supervising attending at all times.

Objectives:
Residents completing inpatient psychiatry rotations at the advanced level are expected to:

1. Patient Care

  • Perform comprehensive psychiatric diagnostic interviews, including a formal mental status examination
  • Conduct comprehensive medical evaluations of psychiatric patients, including assessment of medical conditions likely to mimic or exacerbate psychiatric conditions; to make appropriate use of laboratory and diagnostic procedures; and to obtain consultation when indicated
  • Obtain collateral information from old records, family, outpatient treatment providers
  • Make accurate Axis I-V DSM IV diagnoses in psychiatric inpatients and generate thorough differential diagnoses
  • Independently articulate a biopsychosocial formulation which takes a longitudinal view of the patient's life history
  • Display sound independent clinical reasoning; formulate and implement comprehensive inpatient treatment plans integrating various treatment modalities as appropriate
  • Make appropriate discharge plans
  • Manage acute behavioral disturbances in a safe and effective manner
  • Demonstrate the ability to educate patients and families about psychiatric illness, treatment plans, medications, and the need for follow up care, and to conduct a family interview
  • Demonstrate the ability to provide brief psychotherapeutic interventions, such as supportive therapy, problem solving, coping skills training, and/or motivational interviewing with psychiatric inpatients.

2. Medical Knowledge

  • Display appropriate knowledge of basic and clinical sciences relevant to Psychiatry
  • Understand the indications for psychological and neuropsychological testing in the evaluation of psychiatric inpatients
  • Demonstrate knowledge of the basic principles and applications of the major classes of psychotropic medications, their limitations and side effects, and important possible drug interactions
  • Understand the indications, side effects, and effectiveness of electroconvulsive treatment (ECT)

3. Practice-Based Learning and Improvement

  • Regularly use information technology in the service of patient care
  • Locate and critically appraise scientific literature relevant to patient care, teach the rest of the team about literature findings, and use this information to improve patient care
  • Participate in practice-based improvement activities (such as case conferences, case reviews, and/or CQI projects)

4. Interpersonal and Communication Skills

  • Create and sustain effective therapeutic relationships with patients and families
  • Demonstrate comprehensive diagnostic interviewing skills (i.e. establishing rapport, clarifying the purpose of the interview, attending to cues, making transitions smoothly, demonstrating empathy, thoroughly eliciting important information necessary to make DSM IV diagnoses and inpatient treatment plans)
  • Develop a therapeutic alliance with patients, maintain appropriate professional boundaries, recognize transference and countertransference issues, and use this recognition constructively in treatment
  • Understand the role of other mental health professionals (nurses, social workers, psychologists, mental health specialists, occupational and recreational therapists, etc.) on the team, and work collaboratively with them, while providing leadership in a team context
  • Provide informative sign out to other providers caring for his/her patients (e.g. short call resident, night and weekend providers)
  • Communicate effectively with the patient's other care providers (e.g. outpatient mental health providers, primary care physicians)

5. Professionalism

  • Demonstrate respect for others, compassion
  • Demonstrate reliable attendance and appropriate professional attire
  • Demonstrate integrity, accountability, responsible and ethical behavior
  • Demonstrate "ownership", i.e. attitudes and behaviors consistent with being the patient's physician and taking responsibility to ensure that each patient receives excellent clinical care
  • 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 and pertinent record keeping, including the prompt completion of discharge summaries

6. Systems-Based Practice

  • Communicate effectively with insurance and managed care companies
  • Understand basic legal issues involved in inpatient psychiatry, including indications for involuntary commitment, the psychiatrist's role in involuntary commitment proceedings, informed consent, duty to warn, and medicolegal aspects of record-keeping
  • Understand milieu issues on the inpatient ward
  • Advocate for quality patient care and assist patients in dealing with health care system complexities

7. Leadership

  • Display effective team leadership skills, including the ability to triage, prioritize tasks, and delegate work as appropriate
  • Adjust leadership style to effectively work with a variety of team members and team dynamics
  • Recognize team priorities and patient needs and adjust and implement plans based on those assessments
  • Fully take on the role within the team as the primary "go-to" person for all patients
  • Display full, active involvement in running team and family meetings
  • Set expectations for medical student performance, evaluate students' strengths and weaknesses, and give feedback to and elicit feedback from medical students
  • Effectively teach medical students and test for retention and learning
  • Instruct students in interviewing and therapeutic skills

8. Educational Attitudes

  • Display openness to supervision; accept constructive criticism
  • Seek direction when appropriate; demonstrate eagerness to learn
  • Display flexibility, self-awareness, and the ability to continuously improve one's clinical skills and practice based on feedback

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Psychiatry Residency Training Program
1959 NE Pacific Street, Box 356560
Seattle, WA 98195-6560
206-543-6577
email: psychres@u.washington.edu