Residency Policies & Procedures
V. CLINICAL ROTATIONS
GOALS AND OBJECTIVES FOR OUTPATIENT PSYCHIATRY
Goal: The goal of adult outpatient psychiatry rotations
is to teach and provide supervised clinical experience in the comprehensive,
integrated care of psychiatric outpatients, including diagnostic assessment,
formulation of a treatment plan, and provision of psychotherapy and/or
psychopharmacologic treatment, as indicated.
Supervision: Each resident must receive a minimum of one hour
of direct supervision per clinic day (or 30 minutes per clinic half-day),
and must have direct access (in person or by telephone) to a supervising
attending at all times.
On completing the adult outpatient psychiatry rotation, the resident is
expected to be able to:
1. Patient Care
- Perform adequate psychiatric diagnostic interviews in an outpatient
setting, 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 in psychiatric outpatients.
- Develop individualized treatment plans for outpatients, integrating
medication and different forms of psychotherapy, as appropriate.
- Manage a wide variety of chronic or episodic 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 the diagnosis and monitoring of psychiatric outpatients.
- Use collateral information (e.g. from family members, caretakers,
past treatment records) in assessment and treatment, and display understanding
of associated issues of confidentiality and informed consent.
- Set appropriate goals for treatment and guide the patient through
the process to termination.
- 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.
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 individual clinical practice through supervision and
reading, case conferences, case reviews, quality improvement projects).
4. Interpersonal and Communication Skills
- Engage patients in treatment; maintain a basic therapeutic alliance
throughout the duration of treatment.
- Recognize his/her 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 inpatient psychiatric care.
- Appropriately advocate for quality patient care; help patients with
- Interact effectively with primary care providers and third party payors.
- 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.