Residency Policies & Procedures
V. CLINICAL ROTATIONS
GOALS AND OBJECTIVES FOR THE VA PUGET SOUND VETERANS
ADMINISTRATION URGENT CARE PSYCHIATRY ROTATION
Goal: The goal of the Urgent Care Psychiatry rotation is to provide
a supervised clinical experience leading to the development of knowledge
and skills in the evaluation, crisis management, and triage of patients
seen in an urgent care setting. As part of this rotation, psychiatric
residents will learn to evaluate acute mental health problems specific
to veterans, including combat and non-combat related PTSD and military
sexual trauma. They will also complete a scholarly presentation related
to their urgent care experience.
On completing the Urgent Care rotation, the resident is expected to
be able to:
1. Patient Care
- Perform pertinent diagnostic interviews.
- Develop initial differential diagnoses.
- Establish rapport with and assess acutely ill psychiatric patients.
- Make rapid assessments of acutely psychotic patients.
- Rapidly and effectively evaluate and document suicidality and suicide
- Effectively evaluate and document dangerousness (including homicidality)
and intervene appropriately.
- Effectively assess alcohol and drug intoxication and withdrawal.
- Determine the appropriate level of care for each patient, admit patients
to the inpatient psychiatric service as indicated, and triage patients
to appropriate outpatient services.
- Document and describe the assessment and plan in a complete, accurate,
and succinct manner.
- Understand the medical, neurological, and other physiological causes
for psychiatric symptoms and seek medical, neurological, or other specialty
- Develop beginning brief crisis counseling skills.
- Use medications appropriately in an urgent care setting.
- Develop skills in the coordination of care for urgent care psychiatry
patients in consultation with current outpatient providers.
- Display appropriate knowledge of basic and clinical sciences relevant
- Display knowledge of the assessment and treatment of acute psychiatric
- Display knowledge of clinical syndromes frequently seen in the veteran
psychiatric population, including PTSD from combat, non-combat, or sexual
- Understand the usefulness and indications for stat laboratory and
other diagnostic tests.
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 (CQI), when
- Review and synthesize relevant literature and give a one-hour scholarly
presentation on a psychiatric topic of the resident's choice, related
to urgent care psychiatry.
4. Interpersonal and Communication Skills
- Create effective therapeutic relationships with patients, families,
and caregivers in the urgent care setting.
- Display empathic listening skills.
- Work effectively with social workers, nurses, and other medical staff.
- Display effective verbal and written communication skills.
- Demonstrate respect for others, compassion.
- Demonstrate integrity, accountability, responsible and ethical behavior.
- 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.
6. Systems-Based Practice
- Prioritize and expedite patient evaluation and referral from the
urgent care setting.
- Display familiarity with internal VA and community referral sources.
- Demonstrate understanding of when to make an MHP referral, make MHP
referrals when needed, write appropriate affidavits, and testify in
civil commitment court as indicated.
- Understand the legal principles of duty to warn and participate with
the supervising attending and site leadership in contacting an identified
potential victim who has been threatened, if necessary.
- Decide on the appropriate level of care for each patient.
- Display effective teamwork skills, including the ability to triage,
prioritize tasks, and share workload, as appropriate.
- Display skills in teaching and supervising medical students.
8. Educational Attitudes
- Display openness to supervision; accept constructive criticism.
- Seek direction when appropriate; demonstrate eagerness to learn.