Psychiatry PGY IIl

Description of Rotation or Educational Experience

The purpose of the resident rotation in Psychiatry is to provide the family medicine resident with a focused experience in the diagnosis and treatment of a wide range of psychiatric disorders in children and adults.  It would be expected that the resident will be able to read about a patient’s disorder, demonstrate his/her cognitive understanding of that clinical problem to the psychiatrist preceptor and then witness how the psychiatrist manages that patient’s problem.  Upon completion, each resident should be able to competently evaluate and manage any of the patient care issues delineated in the curriculum in an independent manner.  Each PGY III will participate in this focused interactive two-week required rotation under the direction and supervision of a board certified Psychiatrist, as well as supporting personnel of the Ozark Guidance Center.  This educational experience will be in the outpatient setting.  Residents will work with the preceptor on rotation seven half days per week attending outpatient clinics in adult psychiatry, child psychiatry, medication management and crisis intervention clinic.  The resident will spend three half days in their continuity clinic at the FMC.

Goal I: To gain the knowledge and skills to manage patients with psychiatric disorders/conditions.

Goal II: Recognize the need for proper referral and consultation to a psychologist/psychiatrist for those conditions that are beyond his/her capabilities.

Patient Care

Goal

Residents will provide patient care that is compassionate, appropriate, and effective for the treatment of health problems in the promotion of health. Residents are expected to have a measurable and progressive knowledge of the following:

Competencies

• Perform a mental status exam.
• Make appropriate notes on patients seen in the clinic.
• Seek supervision or consultation when needed for patients with psychiatric/behavioral problems.

Objectives

The resident will be able to:

• Manage and refer patients appropriately with behavioral problems.
• Stabilize the acutely psychotic patient.
• Effectively interview family members to facilitate patient care.

Medical Knowledge

Goal

Residents will demonstrate established and evolving biomedical, clinical, epidemiological, and socio behavioral sciences as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

The resident will gain cognitive knowledge and experience in the diagnosis and management of the following psychiatric disorders :

1.       Organic brain syndromes including dementia, delirium.

2.       Depression

3.       The suicidal patient

4.       Anxiety disorders

5.       Acute psychosis

6.       Personality disorders

7.       Psychopharmacology

8.       Substance abuse

Objectives

The resident will be able to:

• Interview patients with psychiatric complaints and make a diagnosis.
• Demonstrate a knowledge of and indications for antidepressants, benzodiazepines, and other psychotherapeutics.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

Competencies

• The physician/patient relationship
• Stages of stress in a family life cycle

Objectives

The resident will be able to:

• Prescribe effectively commonly used antidepressants, antipsychotics, and anxiolytics.
• Educate patients on reduction of mental health stressors.
• Demonstrate an ability to access appropriate resources such as UpToDate and DynaMed.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Become familiar with and utilize services provided by area mental health organizations.
• Become familiar with “The 72- hour Hold”.
• Become familiar with legal commitment.

Objectives

The resident will be able to:

·         Work with and understand the importance of the multidisciplinary team approach.

·         Discuss the role of and the importance of a support system for the patient with chronic severe mental illness.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Objectives

• Human Behavior & Mental Health issues require the resident to understand and practice compassion and be responsive to a diverse and vulnerable patient population.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to communicate effectively during:

Competencies

• Crisis Counseling
• Family Counseling
• Patient Counseling

Objectives

The resident will:

·         Learn patient interviewing and counseling skills that result in a therapeutic milieu.

Teaching Methods

Direct preceptor/resident interaction in the treatment of psychiatric disorders in children and adults at the Ozark Guidance Center in Springdale and various satellite locations.

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at AHEC Library:

Psychiatry for Primary Care Physicians – Larry S. Goldman, Thomas N. Wise, David S. Brody

This book will be given to the resident before the rotation:

Handbook of Psychiatric Drug Therapy  - Jerrold F. Rosenbaum, George W. Arana

On Line resources:

UpToDate and DynaMed