I. Mission and Goals of the Psychiatry Residency Training Program

Our department values the creation and practical application of new knowledge; excellence in teaching and evidence-based clinical practice; and the care of disadvantaged populations, including the seriously mentally ill and the rural underserved. We believe that psychiatrists are physicians who, as experts in brain and behavior, have a responsibility to advance the quality of psychiatric care and to reduce stigma associated with mental illness, not only through specialty practice, but also through consultation to other physicians and mental health care providers.

Graduates of the University of Washington Psychiatry Residency Program pursue careers in research, teaching, and clinical practice. However, the primary mission of the residency program is to train all of our graduates, regardless of their career goals, to be outstanding, well-rounded, and empathic clinical psychiatrists, able to integrate emerging science and clinical practice. We aim to teach those choosing clinical and academic teaching careers to bring a spirit of scientific inquiry and lifelong learning to clinical practice, and to ensure that those pursuing research careers have the clinical expertise and experience to recognize and pursue important, clinically relevant research questions.

In addition, we seek to foster each resident’s identity as a physician with the highest standards of professionalism and the ability to work collaboratively with other physicians and multidisciplinary teams. We provide a wealth of opportunities to work with clinically diverse populations, and aim to inspire residents to make a difference by working with those most in need.

II. Overall Educational Goals

The University of Washington Psychiatry Residency Program aims to provide an outstanding education in psychiatry, adhering to the Common and Psychiatry-specific requirements of the Accreditation Council for Graduate Medical Education (ACGME); preparing graduates for the Psychiatry examination of the American Board of Psychiatry and Neurology (ABPN); and equipping them for a wide variety of careers within Psychiatry.

Psychiatry residency requires 48 months of training, or 36 months if the resident enters the program at the PGY-2 level, after completing a clinical year of education in an ACGME-accredited specialty requiring comprehensive and continuous patient care, such as Medicine, Pediatrics, Family Medicine, or a Transitional Year. The program specifies elsewhere the mission of the program, and the goals and objectives for each PGY-level of training and for clinical and didactic experiences. Overall goals of the program are:

Patient Care

  • To provide high quality clinical experiences, rotations, and supervision in primary care, neurology, inpatient psychiageneralry, emergency psychiatry, consultation-liaison psychiatry, addiction psychiatry, geriatric psychiatry, child and adolescent psychiatry, and outpatient psychiatry, and exposure to forensic psychiatry, community psychiatry, and electroconvulsive treatment, as required by the ACGME.
  • To provide excellent training in diagnosis, differential diagnosis, pathophysiology, theoretical models, and treatments in psychiatry, including training in psychotherapies, as specified in the ACGME requirements.
  • To provide exposure to, and experience with, the diagnosis and treatment of patients with a wide variety of psychiatric conditions and an appropriate mix of ages, gender, socioeconomic status, ethnicity.
  • To provide supervision that is appropriate to the resident’s knowledge and skills, and to provide increasing autonomy and responsibility as the resident progresses through the program, as appropriate.
    To provide a variety of elective rotations, including opportunities to pursue research during residency.

Medical Knowledge

  • To provide regular, high quality didactics covering a range of topics, as required by the ACGME, and organized in a developmentally appropriate sequence across the years of training.
  • To provide other learning opportunities, such as regular conferences, Grand Rounds, case conferences, journal clubs and evidence-based psychiatry conferences, psychotherapy seminars to enhance residents’ acquisition of existing knowledge and skills in lifelong learning.

Practice-Based Learning and Improvement

  • To provide regular supervision, formative feedback, and evaluations, so that residents can incorporate feedback into their practice and education.
  • To provide instruction and experience in use of information technology in patient care; locating and appraising evidence from the literature; and applying it to patient care, as appropriate.
  • To provide instruction and experience in educating patients, families, other health care providers, medical students, and junior residents.
  • To provide case conferences, case reviews, self-assessment and goal-setting, quality improvement activities, and other opportunities for residents to examine and improve their practice.

Interpersonal and Communication Skills

  • To provide instruction and experience in communication with patients, families, other physicians, other health care providers, health care agencies, and the public, across a wide range of socioeconomic and cultural backgrounds.
  • To teach skills in consultation to other physicians and health care providers.
  • To provide instruction and experience in interviewing, empathic listening, and therapeutic interventions.
  • To teach skills in written communication, including maintaining timely, legible, and clinically appropriate medical records.
  • To teach skills in working in and leading multidisciplinary teams.

Professionalism

  • To foster professionalism in both faculty and residents and provide a supportive, respectful, and collegial learning environment.
  • To help residents to develop a professional identity as a psychiatrist, including demonstrating compassion, integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society and the profession; and, sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
  • To educate residents regarding, and promote thoughtful discussion of, ethical and professional issues particularly relevant to psychiatry.

Systems-Based Practice

  • To provide instruction and experience in working in different health care delivery systems.
  • To teach residents about specific issues in systems-based practice relevant to psychiatry, such as involuntary commitment, decisional capacity, other legal and forensic issues in psychiatry, resources in the system available for treatment and support of patients.
  • To foster a spirit of patient advocacy and skills in coordination of care.
  • To teach residents to incorporate considerations of cost effectiveness and risk benefit analysis into patient care.
  • To provide opportunities to identify and work to solve systems errors.

General

  • To foster a collaborative, collegial, supportive, respectful learning environment.
  • To provide high quality faculty supervision and teaching.
  • To ensure adequate resources, program leadership and staffing to allow a high quality education for residents.
  • To provide a routine, regular, fair evaluation process for residents and faculty.
  • To provide opportunities for residents and faculty to give feedback about the program, and to participate in program-improvement projects.
  • To provide a fair disciplinary, remediation, and grievance process, as necessary.
III. Residency Training Committees
a. Admissions Committee

The Admissions Committee is a subcommittee of the Resident Education Steering Committee (RESC). The responsibility of the Admissions Committee is the selection of applicants with strong academic records, who have the potential to become superior psychiatrists, and to make significant contributions to the field. The membership of the Admissions Committee consists of the Residency Program Director (Chair), at least five other regular faculty members of the Department of Psychiatry and Behavioral Sciences representing all clinical sites (UWMC, Harborview, Seattle VA, SCH) and six senior residents (PGY-3s or PGY-4s). The Admissions Committee meets weekly for 2 hours per week from November until mid-February, and for a whole day in mid-February to make the Match list. The committee considers PGY-1 and PGY-2 applicants according to the program’s Selection and Admissions Procedures.

The Idaho Track have its own Admissions Committee. Applicants to Idaho track are also reviewed by the Admissions Committee in Seattle, which has veto power regarding any Idaho Track applicant, since Idaho Track residents spend 1-2 years of training in Seattle.

b. Curriculum Review Committee

The Curriculum Committee is a subcommittee of the Resident Education Steering Committee (RESC). The responsibilities of the Curriculum Committee include the development, scheduling, and evaluation of the residency didactic curriculum, and revision of the didactic curriculum in response to resident and faculty feedback; ACGME requirements; and evolving priorities of the program, the department, and the field. The membership consists of Joseph Reoux MD (Chair), the Residency Program Director, the faculty didactic curriculum year coordinators (one or more faculty coordinators per PGY-level didactics year), other faculty representatives, and two residents from each PGY-level. The Curriculum Committee meets every two months.

c. Resident Education Steering Committee (RESC)

The Resident Education Steering Committee (RESC) is the formal education and policy making committee for the psychiatry residency program. This committee meets quarterly and oversees the planning, development, implementation, and evaluation of all significant features of the residency program, including:

  • Resident selection, evaluation, advancement, and approval for graduation. Resident selection is delegated to the Admissions Committee, which reports to the RESC. The Site Coordination Committee serves as a resident progress committee and performs initial assessments of each resident’s performance, annual review for advancement, and meeting graduation criteria. The RESC makes formal advancement and graduation decisions, and decisions regarding resident disciplinary actions.
  • Establishing educational standards for the clinical rotations and experiences and ongoing evaluation of clinical rotations and teaching faculty. All required and elective rotations must be approved by the RESC. The Site Coordination Committee provides ongoing, informal, monthly assessments of clinical rotations and teaching faculty, and reports to the RESC.
  • Development and evaluation of the didactic curriculum. Responsibilities in this area are delegated to the Curriculum Committee, which reports to the RESC.
  • Establishing administrative policies and procedures for the residency program, and facilitating communication between faculty and residents regarding training issues. Approval by the RESC is required for all standing policies of the residency program.
  • Performing the annual review of the residency program. The RESC uses program performance data, such as Match results, performance of residents and graduates on the PRITE and ABPN examinations, initial jobs/positions of graduates, resident national awards, confidential annual evaluations of the program by residents and faculty, Internal Review and/or ACGME decisions, to review and evaluate the program as a whole, identify necessary action plans, and track progress regarding areas identified as needing improvement.

Decisions made by a majority vote of a quorum of at least 2/3 of the membership eligible to vote on a particular issue (e.g. junior residents are not eligible to vote on advancement of more senior residents), are binding, with the provision that the decision can be appealed to the Chair, who will hear the arguments and make a final determination within 60 days.

The procedure for review of decisions regarding non-reappointment or non-promotion is as specified in the Graduate Medical Education Academic and Professional Conduct Policy.

The membership of the RESC is as follows:

  • Residency Director (Chair)
  • Recording Secretary (Residency Program Supervisor/Coordinator)
  • Two resident representatives from each PGY-level:
  • The chief residents
  • The Assistant Residency Director or other faculty representative from each Seattle site (UWMC, UWPOC, HMC, VA, SCH)
  • The Directors of the Spokane and Idaho Tracks
  • The Chair of the Curriculum Committee
  • The Director of each subspecialty residency program (Child and Adolescent, Addiction, Forensic, and Geriatric Psychiatry, and Psychosomatic Medicine) or his/her designee (a member of the subspecialty program’s teaching faculty)
  • The Director of each residency interest group/track (e.g. Neuroscience, Community Leadership)

The RESC includes the following subcommittees:

  • Admissions Committee
  • Curriculum Committee
  • Site Coordination Committee

The RESC meets quarterly, although additional meetings can be requested by any member. The agenda is set by the Residency Director. Members can request to have issues placed on the agenda. Recurring issues include the annual program review (July/August and October), annual review of the duty hours policy (October), annual review of residents for advancement (January), approval of residents for graduation and selection of recipients of graduation awards (May/June).

d. Site Coordination Committee

The Site Coordination Committee is a subcommittee of the Resident Education Steering Committee (RESC). At each major clinical site, the Psychiatry Residency Program is coordinated by a faculty member, appointed by the Chair in consultation with the Residency Director and Chief of Service, as the clinical site’s Assistant Residency Director. The Assistant Residency Directors, Chief Residents, and Residency Program Director form the Site Coordination Committee, which meets monthly to:

  • Review the residency program, rotations, and teaching faculty at each site
  • Conduct resident evaluation and progress review
  • Conduct the annual review for advancement of each resident
  • Discuss issues of coordination between sites, rotation requirements, site conferences and other educational programs, resource needs, etc.

The Site Coordination Committee reports to the Resident Education Steering Committee (RESC). The committee meets on a monthly basis. The meeting location rotates between the sites.

e. Wellness and Community Committee

Goals & Objectives

  • Enhance resident wellness on an individual and group level
  • Strengthen community both within and between residency classes

Methods

  1. Committee
    The committee will be comprised of 2 residents from each class. In certain circumstances, a new R2 may join the committee as an additional member. The committee will be overseen by the recruitment chief, as a ninth member (if they are not already one of the committee members). The recruitment chief will communicate with the program director during regularly scheduled chief meetings, or as additional needs arise. The committee may request a faculty advisor for additional support and guidance.
  2. Meetings
    The committee will meet in person or by phone/video conference every 3 months, unless the group collectively feels that more or less frequent meetings are necessary.
  3. Role
    The committee members will serve as a community & wellness leader for their class. They will be responsible for leading a “community vision” discussion (see attached guidelines) once a year, which can build upon the previous year’s discussion after the R1 year. They will also be responsible for following up on the goals their class sets. They can link their activities to T-groups if they feel this is appropriate. The committee will also consider whether there should be an all-residency community vision discussion during the annual retreat.  The committee members should be in communication with the retreat planning committee, though they do not necessarily need to be the same groups. Committee members may organize in support of an individual resident in the event of an observed/expressed need for wellness (eg in the event of a death, birth, etc). The committee should prioritize supporting community-building among the R1s and new R2s.
  4. Funding
    In addition to following up on each class’s goals, the committee will be responsible for allocating $4,000 annually to support wellness and community activities. At least $800 of this should be devoted to entire-residency activities (in which case, an additional $800 would go to each class). All expenses must be pre-approved by the committee (as well as by usual department approval policies), and must be for events that everyone in the class/residency is invited to attend. The committee can determine the minimum number of people who must be in attendance for the event to qualify. Alcohol cannot be paid for with these funds according to UW bylaws.
  5. Selection of committee members
    The program director will email each class (or R1s in subsequent years) with an invitation to join the committee, with the following description:We are looking for 2 people from each class to serve as members of the wellness and community committee. The committee will meet about every 3 months. The members are responsible for leading a community vision discussion among their classmates each year, and then following up on goals set by their class.  The committee as a whole will be able to allocate some residency funding to support wellness and community activities. The committee will also take on other infrequent tasks, including supporting the retreat planning committee and organizing support for individual residents as needed. For R1s, ideally the 2 members would be on offset cycles (1 on psychiatry, 1 off-service at a given time), but this is not a requirement.If more than 2 people respond with interest, the class will be asked to discuss amongst themselves who would be most interested and appropriate (this would likely occur in T-group, if after an advance announcement the class agrees to have the discussion in this space). If they cannot decide, the recruitment chief will organize a vote. Committee members will serve for all 4 years of residency. If they leave the residency early (Idaho track, fast-tracking) they will find someone to replace them.
IV. Selection and Admission Procedures
a. Overview

Through its Selection and Admissions procedures, the University of Washington Psychiatry Residency Program aims to select residents with strong academic records, who have the potential to become superior psychiatrists, and who show promise of making significant contributions to the field.

Residents may enter the program at the PGY-1 or the PGY-2 level. Residents entering at the PGY-1 level complete the four-year program. Those entering as PGY-2s complete the three-year program and must previously have successfully completed an ACGME-accredited PGY-1 year in Psychiatry, Medicine, Family Medicine, or Pediatrics; or an ACGME-accredited Transitional PGY-1 year; or one year of an ACGME-accredited residency in a clinical specialty requiring comprehensive and continuous patient care. A total of four years (48 months) of approved training is required to be eligible for certification by the American Board of Psychiatry and Neurology.

Candidates for PGY-1 positions must apply through the Electronic Residency Application Service (ERAS). All of our PGY-1 positions are filled through the National Resident Matching Program (NRMP). PGY-2 positions are filled outside the Match on a rolling admissions basis throughout the year, until all positions are filled.

The selection process is personally supervised by the Residency Training Director on an ongoing basis. After a preliminary review by the Program Coordinator to ensure that application files are complete, the Residency Training Director makes decisions regarding invitations for interviews, on the basis of the policies described below. Final decisions regarding admission and ranking of candidates are made by the Admissions Committee.

Admissions Committee

The Admissions Committee is a subcommittee of the Resident Education Steering Committee (RESC), to which it reports. The Admissions Committee is chaired by the Residency Training Director and consists of: a) the Residency Training Director; b) five other regular faculty members of the Department of Psychiatry and Behavioral Sciences; c) six senior residents; and d) the Program Coordinator (non-voting).

Procedures

Step 1: Response to Requests for Information

  • All physicians and medical students requesting information about the program are referred to the Psychiatry Residency Training Program recruitment website.
  • The recruitment website is intended to provide comprehensive and accurate information about the program and is regularly reviewed. Major changes in the content of the website require approval of the RESC.
  • Further specific information about the program is furnished to candidates with special interests or circumstances by the Program Coordinator or Program Director upon request.

Step 2: Selecting Candidates for Interviews

  • Applications are reviewed by the Program Coordinator and Program Director for: a) completeness; b) licensing and/or USMLE information; c) special experiences and training (e.g. research, special rotations/externships, community service, work experiences); d) strong grades and/or letters of recommendation. Applications from physicians and medical students trained outside the United States are also reviewed for: a) ECFMG certification; b) VISA or citizenship status; c) the quality of the training completed; and d) command of the English language. If the review indicates that the applicant is competitive, he or she becomes part of the pool of candidates for selection for interviews.
  • Decisions to invite candidates for an interview day are made by the Residency Training Director on the basis of academic performance (e.g. grades, prior training, USMLE scores), interpersonal skills (e.g. as evidenced in letters of recommendation), promise for Psychiatry (e.g. as demonstrated in performance on Psychiatry rotations, in letters of recommendation, in the personal statement, and through relevant extracurricular activities), special experiences (e.g. research, leadership activities, community service), and other factors representing a good “match” with our program (e.g. interest in practicing within the WWAMI region, in underserved populations, in pursuing an academic career, etc.). The program seeks to recruit a diverse and talented group of residents with a variety of interests and with the potential to be clinical, community, and research leaders in our field.
  • If an applicant has been told that his or her application does not appear to be competitive but nevertheless requests to be interviewed, this request will be granted.

Step 3: Interviews

  • Each applicant is interviewed by at least three faculty members and one resident.
  • Each interviewer rates the applicant in terms of: a) general acceptability and b) academic, clinical, and psychological potential, and submits written comments to the Residency Training Office.

Step 4: Admission/Ranking

  • All candidates who have been interviewed are presented to the Admissions Committee. For each applicant, the application package and interview reports are reviewed in depth and presented to the whole Committee by two committee members. The whole Committee then reviews the application and interview reports and discusses the candidate.
  • For PGY-2 applicants, the Committee then votes to offer the candidate a position, to wait to review other applications before making a final decision, or not to offer the candidate a position. PGY-2 positions are filled on a rolling admissions basis until all spots are filled. At that time, all remaining PGY-2 candidates are informed that all of the positions have been filled.
  • For PGY-1 candidates, the Committee ranks each applicant. The Committee decides which applicants will be listed on the program’s NRMP Rank list and in which order. Special consideration is given to target exceptional candidates interested in research, in Child Psychiatry, or in public/community psychiatry for recruitment. The program does not offer positions and does not make any binding commitments to PGY-1 candidates before the results of the Match are known.
  • During the selection process, the Admissions Committee can request the Residency Training Office to obtain additional information about a candidate or to invite a candidate for a second series of interviews before coming to a decision about offering the candidate a position or before ranking them for the Match.
b. Evaluation of Credentials and Performance of Applicants to the Three Year Program

Applicants transferring from a training program in psychiatry: The Training Director of the applicant’s residency program will be contacted by telephone or e-mail (see Appendix F). Specific information will be obtained about

  •  All clinical and didactic experiences for which the resident has received credit,
  • The exact dates of these experiences (with special emphasis on the completion of neurology rotations),
  • The resident’s performance (fund of knowledge, clinical judgment), and
  • The resident’s professional integrity (empathy towards patients, professional interactions, motivation to learn). This information may lead to suggestions for adjustment of the incoming resident’s rotation schedule, depending on the degree to which the prior training is equivalent to that at the UW. It is recommended that all this information be recorded on a standardized form.

Applicants, transferring after a transitional year or another, approved non-psychiatric clinical internship year: A telephone contact with the Internship Training Director is recommended, and should be documented on the same form mentioned under 1 above. Alternatively, a letter of reference from the Internship Training Director, certifying the training and addressing the issues of medical knowledge, clinical competency, and professionalism, is also acceptable. The applicant will be responsible for documenting any credit for neurology rotations which he or she has obtained.

Applicants who have completed residency training in another clinical specialty, or who have completed two or more years of training in another clinical specialty: The applicant will be asked to either document Board Certification or obtain a letter of reference from their previous Training Director, certifying the prior training, and addressing the issues of medical knowledge, clinical competency, and professionalism. The applicant will be responsible for documenting any credit for neurology rotations which she or he has obtained.

c. Recruitment of Child and Adolescent Psychiatry Residents

Selection Procedures

Definitions:

  • Resident applicant in this context means a resident of, or an applicant to the UW Psychiatry Residency Training Program who intends to apply for a Child and Adolescent Psychiatry Residency.
  • Outside Applicant is anyone applying for a Child and Adolescent Psychiatry Residency position who is not a resident in the UW Psychiatry Residency training Program, and does not intend to apply for a general residency position in this program.
  1. Candidates applying for a position in the UW General Psychiatry Residency Training program and expressing an interest in Child and Adolescent Psychiatry.
    • The Residency Training Office determines which candidates are sufficiently qualified to be invited for interviews.
    • The Residency Training Office ensures that the candidates who express an interest in Child and Adolescent Psychiatry visit CHRMC and meet with members of the Division of Child and Adolescent Psychiatry
    • CHRMC faculty report their impressions about the candidate on the interview report form (Appendix E). A copy of the interview report form is sent to Dr. Varley, the Training Director for Child and Adolescent Psychiatry.
    • The Training Director of the Child and Adolescent Psychiatry Residency is a permanent member of the Resident Admissions Committee
  2. Applicants from the General Psychiatry Residency Program at the University of Washington who wish to apply for a position as a resident in Child and Adolescent Psychiatry at the University of Washington will be referred to the Child and Adolescent Psychiatry Training Director to make application to participate in the competitive selection process organized by the Division of Child and Adolescent Psychiatry. University of Washington General Psychiatry resident applicants will be given preference over equally qualified outside applicants.
  3. Outside applicants: Outside applicants apply directly to the Residency Office of the Division of Child and Adolescent Psychiatry and participate in the competitive selection process.

Appointment Procedures

  1. The Child and Adolescent Psychiatry Residency Training Director will receive a copy each year of the allocated position list. The Child and Adolescent Psychiatry Training Director can, at all times, contact the Residency Training Office to discuss the status of the position availability, and the projections.
  2. The Child and Adolescent Psychiatry Residency Training Director, the Psychiatry Residency Director, and the Program Coordinator will meet each year in June, and in December to plan for the hiring of new residents/fellows one year in advance, and to review the projections for the next 24 months. The meeting will be organized by the Residency Training Office.
  3. The Residency Training Office will maintain a roster of Child and Adolescent Psychiatry Residents, with expected date of hiring, and dates of termination.
  4. Residency in Child and Adolescent Psychiatry begins after completion of the PGY-3 year with the exception of residents in the Spokane Track (see Spokane Track schedule) Residents from the General Psychiatry Residency at the University of Washington may apply for a position in the Child and Adolescent Psychiatry residency at any time. If they apply on or after July 1, in the year prior to beginning a July I position, they must go through the NRMP Match. They can be considered for a position outside the Match if they apply more than a year before the July I appointment date.
d. Resident Admissions Policy – Child and Adolescent Psychiatry and Community Psychiatry

Purpose: Actively recruit highly qualified applicants with strong interest in becoming Child and Adolescent Psychiatrists or in becoming Community Psychiatrists

Policy:

  • Resident applicants who have an interest in child and adolescent psychiatry will be interviewed by CHRMC faculty; applicants with an interest in community psychiatry will be interviewed by faculty from the Community Psychiatry Division. They will be evaluated as to (a) the strength of their commitment to becoming Child and Adolescent Psychiatry Residents or Community Psychiatry Residents, and b) their qualifications as future child or community psychiatrists.
  • At the final ranking of the candidates one of the factors which will be considered is their interest in Child and Adolescent Psychiatry or Community Psychiatry.
V. Clinical Rotations
a. Attending/Resident General Policies
  • There should be equity between sites regarding attending functions so that each site is suitable for beginning as well as more experienced residents.
  • There should be a minimum of three patient interviews during a three month rotation conducted by the Attending, and observed by the Resident, and a similar number conducted by the Resident, and observed by the Attending. The interview should last at least thirty minutes. These interviews are in addition to the one hour of supervision. This requirement reflects the importance of modeling, and providing feedback in the interview situation.
  • Inpatient attending duties should represent at least one half-time clinical position. Good inpatient care and teaching requires a minimum of this commitment. The occurrence of resident difficulties, patient emergencies, care planning meetings, and other important teaching functions take considerable time. While this time commitment in itself does not guarantee good attending teaching, it makes the Attending less hurried, and provides an atmosphere that enhances the development of a good attending-resident relationship. The attending becomes a vital part of what occurs on the ward. There are important roles for faculty providing lesser time commitments in the inpatient setting, but these consultation roles should not substitute for the more involved primary attending position.
  • Monthly meetings at each site between Attendings and Residents are strongly encouraged. This is an excellent forum for Attendings and Residents to discuss problems in a collegial way, make appropriate changes in policies, and fine tune the system.
b. Coverage During Absences (Vacation, Sick Leave, etc.)

Absence of the Attending

  • A covering Attending will be designated.
  • The covering Attending functions more in a consultant role; if the regular Attending’s absence is of short duration (less than one week), the covering Attending should see the new patients, review the treatment plans, and be available for spot problem solving.
  • For longer absences (in excess of two weeks), the covering Attending should become more closely familiar with the patients and the unit, and take on the full responsibilities described above.

Absence of the Resident

  • No vacation can be taken in the last week of June or the first week of July. Resident vacations may not overlap for residents on one service. Residents may not take vacations during prolonged absence of their Attendings.
  • Vacations need to be arranged in advance with the Attending (to rule out Attending absence), the Chief Resident (to rule out overlap), and the Psychiatry Residency Program. Residents will arrange their vacation plans as early as possible, and submit the proper form to the residency office, no later than 30 days in advance of vacation leave.
  • Residents will attempt to (a) schedule vacations after the medical students have been on the service for a few weeks, (b) “load their teams up” with patients before going on vacation, thus avoiding too many new admissions during their absence, and (c) avoid “team-of-the-week” assignment during the vacation time, etc.
  • Within reason, Attendings can agree for the team of the absent Resident to be smaller in size.
  • New admissions: Day-time admissions should go to the non-vacationing Resident’s teams. The absent Resident’s team should take admissions at night-time, and on weekends, with work-ups provided by the on-call Resident. In the unusual circumstance that a daytime admission needs to go to the absent Resident’s team, the Attending should consider letting the medical student work the patient up under his/her supervision.
  • Day-to-day management of the absent Resident’s patients will be done by the Attending. However, another Resident (called the “back-up Resident”) will be available for emergency consultation to the medical student, to answer general questions from the students, and the nursing staff, to cosign non-critical orders, and to provide emergency care (especially medical care). These activities are done in a spirit of positive collaboration.
  • The “back-up Resident”, and the Attending of the absent Resident, are asked to communicate coverage problems to the Residency Training Director. If an Attending feels that the back-up Resident is unresponsive to reasonable requests, or if the Resident feels “dumped upon” by the Attending, they should call the Training Director, and give a brief description of the incident.
  • The Attending will supervise the medical student, and give clear guidelines with regard to daily orders and progress notes. The medical student will report to the Attending.
  • Who is the “back-up Resident”? The back-up Resident will be the Resident of the “other” team on the unit; alternatively, a rotating system of back-up Resident assignment is to be worked out by the Assistant Training Director and the Chief Resident.
  • If sick leave is anticipated to be more than two days, a “back-up Resident” will be assigned to help out as in the case of vacation.
  • Residents on non-inpatient assignments (E/R, consultation-liaison) cannot be asked to function as back-up Resident
c. Guide to Writing Clinical Notes
d. Elective Rotations: Limitations

Elective rotations are an important part of a Resident’s education, and our program prides itself in the number, and diversity of available electives. However, there are a few limitations to what one can do.

  • Educational limitation: The elective needs to be sponsored, and supervised, by clinical or regular Departmental faculty.
  • Malpractice limitation: If the elective is not a clinical operation of one of the UW Affiliated Hospitals, it needs to be approved as an off-site, community psychiatry or cross-cultural rotation for reasons of malpractice insurance. Off-site rotations are only acceptable if they are sponsored by the Division of Community Psychiatry/Cross-Cultural Psychiatry; international rotations require the approval of the Associate Dean for Clinical Affairs.
  • Financial limitation: If the elective does not come with a salary, the request for the elective rotation needs to be reviewed by the Residency Training Office to determine if funds are available to pay the Resident’s salary. (An unexpected imbalance between the number of people in funded and unfunded positions could potential create salary/budget problems. Lease research all options before requesting elective rotations.)

NOTE: Elective rotation form: Once your elective plans are finalized, you need to fill out the elective rotation form (see Appendix O) and return it to the training program office. Your salary can not be processed unless the residency program office has been informed exactly at which site you are for each half-day of the week.

e. Goals and Objectives for Addictions Psychiatry Rotations

Goal: The goal of addiction psychiatry rotations is to provide supervised clinical experiences increasing the resident’s knowledge and skills in the assessment and treatment of substance use disorders and coexisting psychiatric conditions.

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.

Objectives:

Residents completing addiction psychiatry rotations are expected to:

  1. Patient Care
    • “Perform comprehensive evaluations of patients with substance use disorders, including assessment of associated medical, legal, and psychosocial consequences of substance use; social support and psychosocial stressors; prior history of and risk for withdrawal symptoms; and comorbid primary and secondary psychiatric conditions.
    • Display the ability to diagnose DSM-V substance use disorders and to assess their severity.
    • Develop comprehensive stabilization and treatment plans for patients with substance use disorders, integrating various treatment modalities as appropriate.
    • Display clinical skills in the treatment of patients with substance use disorders and dual disorders, including an understanding of the indications for and basic principles of pharmacologic, psychoeducational, group, and/or individual therapy approaches
  2.  Knowledge
    • Display knowledge of the expected symptoms, risks, course, and treatment of intoxication with, addiction to, and withdrawal from alcohol and other commonly used drugs, such as cocaine, marijuana, stimulants, opiates, hallucinogens, sedative-hypnotics, and tobacco.
    • Display knowledge of how coexisting substance use and other psychiatric disorders (“dual diagnosis”) can interact with and exacerbate each other, and the implications of these interactions for treatment.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care
    • Regularly use information technology in the service of patient care
    • Participate in practice-based improvement activities (CQI; e.g. case conferences, M&M-type case reviews, quality improvement projects)
  4. Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients and families
    • Display empathic listening skills
    • Work effectively as part of a multidisciplinary team in the care of patients with substance use disorders with or without coexisting psychiatric disorders.
  5.  Professionalism
    • Demonstrate respect for others, compassion
    • Demonstrate integrity, accountability, responsible and ethical behavior
    • Demonstrate understanding of patients and their illnesses in a socio-cultural context, including displaying sensitivity to the patient’s culture, ethnicity, age, gender, socioeconomic status, sexual minority status, and/or disabilities.
  6.  Systems-Based Practice
    • Display an understanding of the health care system and of the broader context of the patient’s care; effectively accesses and utilizes resources; practices cost effective care
    • Appropriately advocate for quality patient care; help patients with system complexities
  7.  Leadership
    • Display effective team leadership skills, including the ability to triage, prioritize tasks, and delegate work as appropriate
    • Display skills in teaching and supervising medical students
  8.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism
    • Seek direction when appropriate; display eagerness to learn
f. Goals and Objectives for Adult Outpatient Psychiatry Rotations

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.

Objectives:
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-V 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.
  2.  Knowledge
    • 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 patient care.
    • 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).
  5.  Professionalism
    • 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 system complexities.
    • Interact effectively with primary care providers and third party payors.
  7.  Leadership
    • 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.
g. Goals and Objectives for Brain Stimulation and ECT Rotations

Goal: The goal of the neuroradiology rotation is to provide a supervised experience and to gain procedural competency in ECT and TMS.

Objectives:
Completing the Brain Stimulation rotation, the resident is expected to be able to:

  1. Patient Care
    • Understand the clinical indications and preparation for ECT, TMS, VNS, DBS and be able to comfortably communicate these to patients and their providers.
    • Gain competency in treatment planning for ECT and TMS patients.
    • Perform basic outpatient brain stimulation consultation.
  2. Knowledge
    • Display basic knowledge of the basis and mechanism of neuromodulation treatments, their risks, and clinical uses.
    • Display basic knowledge in how to run an ECT clinic, procedural set-up, evidence-based procedural technique and managing side effects related to ECT.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise relevant scientific literature.
    • Use conferences, supervision, readings, and reference materials to improve his/her knowledge of neuromodulation therapies.
  4.  Interpersonal and Communication Skills
    • Establish rapport with patients and engage them in the evaluation and treatment process.
    • Provide an explanatory model for their symptoms that facilitates their acceptance of brain stimulation treatments.
    • Communicate effectively with primary providers, patients and families to help them to understand psychiatric conditions in their patients and brain stimulation treatment.
  5.  Professionalism
    • Demonstrate respect for others.
    • Demonstrate integrity, accountability, responsible and ethical behavior.
    • Demonstrate a commitment to excellence.
  6.  Systems-Based Practice
    • Understand issues of cost-effectiveness in the use of brain stimulation in the overall context of patient care.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
h. Goals and Objectives for Chief Resident Rotations

Goal: The goal of the chief resident rotations is to provide supervised experience in leadership, administration, and teaching of psychiatry residents and medical students.

Supervision:
Each chief resident meets with the Assistant Residency Director and Chief of Service at his/her site on a regular basis, with the Residency Director twice a month, and with the Department Chair monthly.

Objectives:
Residents completing chief resident rotations are expected to:

  1.  Patient Care
    • Serve as a role model for other residents in delivering and ensuring excellent patient care.
    • Assist other residents with patient care issues and emergencies, as needed.
    • Make short call, continuity clinic, and other resident work schedules to ensure coverage of patient care responsibilities.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to Psychiatry.
    • Display appropriate knowledge of residency policies and procedures, and ACGME requirements.
  3.  Practice-Based Learning and Improvement
    • Model use of information technology in the service of patient care.
    • Locate and critically appraise scientific literature relevant to patient care.
    • Teach residents and medical students.
    • Organize and participate in practice-based improvement activities (CQI; e.g. case conferences, M&M-type conferences, quality improvement projects).
  4.  Interpersonal and Communication Skills
    • Display effective written and oral communication skills.
    • Display collaborative problem-solving skills.
    • Understand the role of other mental health professionals (nurses, social workers, psychologists, mental health specialists, occupational and recreational therapists, etc.) in the clinical care settings at the site, and work harmoniously with them, while providing leadership in a team context.
    • Communicate clearly and effectively with residents and faculty, including informing them of requirements, problems, and issues related to the functioning of the residency program.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • Demonstrate integrity, accountability, responsible and ethical behavior.
    • Maintain confidentiality of residents, students, faculty, and patients, as indicated.
    • Model 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.
    • Model concise and pertinent record keeping, including the prompt completion of discharge summaries.
  6.  Systems-Based Practice
    • Demonstrate understanding of the role of the residency staff, faculty attendings, nursing and other mental health care professionals, residency Program Director and Assistant Directors,
    • Chiefs of Service, and Chair in raising and resolving issues.
    • Demonstrate understanding of, and sensitivity to, the mission, goals, regulations, and procedures of clinical services at the site and within the department.
    • Advocate for quality patient care and resident education, and assist residents and 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.
    • Display skills in teaching and supervising residents and medical students.
  8.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
i. Goals and Objectives for Child and Adolescent Psychiatry Rotations

Goal: The goal of Child and Adolescent Psychiatry rotations is to provide an organized clinical experience, under the supervision of qualified child and adolescent psychiatrists, in the evaluation, diagnosis, and treatment of children, adolescents, and their families.

Supervision: Each inpatient/consult 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. For outpatient rotations, each resident must receive a minimum of one hour of direct supervision per clinic day (or 30 minutes per clinic half-day).

Objectives:
On completing the Child and Adolescent Psychiatry rotation, the resident is expected to be able to:

  1.  Patient Care
    • Evaluate children and adolescents of different ages and with a variety of psychiatric conditions, and their families.
    • Make appropriate Axis I DSM-V diagnoses of children and adolescents.
    • Gather information from a variety of sources, including the child/adolescent, their family, their school, and relevant social or mental health agencies involved in their care.
    • Develop and implement appropriate treatment plans, including psychopharmacologic treatment and individual and family therapy.
    • Understand indications for intervention in, and how to refer, children of the resident’s own adult patients.
  2.  Knowledge
    • Demonstrate adequate knowledge of child development and psychopathology.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care.
    • Regularly use information technology in the service of patient care.
    • Participate in practice-based improvement activities, including improving his/her practice as a result of supervision, case conferences, M&M-type case reviews, or quality improvement projects.
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients and families.
    • Display empathic listening skills ” Work effectively with health care professionals (including those from other disciplines), colleagues, and staff to provide patient-focused care.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • Demonstrate reliable attendance and appropriate professional attire.
    • 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.
    • Demonstrate concise, pertinent, and timely record keeping.
  6.  Systems-Based Practice
    • Display an understanding of the health care system and the broader context of the patient’s care; effectively access and utilize resources; practice cost effective care.
    • Appropriately advocate for quality patient care; help patients with system complexities.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
j. 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 treatment team.

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.

Objectives:
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-V 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 own priorities.
    • 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
  2.  Knowledge
    • 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 sources, etc.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care.
    • 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).
  5.  Professionalism
    • 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 system complexities.
    • Interact effectively with primary care providers and third party payers.
  7.  Leadership
    • 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.
k. Goals and Objectives for Consultation-Liaison Psychiatry Rotations

Goal: The goal of consultation-liaison psychiatry rotations is to provide organized instruction and supervised clinical experience in the evaluation of psychiatric and/or behavioral problems in patients on medical and surgical services, and in effectively consulting with their health care providers regarding their clinical management.

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 consultation-liaison psychiatry rotations are expected to:

  1.  Patient Care
    • Perform comprehensive, pertinent diagnostic interviews; collect data from important collateral sources; develop thorough, accurate differential diagnoses; formulate and carry out appropriate treatment plans
    • Effectively assess behavioral conditions commonly seen on medical/surgical services (e.g. suicidal/homicidal statements or behavior, grief, depression, anxiety, personality problems, chronic pain)
    • Perform complete and accurate assessments of patients’ potential to harm self or others and of the level of psychiatric care needed after discharge
    • Display the ability to adapt psychopharmacologic and psychotherapeutic treatments for medically ill patients
  2.  Knowledge
    • ” Recognize and know the differential diagnosis of the psychiatric conditions most commonly seen in medical/surgical settings (e.g. delirium, depression, somatoform and factitious disorders, substance abuse and withdrawal)
  3.  Practice-Based Learning and Improvement
    • 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
    • Regularly use information technology in the service of patient care
    • Participate in practice-based improvement activities (CQI; e.g. case conferences, case reviews, quality improvement projects)
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients and families
    • Display empathic listening skills and the ability to use both verbal and non-verbal communication
    • Clarify the consultation request, identify important issues, clearly communicate findings and recommendations
    • Display skills in liaison with medical/surgical services; help non-psychiatric providers to understand and manage psychiatric or behavioral problems in their patients
    • Provide informative sign out to other providers caring for the patients he/she is responsible for (e.g. other consultation-liaison psychiatry team members, short call residents, night and weekend providers)
  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. 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 the patient’s culture, ethnicity, age, gender, socioeconomic status, sexual minority status, and/or disabilities
    • Demonstrate concise and pertinent record keeping, and prompt completion of consult notes
  6.  Systems-Based Practice
    • Display an understanding of legal issues involved in consultation-liaison psychiatry, including use of restraints, involuntary commitment, and competency/decisional capacity
  7.  Leadership
    • Display effective team leadership skills, including the ability to triage, prioritize tasks, and delegate work as appropriate
    • Display skills in teaching and supervising medical students
  8.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism
    • Seek direction when appropriate; display eagerness to learn
    • Display flexibility, self-awareness, and the ability to continuously improve one’s clinical skills and practice based on feedback
l. Goals and Objectives for Continuity Clinic Rotations

Goal: The goal of continuity clinic rotations is to provide supervised clinical experience in the comprehensive, integrated, continuous care of psychiatric outpatients. The continuity clinic gives the resident the opportunity to follow patients for more than a year, and up to 3 years during residency.

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. In addition, each PGY-2 resident must have one hour, and each PGY-3 and PGY-4 resident must have two hours, of individual psychotherapy supervision per week.

Objectives:
On completing the long-term continuity clinic rotation, the resident is expected to be able to:

  1.  Patient Care
    • Perform comprehensive, pertinent diagnostic interviews.
    • Develop thorough differential diagnoses.
    • Formulate and carry out appropriate treatment plans.
    • Each resident must have significant experience treating outpatients longitudinally for at least one year. The number of patients this resident has treated longitudinally for at least one year is: _____.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to psychiatry.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care.
    • Regularly use information technology in the service of patient care.
    • Participate in practice-based improvement activities, such as case reviews, case conferences, and/or practice improvement projects (e.g. using outcome measures to assess effects of and improve treatment).
    • Videotape at least one ongoing psychotherapy case and review videotaped sessions with a supervisor to facilitate continuous improvement in his/her psychotherapy skills.
    • Display flexibility, self-awareness, and the ability to continuously improve one’s clinical skills and practice based on feedback.
  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 with health care professionals (including those from other disciplines), colleagues, and staff to provide patient-focused care.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • Demonstrate reliable attendance and appropriate professional attire.
    • 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
    • Display an understanding of the health care system and of the broader context of the patient’s care; effectively access and utilize resources; practice cost effective care.
    • Appropriately advocate for quality patient care; help patients with system complexities.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
m. Goals and Objectives for Elective Private Practice of Psychiatry Rotations

Goal: The goal of the elective private practice psychiatry rotation is to teach and provide supervised clinical experience in: a) the comprehensive, integrated care of psychiatric outpatients in a private practice setting and b) the organization and conduct of a psychiatric private practice.

Objectives:
On completing the private practice psychiatry rotation, the resident is expected to be able to:

  1.  Patient Care
    • Screen prospective patients by telephone, with attention to asking appropriate clinical screening questions, and describing oneself and one’s practice, including costs of 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-V diagnoses in psychiatric outpatients.
    • Develop individualized treatment plans for outpatients, integrating medication and different forms of psychotherapy, as appropriate.
    • 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.
  2.  Knowledge
    • 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 knowledge of the organization and management of a private practice, including the clinical and fiduciary responsibilities of the provider, record-keeping, scheduling and time management, finances and billing, and professional liability insurance.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care.
    • Regularly use information technology in the service of patient care.
    • Develop a system for ongoing continuing medical education.
  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.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • 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 understanding of the multidisciplinary mental health treatment team and display effective communication patterns with other psychiatrists, psychologists, social workers, and alcohol and drug counselors. Learn to distinguish the role of the team leader and the consultant.
    • 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.
    • Define the scope of one’s practice, identify limitations in the range of provided services, and demonstrate effective integration of outside clinical consultations into the development of treatment plans.
    • Appropriately advocate for quality patient care; help patients with system complexities.
    • Interact effectively with primary care providers and third party payers.
    • Display an understanding of the role of federal, state, and local health care system and regulatory agencies and their importance for the private practice of psychiatry.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
n. Goals and Objectives for Emergency Psychiatry Rotations

Goal: The goal of the emergency psychiatry rotation is to provide organized instruction and supervised clinical experience in emergency psychiatry, leading to the development of knowledge and skills in the emergency evaluation, crisis management, triage, and safe and sound disposition of psychiatric patients in a timely and efficient manner.

Supervision: Each resident must receive a minimum of one hour a week of direct supervision by an emergency psychiatry attending and must have direct access (in person or by telephone) to a supervising attending at all times.

Objectives:
On completing the emergency psychiatry rotation, the resident is expected to be able to:

  1.  Patient Care
    • Perform comprehensive, pertinent diagnostic interviews
    • Develop thorough differential diagnoses
    • Establish rapport with and assess acutely disturbed patients
    • Make rapid assessments of acutely psychotic patients
    • Effectively evaluate dangerousness (suicidality, homicidality) and intervene appropriately
    • Effectively assess alcohol and drug intoxication and withdrawal
    • Document the database and describe the assessment and plan in a complete and succinct manner.
    • Understand the medical, neurological, and other physiological causes for psychiatric symptoms and seek medical, neurological, or other specialty consultations appropriately
    • Effectively assess the need for inpatient versus outpatient treatment
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to psychiatry
    • Display knowledge of the assessment and treatment of psychiatric emergencies
    • 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 patient care
    • Regularly use information technology in the service of patient care
    • Participate in practice-based improvement activities (improvement based on supervision; case reviews; case conferences; CQI activities)
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients, families, and caregivers
    • Display empathic listening skills
    • Work effectively with social workers, nurses, and medical staff in the emergency room
    • Provide informative sign out to other providers (e.g. night and weekend residents, other emergency room staff taking over care of the patient)
  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. 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
  6.  Systems-Based Practice
    • Prioritize and expedite patient evaluation and referral from the emergency room
    • Display familiarity with community referral sources
    • Effectively evaluate risk of patients to caregivers
    • Display understanding of relevant issues of Washington State Mental Health Law and be able to assess the need for civil commitment
  7.  Leadership
    • Display effective team leadership skills, including the ability to triage, prioritize tasks, and delegate work 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
    • Display flexibility, self-awareness, and the ability to continuously improve one’s clinical skills and practice based on feedback
o. Goals and Objectives for Forensic Psychiatry Rotations

Goal: The overall goal of the forensic psychiatry rotation is to provide the resident with supervised clinical experience and instruction in forensic psychiatry.

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 forensic psychiatry rotations are expected to:

  1.  Patient Care
    • Perform comprehensive evaluations of defendants, including assessment of competency to stand trial, sanity, diminished capacity/mens rea, and dangerousness.
    • Display the ability to diagnose mental disorders using DSM-V and other legally relevant nosological approaches.
    • Develop an understanding of the relevance of clinical material and psychiatric models of behavior to legal standards.
    • Display clinical skills in the treatment of patients in forensic settings, including an understanding of the indications for and basic principles of pharmacologic, psychoeducational, group, and/or individual therapy approaches.
    • Participate in the development of appropriate treatment plans.
  2.  Knowledge
    • Display broad general knowledge of the expected signs, symptoms, course, treatment, and social manifestations of mental disorders (including personality disorders), substance abuse disorders, and the psychiatric expression of medical disorders.
    • Display knowledge of historical and clinical risk factors for violence and criminality and of interventions designed to address these risk factors.
    • Display an understanding of malingering, factitious disorders, and symptom exaggeration.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to forensic questions and/or clinical care.
    • Regularly use information technology in the service of patient care and forensic evaluation.
    • Locate and properly utilize legal and medico-legal information such as statutes, case law, polices, codes, and forensic texts.
    • Participate in practice-based improvement activities (CQI; e.g. case reviews and M&M type case conferences).
  4.  Interpersonal and Communication Skills
    • Ethically and sensitively obtain information from patients, families, and other sources of collateral information; ” Display empathic and critical listening skills.
    • Work effectively as part of a multidisciplinary team in the evaluation and/or care of persons in forensic settings.
    • Write thorough, clear and well-reasoned forensic reports.
    • Testify relevantly and accurately about forensic implications of clinical material.
  5.  Professionalism
    • 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
    • Display an understanding of the relationship between the health care system and the legal system.
    • Effectively access and utilizes resources; practice cost effectively.
    • Display and apply an understanding of the differing roles of forensic evaluator and clinical practitioner.
    • Appropriately advocate for quality patient care; help patients with system complexities.
  7.  Leadership
    • Display effective team leadership skills, including the ability to triage, prioritize tasks, and delegate work 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.
p. Goals and Objectives for Geriatric Psychiatry Rotations

Goal: The goal of geriatric psychiatry rotations is to provide general psychiatry residents with supervised clinical experience and training in the comprehensive assessment and initial treatment planning of elderly patients.

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.

Objectives:

On completing a geriatric psychiatry rotation, the resident is expected to be able to:

  1.  Patient Care
    • Perform initial assessments of elderly patients, including evaluation of neuropsychiatric symptoms, cognitive and functional abilities, and medical comorbidity.
    • Identify clinically meaningful cognitive impairment when present, conduct a suitable differential diagnostic evaluation, and interpret the results with adequate supervision.
    • Diagnose and understand special aspects of anxiety and depression presenting in elderly patients with complex medical or situational problems.
    • Generate initial treatment plans, including appropriate first-line treatment modalities and management strategies .
  2.  Knowledge
    • Display adequate knowledge of geriatric psychiatry.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care and use evidence from the literature in clinical decision making, as appropriate.
    • Regularly use information technology in the service of patient care.
    • Participate in practice-based improvement activities (e.g. improve his/her clinical practice as a result of supervision; participate in case conferences, case reviews, and/or CQI projects)
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients, families, and caregivers.
    • Display empathic listening skills.
    • Work effectively with health care professionals (including those from other disciplines), colleagues, and staff to provide patient-focused care.
  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, pertinent, and timely record keeping.
  6.  Systems-Based Practice
    • Adequately assess the nature and quality of the patient’s caregiving network, including primary care physicians, subspecialty physicians, family members, social network, nursing home staff.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
q. Goals and Objectives for Inpatient Psychiatry Rotations – Initial

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.

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 initial level are expected to:

  1.  Patient Care
    • Perform a psychiatric diagnostic interview, 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; make appropriate use of laboratory and diagnostic procedures; and obtain consultation when indicated
    • Obtain collateral information from old records, family, outpatient treatment providers
    • Make accurate Axis I-V DSM-V diagnoses in psychiatric inpatients and generate an appropriate differential diagnosis
    • Provide a biopsychosocial formulation which takes a longitudinal view of the patient’s life history
    • Collaborate in formulating and implementing treatment plans and 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.
  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
    • 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 basic interviewing skills (i.e. establishing rapport, clarifying the purpose of the interview, attending to cues, making transitions smoothly, demonstrating empathy, eliciting important information)
    • Develop a therapeutic alliance with patients, while maintaining appropriate professional boundaries.
    • Understand the role of other mental health professionals (nurses, social workers, psychologists, occupational therapists, etc.) on the team, and work collaboratively with them
    • 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
    • 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
    • In collaboration with the attending and team, 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
    • Cultivate a role within the team as the primary “go-to” person for all patients
    • Begin to recognize team priorities, discuss with attending how to implement treatment plans, and progressively take a more active leadership role in team meetings and family meetings, as appropriate
  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
r. Goals and Objectives for Inpatient Psychiatry Rotations – Advanced

(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
s. Goals and Objectives for Neuroradiology Rotation

Goal: The goal of the neuroradiology rotation is to provide a one-month supervised experience in reading neuroradiology studies with a neuroradiology fellow and/or faculty member, in order to learn indications and clinical uses of neuroradiology studies in neuropsychiatric patients.

Objectives:
completing the neuroradiology rotation, the resident is expected to be able to:

  1.  Patient Care
    • Understand the clinical indications for, and advantages and disadvantages of, different types of neuroradiology studies (e.g. CT, MRI) in the diagnostic assessment of patients with psychiatric disorders and symptoms.
    • Order neuroradiology studies appropriately, choosing the optimal study for a given clinical situation and patient, taking into account contraindications and potential adverse effects of different types of studies.
  2.  Knowledge
    • Display basic knowledge of the basis and mechanism of neuroradiology studies, their temporal and spatial resolution, risks, and clinical uses.
    • Identify major brain structures relevant to neuropsychiatric disease.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise relevant scientific literature.
    • Use conferences, supervision, readings, and reference materials to improve his/her knowledge of neuroradiology.
  4.  Interpersonal and Communication Skills
    • Work effectively with neuroradiology faculty, fellows, and other trainees.
    • Demonstrate the ability to explain neuroradiology studies, their indications, and risks, in preparation for educating patients and families about these tests as part of clinical care.
  5.  Professionalism
    • Demonstrate respect for others.
    • Demonstrate integrity, accountability, responsible and ethical behavior.
    • Demonstrate a commitment to excellence.
  6.  Systems-Based Practice
    • Understand issues of cost-effectiveness in the use of neuroradiology studies in the overall context of patient care.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
t. Goals and Objectives for Nightfloat Rotations

Goal: The goal of the psychiatry night float rotation is to provide a supervised clinical experience in managing and triaging urgent issues arising at night in psychiatric emergency, inpatient, and consultation-liaison settings.

Supervision: Night float residents will be supervised by backup attendings immediately available by telephone or (in some cases) on-site. The resident must discuss with the attending any case in which: a) the resident has any questions or concerns about the patient or the care provided; b) a patient requests to leave against medical advice (AMA); c) the resident intends not to hospitalize a patient seen in the emergency room who has expressed ideas of self-harm or harm to others; d) the resident intends to turn down a request for admission; e) the resident plans to send home from the emergency room a patient who has had a rapidly deteriorating clinical course (e.g. recent onset of mania, anorexia with significant recent weight loss). The resident will also call the backup attending to review all consults. Additional requirements to call the backup attending may be mandated at individual hospital sites. Each night float resident will also receive one hour per week of dedicated 1:1 faculty supervision.

Objectives:
On completing the psychiatry night float rotation, the resident is expected to be able to:

  1.  Patient Care
    • Perform pertinent psychiatric diagnostic interviews.
    • Gather collateral information, as indicated and as possible, to facilitate an accurate acute assessment.
    • Develop an initial working diagnosis and differential diagnoses.
    • Establish rapport with and assess acutely disturbed patients.
    • Make rapid assessments of acutely psychotic patients.
    • Effectively evaluate dangerousness (suicidality, homicidality) and intervene appropriately.
    • Effectively assess alcohol and drug intoxication and withdrawal.
    • Document the database and describe the assessment and plan in a complete and succinct manner.
    • Understand the medical, neurological, and other physiological causes for psychiatric symptoms and seek medical, neurological, or other specialty consultations appropriately.
    • Effectively assess the need for inpatient versus outpatient treatment.
    • Effectively evaluate and triage emergency room, inpatient, and consult cases at night, determining, with supervision, which issues must be addressed immediately and which should be addressed by the daytime treatment teams.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to psychiatry.
    • Display knowledge of the assessment and treatment of psychiatric emergencies.
    • 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 patient care.
    • Regularly use information technology in the service of patient care.
    • Participate in practice-based improvement activities, including discussion during supervision of cases seen and areas for potential improvement in the resident’s care or triage of patients.
    • Follow up on patients the resident has admitted and their hospital course and discuss this follow up in supervision, to learn from these cases and from the subsequent diagnoses and treatment by the inpatient team.
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients, families, and caregivers.
    • Display empathic listening skills ” Work effectively with social workers, nurses, and medical staff.
    • Communicate effectively with daytime clinical teams regarding patient care issues.
    • Check in with staff on the inpatient units and in the emergency room at the beginning of each night float shift.
  5.  Professionalism
    • 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
    • Display familiarity with community referral sources available at night.
    • Display understanding of relevant issues of Washington State Mental Health Law and be able to assess the need for civil commitment.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction and consult the backup attending as appropriate and required; demonstrate eagerness to learn.
u. Goals and Objectives for Primary Care Consultation Rotations

Goal: The goal of primary care consultation rotations is to provide supervised clinical experience and organized instruction in the evaluation of psychiatric and/or behavioral problems in outpatients in primary care settings, and in working in collaboration with the patient’s primary care provider to develop and implement a comprehensive treatment plan.

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.

Objectives:
On completing the primary care consultation rotation, the resident is expected to be able to:

  1.  Patient Care
    • Perform comprehensive, pertinent diagnostic interviews.
    • Recognize and diagnose psychiatric and/or behavioral conditions common in primary care settings (e.g. depression in medically ill patients, anxiety, substance abuse, grief).
  2.  Knowledge
    • Display appropriate knowledge of the interaction between medical illness, prescribed medications, and psychiatric conditions, including the contribution of such interactions to treatment non-compliance, exacerbation or amplification of somatic symptoms, and functional impairment.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care, and use evidence from the literature in clinical decision making, as appropriate.
    • Regularly use information technology in the service of patient care.
    • Participate in practice-based improvement activities, such as improving clinical practice as a result of supervision and reading, case conferences, case reviews, and/or practice improvement projects.
  4.  Interpersonal and Communication Skills
    • Establish rapport with patients in primary care settings, engage them in the evaluation and treatment process, and provide an explanatory model for their symptoms that facilitates their acceptance of psychopharmacologic and/or psychotherapeutic treatments.
    • Communicate effectively with primary care providers; make clear recommendations; help them to understand psychiatric conditions in their patients and possible treatment options; and work with them collaboratively to develop and monitor the success of treatment plans.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • Demonstrate reliable attendance and appropriate professional attire.
    • 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
    • Display an understanding of the health care system and of the broader context of the patient’s care; effectively access and utilize resources; practice cost effective care.
    • Appropriately advocate for quality patient care; help patients with system complexities.
  7.  Educational Attitudes
    • Display openness to supervision; accept constructive criticism.
    • Seek direction when appropriate; demonstrate eagerness to learn.
v. Goals and Objectives for Primary Care in Psychiatric Settings Rotation

Goal: The overall goal of this rotation is to provide a PGY-4 psychiatry resident with supervised clinical experience providing primary medical care within a psychiatric treatment setting, such as a community mental health center.

Supervision: The resident will work closely with, and will be supervised by, a combined-trained family physician and psychiatrist, who will be in clinic at the same time as the resident and who will see patients with the resident for initial and follow up primary medical care visits.

Objectives:
At the conclusion of this rotation, the resident will be able to:

  1. Patient Care
    • Appropriately select and apply population-based preventive health screenings for the following within the SMI (seriously mentally ill) population:
    • Cardiovascular disease risk factors (HTN, cholesterol, diabetes, obesity, smoking)
    • Cancers (colon, cervical, breast, prostate)
    • Osteoporosis o Infectious disease (HIV, syphilis, gonorrhea, chlamydia, hepatitis)
    • Apply evidence-based treatment algorithms and goals of care for common cardiovascular co-morbidities in the SMI population:
    • HTN
    • Diabetes
    • Obesity
    • Dyslipidemia
    • Tobacco Cessation
    • Utilize brief psychotherapy techniques to motivate health behavior change in clinic visits.
  2.  Medical Knowledge
    • Describe the physical health implications of psychotropic medications, and develop integrated treatment plans that balance these risks and benefits with the community psychiatrist.
    • Discuss the health behavior change literature and its application to chronically mentally ill patients.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to patient care.
    • Regularly use information technology in the service of patient care.
    • Describe the cycle of quality improvement, and apply it to basic clinical interventions.
  4.  Interpersonal and Communication Skills
    • Effectively communicate with primary care providers and community psychiatrists, and other members of the client’s healthcare team.
    • Work within an interdisciplinary primary care team, understanding the tasks, roles and expectations of a nurse care-manager, medical assistant and primary care physician in the health of those with SMI.
    • Work within an interdisciplinary community mental health team to better understand the roles of the treating community psychiatrist and case manager.
  5.  Professionalism
    • 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
    • Develop and use a disease registry to monitor outcomes.
    • Describe the breadth of health-services interventions currently being employed nationally, and the pros and cons of each approach.
    • Evaluate the concept of the Patient Centered Medical Home, contrast it with Medicaid Health Homes, and appraise the evidence base for collaborative care.
    • Define the key components along the spectrum of mental health and primary care integration.
    • Discuss the evidence base for primary care integration in behavioral health settings.
w. Goals and Objectives for Psychiatric Assessment Outpatient Rotation

Goal: The overall goal of this rotation is to provide a supervised outpatient experience in performing psychiatric assessments.

Supervision: Residents will be supervised by an outpatient psychiatrist who is present in the clinic and who sees each patient with the resident for the evaluation appointment. The resident and attending team will be scheduled to see two new patients per half-day. Supervision will total at least 30 minutes per resident per half-day.

Objectives:
By the end of the rotation, the resident will be able to:

  1.  Patient Care
    • Introduce him/herself and explain agenda and purpose for appointment
    • Respond empathically to verbal and non-verbal cues
    • Follow clues to identify and discover important information
    • Obtain a complete, accurate, and relevant history
    • Screen for patient safety
    • Collect needed background information from the chart and/or collateral sources
    • Use a clinical hypothesis to guide information gathering in order to refine the differential diagnosis
    • Identify subtle or conflicting findings and incorporate them into case formulation
    • Create a case formulation organized around a comprehensive model, such as bio-psycho-social or 4 P’s, or a major theoretical system
    • Develop a full differential diagnosis without premature closure
    • Link formulation to treatment recommendations
    • Recommend appropriate diagnostic testing to further refine diagnoses, required prior to starting common medications, or required for monitoring during treatment
    • Identify potential treatment options, including medications and psychotherapy as indicated
    • Incorporate patient’s perspective in treatment recommendations
    • Apply understanding of potential effects of patient’s co-morbid medical conditions, drug interactions, and potential side effects to treatment selection
  2.  Medical Knowledge
    • Demonstrate sufficient knowledge to identify and provide diagnostic and treatment recommendations for psychiatric conditions in adults presenting in an outpatient setting
    • Display knowledge of indications for acute psychiatric hospitalization, grounds for breach of confidentiality (e.g. danger to self/others, child/elder abuse)
  3.  Professionalism
    • Exhibit professional and courteous manner throughout assessment
    • Incorporate understanding of ethical principles (e.g. confidentiality, informed consent) into psychiatric evaluation.
    • Demonstrate capacity for self-reflection, curiosity about and openness to different beliefs and points of view, and respect for diversity
    • Elicit beliefs, values, and diverse practices of patients and their families and understands their potential impact on patient care
    • Recognize the role of diversity in psychiatric evaluation
  4.  Interpersonal Communication Skills
    • Discuss diagnosis with patient, using easy-to-understand language
    • Discuss treatment options with patient, using easy-to-understand language
    • Provide patient with relevant written materials
    • Complete accurate and timely notes, consistent with institutional policy
    • Include specific recommendations in the note to the referring provider, using language common to non-psychiatric medical specialties
    • Send completed notes to referring provider, making phone contact with referring providers as needed
  5.  Problem-Based Learning and Improvement
    • Locate and appraise relevant scientific literature and evidence-based resources to inform differential diagnosis and treatment recommendations
    • Seek and incorporate feedback to improve performance
  6.  Systems-Based Practice
    • Incorporate self-help and support groups (e.g. AA), rehabilitation programs (e.g. cognitive and vocational rehabilitation), and community resources (e.g. community mental health centers) into treatment recommendations
    • Consider patient resources and practice cost-effective care in formulating treatment recommendations
x. Goals and Objectives for Research Rotations

Goal: The goal of research rotations is to provide supervised experience in designing, conducting, and/or writing up results of research projects, or in reviewing and synthesizing a body of research literature.

Supervision: Residents doing research rotations have a UW faculty research mentor. The expectation is that the mentor meets with the resident once a week and is available to respond to questions and critique scholarly products (e.g. drafts of research proposals, IRB applications, manuscripts) in a timely manner.

Objectives:
Residents completing research rotations are expected to:

  1.  Patient Care
    • Perform comprehensive, pertinent diagnostic interviews, using research diagnostic interviews and rating scales, as indicated.
    • Develop accurate diagnoses and thorough differential diagnoses.
    • Display understanding of patient care issues in research, including the responsible conduct of research, ethical issues, informed consent, and the need for referral to treatment resources outside the research study, as indicated.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to the research project.
    • Display knowledge of study design and research methodology.
    • Demonstrate knowledge of biostatistics relevant to the research project.
    • Demonstrate the ability to synthesize information and place research findings into the context of existing literature.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to the research study.
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with research subjects, patients, and families.
    • Work effectively with health care professionals (including those from other disciplines), research colleagues, and staff.
    • Display skill in communicating research findings and proposals in writing through manuscripts, IRB applications, and/or grant funding proposals.
    • Display skill in communicating research ideas and findings verbally, including the ability to give research presentations.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • Demonstrate integrity, accountability, responsible and ethical behavior.
    • Demonstrate appropriate and responsible care of animals involved in research.
    • Demonstrate understanding of patients/research subjects 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
    • Appropriately advocate for quality care of research subjects; help research subjects and patients in dealing with system complexities.
  7.  Leadership
    • 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 .
y. Goals and Objectives for Student Mental Health Rotations

Goal: The goal of student mental health rotations is to provide supervised clinical experience in the assessment and treatment of psychiatric disorders and behavioral problems in college and university students seen within a student health center setting.

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.

Objectives:
Residents completing student mental health rotations are expected to:

  1.  Patient Care
    • Perform comprehensive, pertinent diagnostic interviews.
    • Give succinct, well-organized case presentations.
    • Develop thorough differential diagnoses.
    • Formulate and carry out appropriate treatment plans.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to Psychiatry.
    • Display appropriate knowledge of particular conditions common in student health center populations, such as first episodes of affective, anxiety, and psychotic disorders; adjustment disorders; and separation-individuation issues.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to the research study.
    • Participate in practice-based improvement activities (CQI), such as case reviews, case conferences, and quality improvement projects.
  4.  Interpersonal and Communication Skills
    • Create and sustain effective therapeutic relationships with patients.
    • Display empathic listening skills.
    • Work effectively with health care professionals (including those from other disciplines), colleagues, and staff to provide patient-focused care.
    • Provide effective consultation and teaching to other student health center providers.
  5.  Professionalism
    • 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
    • Display an understanding of the health care system and of the broader context of the patient’s care; effectively access and utilize resources; practice cost effective care.
    • Appropriately advocate for quality patient care; help patients in dealing with system complexities.
    • Display an understanding of the student health center care delivery system and its place within the broader context of campus operations.
  7.  Leadership
    • 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.
z. Goals and Objectives for Teaching Rotations

Goal: To provide supervised experience in direct teaching or supervision and/or in curriculum development.

Supervision: Residents doing teaching rotations have a UW faculty research mentor. The expectation is that the mentor meets with the resident once a week and is available to respond to questions and critique teaching products (e.g. the resident’s direct teaching or supervision; drafts of teaching presentations, syllabi, or curricula).

Objectives: Residents completing teaching rotations are expected to:

  1.  Patient Care
    • Display a commitment to teaching and supervising others in a manner that is clinically relevant and improves patient care.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to the teaching project.
    • Demonstrate the ability to synthesize information and place research findings into the context of existing literature.
  3.  Practice-Based Learning and Improvement
    • Locate and critically appraise scientific literature relevant to the teaching project.
    • Use feedback from learners and observers to improve teaching effectiveness.
  4.  Interpersonal and Communication Skills
    • Display effective oral communication skills in lecture, small group, clinical rounds, and/or one-to-one teaching or supervision settings.
    • Display effective written communication skills (e.g. in writing curricula, educational materials, or education-related articles).
    • Demonstrate the ability to assess and respond to learners’ abilities and needs.
  5.  Professionalism
    • Demonstrate respect for others, compassion.
    • Demonstrate integrity, accountability, responsible and ethical behavior.
    • Demonstrate understanding, as part of clinically-oriented teaching, of patients/research subjects 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
    • Understand the system of education/training, curriculum, and context within which he/she is teaching.
    • Include in teaching an appreciation of the broader health care system and the role of clinicians in patient advocacy.
  7.  Leadership
    • 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.
aa. Goals and Objectives for the VA 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.

Objectives:

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 risk.
    • 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 consultations appropriately.
    • 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.
  2.  Knowledge
    • Display appropriate knowledge of basic and clinical sciences relevant to psychiatry.
    • Display knowledge of the assessment and treatment of acute psychiatric illness.
    • Display knowledge of clinical syndromes frequently seen in the veteran psychiatric population, including PTSD from combat, non-combat, or sexual trauma.
    • 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 patient care.
    • Regularly use information technology in the service of patient care.
    • Participate in practice-based improvement activities (CQI), when appropriate.
    • 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.
  5.  Professionalism
    • 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.
  7.  Leadership
    • 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.
ab. Goals and Objectives for Didactics by Year
PGY-1

Goal: The overall goals of the PGY-1 didactics series are to provide first-year residents with knowledge and skills necessary for their work on psychiatry clinical services; to provide introductory, foundational knowledge about the major psychiatric diagnoses and treatments; to foster their development and identity as psychiatric physicians; and to provide basic information about the system of mental health care in which they are practicing.

Objectives:
At the conclusion of the PGY-1 didactics year, residents are expected to be able to:

  1.  Patient Care
    • Describe the elements of a basic diagnostic psychiatric interview and mental status examination
    • Describe at least one approach to a case formulation (e.g. biopsychosocial, 4 Ps, perspectives)
    • Incorporate basic knowledge of major psychiatric diagnoses, differential diagnosis, and treatments into clinical care of patients
  2.  Medical Knowledge
    • Display a basic knowledge of diagnostic criteria, differential diagnoses, and first-line treatment options for major psychiatric disorders, such as mood disorders, psychotic disorders, anxiety disorders, substance abuse and dependence
    • Display a basic knowledge of the clinical indications and use of antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics in psychiatry
  3.  Practice-Based Learning and Improvement
    • Display knowledge of medical student requirements for the psychiatry clerkship, provide guidance and information to medical students appropriate to the student’s existing knowledge and skills, and provide useful feedback to students
  4.  Interpersonal and Communication Skills
    • Describe and display skills in working with a multidisciplinary inpatient team
    • Describe the goals and skills involved in running a family meeting
  5.  Professionalism
    • Display an understanding of their role as a physician and of principles of professionalism in medicine
    • 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
    • Display an understanding of the state involuntary commitment system
    • Display an understanding of types of resources available for psychiatric patients after discharge from the inpatient unit or emergency room
  7.  Educational Attitudes
    • Achieve expected attendance at didactics
    • Maintain a respectful attitude towards instructors, display eagerness to learn and participation in didactics sessions, and provide constructive feedback to help improve didactics
PGY-2

Goal: The overall goals of the PGY-2 didactics are to provide core knowledge of the diagnosis, pathophysiology, and treatment of DSM-V disorders; an introduction to principles and methods common to different forms of psychotherapy; an introduction to supportive therapy and motivational interviewing; an overview of psychodynamic case formulation; education in emergency psychiatry; and a survey of consultation-liaison psychiatry. These topics are intended to complement the PGY-2 resident’s clinical rotations in inpatient, consultation-liaison, and emergency psychiatry, and to provide knowledge and skills needed as he or she begins continuity clinic and seeing patients for psychotherapy.

Objectives:
At the conclusion of the PGY-2 didactics year, residents are expected to be able to:

  1.  Patient Care
    • Discuss common factors in psychotherapy and principles of supportive therapy and motivational interviewing
    • Use knowledge of psychiatric disorders, emergency psychiatry, and consultation- liaison psychiatry to provide the best possible patient care
  2.  Medical Knowledge
    • Display knowledge of the diagnosis, pathophysiology, and treatment of psychiatric disorders; of emergency and consultation liaison psychiatry; of common factors in psychotherapies; of principles of supportive therapy and motivational interviewing; and of basic psychodynamic theory
  3.  Practice-Based Learning and Improvement
    • Use feedback given as part of motivational interviewing training to improve skills
  4.  Interpersonal and Communication Skills
    • Display an understanding of communication skills important in psychotherapy
  5.  Professionalism
    • Understand issues of professionalism related to beginning outpatient practice, such as boundaries
  6.  Systems-Based Practice
    • Display an understanding of systems and legal issues involved in providing consultation to medical and surgical patients and clinical services
    • Display an understanding of legal and systems issues and community resources involved in emergency psychiatry
  7.  Educational Attitudes
    • Achieve expected attendance at didactics
    • Maintain a respectful attitude towards instructors, display eagerness to learn and participation in didactics sessions, and provide constructive feedback to help improve didactics
PGY-3

Goal: The overall goals of the PGY-3 didactics are to build on the first two years of residency and to explore topics relevant to the resident’s outpatient and subspecialty clinical rotations of the PGY-3 year. Thus, PGY-3 didactics include topics in couples and group psychotherapies, integrating psychopharmacology and psychotherapy, child and adolescent psychiatry, geriatric psychiatry, cross-cultural psychiatry, and ethics. A Clinical Interaction Seminar explores challenges in the therapeutic relationship, including countertransference. Areas such as psychiatric neuroscience and evidence-based practice and research methodology are explored in more depth.

Objectives:
At the conclusion of the PGY-3 didactics year, residents are expected to be able to:

  1.  Patient Care
    • Discuss challenges that arise in the therapeutic relationship, transference and countertransference, and how to use an awareness of these phenomena to provide the best possible patient care
    • Describe influences of culture, spirituality, and belief systems on patient care
  2.  Medical Knowledge
    • Display knowledge of couples and group therapy, integration of psychotherapy and psychopharmacology, normal child development, child and adolescent psychiatry, geriatric psychiatry, cross-cultural psychiatry, ethics, neuroscience, and evidence-based practice
  3.  Practice-Based Learning and Improvement
    • Display the ability to critically appraise articles from the treatment literature
    • Display an understanding of basic concepts of study design
  4.  Interpersonal and Communication Skills
    • Display an understanding of how to communicate with patients and families in a culturally sensitive manner
  5.  Professionalism
    • Understand issues of professionalism related to outpatient psychiatric practice
    • Display an understanding of major issues in psychiatric ethics
  6.  Systems-Based Practice
    • Display an understanding of systems of care for children, adolescents, and the elderly
  7.  Educational Attitudes
    • Achieve expected attendance at didactics
    • Maintain a respectful attitude towards instructors, display eagerness to learn and participation in didactics sessions, and provide constructive feedback to help improve didactics
PGY-4

Goal: The overall goals of the PGY-4 didactics are to prepare residents for post-residency practice, the Board examination, and lifelong self-directed learning; and to allow senior residents to explore advanced topics in psychopharmacology, psychotherapy, forensic psychiatry, the history of psychiatry, consultation to primary care providers, and specialized topics of interest to the PGY-4 group. PGY-4s also teach PGY-1s in small group didactic sessions.

Objectives:
At the conclusion of the PGY-4 didactics year, residents are expected to be able to:

  1.  Patient Care
    • Apply knowledge to specific cases presented in didactics sessions, which represent clinically challenging situations
  2.  Medical Knowledge
    • Demonstrate a knowledge base of psychiatry and neurology sufficient to pass the Psychiatry Board examination
    • Display knowledge of advanced psychopharmacology, psychotherapies, forensic psychiatry, and the history of psychiatry
  3.  Practice-Based Learning and Improvement
    • Display the ability to conduct a literature search in a topic area of the resident’s choice
    • Display the ability to critically appraise articles in the current psychiatric literature and assess whether or not a particular article will change the resident’s clinical practice
    • Effectively teach junior residents in a small group seminar setting
  4.  Interpersonal and Communication Skills
    • Display understanding of advanced topics in psychotherapy, including guiding patients through the process of termination
  5.  Professionalism
    • Understand issues of professionalism related to independent practice, lifelong learning and maintenance of certification, financial aspects of practice, and impaired colleagues
  6.  Systems-Based Practice
    • Display an understanding of forms of psychiatric practice
    • Describe requirements for reporting and principles of treating impaired providers
    • Display an understanding of legal issues in psychiatry, forensics
  7.  Educational Attitudes
    • Achieve expected attendance at didactics
    • Maintain a respectful attitude towards instructors, display eagerness to learn and participation in didactics sessions, and provide constructive feedback to help improve didactics
ac. Educational Goals by Year
PGY-1

The Psychiatry Residency PGY-1 year* consists of 4 months of Medicine and/or Pediatrics, 2 months Neurology (OR 1 month Neurology and 1 month approved Psychiatry elective), and 6 months Inpatient Psychiatry. The general goals of the PGY-1 year are to (a) provide residents with medical skills relevant to psychiatric practice and (b) provide residents with closely supervised experience in the evaluation for admission, diagnosis, and treatment of acutely ill psychiatric inpatients.

Specific goals for the PGY-1 year include the resident’s being able to:

  • Perform a complete medical and psychiatric history, mental status examination, and physical examination (including a thorough neurological examination), and to order appropriate diagnostic studies (ACGME Competency: Patient Care)
  • Diagnose common medical, neurological, and psychiatric disorders and to formulate appropriate initial treatment plans (ACGME Competency: Patient Care)
  • Provide limited, but appropriate, continuous care of patients with medical illnesses and make appropriate referrals (ACGME Competency: Patient Care)
  • Be conversant with medical disorders displaying symptoms likely to be regarded as psychiatric, and with psychiatric disorders displaying symptoms likely to be regarded as medical (ACGME Competency: Knowledge)
  • Evaluate patients presenting to psychiatric emergency services and, as appropriate, refer them for inpatient admission, evaluation for involuntary treatment, or other psychiatric care (ACGME Competency: Patient Care, Systems Based Practice)
  • Relate to patients and their families, as well as other members of the health care team, with compassion, respect, and professional integrity (ACGME Competency: Interpersonal and Communication Skills, Professionalism)
  • Display a commitment to excellent patient care, teaching medical students, and developing his or her own knowledge and skills through active participation in supervision and didactic sessions, as well as through critical appraisal and assimilation of scientific literature (ACGME Competency: Professionalism, Practice Based Learning and Improvement)

Satisfactory completion of the PGY-1 year requires:

  • Satisfactory completion of 4 months clinical rotations in Medicine and/or Pediatrics, 2 months Neurology (OR 1 month Neurology and 1 month approved Psychiatry elective), and 6 months Inpatient Psychiatry
  • Achievement of at least Level 1 milestones on all categories of the Inpatient Psychiatry evaluation form.
  • Satisfactory evaluations of interpersonal skills and professionalism by at least two non-attending raters (e.g. nursing staff, social workers, other team members)
  • Attendance at 70% or more of scheduled didactic sessions OR 85% or more of didactic sessions for which the resident is not excused (e.g. for vacation, illness, post-call, on call)
  • Completion of an evidence based medicine presentation on a topic relevant to Psychiatry and/or a quality improvement exercise (generally done during the UWMC or VA Inpatient Psychiatry rotation)
  • Evidence of compassionate, respectful, professional, and ethical behavior as well as openness to feedback and supervision
  • Meeting criteria for indirect supervision with direct supervision available, as assessed by psychiatry attendings and training call residents

* or the first 6 months of Psychiatry residency in the case of residents entering at the PGY-2 level

PGY-2

The Psychiatry Residency PGY-2 year consists of 4 months Inpatient Psychiatry, 1 month Emergency Psychiatry, 4 months Consultation-Liaison Psychiatry, 1 month Night Float, 2 months Selective (Addictions, Geriatrics, Child, Forensics, or Research), and a one-half-day per week outpatient continuity clinic*. The general goals of the PGY-2 year are to provide residents with supervised experience (a) in the evaluation for admission, diagnosis, case formulation, and treatment of acutely ill psychiatric inpatients, and the leadership of a multidisciplinary inpatient treatment team; (b) as a consultant, collaborating with medical and surgical services to diagnose, treat, and manage psychiatric and behavioral problems in their patients; (c) evaluating and managing patients presenting to psychiatric emergency services; (d) in a subspecialty or research area of psychiatry to help the resident begin to explore potential career options; and (e) in treating two outpatients, together with an introduction to the theory and practice of psychotherapy.

Specific goals for the PGY-2 year include the goals listed for the PGY-1 year, in addition to the resident’s being able to:

  • Communicate and collaborate effectively with, and exercise appropriate leadership within, an inpatient multidisciplinary treatment team, appreciating the roles and skills of each team member (ACGME Competency: Interpersonal and Communication Skills)
  • Evaluate patients presenting to psychiatric emergency services; manage psychiatric emergencies such as suicidal or homicidal ideation or aggression in an effective and therapeutic manner; and, as appropriate, refer patients for inpatient admission, evaluation for involuntary treatment, or other psychiatric care (ACGME Competency: Patient Care, Systems Based Practice)
  • Assess medical and surgical inpatients with psychiatric or behavioral problems, formulate appropriate treatment recommendations, and relate effectively to the primary treatment team in understanding the problem and communicating treatment recommendations clearly (ACGME Competency: Patient Care, Interpersonal and Communication Skills, Systems Based Practice)
  • Establish a therapeutic alliance with outpatients and engage them in treatment (ACGME Competency: Interpersonal and Communication Skills)
  • Relate to patients and their families, as well as other members of the health care team with compassion, respect, and professional integrity (ACGME Competency: Professionalism, Interpersonal and Communication Skills)
  • Display a commitment to excellent patient care, teaching medical students, and developing his or her own knowledge and skills through active participation in supervision and didactic sessions, as well as through critical appraisal and assimilation of scientific literature (ACGME Competency: Practice Based Learning and Improvement, Professionalism)

Satisfactory completion of the PGY-2 year requires:

  • Satisfactory completion of an additional 12 months of training, including 4 months Inpatient Psychiatry, 4 months Consultation-Liaison Psychiatry, 1 month Emergency Psychiatry, 1 month Night Float, and 2 months Selective rotations.
  • Achievement of Level 2 milestones or better in most categories of the Inpatient Psychiatry, Emergency Psychiatry, and Consultation-Liaison Psychiatry evaluation forms.
  • Achievement of Level 1 milestones or better in all categories of the evaluation forms for Continuity Clinic and the Selective rotation.
  • Satisfactory evaluations of interpersonal skills and professionalism by at least two non-attending raters (e.g. nursing staff, social workers, other team members).
  • Attendance at 70% of all scheduled didactics sessions OR 85% or more of didactic sessions for which the resident is not excused (e.g. for vacation, illness, post-call, on call).
  • Completion of an evidence based medicine presentation on a topic relevant to Psychiatry and/or a quality improvement exercise (generally done during the UWMC or VA Inpatient Psychiatry rotation).
  • Satisfactory completion of the Supportive Psychotherapy seminar and either the Psychodynamic or Cognitive Behavioral Therapy seminar.
  • Completion of 3 Clinical Skills Assessment examinations (one of which may be the “mock Board” examination), one “mock Board” examination, and the PRITE examination.
  • Evidence of compassionate, respectful, professional, and ethical behavior as well as openness to feedback and supervision

* Residents entering at the PGY-2 level do 8-9 months Inpatient Psychiatry, 3-4 months Consultation Liaison Psychiatry, and one half day per week of continuity clinic. Schedule may vary for residents in the Idaho Track.

PGY-3

The Psychiatry Residency PGY-3 year is an outpatient year and consists of one day a week of Child and Adolescent Psychiatry, one day a week of continuity clinic, and the remainder of the time in adult outpatient psychiatry rotations, including geriatric and addiction psychiatry rotations. The general goals of the PGY-3 year are to provide residents with supervised experience (a) in the assessment and treatment of adult outpatients with a wide range of psychiatric diagnoses, using a variety of treatment modalities, including pharmacotherapy, short- and long-term individual psychotherapies, and couples, family, and group therapies; (b) in the assessment and treatment of children and adolescents with a wide range of psychiatric and behavioral conditions; (c) evaluating and formulating initial treatment plans for elderly patients presenting with psychiatric disorders or symptoms, assessing their functional abilities, and working with their families and caregivers; (d) assessing and treating patients with substance use disorders, including learning motivational interviewing and gaining experience with group therapy; and (e) further developing skills and knowledge in psychodynamic and cognitive-behavioral psychotherapy.

Specific goals for the PGY-3 year include the goals listed for the PGY-1 and PGY-2 years, in addition to the resident’s being able to:

  • Effectively evaluate, diagnose, and formulate treatment plans for children, adolescents, adults, and elderly individuals in outpatient psychiatric settings, including patients with substance use disorders.
  • Work effectively with a multidisciplinary outpatient team and with the patient’s family, caregivers, and other care providers.
  • Engage the patient and, as appropriate, the family and/or caregivers, in treatment; sustain a therapeutic alliance; and guide the patient through the process to termination.
  • Effectively use psychopharmacological and psychotherapeutic approaches, alone and in combination.
  • Display awareness of his or her own responses to patients (countertransference) and use these responses productively in treatment.
  • Relate to patients and their families, as well as other members of the health care team with compassion, respect, and professional integrity, and display sensitivity to the sociocultural context of patients’ illnesses.
  • Display a commitment to excellent patient care, teaching medical students and junior residents, and developing his or her own knowledge and skills through active participation in supervision and didactic sessions, as well as through critical appraisal and assimilation of scientific literature.

Satisfactory completion of the PGY-3 year requires:

  • Satisfactory completion of an additional 12 months of training, consisting of 2-3 months FTE Child and Adolescent Psychiatry and 9-10 months FTE Adult Outpatient Psychiatry, including one day a week of long-term continuity clinic and 1-2 months FTE each of Addiction and Geriatric Psychiatry.
  • Ratings of “proficient” or better in all categories of the Outpatient Psychiatry, Child and Adolescent Psychiatry, Addiction Psychiatry, and Geriatric Psychiatry evaluation forms.
  • Ratings of “emerging” or better in all categories of the evaluation form for Continuity Clinic.
  • Satisfactory completion of both the Basic Analytic Psychotherapy (BAP) and Cognitive-Behavioral Therapy (CBT) seminars.
  • Satisfactory progress towards fulfilling the ACGME psychotherapy competencies.
  • Attendance at 70% of scheduled didactics sessions OR 85% or more of didactic sessions for which the resident is not excused (e.g. for vacation, illness, post-call, on call).
  • Satisfactory completion of at least 3 Clinical Skills Assessments, completion of a “mock Board” examination, and completion of the PRITE examination.
  • Evidence of compassionate, respectful, professional, and ethical behavior as well as openness to feedback and supervision.
PGY-4

The Psychiatry Residency PGY-4 year consists of the Continuity Clinic (at least one half-day per week), a Primary Care Consultation rotation, completion of any remaining required rotations, and elective rotations to allow the resident to explore his or her career interests. The general goals of the PGY-4 year are to: (a) complete all required training; (b) consolidate and further develop clinical skills in preparation for independent practice; (c) develop skills in consultation to primary care providers, managing and teaching them about the psychiatric and behavioral conditions in their patients; (d) develop the skills of life-long learning; (e) develop particular specialized knowledge; administrative, leadership, research, or teaching skills; and an understanding of practice settings and systems to facilitate further career development.

Specific goals for the PGY-4 year include the goals listed for the PGY-1, PGY-2, and PGY-3 years, in addition to the resident’s being able to:

  • Integrate knowledge, skills, conceptual and practical assessment and treatment approaches in providing effective, patient-focused clinical care
  • Effectively and independently formulate treatment plans incorporating a variety of psychopharmacologic and psychotherapeutic modalities, alone and in combination
  • Take responsibility for his/her own learning, keep up with and critically appraise the scientific literature relevant to psychiatry, and use research findings appropriately in the care of individual patients
  • Provide consultation to primary care providers regarding the behavioral and/or psychiatric problems of their patients
  • Display leadership in clinical care settings, administrative roles, teaching of medical students and junior residents, and supervision of other mental health care providers
  • Relate to patients and their families, as well as other members of the health care team with compassion, respect, and professional integrity, and display sensitivity to the sociocultural context of patients’ illnesses
  • Display an understanding of practice settings, systems, and career options within psychiatry
  • Display an understanding of his/her own limitations, a commitment to ongoing professional development, and openness to seeking appropriate supervision and consultation within and beyond residency

Satisfactory completion of the PGY-4 year requires:

  • Satisfactory completion of a total of 48 months of training, including all rotations necessary to meet program graduation and Board requirements
  • Ratings of “proficient” or better in all categories of the Continuity Clinic and Primary Care consultation evaluation forms, as well as in all elective rotations.
  • Passing at least 3 Clinical Skills Assessments, passing a “mock Board” examination, and completion of the PRITE examination
  • Satisfactory demonstration of all ACGME psychotherapy competencies, as assessed by the program’s psychotherapy competency standards and evaluations
  • Demonstration of life-long learning skills through journal club, completion of a scholarly project, and practice-based improvement activities and didactics
  • Attendance at 70% of all scheduled didactics sessions OR 85% or more of didactic sessions for which the resident is not excused (e.g. for vacation, illness, post-call, on call).
  • Participating in teaching PGY-1 residents in their didactics
  • Evidence of compassionate, respectful, professional, and ethical behavior as well as openness to feedback and supervision
ad. Guidelines Following Patient Suicide

Patient suicide is a dreaded potential consequence of psychiatric illness. Such an event requires the treating psychiatrist to respond in a manner that fulfils a number of roles and responsibilities that arise, while also attending to powerful emotions. The ideal outcome of this painful process is the organized completion of immediate responsibilities and the careful resolution of emotional responses to promote higher levels of personal and professional growth and responsibility.

The guidelines and recommendations outlined below are intended to be helpful in identifying immediate responsibilities and potential resources and sources of support for residents following a patient suicide. Since every case is unique, and presents its own issues, these are intended only as general guidelines, to be modified as appropriate for the individual situation. However, in every case of a patient suicide, and other serious adverse outcomes (e.g. the non-suicide death of a patient, violence, arrest of a patient), the resident should immediately notify the supervising attending and residency director for guidance.

I. Attend to Immediate Responsibilities
A psychiatrist has a number of responsibilities following patient suicide. Carrying out these responsibilities often occurs during a period of shock and disbelief upon hearing of the suicide of a patient. The following protocol is meant to help organize the immediate responsibilities following this event.

  1. Call the psychiatry residency office to inform the training director.
  2. Inform your attending (the attending of record) as well as your supervisor (if this differs from your attending).
  3. Make a plan with your attending for completing subsequent tasks:
    • Chief of Service – Your attending should notify the Chief of Psychiatry at the clinical site and the Director of the clinical service(s) involved in the care of the patient, and the Assistant Training Director at the site.
    • Risk management – Call the risk management office at your training site for information and suggestions on how to proceed with contacting the patient’s family members and completing the medical record. At VA sites, write an incident report and contact the Chair of the Suicide Committee.
    • Family members – The patient’s privacy rights do not end at death. You may call the patient’s legally authorized representative and/or those in the patient’s family who you know were involved in the care of the patient and were aware of their treatment to express sympathy and support. Offer to meet with the family with your attending or supervisor. Disclosures of protected health information about the deceased patient are still limited by the HIPAA privacy regulations and ethical and legal requirements for confidentiality remain in place. Only discuss protected health information of which the family has knowledge. You may need to inform family members that your disclosures are limited by State and Federal privacy laws.
    • Staff – Your attending should notify other staff members who may have been involved in the patient’s care or who may be affected by the patient’s death.
    • Other patients – If other patients were involved in treatment settings with your patient, make a plan with your attending about disclosing information to other patients. You may contact the entity Privacy Officer for assistance as well. Points to consider include – to whom to disclose information; what information to disclose; when to disclose information. A general guideline is to disclose only information that has been available through third-party, public sources – i.e. information that is not confidential, protected health information, and/or only provide that information which had already been available to the other patients in the treatment setting and public sources.
  4. Administrative case review – Following an adverse outcome, administrative and clinical leaders will routinely review the circumstances of the event for medical-legal and quality assurance purposes. This administrative case review differs from a suicide case review conference that is meant for educational purposes. Psychiatry residents may or may not participate in the administrative case review process.

References:
Cotton PG, Drake RE Jr, Whitaker A, Potter J. Dealing with suicide on a psychiatric inpatient unit. Hospital and Community Psychiatry 1983; 34(1):55-9.

Kaye MS, Soreff SM. The psychiatrist’s role, responses and responsibilities when a patient commits suicide. American Journal of Psychiatry 1991; 148(6):739-43.

II. Access support for managing emotional experiences
After an initial response of shock and disbelief, common emotional responses to patient suicide include grief, guilt, anger, betrayal, sadness and sometimes relief. Levels of distress in the therapist survivor are sometimes comparable to distress in clinical populations of bereaved individuals seeking treatment after the death of a relative. “Severe distress” is often characterized by grief and guilt. Effective understanding and management of emotional responses following patient suicide facilitates personal and professional growth.

  1. Informal peer support – Case reports and surveys of therapist survivors consistently report that informal peer support from family, friends and professional colleagues is the most beneficial factor in managing emotional experiences following patient suicide. Residents may choose to devote a portion of T-group time to discussing these experiences.
  2. Supervision – Discussions with past and current supervisors are often helpful in managing responses to patient suicide. This is especially the case if the supervisor can share personal experiences of patient suicide.
  3. Literature review – Many therapist survivors have written case reports describing their experience with patient suicide. Reviewing these reports may decrease the sense of isolation that follows patient suicide.
  4. Personal psychotherapy – Individual psychotherapy may be helpful to residents in dealing with emotional responses to a patient suicide.

References:
Gitlin MJ. A psychiatrist’s reaction to a patient’s suicide. Am J Psychiatry 1999; 156:1630-1634.

Kolodny S, Binder RL, Bronstein AA, Friend RL. The working through of patients’ suicides by four therapists. Suicide and Life-Threatening Behavior 1979; 9(1)33-46.

Reeves G. Terminal mental illness: resident experience of patient suicide. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 2003; 31(3):429-41.

III. Suicide Case Review
Following the suicide death of a patient, a suicide case review allows for an examination of the circumstances surrounding the death – including the suicide risk factors, protective factors for suicide and treatment interventions – as well as an opportunity to express emotions related to the case. While it is never clear whether any specific action or inaction played a causal role in patient suicide, case review fosters professional responsibility by allowing the clinician to learn from the negative outcome in a way that may benefit future patients. An ill-timed case review or a case review conducted with a blaming tone can be harmful to clinicians. To avoid these harmful effects, a case review should be conduced after some resolution of negative emotional experiences (especially grief and guilt) and with the acknowledgement of the uncertainty involved in predicting suicidal behavior.

  1. Setting of a case review – A suicide case review may take place in any professional setting that fulfils the educational function of the process. For cases involving a treatment team, this may be in a staff conference or larger morbidity and mortality conference, which should be approved by the Chief of Service to ensure that appropriate institutional confidentiality requirements are observed. For patients seen in individual psychotherapy, this may be in individual psychotherapy supervision.
  2. Components of a case review – For educational purposes, a case review should consist of the following components:
    • General circumstances of the case – Treatment setting, presenting symptoms, events leading up to the suicide.
    • Risk factors for suicide
    • Protective factors for suicide
    • Assessment of suicide risk
    • Treatment interventions for suicide
    • Other interventions that may have been implemented to modify risk or protective factors.

References:
Hendin H, Haas AP, Maltsberger JT, Koestnere B, Szanto K. Problems in psychotherapy with suicidal patients. American Journal of Psychiatry 2006; 163(1):67-72.

Schneidman ES. Suicide, lethality and the psychological autopsy. International Psychiatry Clinics 1969; 6(2):225-50.

IV. Professional Growth and Responsibility
Following an experience with patient suicide, clinicians may benefit from modifying their professional practices and engaging in altruistic activities to help others prepare for or cope with this experience. Please discuss with your supervisor activities such as public sharing and publication of experiences, to ensure that you are following appropriate confidentiality and HIPAA guidelines.

  1. Suicide risk assessment and documentation – Clinicians should review their suicide risk assessment and documentation practices. Documentation should include a review of relevant risk factors, assessment of suicide risk, interventions to modify suicide risk and justification for the level of care (justification for not initiating higher levels of intervention).
  2. Altruistic activities
    • Public sharing of experiences
    • Organizing educational activities related to patient suicide
    • Publishing literature
    • Reaching out to other therapist survivors

References:
Reeves G. Terminal mental illness: resident experience of patient suicide. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 2003; 31(3):429-41.

Sung, J. Clinician’s Response to Patient Suicide.

ae. “Off Ward” Supervision

During inpatient psychiatry rotations, each R1 and new R2 will be assigned an “off ward” supervisor by the Chief Resident. The resident is expected to arrange regular supervision meetings with his/her “off ward” supervisor for one hour per week. “Off ward” supervision is designed to provide another hour of individual supervision from a regular or clinical faculty member who is not the resident’s clinical attending; to provide a different perspective on patient care issues and psychiatry as a field; and to help the resident to develop skills in empathic interviewing, case formulation and presentation, clinical decision-making, reading psychiatric literature, applying basic and clinical knowledge to clinical situations, and/or working as part of a multidisciplinary inpatient team.

The particular focus of the supervision will depend on the interests and educational needs of the resident. “Off ward” supervisors may interview and assess patients with the resident, provide supervision for the resident’s cases, teach the resident to present and formulate cases, provide mentorship in dealing with interpersonal issues or the resident’s role on the inpatient team, or review articles from the Inpatient Psychiatry Syllabus with the resident.

Of note, each resident is required, over the course of their Inpatient Psychiatry rotations, to read, and review with a supervisor, all of the articles in the Inpatient Psychiatry syllabus; to do one formal case presentation and formulation per 3-month rotation; and to obtain documentation of completion of these educational activities from a supervising attending (either their “off ward” supervisor or their inpatient attending).

af. Policy Concerning Admission Physicals

The on-call resident is required to make sure that intake physical exams are performed on all patients admitted during the on-call period, by the time he or she leaves the site. Thus, a resident who does call at one site but is on regular rotation elsewhere, needs to finish intake physicals before leaving. A resident who has admitted to himself or herself may defer the initial physical upon admission but has to perform (or supervise) the exam before leaving post-call.

ag. Role Description of Consultation-Liaison Attending and Resident
  • Residents are assigned to a specific faculty member who meets daily with residents to discuss all new patients and review treatment plans.
  • The Attending Physician has the final clinical, legal, and fiscal responsibility in the care of patients. The Attending supervises and teaches Residents and medical students, and is responsible for review of initial evaluations, which allow for utilization review and billing.
  • Under the supervision of the Attending, the Resident is responsible for the initial evaluation and any needed follow-up, as well as appropriate communication with the primary team. Supervision and teaching of medical students is a joint responsibility of Attendings and Residents.
  • In addition to clinical rounds, the Resident will receive a minimum of one hour per week scheduled supervision time with his/her Attending.
  • As a teacher, the Attending will provide the Resident with information, options, and choices in patient care. The Attending needs to keep abreast of the clinical issues on the service, and supervision needs to be sufficiently close to allow him/her to notice problems.
  • The Attending needs to monitor the Resident’s performance and give feedback. The Attending determines how closely a resident needs to be supervised and how much reporting he or she expects from a particular resident, depending on the Resident’s level of training and experience. The Resident will be open to learning, willing to consult, and be prepared to fully inform the
  • Attending about all matters of patient care. It is strongly recommended that the specific terms of the supervisory agreement be made explicit in a collegial discussion between the Attending and the Resident.
  • As a role model, the Attending will demonstrate interviewing skills, the process of clinical thinking, and effective interaction with patients and staff. The Resident will function as a role model to the medical student. Resident and Attending share the responsibility for promoting an educational climate on the service.
  • There will at all times be a Resident and/or an Attending available to the service. During the day the Attending is available at the hospital site and/or can be consulted by phone. If the Attending cannot be available at the site, a specific other Attending will be designated to cover for emergencies that require the physical presence of an Attending. Attendings are expected to honor a Resident’s request at any time to examine a patient for initial evaluation or re-evaluation.
  • Whenever possible, Residents will cover for one another for the required half-day Continuity Clinic.
  • The Attending will support and facilitate the Resident’s attendance at Didactics, Grand Rounds, Business Meetings, and Continuity Clinic. If the resident is gone for these reasons, the Attending will cover the service and a designated person will carry the regular consult pager. The Attending will honor the Resident’s right to take one week of vacation during a one or two month consult rotation. (As for clinical coverage, the general policy applies: Residents will make a “good faith” effort to cover for one another during absences, but the final responsibility rests with the Attendings. Residents on inpatient units or other required rotations can not be asked to cover for an absent consultation-liaison Resident.)
ah. Role Description of Inpatient Attending and Resident
  • Residents are assigned to a specific faculty member, who makes daily clinical rounds with the Resident, examines all new patients, and reviews the treatment plans.
  • The Attending Physician has the final clinical, legal, and fiscal responsibility in the care of his/her patients. The Attending supervises and teaches Residents and medical students, and is responsible for admission and progress notes, which allow for utilization review and billing.
  • Under supervision of the Attending, the Resident is responsible for the admission and the daily medical and psychiatric management of the patient. The Resident is responsible for physician orders, admission and clinical progress notes, and discharge summaries. The Resident is responsible for the integration of the multidisciplinary treatment plan. The Resident supervises, and teaches medical students.
  • In addition to clinical rounds, the Resident will receive a minimum of one hour per week scheduled supervision time with his/her Attending, and another hour of formal one-to-one supervision by another faculty member (see “Off Ward” Supervision), as well as regular supervision by the Chief Resident.
  • As a teacher, the Attending will provide the Resident with information, options, and choices in patient care. The Attending needs to keep abreast of the clinical issues on the ward, and supervision needs to be sufficiently close to allow him/her to notice problems.
  • The Attending needs to monitor the Resident’s performance, and give feedback. The Attending determines how closely a Resident needs to be supervised, and how much reporting he or she expects from a particular Resident, depending on the Resident’s level of training, and experience. The Resident will be open to learning, willing to consult, and prepared to fully inform the Attending about all matters of patient care. It is strongly recommended that the specific terms of the supervisory agreement (i.e. how much supervision?, how much reporting is expected?, coverage?, etc.) be made explicit in a collegial discussion between Resident and Attending.
  • As a role model, the Attending will demonstrate interviewing skills, the process of clinical thinking, and effective interaction with patients, and staff. The Resident will function as a role model to the medical student. Resident and Attending share the responsibility for promoting an educational climate on the unit.
  • There will at all times be a Resident and an Attending available to the inpatient unit. During the day the Attending is available at the hospital site and/or can be consulted by phone. If the Attending cannot be available at the site, a specific other Attending will be designated to cover for emergencies that require the physical presence of an Attending. Attendings are expected to honor a Resident’s request for immediate on-site supervision.
  • Residents will cover for one another for the required half-day Continuity Clinic.
  • The Attending will support and facilitate the Resident’s attendance at Didactics, Grand Rounds, Business Meetings, Continuity Clinic and supervision sessions. The Attending will honor the Resident’s right to take one or two weeks vacation on a particular three month inpatient rotation, as specified in, and subject to, University and Department policies.
ai. Supervision Policy

Definitions

Psychiatry Resident:
A physician who is engaged in a graduate education program in psychiatry or a psychiatric subspecialty, and who participates in patient care under the direction of attending physicians (or licensed independent practitioners) as approved by the Psychiatry Review Committee of the ACGME. Note: The term “resident” includes all residents and fellows, including individuals in their first year of training (PGY1), often referred to as “interns,” and individuals in approved subspecialty graduate medical education programs who historically have also been referred to as “fellows.”

As part of their educational program, residents are given graded and progressive responsibility according to the individual resident’s clinical experience, judgment, knowledge, and technical skill. Each resident must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence. Residents are responsible for asking for help from the supervising physician (or other appropriate licensed practitioner) for the service they are rotating on when they are uncertain of diagnosis, how to perform a diagnostic or therapeutic intervention, or how to implement an appropriate plan of care.

Attending of Record (Attending):
An identifiable, appropriately-credentialed and privileged attending physician, or licensed independent practitioner, who is ultimately responsible for the management of the individual patient and for the supervision of residents involved in the care of the patient. The attending delegates portions of care to residents based on the needs of the patient and the skills of the residents.

Supervision:
To ensure oversight of resident supervision and graded authority and responsibility, the following levels of supervision are recognized:

  1. Direct Supervision – the supervisor (attending, licensed independent practitioner, or senior resident with documented supervisory capability) is physically present with the resident and patient.
  2. Indirect Supervision:
    • with direct supervision immediately available – the supervisor is physically within the hospital or other site of patient care and is immediately available to provide Direct Supervision
    • with direct supervision available – the supervisor is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities and is available to come to the site of care in order to provide Direct Supervision.
  3. Oversight – the supervising physician is available to provide review of patient care with feedback provided after care is delivered.

Clinical Responsibilities

The clinical responsibilities for each resident are based on PGY-level, patient safety, resident education, severity and complexity of patient illness/condition and available support services. The specific role of each resident varies with their clinical rotation, experience, duration of clinical training, the patient’s illness and the clinical demands placed on the team. The following is a guide to the specific patient care responsibilities by year of clinical training. Residents must comply with the supervision standards of the service on which they are rotating unless otherwise specified by their program director.

PGY-1 (Junior Residents)
PGY-1 residents are primarily responsible for the care of patients under the guidance and supervision of the attending physician and senior residents. They should generally be the point of first contact when questions or concerns arise about the care of their patients. However, when questions or concerns persist, supervising residents and/or the attending physician should be contacted in a timely fashion. PGY-1 residents are initially directly supervised and, when merited, will progress to being indirectly supervised with direct supervision immediately available (see definitions above) by an attending or senior resident. PGY-1 residents may progress to being supervised indirectly with direct supervision available only after demonstrating competence in:

  • the ability and willingness to ask for help when indicated;
  • gathering an appropriate history;
  • the ability to perform an emergent psychiatric assessment; and,
  • presenting patient findings and data accurately to a supervisor who has not seen the patient.

Progress to indirect supervision with direct supervision immediately available requires demonstration of a), b), and d) on at least three different occasions. PGY-1 residents may supervise medical students; however, the attending physician is ultimately responsible for the care of the patient.

PGY-2 (Intermediate Residents)
Intermediate residents may be directly or indirectly supervised by an attending physician or senior resident but will provide all services under supervision. They may supervise medical students; however, the attending physician is ultimately responsible for the care of the patient.

PGY-3, PGY-4, and above (Senior Residents)
Senior residents may be supervised directly, indirectly, or by oversight. They may provide direct patient care, supervisory care, or consultative services, with progressively graded responsibilities, as merited. They must provide all services ultimately under the supervision of an attending physician. Senior residents should serve in a supervisory role of medical students, junior, intermediate, and (in the case of fellows) PGY-3 or PGY-4 residents, in recognition of their progress towards independence, as appropriate to the needs of each patient and the skills of the senior resident; however, the attending physician is ultimately responsible for the care of the patient. When a senior resident is supervising a more junior resident, both residents should inform patients of their respective roles in that patient’s care.

Attending of Record
In the clinical learning environment, each patient must have an identifiable, appropriately-credentialed and privileged primary attending physician who is ultimately responsible for that patient’s care. The attending physician is responsible for assuring the quality of care provided and for addressing any problems that occur in the care of patients, and thus must be available to provide direct supervision when appropriate for optimal care of the patient. The availability of the attending to the resident is expected to be greater with less experienced residents and with increased acuity of the patient’s illness. The attending must notify all residents he/she supervises of when he or she should be called regarding a patient’s status. In addition to situations the individual attending would like to be notified of, the attending should include in his or her notification to residents all situations that require attending notification, per program policy. These are as follows:

  • The supervising attending needs to be informed by the resident: a) when the patient’s condition deteriorates unexpectedly; b) when additional information puts the working diagnosis in doubt or questions the treatment plan; c) when information is obtained that raises concerns regarding the patient’s risk for self-harm or harm to others; d) when the patient or family members disagree with the treatment plan; e) when there are serious disagreements or conflicts within the treatment team or with other services or providers; f) when decisions need to be made that have major clinical or legal implications, such as decisions not to hospitalize suicidal or homicidal patients
  • During on-call duty, the resident will notify the on-call attending when: a) the resident has any questions or concerns about the patient or the care provided; b) when patients decide to leave AMA; c) when the resident intends not to hospitalize a patient seen in the ER who has expressed ideas of self-harm or harm to others; d) when the resident intends to turn down a request for admission; e) when the resident plans to send home from the ER a patient who has had a rapidly deteriorating clinical course (e.g. recent onset of mania, anorexia with significant recent weight loss). The resident will also call the on-call attending to review all consults

The attending may specifically delegate portions of care to residents based on the needs of the patient and the skills of the residents and in accordance with hospital and/or departmental policies. The attending may also delegate partial responsibility for supervision of junior residents to senior residents, but the attending must assure the competence of the senior resident before supervisory responsibility is delegated. The attending remains responsible for assuring that appropriate supervision is occurring and is ultimately responsible for the patient’s care. Residents and attendings should inform patients of their respective roles in each patient’s care.

The attending and supervisory resident are expected to monitor competence of more junior residents through direct observation, rounds, individual and group supervision sessions, and review of the medical records of patients under their care.

Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each resident and delegate to him/her the appropriate level of patient care authority and responsibility.

Supervision of Invasive Procedures

In a training program, as in any clinical practice, it is incumbent upon the physician to be aware of his/her own limitations in managing a given patient and to consult a physician with more expertise when necessary. When a resident requires supervision, this may be provided by a qualified member of the medical staff or by a resident who is authorized to perform the procedure independently. In all cases, the attending physician is ultimately responsible for the provision of care by residents. When there is any doubt about the need for supervision, the attending should be contacted.

Procedures that psychiatry residents can perform on medicine, pediatrics, or neurology rotations, and the required level of supervision, should be as specified by supervision policies of those programs and departments, as appropriate to the resident’s level of training, experience, technical skill, the procedure, and the clinical situation. The following procedures may be performed on psychiatry rotations with the indicated level of supervision:

  • Direct supervision required by a qualified member of the medical staff
    Electroconvulsive therapy (ECT)
  • Indirect supervision required with direct supervision available by a qualified member of the medical staff
    Intravenous line insertion
  • Oversight required by a qualified member of the medical staff
    Phlebotomy Suture removal

Emergency Procedures
It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur. The resident may attempt any of the procedures normally requiring supervision in a case where death or irreversible loss of function in a patient is imminent, and an appropriate supervisory physician is not immediately available, and to wait for the availability of an appropriate supervisory physician would likely result in death or significant harm. The assistance of more qualified individuals should be requested as soon as practically possible. The appropriate supervising practitioner must be contacted and apprised of the situation as soon as possible.

Supervision of Consults

Residents may provide consultation services under the direction of attendings or supervisory residents, including fellows. The attending of record is ultimately responsible for the care of the patient and thus must be available to provide direct supervision when appropriate for optimal care. The availability of the attending and supervisory residents or fellows should be appropriate to the level of training, experience and competence of the consult resident and is expected to be greater with increasing acuity of the patient’s illness. Information regarding the availability of attendings and supervisory residents or fellows should be available to residents, faculty members, and patients. Residents performing consultations on patients are expected to communicate verbally with their supervising attending as soon as possible after seeing the patient and certainly within 24 hours or (for night float and on call residents) within the same call or night float shift. Any resident performing a consultation where there is credible concern for patient’s life, requiring the need for immediate intervention, MUST communicate directly with the supervising attending as soon as possible prior to intervention or discharge from the hospital, clinic or emergency department. If the communication with the supervising attending is delayed due to ensuring patient safety, the resident will communicate with the supervising attending as soon as possible. Residents performing consultations will communicate the name of their supervising attending to the services requesting consultation.

Supervision of Hand-Offs

Residents, attendings, and other primary providers on psychiatry services must provide structured verbal and electronic handoffs when transferring care of a patient, and must be available to receive handoffs when taking over the care of a patient. Residents may be supervised directly or indirectly, by an attending or supervisory resident, in giving and receiving handoffs. Junior residents should be directly supervised in giving and receiving handoffs initially, to establish competence. The attending physician remains responsible for assuring that appropriate handoffs are occurring and is ultimately responsible for the patient’s care.

Resident Competence & Delegated Authority

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members. The program director must evaluate each resident’s abilities based on specific criteria. In psychiatry, these criteria include:

  • Documentation, on at least three occasions, of a PGY-1’s (or beginning resident’s) readiness for indirect supervision with direct supervision available.
  • Documentation of a PGY-1’s (or beginning resident’s) competence in providing and receiving handoffs.
  • Satisfactory peer evaluations of residents by training call residents (supervisory residents evaluating junior residents) or by trainees (more junior residents evaluating supervisory residents)
  • Clinical rotation evaluations
  • Clinical skills assessments f) Demonstration of supervisory capability by PGY-3 and PGY-4 residents through structured role plays, as part of the annual Teach the Teachers program.

Guidelines around Supervision and Progressive Responsibility

Attendings and residents should adhere to the SUPERB-SAFETY model in providing and seeking supervision, as follows:

Attendings should adhere to the SUPERB model when providing supervision. They should:

  • Set Expectations: set expectations on when they should be notified about changes in patient’s status.
  • Uncertainty is a time to contact: tell resident to call when they are uncertain of a diagnosis, procedure or plan of care.
  • Planned Communication: set a planned time for communication (i.e. each evening, on call nights)
  • Easily available: Make explicit your contact information and availability for any questions or concerns.
  • Reassure resident not to be afraid to call: Tell the resident to call with questions or uncertainty.
  • Balance supervision and autonomy.

Residents should seek supervisor (attending or senior resident) input using the SAFETY acronym.

  • Seek attending input early
  • Active clinical decisions: Call the supervising resident or attending when you have a patient whose clinical status is changing and a new plan of care should be discussed. Be prepared to present the situation, the background, your assessment and your recommendation.
  • Feel uncertain about clinical decisions: Seek input from the supervising physician when you are uncertain about your clinical decisions. Be prepared to present the situation, the background, your assessment and your recommendation.
  • End-of-life care (in psychiatry, including risk assessment) or family/legal discussions: Always call your attending when a patient is suicidal, homicidal, gravely disabled, or at imminent risk, or when there is concern for a medical error or legal issue.
  • Transitions of care: Always call the attending when the patient becomes acutely ill and you are considering transfer to another service, facility, or level of care.
  • Help with system/hierarchY: Call your supervisor if you are not able to advance the care of a patient because of system problems or unresponsiveness of consultants or other providers.
aj. Expectations Regarding Supervision

Supervision is designed to help residents to learn the principles and practice of Psychiatry. Residents are supervised throughout residency, as part of every clinical experience. Beginning residents have close, daily supervision. As residents progress through the residency, they will generally be supervised less closely and less frequently. Residents will be given increasing responsibility for patient care, in a graduated manner, appropriate to their level of training and skills. In addition, senior residents are expected to supervise junior residents (with attending backup) during training call. The program’s policies regarding supervision are outlined in the Supervision Policy. The following Expectations Regarding Supervision constitutes an addendum to the Supervision Policy and covers more detailed and specific requirements for types of supervision at each PGY level, as well as general expectations regarding supervisory relationships in our residency program.

Overview of Specific, Required Types of Supervision by PG-year:

PGY-1 year

  • Daily supervision with inpatient Psychiatry attending on rounds
  • During Psychiatry rotations, one hour a week of supervision with the inpatient attending (apart from rounds)
  • One hour per week “off ward” supervision (on Psychiatry rotations) with a faculty member other than your inpatient attending. You can use this time to present and discuss cases, work on case formulation, interview patients with your supervisor, review literature, etc.
  • Back up attending supervision when on call (please see below for guidelines about when to contact your on-call backup attending)

PGY-2 year

  • Daily supervision with inpatient/consult/ER attending on rounds
  • One hour a week of supervision with inpatient/consult/ER attending (apart from rounds)
  • One hour per week of psychotherapy supervision (assigned)
  • Caseload supervision in clinic (i.e. supervision of your patient caseload by an on-site faculty member responsible for the patient care you provide)
  • Back up attending supervision when on call

PGY-3 year

  • Daily supervision with inpatient/consult/ER attending, as relevant
  • One hour/week of supervision with inpatient/consult/ER attending (apart from rounds), as relevant
  • Caseload supervision in every clinic (one hour per clinic day; may be in team/group format)
  • At least two hours per week of psychotherapy supervision
  • Back up attending supervision during clinic days and when on call

PGY-4 year

  • Caseload supervision in every clinic (one hour per clinic day)
  • At least two hours per week of psychotherapy supervision
  • Back up attending supervision during clinic days and when on call

Expectations Regarding Supervision
Interactions between residents and supervising faculty attendings are governed by the following principles:

  • Interactions between residents and attendings are expected to be respectful, collegial, and focused on the common goal of excellent patient care
  • A resident should, at all times, have direct access (in person or by telephone) to a faculty attending
  • When the attending is on vacation or otherwise unavailable, a specific covering attending will be designated
  • A faculty attending on the clinical service in which patient care takes place is designated as the supervising attending and has the ultimate clinical and legal responsibility for the care provided, although the resident is encouraged (and may be required) to also consult with other clinical or regular faculty supervisors
  • Residents will present new cases to the attending on daily rounds on the inpatient, emergency, and consultation-liaison psychiatry services. On outpatient rotations, the resident will present new cases to the attending (caseload supervisor) as soon as possible, and definitely within two weeks, and will provide regular updates for ongoing cases (monthly, or whenever the patient is seen if this is less often than monthly)
  • Residents on Psychiatry services (i.e. not on Medicine, Pediatrics, or Neurology) will have at least two hours of individual supervision per week (including individual supervision with the inpatient/consult/ER attending, “off ward” supervision, psychotherapy supervision, and/or outpatient caseload supervision, as appropriate: see overview by PG-year, above)
  • As a teacher, the supervisor/attending is expected to provide the resident with information, guidance, and choices in patient care. The attending/supervisor needs to keep abreast of clinical issues on the service or with the resident’s patient caseload, and supervision needs to be sufficiently close to allow him/her to notice problems
  • The attending/supervisor needs to monitor the resident’s performance and give regular, constructive feedback. The attending/supervisor determines how closely the resident needs to be supervised and how much reporting he/she expects from a particular resident, depending on the resident’s level of training, experience, and skills. The resident is expected to be open to learning, willing to consult, and prepared to fully inform the attending/supervisor about all patient care issues. It is strongly recommended that the expectations, terms, and goals of the supervisory agreement be made explicit in a collegial discussion between the attending/supervisor and the resident at the beginning of the supervisory relationship
  • As outlined in the Supervision Policy, the supervising attending needs to be informed by the resident: a) when the patient’s condition deteriorates unexpectedly; b) when additional information puts the working diagnosis in doubt or questions the treatment plan; c) when information is obtained that raises concerns regarding the patient’s risk for self-harm or harm to others; d) when the patient or family members disagree with the treatment plan; e) when there are serious disagreements or conflicts within the treatment team or with other services or providers; f) when decisions need to be made that have major clinical or legal implications, such as decisions not to hospitalize suicidal or homicidal patients
  • As outlined in the Supervision Policy, during on-call or night float duty, the resident will notify the on-call attending when: a) the resident has any questions or concerns about the patient or the care provided; b) when patients decide to leave AMA; c) when the resident intends not to hospitalize a patient seen in the ER who has expressed ideas of self-harm or harm to others; d) when the resident intends to turn down a request for admission; e) when the resident plans to send home from the ER a patient who has had a rapidly deteriorating clinical course (e.g. recent onset of mania, anorexia with significant recent weight loss). The resident will also call the on-call attending to review all consults.

Any resident or supervisor who feels uncomfortable with any supervision relationship, for whatever reason, should consult the Residency Director, Associate Residency Director, and/or Chief Resident at the clinical site for help and advice.

VI. Competency and Performance Evaluations; Performance Disagreements
a. General
  1. Examinations
    • Each year all residents, except those in the first year of the program, take the annual American College of Psychiatrists National Examination (PRITE). At the end of each year PGY-2 and PGY-3 residents sit for a “mini-oral” examination (“Mock Boards”) patterned after Part II of the American Board of Psychiatry and Neurology. PGY-4 residents sit for Mock Boards in January. The results of these tests are given to the resident and his or her preceptor for review and feedback discussion. The general performance and competence of the residents who fail these examinations and are given “deficiency” ratings is reviewed by the RESC.
  2. Ongoing Performance Evaluations
    • Residents are both evaluators of the training system and are evaluated by it. Residents provide evaluations of their psychotherapy supervisors, their clinical rotation Attendings, and the didactic lecturers, so that the program can be responsive to their needs. These evaluations allow the program to drop inadequate supervisors and promote good ones. Teaching evaluations are a major basis for promotion of regular faculty.
    • All supervisors, either of clinical rotations or individual psychotherapy, fill out quarterly, and end of rotation forms on the general performance of all Residents. These are reviewed by the Resident, the preceptor, and the Residency Training Director. Performance problems and issues are discussed at the monthly Clinical Site Coordination meeting, which may make recommendations for remedial action or refer the case to the RESC for review (see below).
    • In addition to following a list of training objectives that are to be completed on each rotation, a number of clinical sites have developed, in collaboration with the Residents, the Director’s office and the RESC, specific rotation performance criteria. Residents who fall below the minimum expectation level as described in these criteria, and have not satisfactorily completed the rotation, are required to complete the rotation afterwards (i.e., until the requirements are met).
    • The Site Coordination Committee performs a monthly resident progress review, discussing observed performance, performance problems reported on the evaluation forms, and issues in meeting specific rotation criteria.
  3. Procedures for Addressing Performance Problems
    • Informal procedures
      • Performance problems or concerns reported to the residency training office, or to one of the Chief Residents or Assistant Training Directors, by Residents, supervisors, or Attendings, orally or in writing, are discussed by the Site Coordinators’ Committee. Faculty should report problems immediately and realize that only timely feedback allows for problem solving and corrective action. Residents who disagree with performance evaluations or who would like clarification about feedback, or who would like to receive additional feedback on their progress, can request a review of their performance by the committee.
      • The committee may initiate formal procedures or may determine that the problems are minor and/or incidental and that they can be resolved by supportive or remedial action. For instance, the committee may recommend that Attendings monitor a particular resident more closely or provide more direct support and supervision; the committee may recommend meetings between the Resident and certain faculty for progress review and performance counseling; the committee may recommend special tutoring in particular skills or knowledge areas.
      • The residency training office is responsible for informing the Resident about the fact that concerns have been raised and for implementing the committee’s recommendations. However, should a resident feel that the evaluation was not made in good faith, he or she should feel free to initiate formal evaluation review procedures.
    • Formal evaluation review procedures; formal evaluation review procedures can be initiated:
      • By a faculty supervisor who reports major performance problems and request formal action
      • By the Residency Training Director, especially if immediate action is required
      • By the Site Coordination Committee
      • By the Resident when the informal procedures are experienced as unsatisfactory.

Please see Probation Policy for a description of formal review procedures.

b. Annual Evaluation for Advancement
  • All PGY-1, PGY-2, and PGY-3 residents are evaluated annually for advancement by the Resident Education Steering Committee (RESC). Advancement to the next PGY-level is contingent on the resident’s making satisfactory progress toward meeting the educational goals specified for his/her current PGY-level.
  • Resident progress is monitored in an ongoing way by the resident’s faculty advisor, the program director, and the Site Coordination Committee. If the Site Coordination Committee recommends non-promotion or non-reappointment of a resident, the resident will be notified in advance of the RESC’s January meeting, and the resident’s faculty advisor will be invited to attend the RESC meeting in an advising, non-voting capacity. The RESC may or may not follow the Site Coordination Committee’s recommendations. The recommendations of the RESC are to the Program Director and, ultimately, to the Department Chair.
  • In the case of non-promotion or non-reappointment, as per the Resident Position Appointment, the resident will be notified by February 15th or at least four months prior to the normal termination date of the resident’s existing appointment if the date of appointment is any date other than June 30th. The notification will be by letter to the resident and will contain the reasons for the non-promotion or non-reappointment.
c. Criteria for Graduation

To graduate from the program, and to be eligible to sit for the American Board of Psychiatry and Neurology examinations in Psychiatry, residents must complete 48 months of approved training, including a PGY-1 year (see Application Procedures, for a description of acceptable PGY-1 experiences for those residents entering as PGY-2s). To graduate, each resident must also:

  • Complete, in a satisfactory manner, all required clinical rotations, as well as sufficient elective rotations to total 48 months of training.
  • Pass an oral examination (“Mock Boards”) that includes interviewing a psychiatric patient and answering examiners’ questions regarding diagnostic formulation, assessment methods, and treatment approaches.
  • Be approved for graduation by the department’s Resident Education Steering Committee (RESC). In considering residents for graduation, the RESC considers clinical competence, interpersonal skills, ethical standards, and professional conduct.
d. Evaluation of Didactic Instruction

Policy on Attendance at Didactics

Attendance at didactic lectures is mandatory. Residents who cannot attend (on-call the previous night, vacation, sick leave, etc.) will be excused. Residents are responsible for documenting their attendance by filling out the “record of attendance” part of the didactic teaching assessment form, and returning it to the Residency Training Office. All Residents whose attendance falls below 85% of the lectures that they are required to attend (i.e. the “unexcused” lectures) will be reviewed by the RESC. The RESC may impose the following sanctions:

  • A letter of reprimand, a copy of which will be entered into the Resident’s academic file.
  • Delay of the decision to allow advancement. (The Resident will be notified in writing of the delay, and of the date on which his/her performance will be reviewed; the Resident will not receive his/her contract for renewal until a final decision for advancement is made.)

The Resident may also be required to obtain reading materials on the didactic subjects taught in his/her absence, and to sit for an oral or written examination on this material. The sanctions mentioned above may be made contingent upon failure to pass this exam.

Evaluation Procedures

Residents should obtain a Didactic Teaching Assessment and Record of Attendance Form at the beginning of each lecture (Appendix I). Completed evaluations are returned to the Residency Program Office; in order for the data to be condensed and mailed to the Didactic Program Annual Coordinators (PGY-1: Drs. Marcella Pascualy and Tom Soeprono, PGY-2: Dr. Aaron Green, PGY-3: Dr. Matthew Schreiber, PGY-4: Drs. Catherine Howe and Katherine Michaelson). The Annual Coordinators give feedback to the lecturers. Evaluations are forwarded with the Resident’s Attendance Form removed, i.e. anonymously. Evaluations of didactic lectures are taken very seriously and are used to improve the didactic program, as well as to evaluate faculty teaching for promotion.

e. Evaluation of Resident Performance on Clinical Rotations
  1. Required Inpatient Rotations; Required Outpatient Rotations; Consultation-Liaison Rotations; ATC Rotation
    • The Residency Training Office will send out evaluation forms (Appendix H) the first week of September, December, March, and June.
    • Residents will be evaluated and will evaluate the rotation.
    • The Attending will fill out the “Attending Report”. Attendings are encouraged to discuss their evaluations with the Resident during supervision. The resident will receive a copy of the Attending’s evaluation. Evaluations may be written or typed without using the program’s evaluation forms as long as the evaluation includes Resident/Attending/rotation’s strengths and weaknesses and whether expectations and goals and objectives were met.
    • Goals and objectives for the rotation should be considered in filling out evaluations.
    • The Residency Training Office will:
      • File the Resident’s report on the rotation (to be used for planning, promotions, etc.), collate reports from different Residents, and send collated confidential evaluations to each attending every 6 months.
      • Send a copy of the attending report to the Resident’s preceptor.
    • The Residency Training Office will send out a reminder to discuss overall performance with the Resident, to each preceptor in May and November.
  2. Child Rotations
    • CHMC will maintain its own evaluation system and send copies to the Residency Training Office.
f. Faculty Advisor Program

Each resident is assigned a faculty advisor at the beginning of his or her training in our program. The primary responsibility of the advisor is to develop a personal relationship with the resident and to counsel him/her in various aspects of his/her career development. The faculty advisor is a personal advisor/role model/ombudsman. The program is designed to be as flexible and informal as possible, and to provide the widest possible latitude in types of advisor-resident communications.

Guidelines

  • Assignments are made for all residents in the program.
  • Each resident should contact his or her faculty advisor to set up a first meeting. If no meeting has been arranged by the time the Training Office mails out the Documentation-of-Contact form, the advisor should call the resident and make an appointment.
  • Either the advisor or the resident may resign or request reassignment at any time by notifying the Residency Training Office. No explanation is required.
  • Each faculty advisor should meet regularly with his or her resident. Semi-annual contact with the advisor to review one’s progression through the training program is an RRC requirement. More frequent contact is encouraged.
  • The faculty advisor receives the resident’s performance evaluations, and should review these with the resident.
  • The faculty advisor should also review the resident’s patient load, to assess whether or not the Resident is seeing an adequate variety of patients by age, sex, diagnosis, and treatment modality. Concerns about the resident’s caseload should be communicated to the Training Director for corrective action. The advisor will especially monitor the number of cases in long-term treatment (more than 12 months). (Note that the program requires a minimum of three long-term cases, of which at least one should have an (initial) psychotic disorder and at least one a non-psychotic diagnosis, as a condition for graduation.) The advisor will pay special attention to ethnic and cultural issues. Should the resident receive special training about American subcultures and ethnic minorities? If the resident is a member of a minority group, should he or she be assigned to a supervisor with a similar background?
  • Biannually, the Training Office will distribute a “Documentation of Semiannual Evaluation ” form to the Resident. The Resident will present the form to the advisor and collaborate in completing the form. (The Resident should take log cards and/or log summary sheets to the session with the faculty advisor.) The faculty advisor will return the form to the Residency Training Office, Box 356560.
  • Aside from the formal aspects mentioned above, an informal and flexible interaction is recommended. Case discussions, co-therapy, discussion of administrative issues, curriculum or research, socializing, lunch, or any other ethical activities are appropriate.
  • The relationship between Resident and advisor shall be confidential, If a Resident uses the advisor as a supervisor or if he or she is assigned to the advisor for a clinical rotation, only the strict supervisory sessions will be subject to evaluation and review by the training director or RESC. As a guideline, however, all parties should attempt to avoid the situation in which a faculty advisor supervises his or her resident.
  • If the Resident is involved in some academic or disciplinary problem, the Resident should feel free to ask the advisor to appear at meetings dealing with the issue at hand. Either person may invoke the confidentiality rule at any time during the meeting.
g. Probation Policy

The Department of Psychiatry faculty is responsible for ensuring that residents proceed through their educational/training program in a satisfactory manner. Assessment of clinical skills and competence should reflect a gradual and steady maturation with each rotation and new level of training. Residents should meet competency requirements for knowledge, patient care, problem-based learning, professionalism, interpersonal communication, systems-based practice, and specific psychotherapies in a manner appropriate for their level of training and consistent with the department’s standards. Residents who, for whatever reason, are not making satisfactory progress, need to be informed of this promptly. Similarly, residents who demonstrate exceptional abilities should receive appropriate and timely praise.

  1. Mechanisms for Evaluation
    • Clinical Rotations
      • Faculty should provide specific, informative, and constructive feedback to residents under their supervision during clinical encounters and throughout clinical rotations. For rotations of two months or longer, a midpoint evaluation should occur during a scheduled meeting. At the conclusion of each rotation, a written evaluation should be completed and reviewed with the resident in a scheduled meeting. Completed evaluation forms should be completed in a timely manner and forwarded to the program director so that they can be reviewed to assure that residents are progressing in a satisfactory manner.
    • Didactics and Seminars
      • Residents are expected to attend 85% of didactic and required seminar sessions (with the exception of sessions when they are on vacation, on other leave, or post-call). Teaching faculty should inform the resident in a timely manner of any concerns regarding attendance or performance in the class or seminar. At the conclusion of each required psychotherapy seminar, a written evaluation should be completed and reviewed with the resident in a scheduled meeting. Completed evaluations should be forwarded to the program director.
    • Written and Oral Examinations
      • Each year, all PGY-2 through PGY-4 residents take the annual American College of Psychiatrists Psychiatry Resident In-Training Examination (PRITE), a written, multiple-choice examination. Each resident also completes an oral “Mock Board” examination in each of the PGY-2 through PGY-4 years. The examining faculty member grades the resident’s performance as “Pass”, “Fail”, or “Conditional” for his/her level of training. Each resident must pass at least one oral examination during the PGY-3 or PGY-4 year in order to graduate from the training program. Residents failing the examination in both PGY-3 and PGY-4 years will be offered a re-examination. Results of the PRITE and the annual oral examination are incorporated with written evaluations from attending supervisors to form an overall composite assessment of the resident’s knowledge and skills.
    • Departmental Review
      • Twice a year, resident performance is reviewed with the training director or designee (preceptor) in a scheduled meeting with the resident. Written documentation of the review is maintained by the program director in the resident’s permanent file.
  2. Management of Problems
    • Evaluation of resident performance includes clinical competence, professional attitudes, and humanistic qualities. Each of these areas requires continuous improvement, commitment, and self-monitoring. Notable incidents of concern or praise should be channeled to a central authority and integrated into a composite assessment. The site’s Assistant Training Director and then the Residency Training Director are the points of contact.
      If problems arise, the program director should assess the quality of performance over time, the presence of temporary life crises, the educational responsiveness of the resident, and the impact of the resident on the program. The program director may notify or request assistance for remediation from the faculty preceptor, department Chair, members of the Resident Education Steering Committee, and/or the entire department faculty or an appropriate mental health specialist. Upon notification of a problem in cognitive, clinical, or interpersonal performance, the training director will decide whether the problem can be addressed through the normal evaluation process and/or informal measures or whether it requires a formal intervention and specific remediation program. The program director may use the category focus of concern for serious issues requiring remediation and the category probation for very serious issues that might lead to a failure to renew a resident’s appointment or termination for cause.
  3. Focus of Concern
    • Concerns may arise over clinical performance, following departmental policy or procedures, academic performance, documentation, interpersonal skills, professional and ethical conduct, or other features that negatively impact an individual’s ability to carry out his/her duties. In determining that a trainee is a focus of concern, the supervising faculty should expect that the problem can be corrected immediately or within a defined period of time. A written notice of deficiency and corrective plan should be developed by the program director in consultation with the resident’s preceptor and with support and concurrence from other faculty as needed. The elements of the written plan should include the following:
      • Clear statement and analysis of the problem.
      • Supportive and/or corrective intervention.
      • A monitoring mechanism including a definite statement of the time at which re-evaluation will occur.
      • Consequences if corrective action is not achieved.
    • This focus of concern documentation will be given to the individual and will not normally be considered part of the trainee’s permanent file. However, it can be made part of the file at the discretion of the program director if complete remediation is not achieved. If the problem has been satisfactorily remedied at the time of re-evaluation, the documentation regarding focus of concern may be removed from the resident’s permanent file.
  4. Probation
    • Probation may be designated because of significant deficits in a trainee’s clinical or academic performance, professional and ethical conduct, or interpersonal skills; failure to fully remediate a focus of concern; a second incident directly following a focus of concern remediation effort; or other serious and persistent issues that negatively impact a trainee’s ability to carry out his/her duties. In placing a trainee on probation, a written notice of deficiencies and corrective plan will be developed by the program director in consultation with the resident’s preceptor and other relevant faculty. The written plan will have the following elements:
      • Clear statement and analysis of the problem.
      • Supportive and/or corrective action.
      • A monitoring mechanism including a definite statement of the time at which re-evaluation will occur.
      • Consequences if corrective action is not achieved.
    • The documentation of probation will become part of the trainee’s permanent file and may be disclosed to other agencies or persons when the individual seeks hospital privileges or licensure or if the individual continues in graduate medical education in a different program. Re-evaluation to remove probation status will be made by the program director and other relevant faculty as designated in the written statement. Failure to achieve corrective action may result in extension of probation, non-renewal of appointment, or termination for cause. Procedures for non-renewal of appointment or termination for cause are specified in the individual’s Residency Position Appointment. If a trainee is on focus of concern or probation status at the time of the annual review of all residents for reappointment, the Department may elect not to renew the resident’s appointment until the designated time at which the resident’s progress is re-evaluated, as designated in the written focus of concern or probation plan. The resident will be notified by the standard reappointment date that the decision about reappointment is being deferred.
h. Resident Log
  • A log must be kept on all patients seen during the Residency.
  • Every three months (at the end of September, December, March, and June) the Resident needs to prepare an overall tally on the Log Summary sheet and turn the sheet in to the Residency Program Coordinator. One copy of the Log Summary will be mailed to the Resident’s preceptor; the original copy will be entered into the Resident’s academic record.
  • Certification of training is partly based upon the Summary Sheet information. The resident is responsible for sending a record of this information to the training office. The Resident is advised to save all individual log cards and a copy of all log summary sheets, until Board certification.
  • These data are used to monitor the resident’s progress (for instance, at the yearly review for advancement), to monitor the diversity of one’s training experience, to justify or change the program’s rotations in order to provide well-rounded training; the data may be reviewed by accreditation authorities.

Recommendation:

  • Carry log cards with you at all times.
  • Carry the cards of patients who are currently in your care with you and use the empty spaces on the cards to write down additional pertinent information. (Note: There is no need to change initial information.)
  • Couples and families: only one card for one of the family members is required; for groups: each patient needs a card.

You may drop your log summary by the office during business hours, place it in the Residency mailbox in the 16th floor mailroom, or fax it to 685-8952. If you have any questions, please contact the Residency Program Office at 543-6577.

VII. Resident Rights, Patient Rights

Resident Rights

  • Psychological and sexual abuse; Complaints
    • Sex discrimination in the form of sexual harassment, defined as the use of one’s authority or power, either explicitly or implicitly, to coerce another into unwanted sexual relations to punish another for his or her refusal, or as the creation by a member of the University community of an intimidating, hostile, or offensive working or educational environment through verbal or physical conduct of a sexual nature, is a violation of the University’s human rights policy. (University Handbook, vol. IV, p. 44).
    • Sexual harassment and exploitation (a) abuse the rights and the trust of those who are subjected to such conduct; (b) may influence the academic and professional advancement of medical trainees in a manner that is unrelated to their scholastic or clinical performance; (c) may harm professional working relationships; and (d) are likely to jeopardize patient care. Sexual harassment and exploitation in medical training programs are therefore highly unethical.
    • Consensual sexual relationships between a medical trainee and a supervisor, when the supervisor has professional responsibility for the trainee, are objectionable because of the potential for exploitation and the potential impact on patient care. Consensual sexual relationships between a medical trainee and a supervisor when no professional relationship exists may also be a cause for concern.
    • Anybody who experiences sexual harassment should contact the Residency Training Director or any faculty member who can discuss the formal and informal actions that are available.
    • Psychological abuse is defined as any communication or interaction with a Resident that is patently anti-educational or dehumanizing (examples: insults, name calling, harassment, inappropriate shouting at the resident, withholding clinical guidance or supervision, etc.).
    • Residents who experience psychological abuse will follow the procedures outlined in the conflict resolution policy, or will directly contact the Residency Training Director to discuss alternative action plans. Residents who have a complaint, or who wish to notify the Residency Training Director of an incident, may wish to contact the Director personally, or may use the “Faculty/Resident Incident Report” (see Appendix C).
    • The filing of this report is a first step and only documents the Resident’s side of the incident. In further discussions with the Residency Training Director, or your Preceptor, or the Site Coordinator, you may wish to plan further action along the procedural lines outlined above. The Residency Training Director is especially responsible for assuring the rights of both trainees and supervisors to due process and for protecting the confidentiality of those involved to the greatest extent possible.

Patient Rights

  • Psychological and Sexual Abuse
    • The Statues of the State of Washington (RCW 70.124) mandate the protection of patient rights.
    • Psychological abuse, in this context, is defined as any communication or interaction with a patient that is patently anti-therapeutic, dehumanizing, or that places the patient under excessive duress for non-therapeutic reasons (examples: name calling, use of derogatory nicknames, social slurs, demeaning remarks, inappropriate shouting at patient, inappropriately supporting a patient’s delusional system, anti-therapeutic social involvement with patients, etc.)
    • Sexual abuse is defined as any sexual contact between Resident and patient, physical or psychological (e.g., suggestive remarks, sexual jokes, inappropriate sharing of sexual stories), solicited or unsolicited.
    • Any person hearing of psychological or sexual abuse is required to immediately notify the site coordinator or Residency Training Director, who will initiate the formal procedures set forth in the residency performance evaluation policy.
  • Child and Elderly Abuse
    • Washington State laws require health professionals to report child abuse and elderly abuse. When you suspect abuse, immediately contact you rotation Attending to discuss reporting.
VIII. Conflict Resolution

Housestaff Agreement; Grievance Procedure

  • Grievance: a controversy of claim having to do with the specific provisions of the housestaff agreement.
  • Procedure: (see Housestaff Policy Agreement)

Other Conflict Resolution Procedures

  • Conflict: Controversy or claim not having to do with the provisions of the housestaff agreement (e.g., with regard to rotation assignments, program changes, interpersonal conflicts, etc.). Note: In case of controversy about performance evaluations please see performance evaluation procedures.
  • Procedure:
    • Conflict with Residency Training Director:
      • Present the conflict to the Departmental Chair within 30 days. The Chair will arrange a meeting with the Resident. The Department Chair may seek advice of the Clinical Service Chiefs, and will make final decision within 30 days of presentation.
    • Conflict with an Attending or Supervisor:
      • Step 1: Present the conflict to the Assistant Training Director, who may decide to mediate or refer the issue to the Clinical Service Chief.
      • Step 2: Notify the Clinical Service Chief who will respond within 30 days.
      • Step 3: If no satisfactory solution is reached, notify the Residency Training Director, who may set up meetings with the involved parties. A decision will be formulated within 30 days.
      • Step 4: Either party can appeal the decision made in step 3 to the Department Chair.
    • Conflicts with nursing staff, support staff, other disciplines:
      • Immediately notify the supervisor (i.e., attending, on-call attending, or the Psychiatric Service Chief of the involved program) of the issue. The supervisor may contact the other party’s supervisor before giving advice. Then Resident is expected to follow the advice of his/her supervisor. In case of disagreement, follow the procedures outlined under b, above.
    • Administrative/organizational/safety issues:
      • Problems of an administrative nature (e.g., space, equipment, clinical or education support, safety, etc.) experienced at a particular program should be signaled to the attending, who has administrative responsibilities for that program (e.g., Chief of Psychiatry, Unit Director, Medical Director, Residency Training Director).

General Comment:

“Guide” your conflicts through the appropriate channels. Going over people’s heads is always resented. Conflicts need to be brought to the next level of authority before both parties are locked into stubborn and/or escalated positions.

IX. T-Group
  1. The overall purpose of T-groups is to provide a support group for residents.  Specific goals of T-groups are to:
    • Provide support in dealing with personal and professional stress during residency.
    • Foster mutual support for and from classmates.
    • Provide a safe place to discuss challenging clinical situations and patient interactions.
    • Strengthen relationships within the class.
    • Provide an opportunity to reflect on and meet Psychiatry milestones related to resident self-care, wellbeing, and balancing professional and personal responsibilities (see ACGME Psychiatry milestones PROF 2: 1.1/A, 1.2/A, 2.1/A, 3.1/A, 3.2/A, 4.1/A, 4.2/A, 5.1/A; http://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf).
  2. Attendance is optional but strongly encouraged, especially early in training.
  3. T-groups are NOT group therapy or a didactic program.  T-groups are not intended to take the place of the residency’s disciplinary process with regard to work performance of residents, faculty, or staff.  Such concerns should be referred to the residency director.
  4. T-group should be a safe, supportive, respectful, and confidential environment. Specific ground rules/expectations for T-groups include:
    • Respectful and courteous treatment of all participants.
    • Mutual support.
    • Confidentiality.  The only limits to confidentiality are in the case of safety concerns (e.g. suicidal concerns, physician impairment, discrimination or harassment) in which case the residency director should be notified immediately.
  5. The T-group leader should check in regularly with the group to ensure that the group is meeting its goals.  In addition, T-groups should be evaluated on a regular basis (at least every 6 months) just as other educational components of the residency program (e.g. clinical rotations, supervision) are evaluated.  This process should include anonymous written evaluation by residents of the T-group leader’s ability to facilitate and promote a safe, supportive, respectful environment; group members’ adherence to ground rules of confidentiality, respect, and mutual support; the overall success of the T-group in meeting the goals listed in #4 above; strengths of the group; areas for improvement; and goals that the evaluating resident has for contributing to improving the group.  Residents who do not attend should have the opportunity to provide input regarding the T-group program.  Compiled feedback should be reviewed by the residency director and relevant portions shared with the T-group leader, who should use the feedback as appropriate to better facilitate the group.  The program (residency director, RESC) and department have ultimate responsibility to ensure that the T-group program is meeting its goals and to determine any consequences of consistently negative evaluations of the leader(s) or group(s).
  6. There will be orientation to the residency program that provides an orientation to T-group. This orientation session should include discussion and a written handout regarding the overall purpose and goals of T-group, ground rules/expectations, what T-group is not, and the evaluation process.  If possible, one or more T-group leaders should give or participate in the orientation, or if this is not possible the content of the session and handout should involve substantial input from the T-group leaders.
  7. Appointment of new T-group leaders, and continuing involvement by current leaders, is subject to the approval of the residency director.
  8. The program/department should provide consultation to T-group leaders from an expert in group dynamics. In addition, the residency director should meet with the T-group leaders at least annually to review pertinent program expectations, policies, and changes.
  9. T-group provides one way in which residents can achieve relevant Professionalism milestones and learn lifelong approaches to self-awareness, reflection, self-care, addressing their own mental health and well-being in order to best help patients, and balancing professional and personal responsibilities.  Each resident is responsible for meeting these milestones and expectations, regardless of his/her attendance at T-group and is responsible for informing his/her adviser and the program director, during regular semiannual evaluation meetings, how he/she is doing this.  The program provides one hour per week throughout residency for T-group or (in the case of residents who choose not to attend) other wellness activities to meet these milestones.  The program’s resident wellness committee explores and supports other ways to promote resident well-being.
X. General Program Policies
a. Call Duty Policies: Hours of Duty Statement

Definition of Duty Hours

Duty hours are defined as all clinical and academic activities related to the residency program, i.e. patient care, administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call, and scheduled academic activities such as didactics and conferences. Duty hours do not include reading and preparation time spent away from the duty site.

Duty Hours Policies

The University of Washington Psychiatry Residency Program adheres to all ACGME duty hours requirements1,2. Specific duty hours policies include.

  • Duty hours must not exceed 80 hours a week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.
  • Residents must have one day in seven free from all educational and clinical responsibilities, including call, averaged over a four-week period. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
  • Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
  • On Thursdays, Residents are exempt from clinical duties for didactics, T-group, and business meetings either 12-5pm (R1s, including R1s on Medicine, Pediatrics, or Neurology) or 8am-1:30pm (R2s-R4s). R2s-R4s must resume duties at their assigned clinical site by 2:00pm on Thursdays (unless they are post-call; see below).

On-Call Activities

In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available at the assigned institution. At-home (pager) call is defined as call taken from outside the assigned institution.

  • In-house or at-home call must occur no more frequently than every third night, averaged over a four-week period. Night float rotations are not subject to this constraint.
  • Continuous duty, including in-house or at-home call, must not exceed 24 consecutive hours for PGY-2s-PGY-4s. Continuous duty for PGY-1s must not exceed 16 hours.
  • When residents are called into the hospital from home, the hours residents spend in-house are counted towards the 80-hour limit.

Frequency of On-Call and Nightfloat Rotations

Track and Year Night float Night/Weekend Call Shifts
Seattle Track PGY-1 3 weeks HMC night float One 6pm-2am call at UW/VA with senior resident; 4-6 HMC weekend shifts per year
Idaho Track PGY-1 3 weeks HMC night float One 6pm-2am call at UW/VA with senior resident; 4-6 HMC weekend shifts per year
Seattle Track PGY-2 5-6 weeks night float 10-12 weekend shifts (10-14 hours each) per 6 months
Idaho Track PGY-2 5-6 weeks night float 10-12 weekend shifts (10-14 hours each) per 6 months
Seattle Track PGY-3 None 10-12 weekend shifts per 6 months (includes training call); 2 weeks 1st and 2nd backup per 6 months
Seattle Track PGY-4 None 5-7 weekend shifts per 6 months (includes training call); 2 weeks 1st and 2nd backup per 6 months

Adjustments to Call

  • PGY-3s and PGY-4s are typically assigned one week each of first and second backup.
  • Members of the call committee each receive a reduction of two call equivalents.
  • If individuals owe you calls, you must work these out individually. The only exception to this is if a backup resident is called in by a PGY-1 or PGY-2. In this instance, the call committee should be notified and the appropriate assignment of 1 extra call to the PGY-1 or PGY-2 and call break to the PGY-3 or PGY-4 will be made in the next call cycle.

Other Call Issues

  • Backup Resident:
    • In case of illness or emergency beginning prior to the onset of call, the sick resident must attempt to trade the call if this is physically possible.
    • If the illness or emergency occurs while on call, the resident must personally call the backup resident as soon as possible.
    • The backup resident must respond PROMPTLY.
  • The backup resident is to be called only by other residents.

Hours of Call

HMC 8:00 p.m.-8:00 a.m., weeknights
8:00 a.m.-8:00 p.m. or 8:00 p.m.-8:00 a.m., weekends and holidays

UWMC 6:00 p.m.-8:00 a.m., weeknights
8 a.m.-6 p.m. and 6 p.m.-8 a.m. weekends and holidays

VAMC 6:00 p.m. to 8:00 a.m., weeknights
8 a.m.-6 p.m. and 6 p.m.-8 a.m. weekends and holidays

Call Switch

In order to make changes to the 6-Month Call Schedule you must do each of the following:

  • Inform the Chief Resident at the appropriate site
  • Inform the call schedule coordinator at the appropriate site:

HMC Gayle Schneider 731-3443 gschneid@uw.edu
UWMC Athena Wong 543-6577 aswong@uw.edu
VA Lisa Kelly 768-5218 Lisa.Canady@med.va.gov

  • Inform Charisa Lantin for UWMC call switches within the week.
  • Submit all changes, regardless of site by email to Athena Wong

NOTE: If the site call schedule differs from the original document on file in the Residency Program Office, it will be assumed to be incorrect until the matter can be cleared up.

Backup Call Schedule

During the week of your assigned backup call, the resident’s responsibility is to be available for weeknight and weekend call in the event of illness, injury to, or sudden attrition of the assigned residents during that week. The person absent will make restitution for days covered to the backup resident.

b. Chief Resident Selection Policy

Seattle Track Chief Residents are selected from the pool of interested PGY-3 residents by the Chief of Service of the clinical site, Associate Residency Director for the site, and Residency Director, taking into account input from the resident group and relevant core site faculty (as consulted by the Chief of Service). Decisions regarding Chief resident positions that are not based at a clinical site are made by the Residency Director and any relevant faculty (e.g. Director of the Teaching Scholar Track for a Teaching Chief Resident position), taking into account input from the resident group. Final appointments are subject to the approval of the Department Chair.

The Chief resident selection process is as follows:

  • In December, the Residency Director invites PGY-3 residents to express interest in Chief Resident position(s) for the following academic year, and to rank all Chief Resident positions that the resident is interested in, in order of preference, by no later than January 15. With this invitation, the Residency Director provides PGY-3s with the general program Chief Resident job description.
  • In December, as part of this invitation to express interest in Chief Resident position(s), PGY-3s are instructed to meet with the Chief of Service, Associate Residency Director, and current Chief Resident at any site where he/she is interested in being a Chief Resident (and/or with any faculty member involved in decision-making for a non-site-based Chief Resident position) by no later than January 15, to discuss the position(s). These meetings are intended to be both job interviews and informational for the PGY-3.
  • On January 16 (or the next business day), the Residency Director sends an anonymous electronic voting form to all residents who will be in the program in Seattle in the following academic year, so that residents can express preferences for their Chief Residents for the next year.
  • One week later, the Residency Director sends the results of the resident vote and the list of PGY-3s interested in each position to the Chiefs of Service, Associate Residency Directors, and any other faculty members who will make decisions regarding any non-site-based Chief Resident positions. Within one week (and before February 1), sites and/or decision-making faculty members submit to the Residency Director a list of all PGY-3s they would be interested in and willing to have serve as Chief Resident.
  • By no later than mid-February, the Residency Director convenes a meeting (in person or by phone) with the Chiefs of Service, Associate Residency Directors, and any faculty involved in decisions regarding non-site-based Chief Resident positions, in order to decide on and coordinate offers regarding the Chief Resident positions. Decisions made will be submitted to the Chair for approval.
  • After this meeting, following approval by the Chair, and no later than the last day of February, Chief Resident position offers will be made to all selected PGY-3s on the same day.
  • Any unanticipated issues (e.g. a selected PGY-3 withdraws or becomes unable to serve as Chief Resident) will be managed in a coordinated way by the Residency Director, Chief of Service for the site, site Associate Residency Director, and/or other decision-making faculty for non-site-based positions, with final approval by the Chair.
c. Credit for PGY-1 Rotations Previously Completed/The Individually Designed Program

The UW School of Medicine, Department of Psychiatry and Behavioral Sciences offers a three-year program for Residents entering at the PGY-2 level. The required rotations described in this three-year program need to be completed regardless of clinical experience obtained elsewhere.

The RESC can, at the request of the Admissions Committee, which has reviewed the case, and considered qualifications, and special circumstances, accept a highly qualified candidate into an individually designed program or allow a candidate to enter with credit for previous experience. A candidate who wishes to be considered for this exception needs to make a formal request at the time of his or her application.

d. Educational Leave

General Policy

In addition to vacation time, Residents shall be allowed time off to attend educational meetings at the discretion of the head of the clinical service at their assigned hospital or clinic, and the Department Chair (see Housestaff Policy Agreement, Appendix Q).

Implementation

  • A Resident who plans to attend a conference or seminar will contact the Chiefs of all clinical services at which s/he will be working at the time of the conference or seminar, and request written approval for an educational leave.
  • The educational leave is only for the duration of the conference. Additional time will be calculated as vacation time.
  • The Chiefs of the clinical services will make a positive effort to support and encourage educational leave.
  • The Chiefs of the clinics or hospitals can determine that, at any given time, only a limited number of Residents can be granted educational leave. The Chiefs can grant leave on a first-come, first-serve basis, or organize a fair selection procedure.
  • Residents must submit a written request for educational leave, together with proof of approval of the clinic or hospital Chiefs, to the Residency office. Residents must use the leave request form (Appendix M).
  • The Residency office will request approval from the Chair, take the necessary administrative steps, and notify the Resident as soon as final approval has been granted. (The form in Appendix M will be returned to the Resident with the Chair’s final approval or disapproval noted.)
  • Residents are advised not to pay registration fees before final approval has been granted.
  • Residents who feel that their request for educational leave has been refused by the Service Chiefs in an arbitrary manner or without good reason, should contact the Residency Training Director, who will attempt to mediate or will refer the issue to the Chair for determination
e. Grievance Policy

Residents and Fellows who encounter concerns or problems in their programs should seek to resolve these problems at the local level first. This table provides resources about who to contact based on the nature and location of the concern problem. This diagram from the GME office may also be helpful.

If a resident or fellow cannot resolve a concern or problem at the local level, s/he should look to the GME Grievance Policy and Procedure for a grievance arising from the Residency Fellowship Position Appointment, or to Article 7 of the UWHA Collective Bargaining Agreement for a grievance arising from the CBA. Questions about this process should be directed to the GME office (206.543.6806; uwgme@uw.edu) or the Program Director.

f. Harborview Medical Center ER Policy and Long-Term Care Clinic

During the rotation at Harborview Medical Center Crisis Triage Unit (CTU), the Resident will continue to attend his/her Continuity clinic. On the day of his/her clinic, it is expected the Resident will return to the CTU by 1630 hours. In the interim, the CTU pager is to be carried by the CTU Psychiatry Attending. When the CTU Psychiatry Attending is away on personal leave, the Chief Resident at HMC is responsible for ensuring that there is coverage for psychiatry in the CTU on the day the Resident is at Continuity Clinic.

All Residents are assigned .1 FTE (one-half day) for their Continuity clinic requirement. Extending this time at the expense of other rotations is not allowed.

g. Inclement Weather Policy

In cases of inclement weather (e.g. snow or icy road conditions), residents are expected to fulfill all patient care responsibilities, or to ensure appropriate coverage.

Specifically, residents are expected to:

  • Make appropriate travel arrangements (e.g. chains, 4WD, bus), and allow appropriate travel time, to ensure they can be present at the clinical site for patient care. This can include the hospital’s emergency transportation system, where available.
  • Stay in house if there is no guarantee of returning to the clinical site within 30 minutes (e.g. stay in-house if unable to walk safely to the clinical site within 30 minutes during home call or night float).
  • Remain on-site as needed for patient care, until the next resident or other appropriate provider arrives.
  • Attempt to make a voluntary call/night float trade, or find appropriate daytime coverage of patient care responsibilities, if they anticipate difficulty getting to the clinical site.
  • In case of emergent inability to travel to the clinical site, despite having attempted the measures listed above, notify the attending, and/or (as appropriate) clinic staff, Chief Resident, Assistant Training Director, and/or Chief of Service, and (for call/night float), utilize the backup call system for coverage and notify the resident(s) currently on-site of the need to remain on-site until a backup resident can get there. Please note that backup call residents may have similar difficulty getting to the site. The backup system should only be used when absolutely necessary, and the backup resident should be alerted as soon as possible, to maximize the chances that he/she will be able to get to the clinical site in time for call.
h. Leave of Absence and Part-Time Status

University of Washington psychiatry residents may take leaves of absence in accordance with Graduate Medical Education policies and the Residency Position Appointment. Issues and requirements specific to psychiatry are as follows:

  • Psychiatry residency requires 48 months FTE of training (including an approved PGY-1 year) and must be completed at no less than half-time (50% time). Certain rotations (e.g. medicine, pediatrics, inpatient psychiatry, consultation-liaison psychiatry, inpatient child and adolescent psychiatry) must be completed on a full-time basis.
  • Any unpaid leave, or part-time status, will result in extension of residency to result in a total of 48 months FTE of approved residency and completion of all graduation requirements.
  • The American Board of Psychiatry and Neurology (ABPN) certification examination in Psychiatry is given once a year, in the fall. The resident must graduate by September 15 in order to take the ABPN examination in the same calendar year. Extending residency beyond September 15 will result in a delay in the resident’s ability to take the examination until the following calendar year.
  • Leaves of absence and part-time status must be approved by the program director. The program strongly encourages any resident planning or requesting a leave of absence to notify the program director as far in advance as possible, in order to facilitate planning and ensure that he/she will be able to meet all residency graduation requirements in a timely manner
i. Medical License

All residents are required to have current Washington State Medical Licenses in order to treat patients in the Residency program. If a Resident’s license expires, that Resident will be pulled from his or her service, and not be allowed to practice until the license has been renewed. It is the Resident’s responsibility to ensure that he or she is properly licensed and that a current copy of that license is on file.

For more information on the medical license or applications, please visit the Licensing section of the Forms page.

j. No-Show-for-Duty Policy

Residents are expected to report on time for all assigned duty, including daytime clinical rotations, didactics, call, and night float. If a resident does not report for duty, the attending, chief resident, resident on duty who is awaiting signout, assistant residency director, program director, or other appropriate responsible party will attempt to reach the missing resident by:

  • Pager
  • Home or other primary contact phone number
  • Emergency contact number.

If the resident has not been located within 1-2 hours using the measures above, and any other options appropriate to the circumstance, the police will be notified and asked to go to the resident’s home to do a welfare check. The decision to call the police should be made in consultation with the program director, assistant residency director for the site, and/or chief resident at the site, if at all possible.

All residents are required to provide primary and emergency contact information, as well as their home address, to the Residency Office, and to update this information immediately with any change.

Lack of timely attendance for duty is a serious professionalism issue and is cause for disciplinary action.

k. Professional and Educational Time Commitments: Moonlighting
  • Residents must seek prospective approval of all outside professional activities from the program director prior by submitting a Resident/Fellow Request for Approval of Outside Professional Activities form for each activity.
  • Residents are expected to spend all of the time of the regular training work week in training-sponsored activities, and to fulfill all training assignments, and on-call obligations. Residents are also expected to spend a reasonable amount of non-training time on outside reading, and continued medical education.
  • The total aggregate work hours for residents, including both their activities as part of an accredited residency program and outside professional activities, must not exceed 80 hours per week, when averaged over four weeks. Outside professional activities shall not exceed on average one day per week averaged over 13 weeks.
  • Residents must report to the Residency Office, on a monthly basis, dates and hours spent moonlighting.
  • Residents are hereby advised that the University provides neither liability coverage, supervision, nor consultation for clinical activities outside the assigned training programs.
  • By state law [RCW 18.71.095(3)], Residents possessing only limited licenses are prohibited from moonlighting.
  • Residents may not moonlight at UWMC, SCCA, HMC, or the clinics associated with these institutions.
  • PGY-1 Residents are not eligible to moonlight.
l. Resident Reporting of Critical Incidents
  • Residents are to report ALL incidents of violence or threats of violence directed towards them from patients, no matter how trivial, as well as ALL suicides or serious suicide attempts by patients. These critical incidents should be reported to the Chief Resident within 24 hours, in person or by voice mail. In addition, all such events should be reported to the responsible attending immediately.
  • The Chief Resident will inform the Assistant Training Director for the site and the Training Director
  • The Assistant Training Director will speak with the resident (for minor instances this may be delegated to the Chief Resident) and will be responsible for seeing that adequate psychological support and supervision are provided.
  • Residents will be oriented to the reporting policy upon entering the program and reminded at regular intervals to report critical incidents.
  • The Residency Training Office will maintain statistics and report them regularly to the resident group. The Training Office will also identify any patterns involved in these incidents so that these can be addressed.
m. Resident Vacation Policy

Resident Vacation Policy

  • All Residents receive 21 days of vacation per year consisting of 15 weekdays, and 6 weekend/holiday days (non-cumulative).
  • When a Resident is on vacation for both the day preceding, and the day following a holiday, the holiday will be counted as a vacation day.
  • When a Resident takes an entire Monday-Friday vacation, the Sunday preceding and the Saturday following will be counted as vacation days.
  • Detailed vacation policies can be found on the Resident Position Appointment (page 10).
  • All vacations will be scheduled with the approval of the head of the clinical rotation, and subject to University and Department regulations.
  • On inpatient and consultation-liaison services, resident vacations may not overlap for Residents on one service. Residents may not take vacation during prolonged absence of their Attendings. Vacations need to be arranged in advance with the Attending (to rule out Attending absence), the Chief Resident (to rule out overlap), and the Psychiatry Residency Program office.
  • No vacation is to be taken when one is on the one-month Psychiatric Emergency Service rotation; no vacation is to be taken in the last week of June or the first week of July.
  • No more than one week vacation can be taken on a one-month rotation, and no more than two weeks on a three month rotation. For two month rotations: the Resident who wishes to take more than one week (and up to two weeks) needs to obtain special approval of the Attending.
  • The Residency office needs to be notified once the leave is approved via MedHub 30 days in advance of planned time off and of the exact dates of the vacation.
  • Disagreements between Residents and Attendings or between Residents of the same service regarding vacation plans should be referred first to the Chief Resident and the Associate Residency Director and then if an agreement cannot be reached, to the Residency Training Director

Resident Educational Policy

  • Educational leave is granted at the discretion of the Program Director.
  • Residents are allotted one week per year, but occasionally more if there is a compelling reason.
  • Educational leave must be used for conferences, presentations, residency retreat, and exams.
  • Once approved by your clinical supervisors, education leave request must be entered into MedHub 30 days in advance of the leave.
n. Scholarly Project

Goal:
Each resident is required to complete a scholarly project during residency. The goals of this project are to:

  • Demonstrate the ability to perform an in-depth, comprehensive, and scholarly literature search and analysis of the literature in a topic within or related to psychiatry, of interest to the resident
  • Identify the potential clinical relevance of findings from research and the scientific literature
  • Develop oral presentation and teaching skills
  • Develop a written scholarly product, such as a case report, data-based article, review article, research proposal, curriculum, or report of a clinical continuous quality improvement (CQI) study

To accomplish these goals, each resident will work with a faculty advisor and prepare both: 1) an oral presentation for the Harborview Friday conference; and 2) a written report (as in 4, above). The faculty advisor will evaluate the resident’s performance in achieving the goals and objectives of this project. Residents may collaborate on group projects, as long as each resident makes a substantial contribution to the project and meets the specific objectives listed below.

Specific Objectives:
Each resident will:

Knowledge

  • Conduct a comprehensive review of the literature relevant to a topic, clinical case, or research project.

Skills

  • Identify a topic area to review, a research project to participate in/complete, a clinical case appropriate for presentation and a case report (e.g. a novel presentation of an illness, diagnostic dilemma, unexpected outcome), or a CQI study to conduct on a clinical service.
  • Develop an oral presentation, including (as appropriate) a PowerPoint presentation, handouts, bibliography, articles for distribution, and/or other audiovisual materials (e.g. videotapes).
  • Effectively give an oral presentation, including a scholarly discussion of the topic, research, or issues raised by a clinical case.
  • Write a research paper, research proposal (e.g. grant or part of a grant), review article, annotated bibliography, case report and discussion, report of a CQI study, or curriculum.

Attitudes

  • Understand and appreciate the role of scholarship and critical review of the literature in improving one’s clinical practice, in teaching, and/or in performing research.
o. Supervision: Personal Psychotherapy

Supervision not accomplished during the long-term care clinic half-day and personal psychotherapy time (a) needs to be made up if taken during normal working hours at clinical rotations; and (b) needs to be scheduled as much as possible during clinical “slow time”. Residents leaving their rotation for supervision or therapy should sign out to another covering resident on the same service, whenever possible.

p. Transfer to Child Psychiatry

No “early” transfers, i.e. before having completed the PGY-3 year in our program, are allowed. An exception applies for those residents in the Spokane Advanced Clinician Track (see schedule).

XI. Infection Control Procedures
  • Residents shall strictly adhere to institutional policies and procedures for Infection Control. The standard for infection control at the University of Washington Medical Center is Body Substance Isolation (BSI), and the policies and procedures are found in the relevant infection control manuals of each medical center. The institutions will work with individuals whose compliance depends upon “modified” barrier protection.
  • Residents are required to receive hepatitis B virus (HBV) vaccine or show proof of protection, and are encouraged to consider being tested for HIV, and other bloodborne viruses through their personal physician or alternative testing site, or at no cost through the Employee Health program.
  • If a break in infection control technique results in the exposure of a patient to the Resident’s blood, the Resident is ethically obligated to know his or her serostatus. In the event that s/he is HBV/HIV seropositive, the patient must be notified that a blood exposure has occurred, and offered HBV/HIV testing, counseling, and prophylaxis, where available. Whenever possible, the anonymity, and confidentiality of the source health care provider will be protected.
  • The University provides hepatitis B vaccine, immunizations, confidential HIV counseling, and testing, and, if appropriate, chemo-prophylaxis for occupational exposure to HIV.
  • Health insurance, life insurance, and long-term disability (LTD) policies are available through the University for all employees, and include several optional LTD insurance plans. Employees’ medical bills, and part of their salaries are covered by Washington State Workers’ Compensation insurance for work-related disabilities. Additional coverage specifically for health care providers may be added as it becomes available.
  • Certain invasive procedures are known to be associated with the risk of transmission of HBV. Current scientific data provide insufficient documentation to determine whether these same invasive procedures may lead to transmission of HIV from an infected provider to a patient. However, invasive procedures that have been shown to result in transmission of HBV may also result in transmission of other bloodborne viruses. Unless scientific data demonstrate that HIV is not transmitted under the same conditions that HBV is transmitted, patients should be aware of the potential risk of transmission in these settings from a provider who is HIV seropositive. Health care providers who are both HBV surface antigen positive (HBsAg+) and HBV e antigen positive (HBeAg+) or are HIV seropositive have a legal, and ethical obligation to conduct themselves responsibly for the protection of patients, and co-workers. Therefore, seropositive health care providers shall not perform these exposure-prone procedures without consent from the institution, and the specific written informed consent of the patient.
  • An advisory committee on bloodborne viruses established by the Vice President for health Sciences will be available to provide confidential consultation to HBV/HIV infected employees, and their supervisors regarding job requirements, and workplace accommodation. Health care providers may seek counsel from this committee before choosing to disclose their HBV/HIV status to a supervisor. A supervisor shall be responsible for defining job requirements, and providing accommodation when possible.
  • The course of study of a trainee who is HBV surface antigen positive and HBV e antigen positive (HBeAg+) or HIV infected, and whose training would otherwise require the performance of exposure-prone procedures, shall be reviewed, according to the guidelines established in the respective Health Sciences schools, to modify or exclude performance of these procedures. Reasonable accommodation shall be made whenever possible, and academic counseling shall be made available to trainees who alter their course of study.
  • Confidentiality of a health care provider’s occupational exposure health status, requests for counseling or job accommodation, or modification of an academic program, shall be strictly maintained in accordance with state, and institutional guidelines. Failure to maintain confidentiality shall be grounds for disciplinary action including dismissal.
  • The application of policies developed from these guidelines shall reflect a case-by-case approach, taking into account the unique characteristics of each provider, and each job or course of study, and changes in the provider’s health status, and job requirements. This document shall be revised whenever appropriate to reflect new medical, and research, findings.