PGY-2 Rotation Schedule Description
INPATIENT PSYCHIATRY (UNIVERSITY MEDICAL CENTER) (1 month)
Residents spend each morning in daily rounds, receiving information about patient progress from nursing and other support staff during the first hour, which functions as the Team Meeting. Patients are seen individually with the Attending, and management issues and a treatment plan are developed, working in concert with support staff. Residents participate in group therapy sessions by facilitating a group at least once each week. Residents also take an active role in weekly Treatment Planning Meetings. New patients are evaluated in the presence of the Attending and generally occur at least once each day.
The resident spends the majority of time participating in team-oriented treatment planning and learning about crisis evaluation and intervention, psychopharmacotherapy, group therapy, and family evaluation and therapy. Average caseloads consist of 3-4 patients, one group each week, and 1-2 family evaluations or treatment sessions per week.
All residents have required supervision weekly with a full-time faculty member not working on the inpatient unit in addition to their daily meetings with the Attending on the unit.
The University Medical Center Psychiatry Unit is an 8-bed (and one seclusion room) self-enclosed general psychiatry unit. The unit is a locked, controlled access unit, which is located on the second floor of University Medical Center, a tertiary care hospital with 300-plus medical and surgical beds.
Residents are assigned in-house call based at UPH Hospital. Generally, PGY-I residents have six call nights each month, PGY-II residents have five call nights each month, and PGY-III residents have four call nights each month. PGY-IV residents are not assigned call. Residents assess and evaluate patients in the Emergency Department, cover the Inpatient units, and assume the duties of the Consult/Liaison resident between the hours of 5:00pm and 7:00am. These residents have attending back up via phone, and an attending jeopardy system is in place should a resident be unable to complete or participate in their call duties.
GERIATRIC PSYCHIATRY (2 months)
Residents spend approximately 30 hours per week on the Inpatient gero-psychiatry unit. Residents are expected to fully evaluate, diagnose, and provide treatment for the patients admitted to the Geriatric Psychiatry service. Often this involves recommending and facilitating outreach to community resources for the patients and their families. Residents may also be asked to participate in family meetings to educate caretakers and relatives. They attend interdisciplinary treatment team planning meetings and residents have an inpatient caseload of approximately 6 acute and sub-acute inpatients. Residents on this service may also complete Psychiatry consultations for Geriatric issues arising on the inpatient Medicine/Surgery floors.
Common principle diagnoses include medical, neurological, and psychiatric problems of the elderly, especially depression and dementia.
The average caseload for residents is up to 8 sub-acute inpatients, 1-2 new consults per week, and follow-up of up to 6 geriatric medical inpatients per week.
Residents are supervised daily by the attending Geriatric Psychiatrist and participate actively in the interdisciplinary team meetings. Each resident receives at least two hours of individual supervision each week. The diagnoses and treatment plans of all newly admitted patients are reviewed with the attending and continuing supervision is provided with those patients in the context of team meetings.
Residents are assigned in-house call based at UPH Hospital. Generally, PGY-I residents have six call nights each month, PGY-II residents have five call nights each month, and PGY-III residents have four call nights each month. PGY-IV residents are not assigned call. Residents assess and evaluate patients in the Emergency Department, cover the Inpatient units, and assume the duties of the Consult/Liaison resident between the hours of 5:00pm and 7:00am. These residents have attending back up via phone, and a jeopardy system is in place should a resident be unable to complete or participate in their call duties.
PSYCHOSOMATIC MEDICINE (Consult-Liaison) (2 months)
Attending rounds are made daily, typically in the afternoon. Every new case is presented to the attending and the attending will often interview patients (if still in hospital or emergency department) and discusses the case with the residents and medical students rotating on the service. In addition, a seminar series is conducted in which the major topics in Psychosomatic Medicine are discussed. Assigned readings, typically three to four papers each week, are discussed directly and applied to clinical case examples provided from the Psychosomatic Medicine service.
The University of Arizona/UPH Hospital Program has 72 medical and surgical inpatient beds. Patients are clinically diverse. A majority of the patients are from a lower socioeconomic status, and typically are either self-pay or on AHCCCS (the Arizona healthcare plan for the under and uninsured). The age range is 18 and above, up to the lower 90’s. The leading diagnoses on the Psychosomatic Medicine service include delirium, dementia, other organic mental disorders, major depression, adjustment disorder with depressed mood, substance abuse, and somatoform disorders. A substantial proportion of patients present with symptoms of depression and/or anxiety attributable to organic causes. Primary treatment is psychopharmacologic in nature, supplemented by supportive psychotherapy and behavioral psychotherapeutic modalities such as relaxation and self-hypnosis. Residents often also assist in providing recommendations for behavioral techniques useful in managing patients.
In addition, the Psychosomatic Medicine resident will spend some time in the Psychiatric Emergency Department evaluating and providing disposition for patients when requested.
Residents are not assigned call responsibilities during their Psychosomatic Medicine. Residents on the Psychosomatic Medicine service provide back-up, day time coverage for the Psychiatric Emergency Department. In the event that the workload does not allow for ED coverage, a backup system is available whereby other residents will see ED cases. In addition, the same system is available in the event of unusual work overload for the PGY-II resident. Residents are expected to cover the Consult pager from 0700 – 1700, weekdays. After the on-call resident takes over beginning at 1700, the resident’s responsibilities include finishing any work remaining from the day and to assist in the transition of patient care to the on-call resident or psychiatrist.
INPATIENT CHILD/ADOLESCENT PSYCHIATRY (SONORA BEHAVIORAL HEALTH HOSPITAL) (2 months)
The program is designed to assist residents in developing clinical skills with seriously disturbed hospitalized children, adolescents and their families. Specific skill objectives included the ability to: a) conduct a complete and comprehensive diagnostic interview with the child or adolescent; b) formulate and initiate a treatment plan and c) work collaboratively with a multidisciplinary team and appreciate the contributions of other professions, including social work, education and psychiatric nursing. Specific knowledge objectives include the ability to: a) demonstrate familiarity with the clinical features of common psychiatric syndromes and diagnosis including substance use/abuse affecting children and adolescents; b) to appreciate the impact of development upon symptom expression, character formation, and treatment selection; c) appreciate the continuity of child/adolescent and adult psychiatric disorders, how adult psychopathology develops from undifferentiated childhood pathology, and how adult psychiatric patients function as parents; d) to gain an awareness of the types of cases seen in various settings and the advantage and limitations of each setting; e) to gain an understanding of the impact of culture on family functioning and psychopathology; f) to acquire a basic knowledge base of psychosocial interventions including play therapy, cognitive behavioral therapies, and family therapies; and g) to acquire a basic knowledge regarding medications used in child and adolescent psychiatry, including indications, likely benefits, side effects, and interactions with other medications.
The inpatient team is located within the child and adolescent services of Sonora Behavioral Health Hospital. This inpatient unit has 22-inpatient beds for children and adolescents. The unit is divided into two “tracks,” 8-12 year olds and 13-17 year olds.
At any one time, the residents are responsible for 3-4 patients. Residents spend the majority of their time doing inpatient management, including individual psychotherapy, psychotropic medication prescribing and monitoring, and working with collaborative “resources” (including referring therapist, pediatricians, CPS, school, probation, etc). Residents are expected to participate in staff meetings, group therapy sessions, chemical dependency sessions, and family meetings.
All residents have supervision two hours each day, consisting of one hour of individual supervision during teaching rounds and one hour of group supervision.
Residents do not participate in the regular Adult Psychiatry Call schedule, and are required to take specialized Child call, consisting of one week each month that is home call. Residents answer pages and rarely (once every two to three months) come into the hospital for a consult.
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