PGY-4 Rotation Schedule Description
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/The University of Arizona Medical Center - South Campus 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.
ECT ROTATION (NORTHWEST HOSPITAL) (1 month)
This experiential rotation provides the “hands-on” exposure required to obtain ECT-privileges in most practice settings after graduation. Residents observe most ECT cases occurring at Palo Verde Hospital for one month, and are required to work up and treat a number of patients under supervision. A list of suggested readings is provided as well as two ECT lectures presented during the PGY-I and PGY-II years.
The resident is expected to attend ECT treatments three days per week during the month of their rotation. At a minimum, each resident should actively participate in at least 10 ECT treatments directly supervised by a privileged treating psychiatrist, and involving at least three separate cases. Each resident should participate in the initial evaluation and care of at least two patients including the primary management of their ECT work-up and course of treatment. At the end of this rotation, residents should be eligible for ECT privileges in their clinical practices upon graduation.
Individual supervision is provided by the ECT privileged Northwest Hospital Psychiatrists, (who are affiliated faculty on a part-time basis) and the ECT nurse assigned to the team. The resident is expected to participate actively in the weekly ECT case conference held on Fridays.
PGY-IV residents do not have call responsibilities within the program.
FORENSIC PSYCHIATRY (UMC) (1 month)
During the course of one month, residents are expected to develop their forensic skills by observing civil and criminal evaluations in a variety of forensic settings, preparing parallel forensic psychiatric reports, witnessing courtroom testimony or depositions, and discussing with faculty ethical issues relevant to the practice of general and forensic psychiatry. This PGY-IV rotation is complementary to the clinic experience during the Outpatient Psychiatry Rotation in the PGY-III year.
Forensic evaluations occur at different times at the Outpatient Psychiatric Clinic of University Medical Center. Residents are offered an opportunity to spend time working in nearby correctional facilities (State or Federal Prisons), or at the sex offender treatment unit at The Arizona State Hospital in Phoenix. Residents gain exposure to a wide variety of common and complex forensic psychiatric issues.
The resident is expected to observe several forensic evaluations and is provided with the opportunity to conduct a forensic interview and prepare a “parallel” forensic report. On average, residents observe 6 evaluations for the month, but the number can vary from 4 to 20.
Individual, case-based supervision will be provided by the faculty members listed above. Residents meet with Dr. Morenz at least 4 times during the rotation.
PGY-IV residents do not have call responsibilities within the program.
ELECTIVE ROTATIONS (8 months)
The resident is expected to identify one faculty member who will coordinate and act as a mentor/supervisor for their specific elective rotation. The resident can draw on the entire faculty, including those off-site, to create their elective rotation. Some example rotations include telepsychiatry, Women’s Mental Health Clinic, Forensic psychiatry, Geriatric psychiatry, Addiction psychiatry, Psychosomatic Medicine, further inpatient or outpatient psychiatry, Public Sector psychiatry, Administrative psychiatry, work with Native American populations, and psychiatric research.
Residents spend approximately 4 hours weekly in seminars and case conferences.
The resident must provide a written proposal for their elective rotations late in their third year of training to the Residency Education Committee for approval. The PGY-IV resident is also expected to submit a written critique of their elective rotation after they have completed it to the Residency Education Director.
Case loads will vary depending on the resident’s elective choice. However, the PGY-IV residents are expected to carry at least six adult outpatients throughout the year, many of who are patients continued from treatment during the PGY-III year of training and require both psychopharmacological and psychotherapeutic management.
Residents will have at least three hours of individual supervision per week. Additional supervision is available on an optional basis.
Residents in the PGY-IV year do not have any night or weekend call. |