Rotation Schedule

Year 1
Family Medicine, 3 months
Emergency Medicine, 1 month
Inpatient Psychiatry, 3 months
Emergency Psychiatry, 3 months
Neurology, 2 months

Year 2
Inpatient Psychiatry, 3 months
Inpatient Psychiatry (University Medical Center), 1 month
Geriatric Psychiatry, 2 months
Psychosomatic Medicine (Consult-Liaison), 2 months
Addiction Psychiatry (Southern Arizona VA Health Care System), 2 months
Child Psychiatry (Sonora Behavioral Health Hospital), 2 months

Year 3
Outpatient Psychiatry, 12 months

Year 4
Psychosomatic Medicine (Consult-Liaison), 2 months
Electroconvulsive Therapy (Northwest Medical Center), 1 month
Forensic Psychiatry (University Medical Center), 1 month
Elective Rotations, 8 months

FAMILY MEDICINE
During the course of three months on the Family Medicine (FM) wards at UPH Hospital, residents are expected to develop their skills in treating a wide variety of medical problems.  The Resident will be a member of a team of medical students, FM interns, a FM resident, and a FM attending.  Assessment of the resident is by the senior resident and attending.  The Residency Education Director solicits written feedback from appropriate residents and attendings at the end of each one-month block at UPH Hospital. 

On the Family Medicine wards, physicians treat a wide variety of common and complex medical problems in individuals who range from ages 18 to over 90.  The resident is expected to complete the initial evaluation of a patient and be the person primarily responsible for patient management under the supervision of the senior resident and attending.  A medical team rounds six days a week.  Average caseloads consist of about 6 – 8 patients at any given time during the rotation.

All supervision is provided by faculty from the Department of Family Medicine.  The resident is expected to attend medical conferences and Family Medicine grand rounds, and any other medical conferences the FM residents attend during their rotation.  In addition, Psychiatry residents are expected to come to the lunch meetings with the Psychiatry Residency Education Director, Psychiatry seminars, and Psychiatry Ground Rounds, if at all possible.

Night call is in-house every fourth night with the Family Medicine service.

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EMERGENCY MEDICINE

During this month-long rotation, residents are expected to develop their skills in diagnosing and treating a wide variety of acute medical problems.  The resident is a member of a team that typically includes medical students, emergency department interns, emergency department senior residents, and an emergency department attending.  The resident is primarily assessed by the emergency department attending.  The Residency Education Director so' FONT CENTER)< MEDICAL ADMINISTRATION S>

Residents spend about 40 hours each week assessing patients for both acute and long-term substance abuse treatment. They meet daily with the rotation’s supervisor and are monitored by numerous other treatment team members throughout the duration of the experience.

Residents are generally assigned to care for six patients on the acute detoxification service, though the number of patients followed by the resident can reach eight depending on the census of the inpatient unit. Residents are also involved in outpatient treatment services, including the co-facilitation of substance abuse groups, and assist with general counseling for patients involved in the program. As noted above, the rotation coordinator directly supervises residents, and provides both clinical information regarding patient management and educational, and theoretical discussions about topics in the subspecialty area of substance abuse.

Residents are supervised daily by the attending assigned to the Substance Abuse service, and the resident has additional supervision from other attending psychiatrists at the VA. Residents are also responsible for attending patient group meetings and facilitating some of the group discussions.

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 1700 and 0700. 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.

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GERIATRIC PSYCHIATRY

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 by unable to complete or participate in their call duties.

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INPATIENT PSYCHIATRY (UNIVERSITY MEDICAL CENTER)

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 by unable to complete or participate in their call duties.

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INPATIENT CHILD/ADOLESCENT PSYCHIATRY (SONORA BEHAVIORAL HEALTH HOSPITAL)

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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PSYCHOSOMATIC MEDICINE

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 assisting in the transition of patient care to the on-call resident or psychiatrist.

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OUTPATIENT PSYCHIATRY (UMC)

Currently, plans are underway to open a new psychiatric outpatient clinic on the campus of UPH Hospital in July, 2009.  Once open, the outpatient psychiatry experience will take place in this new clinic.  During the outpatient rotation, which constitutes the entire PGY-3 year, residents develop primarily long- and short-term dynamic, supportive, cognitive behavioral psychotherapy skills, as well as enhance their psychopharmacologic knowledge.  They also are expected to develop some group, and family and/or couples therapy skills, and to become experienced in psychopharmacologic management of outpatients.  Resident learn to blend medication management with psychotherapeutic approaches.  In addition, residents attend seminars, case conferences, and weekly supervision.

The average caseload for residents in the general outpatient clinic includes 12-14 hours per week of individual adult psychotherapy or medication management. In addition, residents co-facilitate a group and average one and a half new outpatient consultations, or “intakes,” per week.  Residents are also expected to follow an ongoing couple or family during the PGY-III year.  It is expected that at least two of the patients a resident follows be in long-term psychodynamic psychotherapy.  Every effort is made to ensure that the resident sees patients representing diverse backgrounds in terms of gender, diagnosis, age, phase of life, developmental level, and cognitive style.

All new patient intakes and consultations are reviewed and supervised by a full-time faculty psychiatrist, and psychiatric residents are assigned individual supervisors.  These supervisors participate in the intakes with the residents on assigned patients and are familiar with residents’ caseloads.  They also meet with patients as needed.  In addition, residents have 1.5 hours per week for group psychotherapy supervision, and ½ hour per week for family or couples therapy supervision, and 1 hour per week of cognitive behavioral therapy supervision.  The caseloads of the third year residents assigned to the outpatient division are monitored by the Medical Director of the Outpatient Clinic.

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 Psychosomatic Medicine resident between the hours of 1700 and 0700. These residents have attending back up via phone.

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ELECTIVE ROTATIONS

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.

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ECT ROTATION (NORTHWEST HOSPITAL)

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.

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FORENSIC PSYCHIATRY (UMC)

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.

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