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PGY-I PROGRAM
GOALS AND OBJECTIVES By the end of PGY-I, the resident will:
Rotation Schedule Internal Medicine In the PGY I year, the resident spends at least three months in an approved Internal Medicine, Family Practice, or Pediatric residency training program. The resident achieves clinical competence in the care of medical patients through scheduled teaching rounds, clinical conferences, assigned readings, and progressive supervised responsibility for the clinical care of patients. Clinical skills and knowledge are assessed by written faculty evaluations. Neurology The neurology rotation lasts for a minimum of one month in which the resident serves as a house physician participating in the diagnosis and treatment of neurological disorders relevant to psychiatric practice. The resident is able to obtain a thorough history regarding neurological disease, perform a competent neurological examination, make a differential neurological diagnosis, and under supervision, plan and carry out the treatment of the common, clinically-important, neurological diseases. This is done through scheduled teaching rounds and case conferences, assigned readings and progressive, supervised responsibility for the clinical care of neurological patients. Clinical skills and knowledge are assessed by written faculty evaluations. Emergency Medicine Each resident is required to spend one month in a general hospital emergency room which provides 24-hour emergency services and also is an approved training site for residents in Emergency Medicine. In this month, the psychiatry resident functions as a house officer in Emergency Medicine and learns the skills and techniques in dealing with acute medical and surgical emergencies. Skills of triage, diagnosis, treatment, and disposition are acquired through progressive supervised clinical responsibility. Board-certified emergency room physicians provide supervision and written evaluation of the resident’s performance. Alcoholism and Drug Abuse This rotation is for one month, in the Alcoholism and Drug Abuse Program at St. Thomas Hospital, where Alcoholics Anonymous was founded. The resident participates in the evaluation, assessment, and treatment of new patients and their families. The resident participates in a comprehensive treatment program that includes medical assessment, detoxification, and a variety of psychotherapeutic modalities, including individual, group, family, and behavioral therapy. Psychotropic medications also are often employed in treating patients with dual diagnoses. All this is done in a multidisciplinary team setting, which is supervised by physicians certified by the American Society of Addiction Medicine and/or psychiatrists with added qualifications in addiction medicine and/or psychiatrists with added qualifications in addiction medicine. Additional experiences are arranged with a supervisor in the treatment of patients utilizing electroconvulsive therapy. General Psychiatry Each PGY I resident is scheduled for six months in general psychiatry. The resident works as a house officer. The resident actively learns the skills of assessment and evaluation of new patients through interviews, conducting mental status examinations, physical and neurological examinations and ordering appropriate laboratory tests. The resident is responsible for history-writing and the formulation of a differential diagnosis and the treatment plan. This is accomplished through direct observation of clinical faculty on teaching rounds, case conferences, assigned readings, and progressive, supervised responsibility for the clinical care of patients. The residents collaborate with medical colleagues, with other specialists such as psychiatric nurses, psychologists, psychiatric social workers, occupational therapists, recreational therapists, nutritionists, and other professionals and paraprofessionals. This particular activity takes place in the form of multidisciplinary team meetings in which the assessment, evaluation, and treatment plans of patients are discussed.
Each resident is responsible for the care of a maximum of six inpatients. These represent a mix of those suffering from chronic or acute psychotic conditions and those who have nonpsychotic illnesses. A significant number of these patients also have co morbid substance abuse problems.
During this rotation, the resident is expected to interact closely with medical colleagues from other specialties by being actively involved in consultation and transfer of patients from medical units to psychiatry, and by requesting the consultation of physicians from other specialties as it relates to the workup and treatment of psychiatric patients on the inpatient psychiatric units.
The month of the PGY I residency includes an orientation to acquaint new residents with the clinical facilities, community mental health services, faculty, and fellow residents. This is an opportunity to review basic knowledge and assume modest clinical responsibility on the inpatient psychiatry unit. The goal of orientation is to facilitate familiarity with the people and the resources within the residency. Emergency Psychiatry As one aspect of formal training in emergency psychiatry, residents have supervised responsibility to provide emergency psychiatric consultations to the general hospital as an integral part of their training. (Other aspects include a three-month rotation on the Consultation/Liaison/ER Service as well as a formal rotation at the Portage Path Psychiatry Emergency Services.) During the call experience, the resident acquires increased knowledge and skill in the assessment and management of psychiatric patients in emergency and crisis situations. Supervision is provided by the attending faculty psychiatrist on call as well as Emergency Department physicians. The Emergency Psychiatry Seminar provides additional learning from the resident on-call experience. Review and discussion of all emergency cases seen occurs with direct faculty input each morning during an organized morning report which involves participation from inpatient residents, medical students, and faculty.
Call frequency does not exceed six times per month, on average, and psychiatry call is scheduled in PGY I only during the six-month rotation in psychiatry. Weekend call is scheduled at a rate of approximately one weekend night for every four-week period.
Progression to PGY II Residents will:
PGY II PROGRAM
GOALS AND OBJECTIVES By the end of PGY II, the resident will:
Rotation Schedule Inpatient Psychiatry Each resident in the PGY-II level rotates on the inpatient Psychiatry service at Akron General Medical Center and St. Thomas Hospital. In this function, the resident serves as a house officer on an inpatient psychiatric unit, and assumes progressive responsibility for patient care under the supervision of the faculty psychiatrist and senior inpatient resident. The resident attains clinical competence in skills of interviewing, conducting a mental status examination, physical and neurological examination, history-writing, and the formulation of a differential diagnosis and treatment plan. This is accomplished through teaching rounds with faculty psychiatrists and senior resident. Progressive, supervised responsibility for direct clinical care of patients is provided. The residents also participate in and use major types of therapeutic techniques such as individual psychotherapy, family therapy, group therapy, crisis intervention, pharmacologic therapies, somatic therapies, and behavioral therapies.
The residents in PGY-II carry a caseload of eight inpatients with a mix of chronic and acute psychotic symptoms, nonpsychotic illnesses, and patients with alcohol and drug abuse.
Residents have an opportunity for follow-up of inpatients after discharge in an outpatient clinic for four hours per week. The follow-up of these patients is supervised by the Outpatient Clinic Directors at either Akron General or St. Thomas Hospital. Participation in Teaching Residents in the PGY-II level participate in teaching medical students from Northeastern Ohio Universities College of Medicine during their six-week psychiatry core clerkship. The residents serve as role models for the medical students and guide them in acquiring skills in doing interviewing and the mental status examination of psychiatric patients. They also supervise medical students when on call and prepare and present formal didactic lectures to the students during each clerkship rotation. Emergency Psychiatry In addition to on call emergency room experiences in the general hospital; PGY II residents spend a two-month rotation at Portage Path Psychiatric Emergency Service (PPPES). This community-based facility manages the majority of the psychiatric emergencies in Summit County. Here residents have the opportunity to manage a variety of psychiatric emergencies with on-site faculty supervision. Here the resident is responsible for the evaluation, stabilization, and disposition of patients presenting with psychiatric emergencies. He or she is responsible for organizing input from a diverse treatment team that includes a charge nurse, psychologist, social worker, and two mental health aides. Child and Adolescent Psychiatry This PGY II rotation takes place for three months at Akron Children=s Hospital Medical Center and involves the evaluation and treatment of children and adolescents with psychiatric disorders. The core experience will involve the care and treatment of inpatients on the 14-bed child psychiatric unit. The resident carries four to six inpatients and is a physician member of the comprehensive multidisciplinary treatment team. The resident is responsible for conducting the assessment and evaluation of new patients to include interviewing, performing the mental status examination, physical examination, and ordering the appropriate laboratory tests. The resident will participate in family evaluation and therapy under supervision. This will include doing an evaluation and, if adequate competence is achieved, to lead the therapy under direct supervision. The resident is expected to develop a formulation on a biopsychosocial model and reach a diagnosis along the various axes of DSM-IV. The resident is then required to present his/her findings in a multidisciplinary team setting, whereby a comprehensive treatment plan will be formulated, interacting with psychologists, psychiatric nurses, psychiatric social workers, occupational therapists, recreational therapists and, when appropriate, a nutritionist and physical therapist.
All of these activities are conducted in a manner which allows the resident to assume supervised, progressive responsibility in the assessment, evaluation, and treatment of patients in Child and Adolescent Psychiatry. Geriatric Psychiatry The PGY-II geriatric rotation takes place at St. Thomas Hospital under the direct supervision of a geriatric psychiatrist. The resident participates in the comprehensive assessment and management of inpatients on a 14-bed Gero-Psych Unit. The resident carries eight inpatients and becomes familiarly with psychopharmacology, electroconvulsive therapy, psychological testing, and systems-based practice issues as they relate to the geriatric population. The resident also participates in psychiatric consultations done on geriatric patients on the medical and surgical floors. All of these activities allow the resident to assume supervised progressive responsibility in the assessment, evaluation, and treatment of geriatric patients.
Progression to PGY III The resident will:
PGY III PROGRAM
GOALS AND OBJECTIVES By the end of PGY III, the resident will:
Rotation Schedule Outpatient Psychiatry and Psychotherapy Clinic The resident spends up to 32 hours a week seeing patients in the Outpatient Clinic who are referred from other hospital clinics, the Consultation/Liaison Service, and from the Inpatient Psychiatry Service. The resident has a mix of patients ranging from psychotic to nonpsychotic disorders. These patients require a variety of therapeutic modalities, including patients seen for short-term and long-term psychotherapy (up to three years in duration). Experience with individual, marital, and family therapy is facilitated. Appropriate use of psychotropic medication, relaxation therapy, behavior modification techniques, and hypnosis are also employed. All of these activities are conducted in a method of supervised, progressive responsibility for the clinical care of patients. The residents are supervised by the Director of the Outpatient Clinic, who meets with the resident at least once a week for one hour. In addition, another hour of weekly supervision is provided by an external supervisor of the resident’s choosing. Community Psychiatry In addition to the third year outpatient experience described above, residents spend two half-days per week on the community psychiatry rotation. This 12-month experience takes place at Community Support Services, an agency of the Summit County Alcohol, Drug Addiction, and Mental Health Services Board. There are opportunities to participate in the evaluation and assessment of patients who are chronically mentally ill. The resident participates in the evaluation assessment of new patients, and works harmoniously as a member of a multidisciplinary team that includes psychologists, psychiatric social workers, occupational therapists, and other mental health and community agency workers. This is done in a manner in which the resident can assume a progressive, supervised level of responsibility in his functions in the community mental health center. The resident gains longitudinal experience with this patient population, as well as familiarity with the organization of the community mental health system managing their care.
Residents spend one half day of the week for three months at the Summit County Jail under the supervision of a forensic psychiatrist. Here emphasis is on assessment and treatment of inmates in the mental health unit of the jail. Another half-day per week for three months is spent at the Psycho-Diagnostic Clinic under the supervision of psychiatrists, psychologists, and attorneys involved in civil commitment hearings through the state mental hospital, and in forensic cases, in the courts. The resident participates with the faculty psychologist in the assessment and evaluation of patients referred by the court for the purpose of evaluating the patient’s ability to differentiate between right and wrong and the patient’s ability to stand trial. In addition, the resident attends court hearings regarding such issues as civil commitment, probation, and guardianship. The resident will also gain experience in writing a comprehensive forensic evaluation
Residents will rotate with Homeless/Outreach one half day per week for three months and gain experience in providing assessment, referral, and psychiatric treatment services to individuals with mental illness who are homeless. Center for Traumatic Stress The resident will rotate at the Center for Traumatic Stress for one half day per week for three months. Here the resident will see traumatized patients under the direct supervision of faculty and will learn to perform a structured trauma focused interview and to provide various traumas related treatments (systematic desensitization, relaxation techniques, and exposure therapy). The resident will also participate in referring trauma victims to appropriate community resources.
Progression to PGY IV Residents will:
PGY IV PROGRAM
GOALS AND OBJECTIVES By the end of PGY-IV, the resident will:
Rotation Schedule Outpatient Psychiatry and Psychotherapy Clinic The major emphasis of PGY IV is refining the principles of outpatient psychiatry and psychotherapy learned during the PGY II and III years. The resident continues to spend one-half day per week seeing patients in an outpatient setting. During this year the resident has the experience of working with patients on issues of terminating psychotherapy in addition to continued emphasis on issues of transference and counter transference. Consultation/Liaison This rotation is done at Akron General Medical Center and/or Summa Health System under the supervision and direction of the Consultation/Liaison Service psychiatrist. This is a six-month rotation, and the resident sees all the patients referred for a psychiatric consultation from the medical/surgical floors.
In the beginning, the resident is observed conducting the psychiatric interview and mental status examination of the patient referred for the psychiatric consultation. In these teaching rounds, the resident participates in the formulation, the discussion of the patient’s diagnosis, and recommendations for a further workup and a treatment plan. All of this is communicated in a written report to the consulting physician. Once these patients are seen, follow-up is provided (in collaboration with the consulting physician) as long as the patients are in the hospital.
In addition, the resident participates in any liaison activities of the Liaison Service, such as: special support sessions for the nursing staff, liaison activities on the Oncology unit, and teaching activities to nonpsychiatric clinical and nursing staff. Senior Administrative Psychiatry Rotation This rotation is full-time for two months. The senior resident is assigned to a primary teaching service, and is responsible for the supervised care of all the patients. The resident is expected to provide supervision and leadership to junior residents and medical students, and to function autonomously with the attending available for supervision as needed. The resident will also attend the inpatient units’ treatment team meetings to gain familiarity with quality of care issues.
In addition, the resident will gain exposure to a variety of aspects of administrative psychiatry in both the public and private sectors of care. This will include participation in hospital quality assurance meetings, attendance at an ADM Board meeting and a visit to the ODMH central office where they will meet with the director and medical director of the department. They will also meet with the business manager of a private practice. Neurology The neurology rotation lasts for one month in which the resident serves in an outpatient setting participating in the diagnosis and treatment of neurological disorders relevant to psychiatric practice. The resident is able to obtain a thorough history regarding neurological disease, perform a competent neurological examination, make a differential neurological diagnosis, and under supervision, plan and carry out the treatment of common, clinically-important, neurological diseases. This is done through scheduled teaching rounds and case conferences, assigned readings, and progressive, supervised responsibility for the clinical care of neurological patients. Clinical skills and knowledge are assessed by written faculty evaluations. Electives The PGY IV residents have two months of elective time where there is opportunity to concentrate on areas of psychiatry of specific interest to the resident. There are a wide range of established electives from which to choose, or the resident may plan for individually arranged electives to enhance and compliment professional development. A portion of the time may be devoted to research or to the writing of a scholarly paper, which is required of all graduating residents. Research Requirements PGY IV residents are required to make a formal presentation of research prior to graduation. They may begin their research at any time during their residency training. The presentation is supported by a faculty advisor, and presented to residents, faculty, or research conferences. Funds are available at each hospital to support resident research. Intensive Outpatient Psychiatry This rotation takes place in the Intensive Outpatient Program (IOP) at St. Thomas Hospital for one month. The resident functions as the leader of the multidisciplinary IOP team under the direct supervision of an attending psychiatrist. The resident will gain exposure to group process and its ability to promote change by functioning as a co-therapist in three different one hour group meetings each morning, supervised by a psychologist and clinical nurse specialist. Experience is gained in performing comprehensive evaluations; brief supportive psychotherapy; psychopharmacologic management and subsequent referral to the appropriate level of care.
Graduation Requirements
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Program Description
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