Program Overview

 

The Northeastern Ohio Universities College of Medicine (NEOUCOM) Affiliated Hospitals Psychiatry Residency Program is based primarily at Akron General Medical Center and Summa Health System’s St. Thomas Hospital.  Viewed collectively both hospitals offer 90 inpatient adult psychiatry beds contained in three separate units, a 14-bed geriatric psychiatric unit, a partial hospital program, three intensive outpatient programs (two adult programs and one addiction focused program), and a 7-bed detox unit.  Children’s Hospital Medical Center hospital provides a setting for three months of training in child/adolescent psychiatry (14 inpatient beds).  Children’s also offers a child/adolescent psychiatry fellowship which is affiliated with the NEOUCOM Psychiatry Residency Program.  Community psychiatry training is integrated across all years and venues of care utilizing several contract agencies of the Summit County Alcohol and Drug Addiction Mental Health Board.  A major strength of our program is a dedicated core teaching faculty of 21 physicians who provide direct supervision for all rotations (12 private full time hospital-based adult psychiatrists consolidated into a core teaching group, 5 community psychiatrists who provide inpatient and emergency psychiatry training, 4 full time hospital-based child and adolescent psychiatrists at Children’s Hospital).

 

Our program philosophy is to train residents in the knowledge, skills, and attitudes that foster the development of competent clinical psychiatrists.  Graduates of our program possess sound clinical judgment, required skills, and excellent knowledge about the diagnosis, treatment and prevention of all psychiatric disorders, as well as common medical and neurological disorders that relate to psychiatric practice.  We emphasize training that respectfully integrates emerging neuroscience and psychopharmacologic knowledge and skills with rigorous attention to illuminating the power of the doctor/patient relationship and the importance of psychotherapeutic skills for effective practice.  Residents possess an awareness of their strengths and limitations as well as knowledge of the importance of continued education throughout their medical career.  Training in this fashion is a process that requires time and a variety of training modalities, all of which are designed with the goal of achieving resident competency in medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based care.

 

The learning of skills, attitudes, and values commensurate with the ability to provide comprehensive, progressive patient care occurs best through the role modeling of clinical faculty and through experiential learning in an atmosphere of collegiality where residents develop mentoring relationships with their teachers.  The cornerstone of our training through which all competencies are essentially taught is to provide quality supervision by faculty who are motivated to develop close relationships with residents as part of all their clinical rotations and experiences. 

 

Medical knowledge is acquired through lectures, reading and discussion groups.  The attainment of medical knowledge is especially facilitated through supervised clinical experiences. 

 

Learning effective interpersonal and communication skills is accomplished through the pairing of resident with supervising clinical faculty.  Faculty model appropriate interpersonal skills and communication strategies which facilitate effective information gathering as well as communication of treatment strategies.  Residents are then observed by faculty as they provide clinical care.  The opportunity for constructive feedback emerges out of this process.  Interpersonal and communications skills are also the major focus of psychotherapy training.  Our program emphasizes residents developing long term treatment relationships with patients from a variety of social, economic and ethnic backgrounds as well as psychiatric diagnoses.  By virtue of developing effective treatment relationships over time, residents develop versatility in their communication skills and ability to individualize their communication efforts to match their patients’ needs.  Videotape is an important component of teaching interpersonal communication skills as part of psychotherapy training. 

 

Competence in practice-based learning and improvement is achieved through resident participation in research, monthly journal club, and in the preparation and presentation of relevant clinical information in a variety of venues including medical student teaching, the teaching of peers, and presentations to their respective treatment teams.  Residents also receive direct feedback from patients regarding their quality of care.

 

Professionalism is viewed as a vital aspect of competent psychiatric care.  Most teaching relating to professionalism occurs again through faculty role modeling as part of the supervisory process.  Residents also participate in conference activities of the Institute for Professionalism Inquiry which provides opportunities for physicians to focus on professionalism across disciplines.  Our focus on psychotherapy training also allows considerable opportunities for emphasize professionalism as it relates to empathic understanding of patients.  

 

Residents have the opportunity to experience multiple systems of care during their training.  They have exposure to private hospital health care delivery systems as well as community-based systems of care.  Residents develop sound understanding of the role that system resources play in effective and efficient patient care.  Residents are active members of multidisciplinary treatment teams both in the private and public sectors, insuring their understanding of the role that systems resources play in patient care.  In addition, they participate in mental health court, jail, and forensic rotations. 

 

Resident Eligibility and Selection Process

The Northeastern Ohio Universities College of Medicine (NEOUCOM) considers applicants who are graduates of medical schools in the United States and Canada accredited by the LCME, graduates of colleges of osteopathic medicine in the United States and Canada accredited by the AOA, and graduates of medical schools outside the United States and Canada who have a currently valid certificate from the ECFMG.

 

The NEOUCOM residency program selects eligible applicants on the basis of preparation, ability, aptitude, academic credentials, communication skills and personal qualities such as motivation and integrity.  NEOUCOM does not discriminate with regard to race, sex, age, religion, color, national origin, disability or veteran status.  All applicants must participate in the National Residency Matching Program and submit applications by the electronic Residency Application System.   Those applicants selected for interviews meet with current residents both individually and in small groups and meet multiple faculty members for individual interviews.  At the conclusion of interviewing season all participating faculty and residents meet for a rank list discussion.  The program director assumes final responsibility for the match list after receiving input from all participating faculty and residents. 

 

GOALS AND OBJECTIVES

Upon completion of the program the resident is able to assess, evaluate and treat patients in a comprehensive way by obtaining competence in the six areas listed below.  

Patient Care

A.  Residents have supervised experiences in evaluating and treating patients of varying age, gender, race, ethnicity, and socioeconomic status.  

B.  Residents become familiar with medical problems that can affect evaluation and care.

C.  The resident learns to effectively use the following data collection methods:

  • interviewing and history-taking of the patient and appropriate family members,
  • a mental status examination, 
  • physical and neurological examinations,
  • laboratory tests such as EEG, EKG, appropriate imaging studies, blood, and urine tests, and
  • psychological and neuropsychological testing when indicated.

D.  The resident learns to analyze the data from a biopsychosocial model and formulate an initial hypothesis.  He or she integrates the data from biological, psychological, and social/environmental dimensions.

E.  The resident formulates initial diagnoses along the various axes of the Diagnostic and Statistical Manual, Edition IV-TR, of the American Psychiatric Association.

F.  The resident plans for and conducts the following interventions:

  • additional data collection when appropriate (further workup), such as consultation from medical, surgical and other services in the hospital,
  • consultation from social services regarding the use of social support systems and agencies in the community,
  • treatment interventions,
  • knowledge of psycho­pharmacology and the effects of psychotropic medication.  Their appropriate usage, side effects and contraindications in treating a variety of psychiatric and behavioral disorders,
  • the various drug interactions between psychotropic medications and the medications used in medicine,
  • the indications and appropriate use of electroconvulsive therapy (ECT),
  • the use of psychotherapeutic modalities including supportive, psychodynamic, cognitive behavioral, and interpersonal in both brief and long-term individual practice.  Experiences also gained in areas of marital, family, and group psychotherapy,
  • the appropriate use of social services for consultation and the appropriate use of various resources in the community for the rehabilitation of psychiatric patients,
  • the indications for use of additional therapies to include: occupational therapy, recreational therapy, and physical therapy.

G.  The resident provides psychiatric consultation in a variety of medical surgical settings.

H.  The resident gains experience in the care and treatment of those patients with chronic mental illness.

I.   The resident learns to function as the leader of an interdisciplinary treatment team.

J.   Residents provide and coordinate care to patients who are receiving treatment from non-medical therapists.

K.  Residents gain exposure to situations of domestic violence and competence in the management of those situations.

l.  The resident learns to evaluate and assess patients and any appropriate interventions in emergency settings, using a comprehensive biopsychosocial model.

Medical Knowledge

A.  A didactic curriculum consisting of scheduled lectures and assigned readings covering the following topics:

  • the major theoretical approaches to understanding the patient-doctor relationship; 
  • the various factors that significantly influence physical and psychological development throughout the life cycle; 
  • the fundamental principles of the epidemiology, etiologies, diagnosis, treatment, and prevention of all major psychiatric disorders in the current standard diagnostic statistical manual;
  • comprehensive discussions of the diagnosis and treatment of neurological disorders commonly encountered in psychiatric practice;
  • the use, reliability, and validity of the generally-accepted techniques to diagnosis and treat patients; 
  • the use and interpretation of psychological testing;
  • the history of psychiatry and its relationship to the evolution of medicine;
  • the legal aspects of psychiatric practice;
  • an understanding of American culture and subcultures as they relate to psychiatric practice;
  • use of case formulation that includes the biopsychosocial diagnosis and management of cases; and
  • instruction in research methods in the clinical, biological, and behavioral sciences related to psychiatry, including techniques to appraise the professional and scientific literature and to apply evidence-based findings to patient care.

B.  In addition, each resident will learn to: critically evaluate and read scientific papers; learn the basic principles of conducting clinical research in psychiatry and how to write a scholarly paper.

Practice-Based Learning and Improvement

Residents will:

  • take responsibility for becoming life-long learners;
  • have the experience of participating in a quality improvement activity;
  • use evaluations by supervisors and patients to improve practice;
  • use information technology and evidence-based medicine to improve patient care; and
  • actively participate in education of patients, fellow residents, and medical students.

Interpersonal and Communication Skills 

Residents will develop knowledge, skills, and attitudes that include:

  • effective communication with patients, family members, colleagues, and other health professionals;
  • a sensitive, non-judgmental approach to a diverse patient population;
  • effective functioning as leader of a treatment team;
  • competent consultative services to other health professionals;
  •  the maintenance of legible, timely, and thorough medical records; and
  • interviewing patients in ways that foster diagnoses and treatment within the biopsychosocial model.

Professionalism

 The resident will demonstrate the following knowledge, skills and attitudes in regards to professionalism:

  • the doctor/patient relationship must be built on a basic acceptance of the patient with a non-judgmental approach;
  • the importance of monitoring one's own emotional responses to the patient and maintaining objectivity in all professional contacts;
  • the need for reliability, responsibility, and confidentiality as it relates to all patient contacts;
  • an awareness of one's own strengths and limitations;and
  • high standards of ethical behavior as outlined in the AMA Principles of Ethics with “Special Annotations for Psychiatry”.

Systems-Based Practice

Residents will demonstrate competence in the following knowledge, skills, and attitudes related to systems-based practice:

  • appreciation of cost and utility of medical care and the need to provide high quality care at a reasonable cost to the patient;
  • an understanding of the variety of medical care delivery systems and how they effect resource allocation;
  • coordination of health care in order to diagnose, treat, and prevent mental illness; and 
  • maintenance of the medical record to allow continuity of care (comprehensive transfer and discharge summaries).

METHODS

Learning is facilitated by reading, didactic seminars, case conferences, discussion groups, Grand Rounds, Journal Club, clinical supervision, role-modeling, experiential learning and through feedback from peers and colleagues.  Direct faculty supervision/meeting is the foundation of our teaching methods.  The supervisor acts as a role model for the resident by having the resident observe the supervisor treating the patients, and later on, by having the supervisor observe the resident in the assessment and treatment of psychiatric patients. Supervision is organized such that there is progressive responsibility for patient care commensurate with residents’ ability.   The resident is also taught and supervised by an external supervisor, who listens to the resident present clinical cases by the use of process notes, audio tapes and video tapes. 

The Northeastern Ohio Universities College of Medicine Affiliated Hospitals Psychiatry Residency Program has a bibliography of recommended reading assigned for each year of the residency program.  These are listed under each year of the program.  In addition to the recommended reading, the resident is assigned reading as part of each course and seminar and of the case conferences.

Residents are also expected to refer to and use a number of standard psychiatric reference books.  See Appendix C for list of reference texts.

EVALUATION OF RESIDENTS

  • Written Evaluation - residents receive written evaluations based on the six competencies completed by attending faculty in charge of each rotation. 
  • Attendance and participation at morning report for PGY I & II residents.
  • Attendance and participation in didactics.
  • Quizzes based on required reading for PGY I residents.
  • 360 degree evaluations
  • Supervision – two hours per week
  • Yearly PRITE exam
  • Completion of skills checklist
  • Completion of patient log books
  • Direct interview of standardized patients with attending review and feedback at end of PGY II.
  • Mock Board exams – three times per year for PGY II, III and IV residents.
  • Yearly Psychodynamic Psychotherapy exam for PGY II, III and IV residents.
  • Feedback from medical students
  • Completion of psychotherapy skills checklist.

The Program Director meets individually with each resident at least two times per year to communicate his or her educational performance and progress in the residency program based on results of the above assessments.  These meetings are documented in the resident’s file.

The Residency Education Committee meets monthly to review administrative and educational issues regarding the evaluation of the residents in the psychiatry program.  Specifically, each resident is reviewed annually by the entire committee.  This involves review of the previous 12 months of clinical evaluations.  The residents’ progress is discussed by the committee and faculty members who have had direct supervisory experience with the resident.  A composite evaluation is generated and a summary of the committee’s discussion is presented to the resident by the Program Director.