Psychiatry (PGY-2)

 

 

Description of Rotation or Educational Experience

 

Family medicine residents will spend four weeks on the CL service at Henry Ford Hospital. The CL service is primarily responsible for the evaluation, treatment, and management of psychiatric issues in patients admitted for medical illnesses. Additionally, CL is involved in other activities that support specific areas inching evaluations regarding decision making ability and ability to function independently. Family Practice residents will work with psychiatry residents, psychology interns, and medical students. One-on-one daily supervision with senior staff psychiatrists and psychologists occurs. Family medicine residents will be involved in evaluation, treatment planning and implementation, daily follow up, and discharge planning. During the CL service rotation, residents will be asked to give brief presentations on relevant areas as well as participate in small group learning experiences.

 

In addition, Family medicine residents will spend four and one-half days at the Henry Ford Behavioral Services – One Ford Place. This innovative experience will allow the resident to gain increasing comfort in diagnosis and pharmacological treatment of psychiatric illnesses. The resident after the first day of observation will be interviewing new psychiatric patients, developing treatment plans and initiating treatment.

 

Additionally, residents will participate in a psychiatric medication clinic for increased exposure to the continued maintenance of patients requiring psychopharmacology. Third-year psychiatric residents will observe/supervise these activities.

 

 

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

  • Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
  • Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

 

Objectives

By the end of the rotation the resident is expected to:

  • Strengthen the resident’s ability to diagnose and treat basic psychiatric illness
  • Perform a psychiatric evaluation with a formal mental status examination
  • Formulate a treatment plan for common psychiatric illnesses including pharmacological, psychological, and social interventions

 

 

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

  • This rotation fulfills family medicine-specific training and educational requirements in Adult Medicine and Human Behavior and Mental Health.

 

Objectives

By the end of the rotation the resident is expected to:

  • Understand the principles of behavioral medicine and psychosomatic illness
  • Expand the resident’s repertoire of psychopharmacology and behavioral interventions
  • Detail the risk factors associated with suicide/homicide/violence as well as appropriate interventions
  • Become familiar with medical illnesses that commonly have psychiatric presentations
  • Understand symptoms and sequelae of common drugs of abuse/dependence
  • Describe the phamacological treatment of common psychiatric illnesses

 

 

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

  • Set learning and improvement goals
  • Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
  • Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations  of a resident’s teaching abilities by faculty and/or learners

 

Objectives

By the end of the rotation the resident is expected to:

  • Expand his/her ability to understand the complex interactions of psychological and physiological factors in psychiatric illness
  • Conceptualize psychiatric illness using a biopsychosocial model

 

 

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

  • Work effectively in various health care delivery settings and systems relevant to their clinical specialty
  • Advocate for quality patient care and optimal patient care systems

 

Objectives

By the end of the rotation the resident is expected to:

  • Resident will assist in consultations through out the hospital system, seeing the other side of the consult process.

 

 

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

  • Respect for patient privacy and autonomy
  • Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

 

Objectives

By the end of the rotation the resident is expected to:

  • Exercise attentiveness to the need for privacy and autonomy as experienced by patients suffering psychiatric illness and disease.

 

 

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

  • Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
  • Act in a consultative role to other physicians and health professionals

 

Objectives

By the end of the rotation the resident is expected to:

  • Develop skill in interviewing patients, performing a focused psychiatric examination including a formal mental status examination, to formulate a psychiatric diagnosis
  • Elicit diagnostic symptoms associated with common psychiatric disorders including major depression, bipolar disorder, panic disorder, delirium, dementia, and schizophrenia

 

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

  • Didactic lecture
  • Discussion groups
  • Independent reading
  • Direct role-modeling and observation
  • Precepting of direct patient care

 

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

  • Faculty evaluations of the rotator’s performance
  • Real-time feedback during direct observation
  • Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.
  • Following this rotation, the resident is expected to achieve 90% post-test score on the Mental Health section of the shelf exam.

 


 

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

  • Resident evaluation of rotation

 

Level of Supervision

How is the resident supervised on this rotation?

·        Directly by attending physicians

 

Educational Resources

List the educational resources

  • Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.

 

Recommended textbooks include:

  1. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Test Revision) Publisher: American Psychiatric Press; ISBN: 0890420254; 4th edition (June 15, 2000)
  2. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry by Benjamin J., MD Sadock, Virginia A., MD Sadock, Harold I, Kapla, publisher: Lippincott Williams & Wilkins Publishers; ISBN 0781725321; 3rd edition (May 15, 2001).
  3. Massachusetts General Hospital Handbook of General Hospital Psychiatry by Ned H. Cassem (Editor), Jerold F. Rosenbaum, Publisher: Mosby Year Book; ISBN: 0815114788; 4th edition (July 1997).
  4. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry by Benjamin J., MD Sadock, Harold I., Kaplan (Editor), Publisher Lippincott Williams & Wilkins; ISBN:0683303309; 8th edition (January 15, 1998).
  5. The American Psychiatric Publishing Textbook of Clinical Psychiatry by Robert E., MD. Hales (Editor), Stuart C., MD. Yudofsky (Editor), Stuart C. Yudofsky, Publisher: American Psychiatric Press; ISN: 1585620327: 4th edition (October 15, 2002).