PSYCHIATRY RESIDENCY PROGRAM
COMPETENCY OBJECTIVES - CLINICAL ROTATIONS
Effective August 1, 2002, all residents are required to be evaluated regarding their competencies
in 6 key areas: Patient Care, Knowledge, Practice-Based Learning, Communication Skills,
Professionalism, and Systems-Based Practice. Each clinical rotation will be evaluating you in
these six key areas. Each rotation has a number of concrete objectives or criteria that you are
expected to achieve in each area. For each of the objectives the following is a more detailed
description of what will be assessed in each of the six key areas:
PATIENT CARE
1. This area covers all areas of clinical activity including your skill in examining the patient
and taking of a careful history; your ability to take the clinical data you have obtained and
effectively use it; your ability to evaluate all appropriate alternative courses of action;
your wise use of therapeutic and diagnostic procedures; and your ability to deal with the
patient in a therapeutic manner.
2. The core of the clinical rotations is to provide you with opportunities to work with
patients under close supervision. All other seminars and supervisions are ultimately
designed to prepare you for your work in the patient care arena. Please note that
competency in patient care does not equal competency the five required psychotherapy
areas. See the psychotherapy competency curriculum for more detail.
MEDICAL KNOWLEDGE
1. The faculty will look at the knowledge base you should have developed at any particular
point in your training and will assess how well you actually apply it. In addition, they
will assess how well you learn key information that they provide you with during the
rotation. Those who are self-motivated to actively use new information will do better
that those whose knowledge is poorly applied. This rating is independent of the
evaluation that you will receive in any particular seminar topic block.
2. Your will have a comprehensive four year seminar series to assist you in expanding your
fund of knowledge.
PRACTICE-BASED LEARNING
1. When you are caring for patients you will run into situations where you have limited
medical knowledge of how to handle the situation. This area will assess your ability to
gain the information you need to handle such a clinical situation. Residents who
passively await faculty to tell them what is happening and what to do will be rated poorly
while those who actively bring new knowledge to the clinical setting and discuss with the
attending how to apply it to the situation at hand will fare well. The faculty will also be
evaluating your ability to realize the weaknesses in literature you find as well as the
strengths.
2. In the psychiatry curriculum there will be journal clubs, research seminars and library
orientations to familiarize you with how to access the literature and evaluate it.
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INTERPERSONAL AND COMMUNICATION SKILLS
1. This evaluates your ability to establish trust with patients and their families by creating an
atmosphere of respect, compassion and empathy. It also relates to your ability to
communicate clearly with patients, families and other professionals.
2. The psychiatry curriculum includes extensive seminars on empathetic listening and basic
techniques for establishing rapport with patients. This is further elaborated on in
seminars on various types of psychotherapy. A key area of psychotherapy supervision is
learning how to help patients deal with difficult situations in a manner that preserves the
therapeutic alliance.
PROFESSIONALISM
1. Do you act like a professional? Are you honest, reliable, punctual, and respectful? Do
you display an awareness of your limitations but within those limitations do you display
initiative and leadership? How good is your ability to maintain appropriate clinical
boundaries between yourself and patients/families.
2. The psychiatry curriculum includes the provision of clinical supervisors (psychiatrists)
for residents in each year of training. In addition to advising on clinical issues, this
faculty is also available to discuss professionalism issues as they come up.
SYSTEMS-BASED PRACTICE
1. This area will assess your understanding of the health care system and how it impacts the
clinical settings you are in. Successful residents will be able to effectively link patients
with needed resources and are good at interacting with other organizations and third party
payors. They can actively work were appropriate with quality improvement committees
of the hospital and the department to improve the overall quality of care.
2. The psychiatry curriculum includes seminar series in systems of care, administrative
psychiatry, and office practice issues. In addition, during your third year you will have
the opportunity to participate on a quality improvement committee and to do a quality
improvement study with the goal of developing recommendations for action by the
committee.
3. Residents are encouraged to discuss with the faculty how the competency objectives will
be measured at the start of each rotation. The Residency Curriculum Committee will be
looking at evaluation methods in an on-going fashion in an effort to make them more
objective and measurable. The committee welcomes the constructive input of trainees.
COMPETENCY OBJECTIVES - PRIMARY CARE ROTATION
PATIENT CARE
1. To conduct a comprehensive medical history and to record it in the appropriate format in
the medical record.
2. To conduct and to record appropriately a complete physical examination.
3. To order appropriate laboratory studies and to interpret the results in relationship to the
patient's illness.
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4. To diagnose common medical and surgical disorders and formulate appropriate initial
treatment plans.
5. To provide appropriate continuous care of patients with medical illness within the
limitations of a first year trainee and to make appropriate referrals.
KNOWLEDGE
1. To have the knowledge base to formulate a full differential diagnoses for common
psychiatric complaints and to establish a final diagnosis.
2. To understand how to manage situations arising as medical emergencies.
3. To understand how to manage acute medical illnesses.
4. To understand how to manage chronic medical illnesses.
PRACTICE-BASED LEARNING
1. To effectively be able to access healthcare information and apply it to clinical situations
for the benefit of the patient.
COMMUNICATION
1. To effectively communicate to enhance the doctor-patient relationship as it develops in a)
emergencies b) acute illness and c) chronic illness.
2. To effectively communicate with families, other healthcare professionals and other
organizations.
PROFESSIONALISM
1. Work effectively with a medical team including the use of appropriate referrals.
2. To recognize the role of the primary physician in the care of medically and
psychiatrically ill patients.
SYSTEMS-BASED PRACTICE
1. To develop an understanding of how to utilize hospital resources to obtain the services
the patient needs in the community.
COMPETENCY OBJECTIVES - NEUROLOGY ROTATION
PATIENT CARE
1. To take a thorough history and conduct a complete neurologic evaluation of patients
presenting with neurologic or behavioral symptoms and to record findings in the medical
record.
2. Make use of appropriate laboratory examinations and special procedures as indicated in
the work-up of neurologic problems.
3. To formulate a differential diagnosis and through an appropriate diagnostic work-up
establish a final diagnosis.
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4. To diagnose and treat common neurologic disorders including disorders especially
applicable to psychiatry such as organic brain syndromes, seizure disorders, movement
disorders, and degenerative disorders.
5. To provide for effective follow-up of patients with neurologic complaints.
KNOWLEDGE
1. To have the knowledge to diagnose those neurologic disorders that might reasonably be
expected to be encountered in psychiatric practice and must be considered in the
differential diagnosis of psychiatric disorders.
PRACTICE-BASED LEARNING
1. To effectively access health care information and apply it to the care of patients
COMMUNICATION
1. To effectively communicate with patients, families, and other health care professionals.
PROFESSIONALISM
1. To conduct his/herself in a professional manner consistent with the AMA’s statement of
medical ethics.
SYSTEMS-BASED PRACTICE
1. To be able to utilize hospital and outpatient clinic resources to access services through the
patient needs in the community.
COMPETENCY OBJECTIVES-ADULT INPATIENT PSYCHIATRY ROTATIONS
It is expected that a resident will master all of these objectives by the end of his/her 10 months of
adult inpatient psychiatry.
PATIENT CARE
The resident will demonstrate the ability to:
1.
Conduct a complete and accurate psychiatric evaluation including history, mental
status examination, appropriate physical examination and collateral information.
2.
Evaluate patients for risk/dangerousness and take appropriate action based on such
evaluation.
3.
Utilize and interpret appropriate laboratory examinations and consultation.
4.
Administer, score, and interpret the following assessment tools in appropriate
patients: BDI-2, geriatric Depression Scale, ADL Assessment, MMSE, BPRS.
5.
Sensibly utilize common psychological tests under the supervision of a clinical
psychologist.
6.
Conduct a therapeutic interview (individual and family)
7.
Formulate an accurate diagnosis integrating all domains: DSM, biological,
psychological, social and cultural.
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8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Generate an appropriately broad differential diagnosis, and identify the most likely
diagnosis.
Develop a comprehensive treatment plan that addresses all pertinent problems.
Mobilize resources to implement the treatment plan, evaluate for clinical and costeffectiveness and update the plan based on such evaluations.
Develop and carry out a range of somatic and psychosocial therapies using accepted
evidence-based models.
Administer ECT in a safe and appropriate manner.
Conduct short-term supportive psychotherapy with appropriate patients.
Articulate basic principles of behavior modification. Sensibly decide when behavior
modification is appropriate in the inpatient setting and when to obtain consultation.
Synthesize clinical data.
Incorporate knowledge of medico-legal issues into patient care.
Be conversant with medical disorders likely to be regarded as psychiatric and
psychiatric disorders displaying symptoms likely to be regarded as medical.
Be cognizant of the volume of the interactions between psychiatry, medical and
surgical environments.
MEDICAL KNOWLEDGE
The resident will demonstrate:
1.
A working knowledge of the epidemiology, diagnostic criteria, natural history and
treatment options for common illnesses that present in the following ways:
a. Depression
b. Psychosis
c. Mania
d. Catatonia
e. Anxiety
f. Intoxication and withdrawal states
g. Cognitive impairment
h. Aggression or other behavioral disturbance
i. Self-harm
j. Disordered eating patterns
2.
A working knowledge of pharmacologic agents used to treat the conditions listed
in #1. This should include indications, clinical effects, mechanism of action,
ADRs, pharmacodynamics, pharmacokinetics, drug interactions (including
alternative compounds), and dietary restrictions.
3.
A working knowledge of ECT, including indications, patient selection, pretreatment evaluation, monitoring and informed consent.
4.
A working knowledge of the following medico legal issues:
a. Detention and Evaluation
b. Voluntary and involuntary hospitalization.
c. Right to refuse treatment
d. Informed consent
e. Treatment over objection
f. Seclusion and restraint
g. Duty to warn
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5.
6.
7.
h. Evaluation of competency
Knowledge and application of basic and clinical sciences in-patient care.
A working knowledge of current practice standards and guidelines.
Analytic and investigatory thinking.
PRACTICE-BASED LEARNING AND IMPROVEMENT
The resident will:
1.
Read about his/her patients.
2.
Identify deficiencies in his/her database and seek appropriate resources to correct
this.
3.
Be able to critically evaluate and defend such resources.
4.
Understand and utilize basic information technology, including hospital-based
computer systems, literature search engines and common electronic databases.
5.
Act as educator to his/her patients and their families.
6.
Participate in the education and supervision of medical students, making an effort
to maximize their participation in patient care.
7.
Present at least one didactic/content presentation to other team members for each
month on service.
INTERPERSONAL AND COMMUNICATION SKILLS
The resident will be able to:
1.
Establish an empathic and therapeutic relationship with patients and teammembers
2.
Listen effectively
3.
Communicate effectively, both verbally and non-verbally
4.
Present cases and formulations in an organized, concise and accurate fashion.
5.
Write legible, organized, concise and accurate H+Ps, progress notes and discharge
summaries.
6.
Effectively lead team meetings or family meetings.
7.
Communicate in a timely and effective manner with referring or consulting
physicians and mental health agencies.
PROFESSIONALISM;
The resident will:
1.
Be honest and responsible
2.
Empathically and respectfully interact with all patients and staff.
3.
Be sensitive to the wide range of human diversity.
4.
Interact responsibly with other members of the treatment team:
check out
patients evenings/week-ends, answer pages promptly, do dictations or notes
promptly.
5.
Be self-aware
6.
Demonstrate behavior consistent with the AMA Standards of Ethical Behavior for
Physicians with special annotations for Psychiatry.
7.
Demonstrate appropriate boundaries.
8.
Exhibit professional attire and demeanor.
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SYSTEMS-BASED PRACTICE
The resident will:
1.
Advocate for his/her patients.
2.
Interact promptly and appropriately with mental health agencies, emergency
rooms and general medical floors when needed for appropriate patient care or
disposition.
3.
Articulate and demonstrate the appropriate use of:
a. Assertive Community Treatment programs
b. Partial Hospitalization Program
c. Visiting Nurses
4.
Be aware of various payor sources for his/her patients, and understand how this
impacts access to care.
5.
Understand and participate in the utilization review process for his/her patients.
6.
Be familiar with the clinical and documentation requirements for CPT coding
(Senior Residents only).
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