Outpatient Psychiatry

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Department of Psychiatry and Human Behavior
Butler Hospital - Rhode Island Hospital –VAMC
Revised Date 5/8/2010
Outpatient Psychiatry
Overview of Rotation
The outpatient psychiatry rotations in the Brown Psychiatry Residency are core training experiences during
which residents gain knowledge, skills and practice in the care of psychiatric patients in an outpatient setting.
The rotation requires a high degree of organization and efficiency, as well as a strong commitment to
professionalism. This latter quality is a core value, which should guide residents in decision-making about which
steps to take on behalf their patients, as well as their own education.
Description of Rotation
This rotation is a 1-year assignment that occurs in the PG3 year. It allows residents to develop important diagnostic,
treatment, and other skills in an outpatient setting. The rotation affords a more varied and in-depth outpatient experience
than they have had in other outpatient settings throughout the residency. It allows residents to work more independently
and to assume increasing responsibility for a varied patient caseload. This rotation takes place at one of the three
outpatient sites described below. All residents evaluate and treat geriatric outpatients and have specific supervision with a
geriatric psychiatry supervisor who has subspecialty boards in this area.
RI Hospital: The Rhode Island Hospital outpatient psychiatry rotation is a full-time rotation where residents learn to
assess and treat psychiatric outpatients with varied and frequently lower socio-economic status. There is considerable
emphasis on the importance of a complete psychiatric multi-axial diagnosis with a weekly conference focused on this
important clinical issue. There is also an emphasis on treating patients based on the current evidence in the literature; a
weekly mandatory journal club teaches residents how to critically appraise the psychiatric literature particularly as it
relates to assessment, treatment and outcome.
Butler Hospital: The Butler Hospital outpatient psychiatry rotation is a full-time rotation that occurs largely at Butler
Hospital. Residents will also spend one half day a week at Northern Rhode Island Community Mental Health, where they
also see outpatients under supervision. There is also limited opportunity for residents to rotate ½ day a week at Brown
University Psychological Services. Residents have the opportunity to participate in one of the following specialty
clinics—the mood disorders clinic, the Obsessive Compulsive Disorder clinic and the Body Dysmorphic Disorder clinic.
VAMC: The VAMC outpatient psychiatry rotation is a full-time rotation that occurs largely at the VAMC. Residents
spend time seeing general outpatients and may participate in one or more specialty clinics including the Clozaril Clinic,
substance abuse treatment program, and post-traumatic stress disorder clinic. Residents also spend one-half day per week
in interim care (the emergency services). Some also spend one half day a week at the Kent Center, where they also see
outpatients under supervision.
I. GENERAL INFORMATION
Name of Rotation
Unit Chiefs
Contact Information
Residency Coordinator
Outpatient Psychiatry
Benjamin Greenberg, MD (Butler Hospital);
Mark Zimmerman, MD (Rhode Island Hospital),
Laura Levine, MD (VAMC)
Benjamin Greenberg, MD (Butler Hospital): 455 6209
Mark Zimmerman, MD (Rhode Island Hospital):
Laura Levine, MD (VAMC): (401) 273-7100, x-3878
Roberta Swanson: (401) 455-6375
II. FACULTY
Drs. Greenberg, Phillips, Eisen, Tyrka, Carpenter, Westlake (Butler Hospital); Zimmerman, Atiullah, Posternak,
Friedman, Burrock, Boerescu, Ragheb, and Anthony (RIH); Drs. Levine, Correia, Skoble, Vestner, Johnston, Khan,
Kaufmann, Shafer, Corre, Sheehan, Smokler, Ali (VAMC)
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III. TOPICS/TEACHING METHODS/MATERIALS USED DURING THIS ROTATION
Topics to be covered are based upon:
 The patients assessed and treated by the residents over the course of the rotation
Principal teaching methods:
 Attending supervision
 Weekly afternoon seminars
Educational materials provided/referred to residents:
 Reading: Each attending and resident is expected to utilize current psychiatric literature regarding assessment and treatment of
psychiatric patients in the emergency/acute setting.
 Computer-assisted educational materials: All housestaff have access to full-text literature search and retrieval capacity through
the hospitals’ computer networks. Terminals are located in the emergency room of the hospitals.
 Other: Residents are given articles as part of their weekly afternoon seminar series .
IV. SPECIFIC AREAS & EXPECTATIONS
V.
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EVALUATIONS
Evaluation of the resident's successful completion of the above goals will be carried out by the attending.
Evaluation of the attending's successful completion of the above goals will be carried out by the resident.
Evaluation of the rotation will be completed as part of the annual resident retreat report.
VI. RESPONSIBILITIES OF ATTENDING ON ROTATION
 The chief of service will oversee the educational experience for the residents.
 Supervisors will oversee the care of the patients in the resident’s caseload assigned to that particular supervisor.
VII. RESPONSIBILITY OF RESIDENT ON ROTATION
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Resident is expected to spend 20 hours a week seeing general outpatients plus 4 hours a week in a specialty clinic (BH and
VAMC).
Resident is responsible for evaluation, treatment, and disposition of psychiatric outpatients.
Resident is responsible for collecting all relevant information on the patient, including reviewing old medical records.
Resident is responsible for family and patient communication.
Resident is responsible for discussing the case with his or her supervisor, other health care professionals involved with the patient
and the patient’s family, as dictated by the circumstances.
Resident is responsible for written or dictated evaluations of all patients assessed and followed.
Resident will submit an online evaluation of the attending upon completion of the rotation.
Resident must attend weekly educational experiences that are site- and rotation-specific.
 Resident is responsible for covering for their patients 24 hours a day (BH and RIH).

Resident must inform their patients how they can be reached in the event of an emergency
VIII. SCHEDULE DURING THIS ROTATION
Grand Rounds
1st Wednesday of each month, 11:00, Ray Hall, Butler Hospital Campus
Weekly Afternoon
Seminars
Wednesdays from 1:10 to 4:30 required for all PG3 residents
RCC Clinic
Butler Hospital:
Clinical Case Conference
Geriatric Psychiatry Seminar
Forensic Psychiatry
RIH:
Clinical Case Conference
Journal Club
DSM Conference
VAMC:
Clinical Case Conference
Tuesdays at 1:00
3rd Thursday of each month, 12:00, Ray Hall, Butler Hospital Campus
weekly (3 weeks/month)
biweekly
monthly last Tuesday of month at 8 am
Thursdays at 8 am
Tuesdays at 8 am
4th Wednesday of each month 8am
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Geriatric Psychiatry Seminar
Departmental Colloquium
Challenging Case Conference
Neuropsychiatry seminar
Departmental Journal club
biweekly
3rd Wednesday of each month 11am
4th Wednesday of each month 11am
biweekly
monthly
IX. GENERAL EDUCATIONAL OBJECTIVES
Residents will:
 Assess outpatients and implement outpatient treatment for individuals with psychiatric and or psychological difficulties
 Develop important diagnostic and treatment skills in an outpatient setting
 Function independently in an outpatient setting with supervision
 Have both a theoretical and practical understanding of individual psychotherapies
 Have both a theoretical and practical understanding of group and family therapy
 Recommend laboratory/imaging tests
 Prepare and present case presentations
 Develop an appreciation for cost-efficient care, and proper utilization of resources
 Work in a coordinated fashion with other treatment providers
 Recognize when patients need a higher level of treatment (e.g., inpatient hospitalization or partial hospitalization)
X. GOALS AND OBJECTIVES FOR THIS ROTATION – COMPETENCY-BASED
Competency/Description
1. Patient Care
Goals and Objectives
 Resident must be able Resident will
Prepare and present case presentations
to provide care that is
Develop the ability to communicate effectively and demonstrate caring and
compassionate,
respectful behaviors when interacting with patients and their families.
appropriate, and
Learn to gather essential and accurate information about their patients
Learn to make informed decisions about diagnostic and therapeutic
effective for the
interventions based on patient information and preferences, up-to-date
treatment of health
scientific evidence, and clinical judgment
problems and the
Learn to develop and carry out patient management plan
promotion of health.
Learn to counsel and educate patients and their families
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2. Medical Knowledge
 Residents must
demonstrate
knowledge about
established and
evolving biomedical,
clinical, and cognate
(e.g. epidemiological
and socialbehavioral) sciences
and the application of
this knowledge to
patient care.
3. Interpersonal and
Communication Skills
 Residents must be
able to demonstrate
interpersonal and
communication skills
that result in effective
information exchange
and teaming with
Provide health care services aimed at preventing health problems or
maintaining health
Work with health care professionals, including those from other disciplines,
to provide patient-focused care
Use information technology to support patient care decisions
Goals and Objectives
Residents will
Demonstrate an investigatory and analytic thinking approach to clinical
situations
Know and apply the basic and clinically supportive sciences which are
appropriate to their discipline
Learn to generate a differential diagnosis and unique treatment plan for each
patient encounter
Learn to effectively communicate their investigatory and analytic thinking
approach via written notes and presentations to supervisors and other health
care professionals
Will keep abreast of new scientific knowledge, which is obtained via
didactic sessions, Grand Rounds, critical review of scientific literature,
computer and web-based resources
Will actively participate in seminars
Goals and Objectives
Residents will
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Evaluation Method
- Residents are evaluated by
their supervisors
Create and sustain a therapeutic and ethically sound relationship with
patients
Scrupulously maintain patient confidentiality, and specifically reassure
patients/families of the confidentiality of their personal and medical
information
Know and be able to describe the proper boundaries of the physician/patient
Evaluation Method
- Feedback of both oral and
written presentations will be
provided by supervisors
Evaluation Method
Residents are evaluated by their
supervisors
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patients, their
patients’ families,
and professional
associates.
4. Professionalism
 Residents must
demonstrate a
commitment to
carrying out
professional
responsibilities,
adherence to ethical
principles, and
sensitivity to a
diverse patient
population
relationship, and will consistently and conscientiously avoid any breach of
these boundaries.
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Residents will write clearly and legibly when hand-writing instructions or
other information for patients/families
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Written communications in patient charts will effectively permit subsequent
caregivers to understand the nature of the patient interaction and the goals
and plans for the encounter as well as future encounters when applicable
Goals and Objectives
Residents will
Demonstrate their responsibility to patient care by: (1)Responding to
communication from patients and health professionals in a timely manner,
(2) Establishing and communicating back-up arrangements, including how
to seek emergent and urgent care when necessary, (3) Using medical records
for appropriate documentation of the course of illness and its treatment , (4)
Providing coverage if unavailable, (for example, when out of town or on
vacation), (5) Coordinating care with other members of the medical and/or
multidisciplinary team, (6) Providing for continuity of care, including
appropriate consultation, transfer, or referral if necessary
Demonstrate ethical behavior, integrity, honesty, compassion, and
confidentiality in the delivery of care, including matters of informed
consent/assent, professional conduct, and conflict of interest.
Demonstrate respect, sensitivity and responsiveness for and to patients and
their families, and their colleagues as persons, including their ages, cultures,
disabilities, ethnicities, genders, socioeconomic backgrounds, religious
beliefs, political leanings, and sexual orientations.
Demonstrate understanding of and sensitivity to end of life care and issues
regarding provision of care.
Review their professional conduct and remediate when appropriate.
Residents will make reasonable efforts to act as advocates for their patients.
Residents will truthfully report medical errors of their own to their
attending, or Risk Management and to follow hospital protocols in the face
of errors. Residents will encourage and facilitate reporting of medical error
on the part of professional colleagues.
Residents will seek professional help for personal impairments that may
compromise patient care; will assist impaired colleagues to obtain
professional help; and will take responsibility for interceding to protect
patient safety when impaired colleagues do not respond appropriately to
their own duties in this regard.
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5. Practice-Based
Learning and
Improvement
 Residents must be
able to investigate
and evaluate their
patient care practices,
appraise and
assimilate scientific
evidence, and
improve their patient
care practices.
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- Attendings will evaluate
residents
- Feedback from nursing staff,
other disciplines
Residents will clearly and openly identify and repudiate statements of
prejudice made by professional colleagues, and will not permit their actions
as physicians to be influenced by such prejudice..
Residents will create and sustain a therapeutic and ethically sound
relationship with patientsResidents will participate in the review of the
professional conduct of their colleagues. (teaching call)
Goals and Objectives
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Evaluation Method
At the end of this rotation, the resident should be able to identify gaps in
knowledge based upon experience, introspective awareness, and feedback
for the year. The resident is expected to regularly review both textbook and
primary source literature to maintain up to date understanding of specific
topics that have arisen in practice.
The resident should actively seek feedback and advice on practice from
peers, mentors, staff, and patients alike to gain greater objective insight into
their strengths and weaknesses.
The resident should be able to obtain scientific literature, appraise quality,
and assimilate data through the use of up to date resources to improve their
practice and care of patients’ health problems.
The resident will gain basic skills in literature search methodologies using
standard web-based medical literature search engines such as Ovid, MD
Consult, Pubmed.
The resident will have familiarity with a variety of computer and hand-held
computer based resources for looking up medications, dosing, and other
topics of use to the general internist
The resident will actively participate in lectures and discussions with peers
and experts on the topics related to the care of their patients.
Evaluation Method
- Day to day knowledge base
evaluated by feedback on
diagnoses, and both
psychooharmacologic and
psychotherapeutic treatment
approaches
The resident is expected to take a proactive and interactive
approach to enhancing their knowledge. The resident is expected to
“think out loud”, ask for clarification and guidance, and actively
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6. Systems-Based
Practice
 Resident must
demonstrate an
awareness of and
responsiveness to a
larger context and
system of health care
and the ability to
effectively call on
system resources to
provide care that is of
optimal value. By
the end of their
training, residents are
expected to have
attained competence
in the following
goals.
seek input on their practice and knowledge base from their mentors.
The resident will facilitate the learning of students and other health
care professionals
Goals and Objectives
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The resident will learn to practice cost-effective health care and resource
allocation that does not compromise quality of care
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The resident will learn how to partner with health care managers and health
care providers to assess, coordinate, and improve health care and know how
these activities can affect system performance
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The resident will learn how to work other health care providers to develop
and coordinate a care plan for their patients.
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The resident will be familiar with the presence and influences of alternative
and complimentary therapies, and its use in their populations and patients.
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The resident will learn about a variety of insurances and how they affect
patient referrals and prescriptions. They will learn the legal rights of the
uninsured and will work with the appropriate services to assist patients who
are under- or un-insured.
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The resident will learn how to interact and advocate effectively with other
physicians, ancillary caregivers, community agencies, landlords, and
insurance companies etc. via spoken and written communications when it
effects the health of their patients.
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The resident will learn about the various community resources available for
patients and will work with case managers and social workers to enable
patients to access these resources
Evaluation Method
- Evaluations from supervisors
XI. OTHER IMPORTANT INFORMATION FOR RESIDENT DURING THIS ROTATION
Residents should be mindful of the unique opportunity with which they are presented during this rotation. In caring for sick,
hospitalized patients in a supervised environment, you are being given the chance to study in a protected environment while caring for
patients with the illnesses you are studying. We urge you not to waste this time but rather to embrace your responsibilities and to
study and teach based upon the needs of your patients.
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