MUSC PSYCHIATRY RESIDENCY
PROGRAM MISSION AND OVERALL GOALS AND OBJECTIVES
SPRING 2004 (REVISED SPRING 2008, FALL 2009)
I.
INTRODUCTION AND MISSION
The mission of the graduate medical education training program in psychiatry is to provide an
educational experience such that its graduates will have a high degree of knowledge, skills and clinical
judgment in the diagnosis and treatment of psychiatric disorders and the common medical and
neurological disorders which relate to the practice of psychiatry. The specific experiences and
curricula offered to individual residents are designed to both meet the minimum requirements for the
ACGME and the ABPN, as well as to provide flexibility for exploration of interests toward the
resident’s individual career goals.
It is expected that graduates will develop facility in approaching psychiatric/medical disorders
with a "biopsychosocial" perspective. Graduates must demonstrate competence in patient care, medical
knowledge, practice-based learning and improvement, interpersonal and communication skills,
professionalism, and systems-based practice as applies to the specific practice of psychiatry.
Graduates must develop requisite interest and skills for continuing their professional development.
These main goals are operationalized through general goals and more specific goals and objectives
based in service and content areas. The goals for the service areas are accomplished through specific
enabling objectives within the framework of the supervision policy. This document describes the goals
for each service, with specific objectives and a graduated level of independence, all under faculty
supervision.
A. SUPERVISION AND GRADUATED RESPONSIBILITY
1. The department believes, and operates on the premise, that residents must have graduated
responsibility based upon their years of successful progression through each year of training, with
due concern for the benefit and safety of each patient.
2. Residents cannot become competent to make judgments of increasing complexity or perform
procedures of increasing difficulty without involvement in the decision making process
throughout the residency training process. Whenever possible, the responsibility of ‘first
decision’ shall be relegated to residents, with all patient care decisions subject to review and
modification by faculty clinicians, who shall have the final decision in all cases.
3. Supervision is provided by faculty and other, more senior residents as appropriate. It is
desirable that residents who are more senior, will have some responsibility for the supervision and
education of junior residents, in keeping with the guidelines of the Accreditation Council for
Graduate Medical Education (ACGME).
4. While faculty credentialed clinicians have the ultimate authority for patient care, both faculty
and residents, at all levels, have individual responsibility for their actions in patient care,
scholarly activities and teaching of others. During training, a great deal of varied Supervision is
offered through teaching-focused rounds, structured seminars, many of which implement case
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
discussion and example, as well as individual and group supervision with Setting-based, Seminar
group discussion, and Longer-Term General and case –based Supervisors (typically year-long),
Senior and Chief Residents.
Supervision Definitions:
The following terms defining levels of supervision will be used:
A. Direct:
Direct supervision exists when faculty are in contact with the patient AND participate
in providing care or decision-making with the resident. Certain tasks will require direct
supervision as defined here-in, regardless of training level.
B. Consultative:
Consultative supervision exists when faculty participate in the real-time decision-making
AND provide guidance to the resident during the episode of care. Consultative supervision
may be in-house or real-time by phone, radio or two-way video teleconferencing. A predesignated faculty member is always available to residents while they are providing patient care.
C. Indirect:
Indirect supervision exists when faculty review the care given to patients by verbal discussion
with resident, review of audio or video tapes and/or examination of the medical record/treatment
plan with the resident. Indirect supervision occurs before or after an episode of care. One
example of indirect supervision would be case review with a therapy supervisor prior to an upcoming therapy session for care planning and interpretive purposes.
D. General:
General supervision exists when faculty are involved in patient care through instruction and the
establishment of a system of patient care within which the resident functions. Ongoing
supervision is a requirement of training under the Psychiatry RRC training regulations. In
keeping with these guidelines residents are assigned a long-term supervisor and expected to meet
weekly (except interns on non-psychiatry rotations). In addition, PGYI, II and III residents
receive supervision through individual and group settings. Some setting are more structured with
educational content to promote communication skills, boundaries and professionalism, and others
more open and freeform, allowing the resident(s) to direct the agenda with the attending. General
supervision is meant to assist the resident in role definition and professional development as well
as to develop an understanding of the concepts of boundaries, therapeutic relationships, systemsbased care and resource management. General supervision also includes departmental and
hospital guidelines for the provision of specific types of care (for example- Guidelines for
Detoxification of Inpatients and Pain Guidelines). Residents are expected to consider
departmental and hospital-wide guidelines and utilize them in their patient care decision making
unless individual patient issues suggest they may not apply.
These supervision guidelines serve as part of the overall philosophy and mission principals of the
program and work to complement the goals and objectives as well as help to delineate the MUSC
Psychiatry Resident Scope of Practice policies.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
II. GENERAL TRAINING GOALS
1. First Year psychiatry residents will develop basic general medical and neurology skills
through didactics and rotations on clinical medical, emergency medical services, such that they are
able at a minimum:
a. to perform a skilled physical examination, with particular emphasis on the mental status
and neurological exam with the ability to identify a broad range of common medical
disorders.
b. to undertake initial clinical and laboratory studies of patients presenting with common
medical disorders with sensitivity to patient rapport, developing empathy and evolving a
style of therapeutic communication.
c. to diagnose common medical and neurological disorders and formulate an appropriate
initial treatment plan
d. to make appropriate referrals and communicate effectively with other medical
specialties
e. to provide limited, continuous care of patients with medical illnesses
f. to be especially conversant with disorders which may have concomitant
medical/psychiatric or neuropsychiatric presentations.
g. to be especially conversant with the interactions between psychiatric treatments and
medical treatments.
h. to be especially conversant with the psychological stresses and disorders associated
with medical illness, and to be able to effectively support patients, their families and
other health care providers.
In addition, First Year psychiatry residents will develop basic general psychiatric skills in
hospital and acute care settings such that they are able:
i. to perform a skilled psychiatric interview and mental status examination and identify
psychiatric diagnoses with particular reference to DSM-IV criteria and nosology.
j. to use appropriately diagnostic testing (e.g. laboratory testing, imaging,
neuropsychological testing) in the evaluation of the patient.
k. to conceptualize illness in terms of biological, psychological, and sociocultural factors.
l. to formulate an appropriate treatment plan (including multiple modalities of treatment),
implement the treatment plan and provide continuous care.
m. to demonstrate skill in the major types of therapies appropriate to the acute care setting;
including pharmacological and other somatic therapies, crisis intervention (including
the evaluation and management of patients who are dangerous to themselves or others)
and substance abuse assessment, detoxification and follow-up treatment.
n. to gain experience assisting in the supervision and teaching medical and other students
working under them in clinical settings.
o. to have basic knowledge of:
1. the biological, psychological and sociocultural factors that influence
psychological development from infancy to death.
2. the critical appraisal of major theories of personality.
3. the theories of etiology, prevalence and prevention of all major psychiatric
conditions.
4. the standards and practice of medical and psychiatric ethics.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
5. legal aspects of psychiatric practice and issues relating to civil commitment.
6. boundary issues and professional roles in the provision of psychiatric care.
p. In keeping with the philosophy of graduated responsibility, PGYI residents will increase
responsibility as they achieve knowledge and documented skill in the basic
components of psychiatric assessment and treatment. Levels of supervision will be
decreased as these skills and knowledge are achieved, per the supervision guidelines.
2. PGYII residents will develop knowledge and competence in general psychiatric and medical
skills such that they are able at a minimum to:
a. Effectively supervise a clinical team caring for patients with disorders which may have
concomitant medical/psychiatric presentations and to help interpret the significance to
other medical disciplines, family members and patients.
b. Provide treatment to acute care patients with conditions that occur at the interface
between psychiatric, neurologic and medical treatments.
c. Develop competence and a strong understanding of the psychological stresses and
clinical disorders associated with medical illness, and to be able to effectively support
patients, their families and other health care providers in diagnosing and treating
complex psychiatric disorders in the acute care setting.
d. Competently perform an in depth psychiatric interview and mental status examination
and identify psychiatric and medical diagnoses with particular reference to DSMcriteria and nosology.
e. Understand the reasons for and implement appropriate and cost-effective diagnostic
testing (e.g. laboratory testing, imaging, neuropsychological testing) in the evaluation of
the acute care psychiatric and dual diagnosis patients.
f. Conceptualize illness in terms of biological, psychological, and sociocultural factors
and develop culturally sensitive and non-judgmental treatment plans where appropriate.
g. formulate an appropriate treatment plan (including multiple modalities of treatment),
implement the treatment plan and provide continuous care.
h. to demonstrate intermediate level skill in the major types of therapies; including acute
care psychopharmacology and other somatic therapies; understand the indications,
contraindications, risks and social issues relating to ECT. Have a basic understanding
of short term psychotherapy options applicable to acute care settings such as cognitive,
supportive and crisis intervention and basic behavioral interventions; as well as serve as
a resource to lower level residents in cased involving crisis intervention and the
evaluation and management of patients who are dangerous to themselves or others, and
substance abuse detoxification and treatment.
f. to coordinate treatment care plans which include interventions from multiple medical
and rehabilitative services and cross between the public and private system of mental
health care.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
g. to coordinate treatment with non-psychiatrists and mental health care providers.
h. to have significant knowledge of:
1. the biological, psychological and sociocultural factors that influence
psychological development form infancy to death.
2. the critical appraisal of major theories of personality.
3. the theories of etiology, prevalence and prevention of common psychiatric conditions.
4. the basic standards and practice of medical and psychiatric ethics.
5. legal aspects of psychiatric practice.
7. the psychiatric profession, including history, and knowledge of financing and
regulation of psychiatric practice.
8. specialty issues in the care and treatment of the chronically mentally ill,
including community mental health programs and care of the indigent.
3. PGY III and above residents will develop comprehensive psychiatric skills across a variety of
settings, illnesses and show competence with general psychiatric skills such that they are able:
a. to perform a skilled psychiatric interview and mental status examination and identify
psychiatric diagnoses with particular reference to DSM-IV criteria and nosology in the
outpatient settting over a period of time.
c. to conceptualize and formulate illness in terms of biological, psychological, and
sociocultural factors .
d. to develop an appropriate treatment plan under less structured supervision (utilizing
multiple modalities of treatment), and to implement the treatment plan and provide
setting specific continuous care for patients over and extended period of time in a clinic
setting..
e. demonstrate skill in the major types of therapies; including outpatient pharmacological
and; individual psychotherapy (including short-term cognitive and psychodynamic and
long-term psychodynamic therapies), group, family and behavioral therapies; crisis
intervention (including the evaluation and management of patients who are dangerous to
themselves or others) and substance abuse detoxification and treatment.
f. coordinate treatment care plans which include interventions from multiple medical and
interdisciplinary participation and rehabilitative services.
g. Provide basic supervision and teaching to lower level residents and medical students
appropriate to service setting and clinical conditions.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
h. to have an in depth knowledge of:
1. the biological, psychological and sociocultural factors that influence psychological
development form infancy to death.
2. the critical appraisal of major theories of personality.
3. the theories of etiology, prevalence and prevention of all psychiatric conditions.
4. the standards and practice of medical and psychiatric ethics.
5. legal aspects of psychiatric practice.
6. research methods in the clinical and behavioral sciences, particularly knowledge of
rating scales and outcome measures and the ability to critically appraise the
scientific literature.
7. the psychiatric profession, including history, and knowledge of financing and
regulation of psychiatric practice.
9. specialty issues in the care and treatment of the chronically mentally ill, including
community mental health programs and care of the indigent.
4. GOALS FOR GRADUATION
1. Residents must complete all required clinical rotations in a satisfactory manner,
commensurate with the stated objectives of each service.
2. Residents must demonstrate sound clinical judgment and a thorough knowledge of the
diagnosis, treatment and prevention of psychiatric disorders and medical and neurological
disorders that relate to psychiatry.
3. Residents must demonstrate an attitude of scholarship and a thorough knowledge of human
emotional and behavioral phenomena, conducive to the continual integration of new
pertinent information.
4. Residents are expected to have the requisite interpersonal skills essential for collaboration
with other health care professionals in all areas of the health care delivery system.
5. Residents are expected to have laid the foundation for development of the skills necessary for
the delivery and coordination of educational, research and service programs.
6. Finally, residents are expected to demonstrate impeccable personal and professional ethics,
high moral standards, intelligence, industry and dedication to the highest quality patient care.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
GENERAL ADULT INPATIENT PSYCHIATRIC UNITS
REQUIRED PGY-1 AND 2
ELECTIVE PGY-4
Sites: IOP 3N AND VAMC 3A
Medical knowledge
1.
To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a
differential diagnosis of acute and chronic severe mental illness.
2.
To understand the use of pharmacotherapy for the treatment of inpatient psychiatric disorders,
including the indications, side effects, and following medications:
1.
a.
Antipsychotic Medications (1st and 2nd generations)
b.
SSRI’s
c.
Other new antidepressants
d.
Tricyclic Antidepressants
e.
Monoamine Oxidase Inhibitors
f.
Benzodiazepines and other sedatives
g.
Lithium
h.
Anticonvulsants
i.
Psychostimulants
j.
Other medications used in the management of psychiatric illness
3.
To develop an understanding of the role of medical comorbidity in psychiatric illness.
4.
To appreciate the principles guiding the therapeutic use of ECT in the treatment of affective and
psychotic disorders.
5.
To understand non-pharmacologic treatment modalities, including:
a.
b.
c.
d.
Supportive psychotherapy
Occupational therapy
Recreational therapy
Group therapy
6.
To understand the components of a therapeutic milieu.
7.
To learn standards of seclusion and restraint.
8.
To understand the use of medication algorithms to provide evidence based treatment to the
seriously mentally ill (optional).
Patient care
9.
To perform a diagnostic interview and examination, synthesize the available information, and
arrive at a differential diagnosis.
10. To interview and manage a psychotic or acutely agitated patient.
11. To evaluate patients for risk of suicide and/or violence.
12
To formulate a comprehensive and multimodal plan appropriate to the individual patient’s needs.
13
To effectively and appropriately use adjunct sedatives.
14
To build a therapeutic alliance with patients with psychiatric illness.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
15
To understand the issues of informed consent in the treatment of severely psychiatrically ill
patients.
Interpersonal and communication skills
16.
To present a case in a clear, concise and complete manner in oral and written forms.
17
18
To build a therapeutic alliance with patients with psychiatric illness.
To effectively communicate with ancillary staff regarding patient care.
Systems-based practice
19
To understand the role that payors play in determining the length of stay, treatments rendered, and
process of authorization of treatment on an inpatient unit.
20
To become familiar with and be able to utilize adjunctive treatment programs, including residential
care facilities and community-based treatments.
Practice-based learning and improvement
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
21
Professionalism
22 To develop respectful, ethical, and professional attitudes with regard to patient care and interaction
with colleagues.
EMERGENCY PSYCHIATRY
REQUIRED PGY-1, 2, 3
PGY 4 ELECTIVE
Sites: IOP 1N ACUTE UNIT, EMERGENCY DEPT PSYCHIATRY NITE FLOAT –MUHA AND
MUSC CHILDREN’S, EDCMHC MOBILE CRISIS (VARIABLE)
Medical knowledge
1.
To understand acute psychiatric conditions in the context of emergency situations and during acute
stabilization.
2.
To understand the use of psychopharmacotherapy in the treatment of psychiatric emergencies,
including the indications , side-effects, and following medications:
1.
a.
Antipsychotic Medications (1st and 2nd generations)
b.
SSRI’s
c.
Other new antidepressants
d.
Tricyclic Antidepressants
e.
Monoamine Oxidase Inhibitors
f.
Benzodiazepines and other sedatives
g.
Lithium
h.
Anticonvulsants
i. Psychostimulants
j.
Other medications used in the management of psychiatric illness
3.
To develop an understanding of the role of medical comorbidity in psychiatric illness.
4.
To understand nonpharmacologic treatment modalities, including supportive therapy and crisis
intervention.
5.
6.
To understand the components of a therapeutic milieu.
To learn standards of seclusion and restraint.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
Patient care
7.
To develop the skill of rapid, thorough assessment of psychiatric symptoms, including:
a.
b.
c.
d.
a.
Developing differential diagnoses
Distinguishing acute psychopathology from chronic illness.
Identifying complicating medical issues.
Determining risk of suicidality, violence, and homicidality.
8.
To be able to interview a psychotic or acutely agitated patient.
9.
To effectively and appropriately use adjunct sedatives.
10.
To develop skills of crisis intervention, including individual and family therapy techniques when
appropriate, and determining when adequate resolution has been reached.
11.
To determine appropriate dispositions for patients, including acute observation and stabilization,
inpatient versus outpatient treatment, psychiatric versus medical admission, and voluntary versus
involuntary status.
12.
To become skilled in behavioral and psychopharmacological management of acutely agitated
patients.
13.
To diagnose and treat substance intoxication and withdrawal syndromes.
14.
To appropriately address forensic issues including confidentiality, Tarasoff, civil commitment,
assessment of capacity, child abuse.
15.
To understand the issues of informed consent in emergency treatment settings.
Interpersonal and communication skills
16.
To be able to present a case in a clear, concise and complete manner in oral and written forms.
17.
To effectively communicate with ancillary staff regarding patient care.
Systems-based practice
18.
To understand the role that payors play in determining disposition of patients in emergency
treatment settings.
19.
To utilize hospital and community resources, including liaisons and consultants, as well as family
and friends to form adequate support networks.
20.
To coordinate treatment with ER physicians and ancillary staff.
Professionalism
21.
To develop respectful, ethical, and professional attitudes with regard to patient care and interaction
with colleagues.
Practice-based learning and improvement
22.
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
IOP CHILD AND ADOLESCENT INPATIENT UNIT
REQUIRED PGY-1
ELECTIVE PGY-4
Site: IOP 2N
Medical Knowledge
1. To understand the application of the diagnostic criteria for major Axis I and Axis II disorders in the child
and adolescent population.
2. To understand the use of pharmacotherapy in the treatment of child and adolescent patients, including the
indications for and side effects of the following medications:
1.
a. Antipsychotic Medications
b. SSRI’s
c. Other new antidepressants
d. Tricyclic Antidepressants
e. Monoamine Oxidase Inhibitors
f. Benzodiazepines and other sedatives
g. Lithium
h. Anticonvulsants
i. Psychostimulants
j. Other medications used in the management of psychiatric illness
a.
3
To have an understanding of normal and abnormal development.
4
To understand nonpharmacologic treatment modalities, including:
a
Supportive psychotherapy
b
Group therapy
c
Family therapy
5
To understand the components of a therapeutic milieu.
6.
To learn standards for seclusion and restraint
Patient care
7. To perform a diagnostic interview and examination, synthesize the available information, and arrive at a
differential diagnosis.
8. To gain familiarity in interviewing children of pre-school, latency, and adolescent ages and understand how
the technique of interviewing differs at each age.
9. To evaluate child and adolescent patients for risk of suicide and/or violence.
10. To formulate a comprehensive and multimodal plan appropriate to the individual patient’s needs.
11. To build a therapeutic alliance with child and adolescent patients, and their parents and guardians..
12. To appropriately involve families in the patient evaluation and recognize family adjustment to, or role in,
the disorder.
13. To develop the skills to work with cooperative and non-cooperative parents.
14. To understand the issues of informed consent in the treatment of child and adolescent patients.
Interpersonal and communication skills
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
15. To present a case in a clear, concise, and complete manner in oral and written forms.
16. To build a therapeutic alliance with child and adolescent patients.
17. To appropriately involve families in the patient evaluation and recognize family adjustment to, or role in,
the disorder.
18. To develop the skills to communicate with cooperative and non-cooperative parents.
19. To effectively communicate with ancillary staff regarding patient care.
Systems-based practice
20. To understand the role payors plays in determining the length of stay, treatments rendered, and process of
authorization of treatment on an inpatient unit.
21. To integrate ancillary information, such as school reports and psychological testing, into the diagnostic
evaluation.
22. To become familiar with and be able to utilize adjunctive treatment programs, including residential care
facilities and community-based treatments.
Professionalism
23. To develop respectful, ethical, and professional attitudes with regard to patient care and interaction with
colleagues.
Practice-based learning and improvement
24. To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
MEDICINE ROTATIONS - 4 Months
REQUIRED PGY-1
Emergency Medicine MUSC ED
Internal Medicine MUSC General Medicine Ward
Internal Medicine VAMC Medicine Ward
Internal Medicine VAMC Medicine Outpatient Clinic
(Pediatrics – MUSC Children’s Hospital Inpatient Service Elective, replaces one Medicine Ward, typically chosen by
interns intending to pursue child and adolescent psychiatry)
Residents spend one month on each of the above services. These rotations are selected to provide psychiatry residents with
experience and basic competence in the care of medical patients across a spectrum of settings pertinent to basic medical
practice and to the practice of modern psychiatry. The resident will have first contact responsibility for an unselected patient
population, which ranges across adult medicine and the medical management of surgical illnesses. Residents care for patients
with a wide variety of clinical syndromes including chest pain, coronary artery disease, CVAs, CHF, diabetes mellitus, DKA,
pneumonia, COPD, asthma, pyelonephritis, acute and chronic renal insufficiency, SLE, vasculitis, dementia, and many others.
In the ED rotation, there is an emphasis on medical patient care and not surgical care or procedures for psychiatry residents.
VAMC: There are no subspecialty medicine services in the VAH, so all the medical admissions come to the General Medicine
services. It is designed to develop the clinical skills necessary to diagnose and treat undifferentiated medical patients with a
wide range of illnesses.
MUSC: The General Medicine inpatient rotation at MUH is structured to give residents a broad-based experience in managing
acutely ill general medicine patients. It is designed to develop the clinical skills necessary to diagnose and treat
undifferentiated medical patients with a wide range of illnesses. The rotation provides each resident with graduated autonomy
combined with direct supervision by expert faculty. There are four General Medicine Teams at MUH.
Pediatrics: Resident serves as part of a graduated team of pediatrics residents under faculty supervision on the general
pediatrics service. Residents take call with the home service on medicine and pediatric wards.
Goals and Objectives:
1. To recognize acutely ill patients in the Emergency Department setting and to initiate initial treatment including assessing
airways, respiratory status, and circulation.
2. To appreciate the acute presentation of undifferentiated cardiac, pulmonary, GI, and other medical syndromes.
3. To refine focused history and physical examination skills.
4. To learn decision-making skills for determining the need for hospitalization.
5. To understand the management of toxic ingestions, intoxication, and drug overdoses.
6. To enhance the residents’ history taking and physical diagnosis skills.
7. To develop differential diagnoses and formulate a treatment plan on acutely ill patients.
8. To manage the inpatient illnesses which are commonly cared for in general medicine.
9. To understand the indications/need for appropriate subspecialty consultation.
10. To demonstrate interpersonal skills and to communicate with patients and families.
11. To understand appropriate pain control and the tenets of end of life care.
12. To under stand the basic management of medical conditions that are likely to present in psychiatric patients, including
medical co-morbidities, drug side effects and interactions.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
NEUROLOGY ROTATIONS
REQUIRED PGY 1, MUSC NEUROLOGY INPATIENT SERVICE
REQUIRED PGY-2 MUSC NEUROLOGY CONSULT SERVICE
1. Upon completion of the Neurology education experience, the resident will achieve comprehension of
the diagnosis and treatment of neurologic disorders commonly encountered in psychiatric practice such as
brain neoplasm, dementia, delirium, headache, traumatic brain injury, infectious diseases, movement
disorders, multiple sclerosis, Parkinson’s disease, seizure disorders, stroke, intractable pain, and related
disorders.
2. The resident will learn to manage neurologic patients through the provision of care
as part of the neurology team both on inpatients and on the neurology consultation services at MUSC.
a. Resident will demonstrate knowledge of basic neurologic disorders
b. Resident will demonstrate skill in the neurologic examination
c. Resident will demonstrate the ability to evaluate and develop basic treatment
plans for patients in the hospital neurology service or with co-morbid neurologic
problems on the consultation service.
Additional electives in neurology are available and encouraged in the PGY4 year to prepare for
the certifying board examination and future practice.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
ADULT GERIATRIC INPATIENT UNIT
REQUIRED PGY-2
ELECTIVE PGY-4
Site:
IOP SENIOR CARE UNIT
Medical knowledge
1. To understand the application of the diagnostic criteria for major Axis I and Axis II disorders and
generate a
differential diagnosis of acute and chronic illness in the geriatric population.
2.
To understand the use of pharmacotherapy in the treatment of geriatric patients, including
the indications, side effects, and following medications:
a. Antipsychotic Medications (1st and 2nd generations)
b. SSRI’s
c. Other new antidepressants
d. Tricyclic Antidepressants
e. Monoamine Oxidase Inhibitors
f. Benzodiazepines and other sedatives
g. Lithium
h. Anticonvulsants
i. Acetylcholinemimetic and Memantine
j. Psychostimulants
k. Other medications used in the management of psychiatric illness
3 To develop an understanding of the evaluation and treatment of delirium and dementia.
4. To develop an understanding of the role of medical comorbidity in psychiatric illness in the geriatric
population.
5. To appreciate the principles guiding the therapeutic use of ECT in the treatment of affective and
psychotic disorders in the geriatric population.
6. To understand nonpharmacologic treatment modalities, including
a. Supportive psychotherapy
b. Occupational therapy
c Recreational therapy
d. Group therapy
e. Physical therapy
7.
8.
9.
To understand the concepts of informed consent, durable power of attorney and living will
To understand the components of a therapeutic milieu.
To learn standards for the use of restraints.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
Patient care/Interpersonal and communication skills
10.
To perform a diagnostic interview and examination, synthesize the available information and arrive
at a differential diagnosis.
11.
To interview and manage the patient with memory disturbance.
12.
To evaluate geriatric patients for risk of suicide and/or violence.
13.
To present a case in a clear, concise and complete manner in oral and written forms.
14
To formulate a comprehensive and multi-modal plan appropriate to the individual patient’s needs.
15
To appropriately involve families in the patient evaluation and recognize family adjustment to or
role in the disorder.
16
To effectively communicate with ancillary staff regarding patient care.
17
To become at ease and adept at discussing with patients and family durable power of attorney and
resuscitation orders.
Interpersonal and communication skills
18
To appropriately involve families in the patient evaluation and recognize family adjustment to or
role in the disorder.
Systems-based practice
19
To understand the role that payors play in determining the length of stay, treatments rendered, and
process of authorization of treatment on an inpatient unit.
20
To become familiar with and be able to utilize adjunctive treatment programs, including nursing
homes and residential care facilities.
Practice-based learning and improvement
21
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
22
To develop respectful, ethical, and professional attitudes with regard to patient care and interaction
with colleagues and families.
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MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
ADULT CONSULT-LIAISON SERVICE
REQUIRED PGY-2
ELECTIVE PGY-4
Sites: MUHA, VAMC
Medical knowledge
1. To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a differential diagnosis
in the acute medical/surgical setting.
2 To understand the use of pharmacotherapy for the treatment of psychiatric disorders in the acute
medical/surgical setting, including the indications, side effects, and following medications:
a. Antipsychotic Medications (1st and 2nd generations)
b. SSRI’s
c.
d.
e.
f.
g.
h.
i.
j.
Other new antidepressants
Tricyclic Antidepressants
Monoamine Oxidase Inhibitors
Benzodiazepines and other sedatives
Lithium
Anti-convulsants
Psycho-stimulants
Other medications used in the management of psychiatric illness
3. To understand the interplay between acute medical/surgical illness and psychopathology.
4
To understand normal and abnormal psychological responses to acute medical/surgical illness.
5
To evaluate patients for appropriateness for ECT and to learn to properly administer ETC.
Patient care
6
To perform a diagnostic interview and examination, synthesize the available information, and arrive at a
differential diagnosis.
7
To evaluate patients for risk of suicide and/or violence.
8
To recognize and manage psychiatric symptoms arising as side-effects of medications in the acute
medical/surgical setting.
9
To evaluate patients’ capacity to consent to or refuse treatment.
Interpersonal communication skills
10 To present a case in a clear, concise and complete manner in oral and written forms, including clear
recommendations for the treating team.
11 To develop skills in working and communicating with other professionals providing care to the patient.
Systems-based practice
12 To coordinate care with physicians and ancillary staff.
13 To assist with development of effective post discharge plans.
Practice-based learning and improvement
14 To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
15 To develop respectful, ethical, and professional attitudes with regard to patient care and interaction with
colleagues.
16
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
VAMC ADULT SUBSTANCE ABUSE INTENSIVE OUTPATIENT TREATMENT
PROGRAM
REQUIRED PGY-2
ELECTIVE PGY-4
Site: VAMC
Medical knowledge
1.
To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a differential
diagnosis applicable to the addicted patient.
2.
To understand the use of pharmacotherapy for the inpatient treatment of substance use disorders, including
the indications, side effects, and following medications:
1.
a.
Antipsychotic Medications (1st and 2nd generations)
b.
SSRI’s
c.
Other new antidepressants
d.
Tricyclic Antidepressants
e.
Monoamine Oxidase Inhibitors
f.
Benzodiazepines and other sedatives
g.
Lithium
h.
Anticonvulsants
i.
Psychostimulatns
j.
Replacement therapies
k.
Anti-craving medications
l.
Aversive medications (eg, disulfiram)
m.
Other medications used in the management of psychiatric illness
a.
3.
To understand the clinical signs, symptoms, and management of withdrawal syndromes.
4.
5.
To understand the role of medical comorbidity in psychiatric illness.
To understand nonpharmacologic treatment modalities, including:
a.
b.
c.
d.
e.
f.
Relapse prevention
Motivational enhancement
Group therapy
Vocational rehabilitation
Supportive psychotherapy
Recreational therapy
Patient care
6.
To perform a diagnostic interview and examination, synthesize the available information, and arrive at a
differential diagnosis.
7
To manage intoxication and withdrawal syndromes on an outpatient basis.
8
9
10
11
12
To evaluate patients for risk of suicide and/or violence
To formulate a comprehensive and multimodal plan appropriate to the individual patient’s needs.
To appropriately diagnose and treat comorbid psychiatric conditions.
To build a therapeutic alliance with patients with substance use disorders.
To effectively communicate with ancillary staff regarding patient care.
17
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
Interpersonal and communication skills
13
To present a case in a clear, concise and complete manner in oral and written forms.
14
To build a therapeutic alliance with patients with substance use disorders.
Systems-based practice
15
16
17
To effectively utilize case management services.
To coordinate clinical care with other specialties within the VA medical system.
To become familiar with and be able to utilize adjunctive treatment programs, including:
a.
Alcoholics Anonymous and other 12-step groups
b.
Inpatient Treatment – Detoxification vs. Rehabilitation
c.
Recovering Physicians Programs
d.
Community-based Treatment
e.
Residential care facilities
Practice-based learning and improvement
18
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
19
To develop respectful, ethical, and professional attitudes with regard to patient care and interaction with
colleagues.
18
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
VAMC OUTPATIENT PSYCHIATRY CLINIC
REQUIRED PGY-2 AND 3
ELECTIVE PGY-4
Sites: VAMC OUTPATIENT CLINIC
Medical knowledge
1.
To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a differential
diagnosis of acute and chronic severe mental illness.
2.
To understand the use of pharmacotherapy for the treatment of outpatient psychiatric disorders, including
the indications, side effects , and following medications:
1.
a.
Antipsychotic Medications (1st and 2nd generation)
b.
SSRI’s
c.
Other new antidepressants
d.
Tricyclic Antidepressants
e.
Monoamine Oxidase Inhibitors
f.
Benzodiazepines and other sedatives
g.
Lithium
h.
Anticonvulsants
i.
Psychostimulants
j.
Other medications used in the management of psychiatric illness
Patient care
3.
To perform a diagnostic interview, synthesize the available information, and arrive at a differential
diagnosis.
4.
To develop a psychopharmacological treatment plan with itemized targets.
5.
To develop skills in the estimation of compliance and its reinforcement.
6.
To evaluate patients for risk of suicide and/or violence.
7.
To build a therapeutic alliance with patients with psychiatric illness.
8.
To understand and utilize the indications for hospitalization.
Interpersonal and communication skills
9.
To present a case in a clear, concise and complete manner in oral and written forms.
10. To develop skills in working and communicating with other professionals providing care to the patient.
11. To develop skills in working and communicating with other professionals providing care to the patient
Systems-based practice
12. To effectively utilize case management services.
13. To coordinate clinical care with other specialties within the VA medical system.
Practice-based learning and improvement
14.
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
15. To develop respectful, ethical, and professional attitudes with regard to patient care and interaction with
colleagues.
19
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
ADULT OUTPATIENT AND PSYCHOTHERAPY
REQUIRED PGY-3 AND PGY-4
Sites: IOP 5S (CAPS, CMHC ELECTIVES)
Medical knowledge
1.
To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a
differential diagnosis applicable to the psychiatric outpatient.
2.
To understand the practice of and indications for various psychotherapeutic modalities, including:
a.
brief psychotherapy
b.
dynamic psychotherapy
c.
cognitive behavioral psychotherapy
d.
combined psychotherapy/pharmacotherapy
e.
supportive psychotherapy
f.
group psychotherapy
g.
couples psychotherapy
h.
family psychotherapy
3.
To understand the use of pharmacotherapy for the treatment of psychiatric disorders in the acute
medical/surgical setting, including the indications, side effects and following medications:
1.
a.
Antipsychotic Medications (1st and 2nd generations)
b.
SSRI’s
c.
Other new antidepressants
d.
Tricyclic Antidepressants
e.
Monoamine Oxidase Inhibitors
f.
Benzodiazepines and other sedatives
g.
Lithium
h.
Anticonvulsants
i.
Psychostimulants
j.
Other medications used in the treatment of psychiatric illness
Patient care
4.
Chooses appropriate treatment modality(s) in light of patient’s capacities and preferences.
5.
To perform a diagnostic interview and examination, synthesize the available information, and
arrive at a differential diagnosis.
6.
To develop an appropriate treatment plan addressing psychotherapeutic and psychopharmacologic
goals and interventions.
7.
To evaluate patients for risk of suicide and/or violence.
8
To develop the ability to build and maintain a collaborative therapeutic alliance.
9.
To understand and utilize the indications for hospitalization.
10.
To develop a case formulation using the biopsychosocial model.
11.
To develop the ability to establish an appropriate treatment frame (including boundaries,
appointment times)
12.
To use self-reflection to understand one’s own responses to patients
13.
To understand how psychological and sociocultural factors influence the meaning of taking
medication.
14.
To develop the ability to recognize and utilize transference, countertransference, defense, and
resistance.
15.
Identifies and elicits automatic thoughts and identifies common cognitive errors and employs
cognitive restructuring techniques.
16.
Uses appropriate behavioral techniques (e.g., relaxation training, exposure-based techniques).
17.
Chooses appropriate duration of therapy.
18.
Chooses appropriate balance between enhancing and reducing defensive operations.
19
To appropriately use direction, advice, limit-setting, patient education.
Interpersonal and communication skills
20
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
20.
To present a case in a clear, concise and complete manner in oral and written forms.
21.
To present relevant details of psychotherapeutic techniques to a supervisor and use supervision
effectively.
22.
To develop the ability to build and maintain a collaborative therapeutic alliance.
23.
To attend to both verbal and nonverbal communication
Systems-based practice
24.
To coordinate care with other professionals.
Practice-based learning and improvement
25
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
26.
To develop respectful, ethical, and professional attitudes with regard to patient care and interaction
with colleagues.
21
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
Site:
COMMUNITY MENTAL HEALTH
REQUIRED PGY-3
DMH CHARLESTON MENTAL HEALTH CENTER
Medical knowledge
1.
To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a
differential diagnosis of acute and chronic severe mental illness.
2.
To understand the use of pharmacotherapy for the treatment of psychiatric disorders in the acute
and SPMI setting, including the indications, side effects, and following medications:
a.
Antipsychotic Medications (1st and 2nd generations)
b.
SSRI’s
c.
Other new antidepressants
d.
Tricyclic Antidepressants
e.
Monoamine Oxidase Inhibitors
f.
Benzodiazepines and other sedatives
g.
Lithium
h.
Anticonvulsants
i.
Psychostimulants
j. Other medications used in the management of chronic psychiatric illness
Patient care
3. To perform a diagnostic interview and examination, synthesize the available information, and arrive at a
differential diagnosis.
4. To develop a psychopharmacological treatment plan with itemized targets.
5. To develop skills in the estimation of compliance and its reinforcement.
6. To evaluate patients for risk of suicide and/or violence.
7. To build a therapeutic alliance with patients with psychiatric illness.
8. To develop skills in working and communicating with other professionals providing care to the patient.
9. To understand and utilize the indications for hospitalization.
Interpersonal and communication skills
10. To present a case in a clear, concise and complete manner in oral and written forms.
11. To build a therapeutic alliance with patients with psychiatric illness.
Systems-based practice
12 To effectively utilize case management services.
Practice-based learning and improvement
13. To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
14.
To develop respectful, ethical, and professional attitudes with regard to patient care and interaction with
colleagues.
22
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
ADULT SUBSTANCE ABUSE DETOXIFICATION AND DUAL DIAGNOSIS
REQUIRED PGY-2
ELECTIVE PGY-4
Site: IOP 4N
Medical knowledge
1. To understand the diagnostic criteria for major Axis I and Axis II disorders and generate a differential
diagnosis applicable to the addicted patient.
2. To understand the use of pharmacotherapy for the inpatient treatment of substance use disorders, including
the indications, side effects, and following medications:
1.
a. Antipsychotic Medications (1s and 2nd generations)
b. SSRI’s
c. Other new antidepressants
d. Tricyclic Antidepressants
e. Monoamine Oxidase Inhibitors
f. Benzodiazepines and other sedatives
g. Lithium
h. Anticonvulsants
i. Psychostimulants
j.
Replacement therapies
k. Anti-craving medications
l. Aversive medications (eg, disulfiram)
m. Other medications used in the management of psychiatric illness
a.
3
4
5
a.
b.
c.
d.
e.
f.
6.
7.
To understand the clinical signs, symptoms, and management of withdrawal syndromes.
To understand the role of medical comorbidity in psychiatric illness.
To understand nonpharmacologic treatment modalities, including:
Relapse prevention
Motivational enhancement
Group therapy
Occupational therapy
Supportive psychotherapy
Recreational therapy
To understand components of a therapeutic milieu.
To learn standards for seclusion and restraint.
Patient care
8 To perform a diagnostic interview and examination, synthesize the available information, and arrive at a
differential diagnosis.
9 To manage intoxication and withdrawal syndromes.
10 To evaluate patients for risk of suicide and/or violence.
11 To formulate a comprehensive and multimodal plan appropriate to the individual patient’s needs.
12 To effectively and appropriately use adjunct sedatives.
13 To appropriately diagnose and treat comorbid psychiatric conditions.
14 To build a therapeutic alliance with patients with substance use disorders.
15 To understand the issues of informed consent in the treatment of patients with substance use disorders.
Interpersonal and communication skills
23
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
16 To present a case in a clear, concise and complete manner in oral and written forms.
17 To build a therapeutic alliance with patients with substance use disorders.
18 To effectively communicate with ancillary staff regarding patient care.
Systems-based practice
19 To understand the role payors play in determining the length of stay, treatments rendered, and process of
authorization of treatment on an inpatient unit.
20 To become familiar with and be able to utilize adjunctive treatment programs, including:
a. Alcoholics Anonymous and other 12-step groups
b. Inpatient Treatment – Detoxification vs. Rehabilitation
c. Recovering Physicians Programs
d. Community-based Treatment
e. Residential care facilities
Practice-based learning and improvement
21 To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
22 To develop respectful, ethical, and professional attitudes with regard to patient care and interaction with
colleagues.
24
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
OUTPATIENT CHILD AND ADOLESCENT
REQUIRED PGY-3 or PGY-4
Sites: MUSC LEINBACH CLINIC, DMH CAF CLINIC, MUSC CHILDREN’S ED
Medical knowledge
1. To understand the application of the diagnostic criteria for major Axis I and Axis II disorders in the child
and adolescent population.
2. To understand the use of pharmacotherapy in the treatment of child and adolescent patients, including the
indications, side effects, and following medications:
1.
a. Antipsychotic Medications (1st and 2nd generation)
b. SSRI’s
c. Other new antidepressants
d. Tricyclic Antidepressants
e. Monoamine Oxidase Inhibitors
f. Benzodiazepines and other sedatives
g. Lithium
h. Anticonvulsants
i. Psychostimulants
j. Other medications used in the management of psychiatric illness
a.
3.
4.
To have an understanding of normal and abnormal development in relation to psychopathology.
To understand nonpharmacologic treatment modalities, including:
a.
b.
c.
Supportive psychotherapy
Group therapy
Family therapy
Patient care
5
To perform a diagnostic interview, synthesize the available information, and arrive at a differential
diagnosis.
6.
To gain familiarity in interviewing children of pre-school, latency, and adolescent ages and
understand how the technique of interviewing differs at each age.
7.
To evaluate child and adolescent patients for risk of suicide and/or violence.
8.
To formulate a comprehensive and multimodal plan appropriate to the individual patient’s needs.
9
To build a therapeutic alliance with child and adolescent patients and their parents and guardians.
10.
To appropriately involve families in the patient evaluation and recognize family adjustment to, or
role in, the disorder.
11.
To develop the skills to work with cooperative and non-cooperative parents.
12.
To understand the issues of informed consent in the treatment of child and adolescent patients.
13.
To understand and utilize the indications for hospitalization.
Interpersonal and communication skills
14.
To present a case in a clear, concise, and complete manner in oral and written forms
15
To build a therapeutic alliance with child and adolescent patients.
16.
To appropriately involve families in the patient evaluation and recognize family adjustment to, or
role in, the disorder.
17.
To develop the skills to communicate with cooperative and non-cooperative parents.
25
MUSC PSYHIATRY- RESIDENCY GOALS AND OBJECTIVES-2004 (REVISED 2009)
Systems-based practice
18.
To integrate ancillary information, such as school reports and psychological testing, into the
diagnostic evaluation.
19.
To coordinate clinical care with other providers, relevant agencies, and organizations.
Practice-based learning and improvement
20.
To assess one’s knowledge base and initiate the acquisition of new knowledge and skills.
Professionalism
21.
To develop respectful, ethical, and professional attitudes with regard to patient care and interaction
with colleagues.
.
26