Psychiatry and Behavioral Science

Rotation Goals and Objectives

  1. General Description
    1. The Psychiatry and Behavioral Science rotation is somewhat unique in our residency in that it is in the third year of training and is an extension of our behavioral science longitudinal curriculum. In addition, in this country the majority of ambulatory mental health care is provided in various degrees by family physicians and other primary care clinicians (e.g., family nurse practitioners, physician assistants, general internists). and up to 70% of all medical complaints have coexisting psychosocial themes. Practices of family physicians vary to the extent and depth in which they might intervene at this level. This can be a function of time (limitations), reimbursement penalties, insurance panels, student loans, commitment, organizational (management) skills, patient care expertise, the extent of coverage, their practice culture, developmental or current relationship challenges, degree of community involvement, the "complexity" of the patient or family illness (e.g., Axis II disorders, terminal disease), and their extent of training and CME. For example, some family physicians provide couples counseling at the end of their clinics (within their own private offices), while other FPs thrive in practices that mimic urgent care settings (e.g., open appointments, scheduling six [walk-in] patients to one hour, etc.). The goal of this rotation is to provide an immersion experience in Psychiatry and Behavioral Science, and to make it as seamless as possible as the resident provides comprehensive, continuity care in their clinic, hospital and community settings. Because this rotation is in the third year, and "relationship" and "self growth" are at the core of developing and sustaining traditional family physician practices (irrespective of age, gender, ethnicity, race, sexual orientation, faith and disease process), special attention is given to identifying the resident's strengths and unique skills (e.g., "common factors," patient management, leadership, interdisciplinary collaboration, creating a healthy team environment) that the resident has learned from our family physician faculty, other attendings and within the behavioral science longitudinal curriculum during their previous years of training.
    2. The rotation will be precepted by Barbara Kohlenberg, Ph.D., Director of Behavioral Science, University of Nevada, Reno School of Medicine Department of Family and Community Medicine. Patient care activities in other sites will be directly precepted by community clinical faculty that include a combination of psychologists and psychiatrists affiliated with the University of Nevada, Reno School of Medicine Department of Psychiatry. . You will need to meet with Dr. Kohlenberg at the start of the rotation to discuss your schedule, the time you will be spending in various settings, and rotation expectations. You will also need t meet with Dr. Kohlenberg toward the end of the rotation to discuss your learning experience. Required reading is a part of the learning process, and will be provided to you by Dr. Kohlenberg. In addition, you can borrow DSM Vfrom the linic in order to enhance your practice-based diagnostic skill development.
    3. The longitudinal aspect of the Behavioral Science Curriculum involves multiple components. As with nearly all aspects of our training in Family Medicine, we cannot completely compartmentalize our learning. It is expected that you will learn how to enhance your effectiveness with patients using evidenced-based behavioral health interventions throughout your residency and beyond. To encourage this, each resident is required to attend monthly Balint Groups/physician growth groups, Behavioral Science Didactics, and utilize Dr. Kohlenberg as a consultant in conducting multiple behavioral health-oriented patient-consultations throughout each residency year.
    4. Residents are expected to follow their patients in the Family Medicine Center during this rotation.
    5. Level: Post Graduate Year (PGY) 3
    6. Location: Psychiatry and Behavioral Science is offered in several settings: Family Medicine Center, Renown Regional Medical Center, University of Nevada, Reno School of Medicine Mojave Adult, Child and Family Services, Willow Springs Center, the VA Sierra Healthcare System, and the Kids Kottage.
    7. Duration: One four week block
    8. Psychiatry and Behavioral Science is a full time rotation.
    9. Two full days per week are spent in the Family Medicine Center.
    10. Work hour form submission is required at the completion of this rotation
    11. Evaluation of Rotation
      1. An evaluation form will be completed by the attending psychologists and psychiatrists at the end of the rotation.
      2. The resident will complete an evaluation at the end of the four-week rotation.
      3. The knowledge, skills and competencies acquired during this rotation will be evaluated by all attending psychologists and psychiatrists who work with residents throughout the rotation
      4. The resident's performance on the American Board of Family Medicine In- Training examination will also be used to assess knowledge in this area.
  2. Patient Care and Medical Knowledge skills to be mastered
    1. Learn to assess, understand, and manage the biopsychosocial, family systems and multicultural needs of their patients and families.
    2. Learn the research evidence on how to diagnose, intervene, treat, and triage the most common behavioral health presentations in family medicine, including both psychotropic and behavioral interventions, in patients who present at all stages in the life cycle.
    3. Learn strategies to effectively collaborate (including interacting with legal systems when appropriate) with interdisciplinary behavioral health professionals and multiple medical and behavioral health systems in order to enhance continuity and quality of patient-care
    4. Learn how to discriminate when to effectively treat vs. triage patients with behavioral health presentations
    5. Enhance understanding of DSM V Classification System and diagnostic skills
    6. Learn how to conduct brief solution-focused behavioral health assessments and deliver interventions using motivational interviewing and cognitive-behavioral strategies
    7. Perform multiple behavioral health patient consultations and case-oriented conferences with Dr. Kohlenberg
    8. Participate in multiple interdisciplinary behavioral health care treatment teams
    9. Enhance physician-patient relationship skills and competency in managing challenging patient presentations, including those with chronic health conditions
    10. Learn how to integrate behavioral health interventions into disease management treatment plans
  3. Practice Based Learning and Improvement
    1. This competency is addressed longitudinally throughout the rotation.
      1. Scientific evidence will be reviewed by the resident and supervisors.
      2. The practical implementation of evidence-based medicine will be discussed as the medical decision making and public health decision making is reviewed.
      3. Information technology will be utilized by the resident as he or she is required to research topics for completing the community medicine cases.
  4. Interpersonal and Communication Skills
    1. This competency is addressed longitudinally throughout the rotation by helping the resident improve his or her ability to communicate effectively with patients, colleagues, and health-care professionals at all levels.
  5. Professionalism
    1. This competency is addressed longitudinally throughout the rotation.
      1. The resident's sense of personal responsibility including attendance, promptness, motivation, completion of duties, and appropriate dress will be observed and evaluated.
      2. Ethical and legal practice skills will be taught
      3. Respect for cultural, gender and age, differences will be taught, observed and evaluated.
      4. The resident is expected to treat patients, families public health workers and colleagues with respect, understanding, sympathy and honesty
  6. Systems Based Practice
    1. This competency is addressed longitudinally throughout the rotation.
      1. The resident will learn to become aware of available resources and the cost effectiveness of testing and therapeutic options from a mental and public health point of view.
      2. The resident will gain an increasing understanding of the role of the patient, physician, support staff, public resources and insurer in the health care environment.
      3. The resident will become aware of the available resources in our community as well as to the limitations of the resources in our community that our available.

Revision: May 2, 2018 by Richard D. Williams, MD