Overall Objectives

Department of Psychiatry and Behavioral Sciences

Competencies

  1. Patient Care
  2. Medical Knowledge
  3. Interpersonal and Communication Skills
  4. Professionalism
  5. Practice-Based Learning and Improvement
  6. Systems-Based Practice

I. Patient Care

Outcome/Goal

Residents must be able to provide patient care that is compassionate, comprehensive, appropriate, and effective for the treatment of mental-health problems and the promotion of mental health.

Knowledge

Residents will demonstrate knowledge of:

  1. The tools available for assessment. These include developmental screening instruments, diagnostic scales, and psychological evaluation such as; intelligence testing, developmental assessment, personality and projective measures.
  2. Current DSM criteria
  3. Available treatment methods and the evidence which supports their use, including awareness of the AACAP practice parameters and other standards of practice
  4. Preventive interventions used in child and adolescent psychiatry
  5. Crisis assessment and interventions

Skills

Residents will demonstrate the ability to:

  1. Establish and maintain an effective therapeutic treatment alliance with patients and families
  2. Communicate effectively with patients and their families
  3. Demonstrate caring and respectful behaviors when interacting with patients and their families, while maintaining appropriate boundaries
  4. Perform a comprehensive psychiatric assessment of children from preschool through adolescence. This includes interview of the child, his/her family, and other sources as appropriate (e.g., schools), as well as physical and neurological examinations as indicated. It also includes appropriate assessment for family or community violence, child abuse and neglect.
  5. Order appropriate psychological, medical, and laboratory tests to aid in clinical evaluation
  6. Develop a comprehensive formulation of children and adolescents taking into consideration biological, psychological, sociocultural, and developmental factors; individual and family strengths also should be identified
  7. Develop a differential diagnosis using current DSM criteria
  8. Develop and implement a comprehensive biopsychosocial-spiritual treatment plan. This includes being able to set appropriate treatment goals and to have a rationale that guides the selection and combination of available forms of treatment. Treatment plans will be based on patient information and preferences, current scientific evidence, and clinical judgment. It also includes an awareness of the AACAP Practice Parameters and their appropriate use
  9. Effectively communicate with the patient and family the results of the assessment, risks, and benefits of the proposed treatment plan, alternatives, and education concerning the disorder, its prognosis, and prevention strategies
  10. Use information technology to support patient care decisions and patient education
  11. Document assessment, formulation, diagnosis, and treatment plan in a timely, clear, and concise manner
  12. Refer a child and/or family for necessary medical, social, and community services
  13. Develop competence in a variety of therapeutic modalities, including brief and long-term individual therapy, family and group treatments, using psychodynamic, behavioral, cognitive, supportive, crisis intervention, and pharmacologic methods. This will include patients seen from a variety of ages and diagnostic categories.
  14. Work within a multidisciplinary team which includes social workers, psychologists, pediatricians, nurses, teachers, therapists, and other disciplines to provide a comprehensive evaluation and/or treatment program
  15. Provide health care services aimed at preventing mental health problems or maintaining mental health
  16. Communicate effectively with other health professional in the direct care of the patient

Attitudes

Residents will:

  1. Monitor personal reactions and counter transferences toward patients and seek supervision so as to develop increased clinical precision, and ensure the presence of appropriate boundaries
  2. Be strong advocates for the patient's best interest
  3. Strive to provide quality care within available resources
  4. Recognize the importance of the multiple systems involved in the lives of children and adolescents, being respectful of the context in which they live
  5. Be sensitive and responsive to their own and patients' cultural differences
  6. Be sensitive to the dependent status of children and the ramifications of this in the treatment alliance, including confidentiality and consent issues

Demonstrated by

Clinical care of all patients; teaching medical students, junior residents, and other professionals; clinical skills examinations; Child PRlTE examinations; self-directed learning related to clinical activities; seeking feedback on clinical performance; direct observation by faculty during clinics and on clinical rotations; case conferences; preparation for and participation in didactics; chart reviews with supervisors

Evaluation

  • Rotation evaluations by supervisors
  • Annual clinical skills examination
  • Mock Boards
  • Annual Child PRlTE examination
  • Resident self-evaluation and plan for improvement
  • Regular review of the resident's performance by the residency director and Residency Education Committee

Remediation

The residency director, in consultation with the residency education committee, will regularly review the resident's performance etc.

II. Medical Knowledge

Outcome/Goal

Residents must demonstrate knowledge about established and evolving biomedical, neurological, clinical, epidemiological, and psychosocial sciences relevant to child and adolescent psychiatry and the application of this knowledge to patient care.

Knowledge

Residents will demonstrate knowledge of:

  1. Normal development including biological, psychological, sociocultural, and family factors which influence development
  2. Contributions of major developmental theorists and researchers, including knowledge of current and past literature/context/theories in child and adolescent psychiatry
  3. Neurobiological sciences relevant to child psychiatry, including an appreciation of brain behavior relationships
  4. All forms of child and adolescent psychopathology and syndromes using the current diagnostic statistical manual. This includes knowledge of the etiology, epidemiology, prevention, diagnosis, and treatment of the full range of psychopathology seen in children and adolescents, including developmental and substance use disorders.
  5. Neurological disorders and the interface of pediatric neurology with child and adolescent psychiatry
  6. Psychological manifestations of pediatric disorders
  7. Forensic and legal issues relevant to child and adolescent psychiatry
  8. The impact of culture, religion, gender, socioeconomic factors, and family structure and systems on the development and maintenance of psychopathology
  9. The theoretical basis for therapeutic interventions used in child and adolescent psychiatry including psychodynamic psychotherapy, supportive, cognitive and behavioral therapy, group therapy, family therapy, crisis intervention, and pharmacotherapy

Skills

Residents will demonstrate the ability to:

  1. Identify gaps in their knowledge base and create a plan to remedy weaknesses
  2. Create and implement a plan for self-directed, lifelong learning
  3. Critically appraise the scientific literature

Attitudes

  1. Residents must maintain and apply an investigatory and analytic thinking approach to clinical situations.
  2. Residents must remain responsive to and appreciative of different modes of thinking.

Demonstrated by

Clinical care of all patients; Child PRITE examinations; preparation for and participation in didactic activities; teaching medical students, junior residents, and other professionals; clinical skills examinations; formal presentations at conferences; self-initiated independent learning

Evaluation

  • Annual Child PRITE examination
  • Rotation evaluations by supervisors
  • Annual clinical skills examination
  • Resident self-evaluation and plan for improvement
  • Regular review of the resident's performance by the residency director and Residency Education Committee'

Remediation

The residency director, in consultation with the Residency Education Committee, regularly will review the resident's performance, and will:

  1. Identify any specific deficits
  2. Document all identified areas requiring remediation or additional concentration
  3. Have the resident outline a plan of remediation of the specific deficiencies
  4. Provide additional recommendations for remediation of specific deficiencies
  5. Plan for further assessment with the outcome being determined by a method of assessment similar to the one used to identify the original deficiency (e.g., relative deficits on the Child PRITE might be reassessed by remediated and subsequent performance on the Child PRITE or another written examination; deficits identified through the supervisory process might be reassessed by subsequent supervisory reports specifically targeted at assessing the identified deficits)

III. Interpersonal Communication and Skills

Outcome/Goal

Residents will demonstrate the knowledge, skills, and attitudes necessary to develop and maintain appropriate interpersonal therapeutic relationships and to communicate effectively with patients, families, colleagues, and the public.

Knowledge

Residents will demonstrate knowledge of:

  1. Interviewing techniques
  2. Communication techniques including theory and available literature (e.g., open vs. closed-ended questioning, verbal vs. nonverbal communication, demonstration of empathy, delivering bad news)
  3. Consultation strategies
  4. Knowledge of medical culture/community to facilitate communication with other disciplines

Skills

Residents will be able to:

  1. Create and sustain a therapeutic and ethically sound relationship with patients
  2. Use effective listening skills
  3. Elicit and provide information using effective nonverbal, explanatory, and questioning skills
  4. Use effective written communication skills via documentation which is legible, timely, uses proper English, and captures essential information while respecting patient privacy
  5. Effectively communicate with the patient and family the results of the assessment, risks and benefits of the proposed treatment plan, alternatives, and education concerning the disorder, its prognosis, and prevention strategies
  6. Educate patients and professionals about medical, psychological, and behavioral issues; then assess the effectiveness of the communication (e.g., the audience's understanding)
  7. Recognize the need for, access, and effectively use interpreters when necessary
  8. Collaborate effectively with others as a member or leader of a health care team or other professional groups. Communicate effectively with allied healthcare professionals and with other professionals involved in the lives of patients.
  9. Serve as an effective consultant to other medical specialists, mental health professionals, and community agencies. The resident should demonstrate the ability to communicate effectively with the requesting party to refine the consultation question, maintain the role of consultant, communicate clear and specific findings and recommendations, and respect the knowledge and expertise of the requesting party.
  10. Demonstrate leadership skills in multidisciplinary or team settings
  11. Recognize and manage his/her own affects and counter transference
  12. Provide feedback to students, residents, and other professionals
  13. Utilize different styles of communication depending on the medium of communication (e.g., telephone, email, telemedicine)
  14. Use technology to facilitate communication

Attitudes

Residents will:

  1. Maintain an attitude of respect for others, even those with differing points of view or from different backgrounds; the desire to gain understanding of another's position and reasoning; a belief in the intrinsic worth of other human beings; the wish to build collaboration; the desire to share information in a consultative rather than dogmatic fashion; and the willingness to continuously self-observe and confront one's own biases and transferences and their impact on clinical work.
  2. Exhibit culturally sensitive, professional, ethically sound behavior and attitudes in all patient and professional interactions
  3. Maintain an attitude of interdisciplinary collaboration
  4. Maintain a polite and courteous attitude at all times

Demonstrated by

Clinical care of patients; chart documentation; forensic reports; direct observation by attending; clinical skills examinations; teaching others; interprofessional relationships; formal presentations; independent learning; seeking feedback on communication skills and performance

Evaluation

  • Rotation evaluations by supervisors
  • Annual clinical skills examination
  • Resident self-evaluation and plan for improvement
  • Regular review of the resident's performance by the residency director and Residency Education Committee

Remediation

The residency director, in consultation with the Residency Education Committee, regularly will review the resident's performance, and will:

  1. Identify any specific deficits
  2. Document all identified areas requiring remediation or additional concentration
  3. Work with the resident to develop a plan of remediation of the specific deficiencies. This might include additional supervision focused on the area of deficiency, review of videotaped clinical encounters with a supervisor, etc.
  4. Plan for further assessment with the outcome being determined by a method of assessment similar to the one used to identify the original deficiency (e.g., relative deficits on clinical skills exams might be remedied with additional exams; deficits identified through the supervisory process might be reassessed by subsequent supervisory reports specifically targeted at assessing the identified deficits)

IV. Professionalism

Outcome/Goal

Residents will demonstrate the knowledge, skills, and attitudes necessary to practice professionally responsible, ethical, and culturally sensitive child and adolescent psychiatry.

Knowledge

Residents will demonstrate knowledge of:

  1. The impact of gender, culture, religion, socioeconomic factors, and family structure and systems on children's development and psychiatric disorders and their treatment
  2. The different roles a child and adolescent psychiatrist might fulfill in different settings.
  3. Legal issues relevant to child and adolescent psychiatry, including consent, commitment, custody, competency, adjudication to adult court, etc.
  4. Ethical issues in the psychiatric treatment of children and adolescents. This includes knowledge of the, AACAP code of ethics, and principles of confidentiality, assent, and consent.
  5. Ethical issues important in conducting research with children, and the role of the Committee for the Protection of Human Subjects (CPHS)

Skills

Residents will demonstrate:

  1. Responsible professional behavior. This includes:
    1. Prompt response to patient communications
    2. Being appropriately available for patient care activities
    3. Use of the medical record for appropriate documentation of the course of illness and its treatment
    4. Providing coverage if otherwise unavailable
    5. Coordinating care with other members of the medical and/or multidisciplinary team
    6. Providing for appropriate transfer or referral when necessary
    7. Recognizing the resident's own abilities and limitations, and asking for help or supervision when needed
    8. Being where the resident is supposed to be, when they are supposed to be there
  2. Responsible social behavior appropriate for a physician
  3. Response to communications from patients and health professionals in a timely manner. If unavailable, the resident will establish and communicate back-up arrangements. The resident will communicate clearly to patients about how to seek emergent and urgent care when necessary.
  4. Ethical behavior that complies with the AACAP code of ethics
  5. Respect for patients from all cultural, religious, and socioeconomic backgrounds
  6. Clinical care which is culturally sensitive
  7. Appropriate, ethical alliances with patients and families with specific attention to boundary issues

Attitudes

Residents will demonstrate:

  1. A commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
  2. Respect, compassion, and integrity; responsiveness to the needs of patients and society that supersedes self interest; accountability to patients, society, and the profession; and a commitment to excellence and ongoing professional development
  3. Sensitivity and responsiveness to cultural, religious, and psychosocial differences, including awareness of their own and their patients' cultural differences and perspectives, as well as potential barriers to treatment

Demonstrated by

Clinical care of patients; preparation for and participation in didactics; bringing for discussion experiences with ethical dilemmas; interactions with other professionals; case conferences; participation in advocacy and community activities; chart review or discussion in supervision about ethical dilemmas and cultural considerations; interactions with CPHS during research activities; participation in professional organizations; participation with hospital ethics committees; clinical skills examinations

Evaluation

  • Rotation evaluations by supervisors
  • Annual clinical skills examination
  • Annual Child PRITE examination
  • Resident self-evaluation and plan for improvement
  • Regular review of resident's performance by the residency director and Residency Education Committee

Remediation

Incidents of unethical or unprofessional behavior may require reporting to appropriate agencies (e.g., local ethics committee or State licensing board). Patterns of unethical or unprofessional behavior will be subject to appropriate disciplinary action according to the residency policies and procedures.

The residency director, in consultation with the Residency Education Committee, regularly will review the resident's performance, and will:

  1. Identify any specific deficits
  2. Document all identified areas requiring remediation or additional concentration
  3. Develop a plan of remediation of the specific deficiencies. This might include additional supervision focused on the area of deficiency, attendance at additional ethics seminars and/or activities, etc.
  4. Plan for further assessment with the outcome being determined by a method of assessment similar to the one used to identify the original deficiency (e.g., deficits identified through the supervisory process might be reassessed by subsequent supervisory reports specifically targeted at assessing the identified deficits).

V. Practice-Based Learning and Improvement

Outcome/Goal

Residents will demonstrate the knowledge, skills, and attitudes necessary to initiate self-directed and independent learning to keep abreast of current information and practices relevant to child and adolescent psychiatry, to correct any areas of information or skills gaps, and to improve patient care practices.

Knowledge

Residents must demonstrate knowledge of:

  1. Research methodology, including critical assessment of the primary literature
  2. Principles of evidence-based medicine
  3. Awareness of available information technologies and the ability to access them

Skills

Residents will demonstrate the ability to:

  1. Develop a systematic approach for investigating, evaluating, and improving their fund of knowledge and clinical practices relevant to child and adolescent psychiatry
  2. Utilize patient logs to evaluate caseload and practice experience
  3. Maintain a system for examining errors in practice and initiating improvements to eliminate or reduce errors
  4. Teach medical students, junior residents, and other health professionals basic principles of child and adolescent psychiatry .
  5. Locate, appraise, and assimilate evidence from scientific studies related to patients' health problems
  6. Apply the results of research and current literature to clinical practice
  7. Use information technology to manage information, access on-line medical information, and support their own education
  8. Use evidence-based medicine principles to appraise scientific articles

Attitudes

  1. Maintain an attitude of inquiry and scholarship, recognizing the need for lifelong learning
  2. Maintain openness and flexibility in treatment approaches with patients, assimilating new knowledge in patient care practices

Demonstrated by

Researching learning issues and summarizing/synthesizing/presenting findings during conferences; self-directed inquiry guiding clinical care of patients, with discussion during supervision; self-directed learning; preparation for and participation in evidence-based medicine seminar, including preparation of at least one CAT (critically appraised topic); preparation for and participation in other didactic activities; journal clubs; formal presentations which include literature review, either during local case conferences or at professional meetings; and teaching others

Evaluation

  • Critique of CAT
  • Rotation evaluations by supervisors
  • Resident self-evaluation and plan for improvement
  • Regular review of the resident's performance by the residency director and Residency Education Committee

Remediation

The residency director, in consultation with the Residency Education Committee, regularly will review the resident's performance, and will:

  1. Identify any specific deficits
  2. Document all identified areas requiring remediation or additional concentration
  3. Develop a plan of remediation of the specific deficiencies. This might include additional discussion of journal articles and scientific literature during supervision, completion of additional CAT's, etc.
  4. Plan for further assessment with the outcome being determined by a method of assessment similar to the one used to identify the original deficiency (e.g., deficits identified through the supervisory process might be reassessed by subsequent supervisory reports specifically targeted at assessing the identified deficits; weaknesses identified during seminars will be reassessed by future instructors)

VI. Systems-Based Practice

Outcome/Goal

Residents will demonstrate the knowledge, skills, and attitudes necessary to manage effectively in multiple, diverse; and complex systems of care to provide effective treatment, consultation, and advocacy for children, adolescents, families, and child-related agencies.

Knowledge

Residents will demonstrate knowledge of:

  1. The different forms of consultation and liaison, and the different roles a child and adolescent psychiatrist might fulfill in different settings
  2. Basic concepts of systems theory
  3. Administrative issues in child and adolescent psychiatry
  4. Practice-management skills and setting up a practice
  5. Legal aspects of education as they impact children and adolescents with psychiatric problems
  6. The development of an Individual Educational Plan (IEP) and the child and adolescent psychiatrist's role in the process for determining the educational needs of special populations
  7. The role of child protective services
  8. How residents' patient-care practices and related actions impact component units of the health care delivery system and the total delivery system, and how delivery systems impact provision of health care
  9. Systems-based approaches for controlling health care costs and allocating resources
  10. Available community mental health services, both public and private and how to access them
  11. Local and national agencies and organizations involved in advocating and caring for children, adolescents, and families
  12. Awareness of racial, cultural, and psychosocial biases and their impact on systems

Skills

Residents will demonstrate the ability to:

  1. Educate community groups and other professionals about children's psychiatric problems, treatment, and prevention
  2. Advocate for patients within a variety of systems
  3. Educate and empower families to work within a variety of systems
  4. Act as a consultant in a variety of settings where residents use their specialized knowledge and skills to assist others to function better in their roles. This includes other medical, forensic, school, and community settings.
  5. Partner with insurance and managed care companies to meet patients' needs
  6. Strive to practice cost-effective health care and resource allocation that does not compromise quality of care
  7. Be able to adapt to the different roles a child and adolescent psychiatrist has in different settings
  8. Help patients access nontraditional avenues for treatment (e.g., research projects, community groups)

Attitudes

Residents will:

  1. Maintain an attitude of interdisciplinary collaboration, advocacy, and cooperation
  2. Maintain flexibility in adapting to the needs and expectations of different settings and systems
  3. Demonstrate sensitivity to the needs and limitations of different systems
  4. Be respectful of the expertise of other professionals
  5. Maintain a patient's best interest as the top priority

Demonstrated by

Clinical care of patients; interactions with other agencies involved in the care of patients, including schools, foster care agencies, child protective services, juvenile detention system, managed care and insurance companies; participation in forensic evaluations; consultation with other professionals; participation in quality improvement committees; Child PRITE examinations; oral exams; self-directed, independent learning; teaching others

Evaluation

  • Rotation evaluations by supervisors
  • Annual Child PRITE examination
  • Annual clinical skills examination
  • Resident self-evaluation and plan for improvement
  • Regular review of the resident's performance by the residency director and Residency Education Committee

Remediation

The residency director, in consultation with the Residency Education Committee, regularly will review the resident's performance, and will:

  1. Identify any specific deficits
  2. Document all identified areas requiring remediation or additional concentration
  3. Develop a plan of remediation of the specific deficiencies. This might include additional supervision or mentoring focused on the area of deficiency, analysis of breakdowns in interactions in systems, directed reading, etc.
  4. Plan for further assessment with the outcome being determined by a method of assessment similar to the one used to identify the original deficiency (e.g., deficits identified through the supervisory process might be reassessed by subsequent supervisory reports specifically targeted at assessing the identified deficits)