PGY 1: Inpatient Psychiatry and Substance Use Disorders at Reno VAMC

Student Handbook, Appendix A

PGY-1 Three Month Rotation In Inpatient Psychiatry And Substance Use Disorders At Reno VAMC

  1. This is a full-time PGY 1 position at the VA inpatient psychiatric unit (5C) and outpatient substance use disorders treatment clinics. The rotation is 3 months in length.
  2. The supervisors are the staff inpatient psychiatrist and a university faculty psychiatrist. The faculty psychiatrist will have a scheduled time once a week for supervision. The staff psychiatrist supervises on a daily and as needed basis. All patients assessed by the resident should be discussed at the earliest opportunity with the staff psychiatrist and an initial treatment plan outlined.
  3. The resident is expected to be in the hospital from 8:00 to 4:30. Inpatient work is unpredictable and extension of these hours will happen. The expectation is that the resident will finish all their work before leaving. The resident is to discuss with attending if they need to be off grounds for any period of time during working hours.
  4. Rounding on assigned patients and making daily notes is the standard unless a patient is a long-term stay (e.g. waiting for placement) and is stable. Then a note every third day is appropriate.
  5. Type daily notes. Dictation is not allowed except for H&Ps and discharge summaries. Residents have used templates for these types of notes and find it more efficient than dictating. If dictating an H&P type a brief note regarding the reason for admission, working diagnosis and treatment plan. Indicate in this note that an H&P has been dictated. Discharge summaries should be done at the same time the discharge orders and note are written, and never more than 24 hours after discharge. Residents leaving the service with un-dictated discharge summaries will be reported to the residency director.
  6. Assignment of new patients is at the discretion of the attending psychiatrist, with a limit of no more than eight patients being assigned to the resident.

Goals

By the end of the PGY-I VA inpatient psychiatry rotation the resident will:

  • Diagnose psychiatric disorders, and common medical and surgical disorders, and to formulate appropriate initial treatment plans.
  • Undertake the initial clinical and laboratory studies of patients presenting with a broad range of psychiatric, medical and surgical disorders.
  • Provide limited, but appropriate care of medical illnesses and to make appropriate referrals.
  • Initiate and monitor appropriate psychiatric care.
  • Recognize medical disorders likely to be regarded as psychiatric and psychiatric disorders which display symptoms likely to be regarded as medical.
  • Be cognizant of the nature of the interactions between psychiatric treatments and medical and surgical treatments. Relate to patients, their families as well as other staff members with compassion, respect and professional integrity.
  • Be capable of diagnosing substance Use Disorders as both independent disorder and as part of Co-occurring disorders.

Educational Objectives

Residents will be able to demonstrate competency in the following areas:

  1. Patient Care
    1. Conduct a thorough psychiatric evaluation, including a clear and accurate history, physical examination, neurological examination and mental status examination and complete and systematic recording of findings.
    2. Write up a bio-psycho-social formulation, DSM-IV multi-axial diagnosis and treatment plan.
    3. Evaluate a patient’s capacity to make informed decisions in their best interest.
    4. Assess patient’s potential for harm to self or others and make appropriate disposition.
    5. Demonstrate appropriate detoxification regimes for at least two substances.
    6. Appropriately refer patients to treatment after detoxification.
  2. Medical Knowledge
    1. Demonstrate knowledge of commonly prescribed psychotropics and their appropriate indications of use.
    2. Demonstrate knowledge of medical illnesses that can present as psychiatric illnesses and vice versa with appropriate medical evaluation and appropriate referrals.
    3. Demonstrate understanding and appropriate treatment of alcohol withdrawal.
    4. Demonstrate knowledge of the criteria for Abuse and Dependence
    5. Be able to verbalize the basic elements of appropriate outpatient addiction treatment.
  3. Practice-based Learning and Improvement
    1. Recognize and correct gaps in their knowledge and expertise.
    2. Facilitate the education of students and other health care professionals who are working on the inpatient unit.
    3. Use the various modalities available for practice-based learning including self-directed reading and on-line resources available through the VA library system.
  4. Interpersonal and Communication Skills
    1. Create and sustain a therapeutic and ethically sound relationship with patients and their families (if involved in the patient’s care).
    2. Consider cultural and language differences in interpersonal interactions.
    3. Use effective listening skills.
    4. Demonstrate effective nonverbal, explanatory, questioning and writing skills.
    5. Maintain clear and concise progress notes on a daily basis.
    6. Work effectively with the other professionals as a member of the treatment staff.
    7. Demonstrate the ability to discuss issues of substance dependence with even pre-contemplative patients.
  5. Professionalism
    1. Demonstrate understanding and adherence to the domains of medical professional.
    2. Behavior including respect, caring, compassion, conscientiousness, and accountability.
    3. Understand and demonstrate the ethical principles of informed consent and patient confidentiality.
    4. Present with a professional appearance and demeanor.
    5. Arrive to work on time.
    6. Answer pages in a timely manner.
    7. Take call as scheduled or arrange for coverage if a conflict arises.
    8. Comply with hospital and departmental policies and procedures.
  6. Systems-based Practice
    1. Practice cost-effective care and resource allocation that does not compromise. Quality of care, such as medication costs, procedure costs and length of stay.
    2. Understand the broader aspects of the health care system and its effect on patients, for example, outpatient follow-up, housing options, long-term inpatient options.
    3. Advocate for quality patient care.
    4. Understand and address involuntary commitment process.