PGY 2: Emergency Psychiatry at NNAMHS

Student Handbook, Appendix A

PGY-2 Three Month Rotation in Emergency Psychiatry at NNAMHS

  1. Hours are 8:30 am – 5:30pm unless otherwise arranged.
  2. Treatment team meeting begins at 8:30 am
  3. When a resident becomes comfortable, a resident will be encouraged to see 2-4 new evaluations in a day. They may be asked to see additional patients for follow up.
  4. All patient evaluations are to be presented to the attending.
  5. All patients must be seen by an attending in order to be discharged.
  6. All admit orders and discharge orders require an attending’s co-signature.
  7. A resident is expected to understand the medical chart, the procedure for admissions, typical admission orders, and portions of the chart that need to be signed.
  8. Part of the admission process is to understand when the patient has physical medical problems. The resident is expected to either request more information or refer to Dr. Oksenholt for medical issues if they have questions.
  9. The resident will be working closely with social work, nursing and other staff members. The POU is a team approach to patients, collateral information is required and open communication and respect to all staff is essential.
  10. Notes are to be written on each patient in the Avatar system. Evaluations and notes require being marked to be co-signed by the attending on duty and finalized.
  11. Residents are expected to not fall delinquent in signing medical records.
  12. Call the POU at (775) 688-2020 if calling in sick. Advanced notice is appreciated when arranging for vacation days.

Competencies to be achieved by the end of the rotation:

Patient Care

  1. Demonstrate the ability to appropriately manage patients with homicidal or violent behavior.
  2. Demonstrate the ability to manage patients with suicidal thought or attempts.
  3. Consistently perform a data-based assessment of acute suicidal risk.
  4. Demonstrate the ability to use appropriate pharmacologic agents to manage acute psychomotor agitation.
  5. Implement appropriate disposition plans based on risk assessments.
  6. Demonstrate the ability to use crisis management theory in the treatment of patients.
  7. Demonstrate the ability to use appropriate laboratory tests in conjunction with the Mental Status examination in the evaluation of patients.

Medical Knowledge

  1. Show knowledge of the criteria for involuntary civil commitment
  2. Know how to adequately evaluate a patient with co morbid medical and psychiatric disorders.
  3. Know how to adequately evaluate a patient with co morbid substance use and psychiatric disorders.
  4. Know the differential diagnosis of psychosis
  5. Know the tests and further evaluations to perform in evaluating the differential diagnosis of psychosis.
  6. Know how social factors may affect dispositional options.

Practice Based Learning and Improvement

  1. Demonstrate the ability to learn independently by identifying one knowledge deficit and appropriately collecting new information in that area
  2. Demonstrate the ability to appropriately collect new information in knowledge deficit area.
  3. Demonstrate the ability to apply to knowledge to patient care issues.

Interpersonal and Communication Skills

  1. Demonstrate the ability to work with ancillary staff by collaborating to develop appropriate multi-disciplinary treatment plans.
  2. Demonstrate the ability to work with families of adolescent and geriatric patients by involving then in treatment planning.
  3. Know the dynamics involved in burnout and cynicism commonly seen in caregivers and PES staff.

Professionalism

  1. Show respectful and professional behavior by being on time to team meetings.
  2. Demonstrate appropriate diligence to paper work by completing all work ups and note on time.
  3. Demonstrate appropriate concern for the protection of the patient’s right of privacy and confidentiality.

System-based Practice

  1. Know how to refer to other agencies within the system as demonstrated by….
  2. Know the criteria for justifying hospitalization according to Nevada revised Statutes.
  3. Know the role of case management in the PES and PACT as demonstrated by appropriate utilization in treatment planning.
  4. Know the function of the PES as a utilization management unit in a managed care environment.