PGY 3: Outpatient at NNAMHS

Student Handbook, Appendix A

PGY-3 Twelve Month Rotation in Outpatient at NNAMHS

Outpatient NNAMHS PGY 3 Expectations

  1. Hours are 8am – 5pm unless otherwise arranged.
  2. A resident is expected to see all scheduled patients
    1. Medication checks are allotted 30 minutes for patient care and paperwork.
    2. New evaluations are allotted 90 minutes.
  3. If there is a cancellation or a patient does not show up for an appointment a resident is expected to see “walk in” clients. These patients are screened by nursing; their charts are available on a shelf in the clinic. The resident is expected to check the shelf to see if there are unscheduled patients waiting to be seen. If a patient that is on the resident’s patient load is there for a walk-in, the resident should attempt to fit the patient in, even if the resident doesn’t have an opening. If they feel unable to do so, they should let nursing know so that the nurse can let another MD know.
  4. The average number of patients seen in a day is 8-12, but may be up to 15. The majority of these patients are follow-up patients. Typically there is one new evaluation daily, but on occasion there may be two.
  5. Due to scheduling, it is requested that residents provide as much notice as possible- preferably 3 months- of pending vacations so that patients will not have to be rescheduled.
  6. When calling in sick please call the front desk at (775) 688-2078 by 7:30 am, let the administrative assistant know and then request to be transferred to Greg Kitchingman, the outpatient supervisor, to notify him as well.
  7. Each patient encounter requires a note completed in the Avatar computer system. This note should be written in basic SOAP note format. All notes and psychiatric evaluations are to be completed in a timely manner; the notes are to be sent to the attending for co-signing. Evaluations are to be finalized and sent for co-signature. Please print finalized evaluations, sign and place in paper chart. Prescriptions are hand written, carbon copies are to be filed in the paper chart.
  8. Please arrange outside supervision in a manner that will least interfere with outpatient clinic schedule. i.e. first thing in the morning or last thing in the day.
  9. A resident is expected to become familiar with the many services offered through NNAMHS to provide appropriate referrals. If a resident has questions about what is available or how to make referrals, then they are expected to initiate a conversation with their supervisor or nursing.
  10. A resident is expected to keep all medical records competed and current. There are treatment plans, medication reconciliation forms as well as evaluations to be signed. If there are any questions as to how or what to sign or complete, ask the supervisor or medical records.
  11. Once a month the resident schedule will have a time allotted for treatment team. This is an important multidisciplinary meeting to discuss patients that receive service coordination.
  12. If the residency has made plans for outside activities during normal clinic activities a resident is expected to provide as much notice as is possible to allow for patients to be rescheduled.
  13. A resident will spend one hour a week, minimum with their assigned clinical supervisor to discuss patients and learning topics.
  14. A resident is expected to seek out supervision, by their assigned attending or other staff attending, if they have questions or concerns about patient care. The resident will be working and seeing patients on their own much of the day so that it is expected that the resident will seek assistance when needed.
  15. Outpatient is a busy clinic, time management is vital. Seeing patients at their scheduled time is a professional skill that is important to develop. The system allows for some lee way, both staff and patients appreciate that emergencies come up and that doctors may run behind. It is an important goal to make this an exception rather than the rule.

Competencies to be achieved by the end of the rotation:

Patient Care

  1. Demonstrate the ability to apply supportive, psychodynamic and cognitive-behavioral psychotherapies in both brief and long term practice.
  2. Demonstrate the ability to safely use pharmacologic regimens which are evidence based and appropriate for the identified disorder
  3. Demonstrate the appropriate use of medications and psychotherapy in the same patient.
  4. Demonstrate the ability to formulate bio-psycho-social formulations which lead to appropriate treatment interventions

Medical Knowledge

  1. Demonstrate, from clinical interviews, the ability to appropriately diagnose mood disorders, anxiety disorders and psychotic disorders in an outpatient setting
  2. Show how to appropriately dose, titrate and taper antidepressant mediations
  3. Show how to appropriately dose, titrate and taper medications used in the treatment of bipolar disorder
  4. Demonstrate the effective use of medications uses in adjunctive treatment of Mood and anxiety disorders

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 new knowledge to patient care issues.

Interpersonal and Communication Skills

  1. Demonstrate the ability to work with ancillary staff by responding quickly and professionally to staff requests concerning patient care issues.
  2. Demonstrate appropriate and effective communication with primary care physicians involved in care of the residents patients.
  3. Demonstrate appropriate communication with other treatment providers involved in the care of the resident’s patients.
  4. Effectively communicate patients condition and needs when making referral to other treatment providers


  1. Show respectful and professional behavior by being on time to team meetings and patient appointments.
  2. Demonstrate appropriate diligence to paper work by having all notes and write-ups completed by time of supervisor’s weekly review.
  3. Demonstrate at all times appropriate boundaries in M.D. – Patient relationship.
  4. Always notifies site personnel when sick, late or delayed for duties.

System-based Practice

  1. Know how to refer to other agencies within the system as demonstrated by making such referrals when appropriate
  2. Demonstrates the ability to work with formularies to minimize costs to patient.
  3. Appropriately follows procedures to procure needed medical treatment when necessary
  4. Works with health care managers to improve quality of and access to patient care within the facility.