PGY 4: Geriatric Psychiatry at Reno VAMC

Student Handbook, Appendix A

PGY-4 Rotation in Geriatric Psychiatry at Reno VAMC

  1. This is a full time PGY 4 position located in the VA Mental Health Clinic. The rotation is three to six months in length.
  2. The supervisors are staff psychiatrists. Currently, Dr. Van Biber supervises the geriatric clinic. Supervision will formally be scheduled for one hour a week. However, the resident is encouraged to discuss questions and difficulties with any staff psychiatrist at any time.
  3. Responsibilities of resident:
    1. Work hours are from 8:00 am to 4:30 pm with half-hour lunch. No patients are scheduled from 12:00-1:00. The resident is expected to remain at the worksite even if there are no patients scheduled or there are “no-shows”. If you need to leave the VA during the day please let the clerk know and be available by pager.
    2. Residents are expected to help out if able with “walk-in” and triage outpatients.
    3. Notes are to be completed the day of the visit.
    4. VERY IMPORTANT: Encounters must be entered the day of the visit.
    5. The resident is expected to assist patients and clerks regarding scheduling follow-up appointments with their patients and use “paperwork” slots to “overbook” as necessary for appropriate follow up.
    6. If the resident is sick, he or she must call the scheduling office (three numbers to try are (775) 786-7200 ext. 1097 or ext. 1092 or 326-5720) and Dixie at 326-5712. You may leave a message for Dixie if she does not answer, but do not leave a message if a clerk doesn't answer. Please call Dr. Drymalski on her cell phone, (775) 233-5348, if you cannot connect with a "live" person. The sooner the staff knows a doctor is out sick the sooner they can contact patients to cancel appointments. A voicemail message may not be received as quickly as direct contact.
    7. Residents are expected to respond to pages in a timely manner.

Educational Objectives

Patient Care
  1. Conduct a thorough psychiatric evaluation, including a clear and accurate history,
  2. and mental status examination and with concise and timely documentation of findings.
  3. Perform a competent assessment of patient dangerousness with regard to suicide and,
  4. violent behaviors based on interview assessment and an understanding of critical risk factors.
  5. Examine patient progress in treatment sufficient to monitor for patient safety and
  6. Adverse medication effects, as well as to make appropriate therapeutic adjustments.
  7. Become familiar with neuropsychology testing and the significance of the results.
Medical Knowledge
  1. Demonstrate understanding of psychoactive medications to treat psychiatric illness in the elderly and understanding of the possible side effects.
  2. Monitor medication effects, including appropriate laboratory testing.
  3. Demonstrate familiarity with DSM-IV diagnostic criteria.
  4. Identify potential co morbid medical and neurological conditions with appropriate evaluation and referrals.
  5. Demonstrate understanding of end-of-life issues.
  6. Demonstrate understanding of common medical illnesses in the elderly and the impact.
  7. These illnesses have on a patient’s mental health.
  8. Demonstrate the appropriate use of medications to treat dementia.
Practice-based Learning and Improvement
  1. Understands that medical knowledge is incomplete and evolving
  2. Appraise own patient care practices
  3. Use the various modalities available for practice-based learning including self-
  4. Directed reading and on-line resources available through the VA library system.
  5. Demonstrate ability to incorporate constructive feedback from supervisors, coworkers and patients.
Interpersonal and Communication Skills
  1. Create and sustain a therapeutic and ethically sound relationship with patients
  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 documentation
  6. Work effectively with the other professionals as a member of the treatment staff.
  7. Demonstrates awareness of and ability to manage counter transference issues.
  8. Demonstrate ability to interact with colleagues and ancillary staff in a collaborative manner.
Professionalism
  1. Demonstrate understanding and adherence to the domains of medical professional behavior including respect, caring, compassion, conscientiousness, and accountability.
  2. Understand and demonstrate the ethical principles of informed consent and patient confidentiality.
  3. Present with a professional appearance and demeanor
  4. Arrive to work on time and be on site until duty hours end, unless approved by supervisor and appropriate staff informed of absence.
  5. Answer pages in a timely manner
  6. Respond to phone messages 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
Systems-based Practice
  1. Advocate for quality patient care
  2. Understand and address forensic issues such as, involuntary commitment process, reporting child or elder abuse, informed consent, Tarasoff concerns.
  3. Apply patient safety standards
  4. Ability to understand and adhere to formulary requirements or the pharmacy
  5. Ability to understand and follow relevant county, state, federal and professional regulations.
  6. Ability to understand the appropriate use of consultants and ancillary staff
  7. Demonstrate understanding of Advance Directives, Power of Attorney and Guardianship.