Resident Responsibility

Student Handbook, Psychiatry and Behavioral Sciences: Reno

General

All residents are expected to:

  1. Develop a program of self-study with appropriate guidance from faculty supervisors.
  2. Fully participate in the educational activities of the program and, as required, assume responsibility for supervising and teaching medical students and other residents. In particular, each resident is expected to attend and participate in all scheduled seminars and conferences. Exceptions will be made when dealing with a crisis where leaving could jeopardize the welfare of patients. Inadequate attendance may result in an unsatisfactory overall annual evaluation or be used as grounds for non-promotion or dismissal from the program. When possible, residents are to pass beepers to their senior residents or attendings during Wednesday afternoon scheduled seminars and case conferences to prevent interference with the learning experience. Residents are expected to return to wards to complete unfinished work.
  3. Provide safe, cost effective, high quality and compassionate care, commensurate with their level of training.
  4. Respect and strictly adhere to the policies of the medical practice at each participating hospital with particular attention to the timely completion of medical records.
  5. Provide thorough, complete and prompt documentation of all aspects of patient care. Residents have the legal responsibility to countersign all student notes and assessments.
  6. Participate in onsite clinical supervision at least two hours weekly and when appropriate, at least one hour off-site weekly.
  7. Be available by pager Monday-Friday, 8:00 a.m. - 5:00 p.m. and when on call. The only exceptions to this rule are when a resident is sick, on vacation, on official holidays, or on educational leave.
  8. Notify the department secretary, your attending/supervisor and the program coordinator of any illness or other health problems that might interfere with duties.
  9. Fulfill call obligations as outlined in your schedules. Any changes must be cleared by the Residency Director.
  10. Dress and act in a professional manner.
  11. Residents are required to critically evaluate their students, supervising resident, attending/supervisor, and the rotation.
  12. Complete the appropriate Training Skills Checklist during the course of the year. See Appendix A.

Yearly Specifics

  1. PGY-1
    1. Meet competency expectations for each rotation.
    2. Primary responsibility for moment to moment, daily and overall patient care.
    3. Perform daily work rounds in the morning including examining patients and gathering information for discussion purposes on each patient in preparation for attending rounds.
    4. Remain in-house until his/her duties for patient care have been completed or arranged to be completed by another resident on-call. It is expected that the PGY-1 resident will examine every admission to their service and will be required to:
      1. Complete an H&P according to the established procedure.
      2. Keep an up-to-date and complete problem list face-sheet on each chart and if applicable, a laboratory flow sheet.
      3. Write concise, accurate off-service notes on the afternoon prior to a rotation switch.
      4. Write a short discharge note in the chart in addition to completing a dictated summary on each patient prior to discharge.
      5. Provide for appropriate outpatient follow-up.
      6. Directly evaluate any patient concern that is brought to your attention.
      7. Keep ward attending/supervisor and the on-call attending/supervisor informed of any major changes in patient status.
      8. Not write notes on or provide care for any non-resident patients except under life threatening or emergency situations.
      9. For each individual procedure performed, write and dictate a separate procedure note. There must be only one procedure per dictation and all pertinent information listed including the name of the attending physicians or supervisor.
      10. Make certain that a staff physician (normally your attending supervisor) is responsible for supervising any procedure performed. The staff physician must be informed prior to doing the procedure, except during an emergency, life threatening situation.
    5. Be responsible for writing daily progress notes on all patients with the following exceptions:
      1. When the note is written by the medical student and is corrected and countersigned by the PGY-1.
      2. When the responsibility for note writing has been deferred to the supervising resident or cross-coverage team of physicians.
    6. Residents must participate in a responsible check-out policy. Under no circumstances will an unstable patient be checked out. It is the responsibility of the admitting resident to stabilize the patient, prior to leaving the hospital premises.
    7. The Intern will see no patient unless direct, immediate supervision from an attending/supervisor or senior resident is available until they have three (3), successfully completed Level of Supervision Evaluations in their resident file.
    8. Interns are expected to interact appropriately with medical students who may be on the treatment teams with them. this may include giving direct feedback to students, answering questions and providing support at the direction of the attending physician.
  2. PGY-2
    1. Abide by all appropriate PGY-1 responsibilities and meet the competency expectations for each rotation.
    2. The primary responsibility of the resident is to undertake psychiatric assessments and treatment of a wide variety of patients in various specialty inpatient settings. Assessments will include:
      1. A comprehensive psychiatric history.
      2. A thorough mental status examination. c. A biopsychosocial formulation.
      3. A DSM-IV diagnosis on five axis.
      4. A biopsychosocial treatment plan.
    3. Residents at this level are expected to learn basic Inpatient psychotherapeutic, psychopharmacologic, and somatic therapy knowledge and skills including conducting ECT under supervision.
    4. Residents are expected to provide direct supervision of medical students on their service. They will be expected to critically evaluate and give constructive feedback to medical students regarding patient interviews and work-ups. By the end of the PGY-2 year, the residents should have completed the Institution's Residents As Teachers program.
  3. PGY-3
    1. Meet competency expectations for the yearlong rotations.
    2. The primary responsibility of the resident is to undertake psychiatric assessments and treatment of a wide variety of outpatients. Assessments will include:
      1. A comprehensive psychiatric history.
      2. A thorough mental status examination. c. A biopsychosocial formulation.
      3. A DSM-IV diagnosis on five axis.
      4. A biopsychosocial treatment plan.
      5. Facilitate referral to appropriate level of care.
    3. Development of competencies in the pharmacological and psychotherapeutic treatment of patients will include:
      1. Treating of at least 30 patients weekly in one-half hour sessions in general outpatient clinics using predominately pharmacotherapy.
      2. Use of the full range of psychotherapies including supportive, psychodynamic, cognitive-behavioral and brief as outlined in the psychotherapy training program.
    4. Residents are expected to be responsible for teaching medical students in a formal didactic setting. They are also expected to be able to evaluate Interns using the Level of Supervision Evaluations found in Appendix C.
    5. Other Responsibilities:
      1. Residents should begin to fulfill their scholarly activity obligations, if they have not already done so.
      2. Residents should begin to plan their PGY-4 year electives.
  4. PGY-4
    1. Meet competency expectations for each rotation.
    2. Complete required rotation in Geriatric medicine if not already completed.
    3. PGY-4 residents are expected to supervise less experienced residents when appropriate and assist with administrative activities as directed and supported by the Program Director or Chief Resident.
    4. Residents are responsible for developing a six-month elective curriculum with the assistance of the program director 3 to 6 months in advance of PGY-4. The following must be kept in mind:
      1. Curricula should address both special interests and training weaknesses.
      2. Training experiences must be arranged at sites providing financial support for both residents and supervisors.
    5. In addition to being able to teach formal didactics in more than one subject, the resident would be expected to provide a higher level of supervision and instruction to interns as well as to residents in other disciplines of medicine.