Goals and Objectives of the Pediatric Psychiatry Consult/Liaison Service in the Six Core Competencies
Patient Care: Ability to gain a firm understanding of the psychopharmacology of the medically ill child, including adverse drug effects and drug-drug interactions. Ability to understand the interplay of normal and abnormal development in infancy through adulthood within a pediatric medical setting. Ability to identify the indications, contraindications and possible adverse effects of the full spectrum of treatment modalities that may be used for children, adolescents and families in medical or surgical settings, including brief individual therapy, supportive therapy, psychodynamic psychotherapy crisis intervention, family therapy, cognitive-behavior therapy, pharmacotherapy and combined psychotherapy and psychopharmacology.
Medical Knowledge: Assessment of children, adolescents and families in a range of settings, including the outpatient clinics, emergency room, inpatient medical wards. Ability to comprehensively assess, discuss, document and intervene concerning the patients potential for self-harm or harm to others. Ability develop specific clinical knowledge regarding the psychiatric care of the medically ill child.
Practice Based Learning and Improvement: Ability to receive feedback from multi-disciplinary psychiatry team members and to improve upon care delivered. Ability to receive feedback from consulting team members.
Interpersonal and Communication Skills: Ability to develop a comprehensive differential diagnosis and multimodal treatment plan for children, adolescents and families, including use of appropriate laboratory, medical and psychological examinations. Ability to conduct therapeutic interviews with children, adolescents and families. Ability to understand the principles of cultural difference in patients and their families.
Professionalism: Ability to work with a multi-disciplinary team to conduct assessments and treatments with diverse populations of children, adolescents and families, with attention to differences in age, gender, race, culture and socioeconomic status. Ability to work within the system of health care as it pertains to children, adolescents and families, including the role and function of community and state agencies as referral bases.
Systems Based Practice: Ability to liaison effectively to medical and surgical teams. Ability to evaluate and conduct emergency interventions in a range of settings, including outpatient clinics, pediatric wards, the emergency room, inpatient and partial hospital settings. Ability to understand the interrelationships among psychosocial and biomedical factors in the general hospital setting.
Goals and Objectivesof the Psychosomatic Medicine Rotation in the Six Core Competencies (Evaluation Form)
PATIENT CARE
Ability to obtain a thorough history from patient and collateral information
Ability to perform an accurate and thorough mental status examination
Ability to formulate a thorough diagnostic work-up
Ability to develop a thorough treatment plan
Ability to assess medical decision-making capacity
Ability to provide psychoeducation to patients and family
Ability to develop a complete differential diagnosis
PSYCHIATRIC KNOWLEDGE
Knowledge of psychological complications of medical/surgical illnesses (grief, anxiety, depression, regression, denial, family conflict…)
Knowledge of psychopharmacology of the medically ill including adverse drug reactions, drug-drug interactions, and indications and appropriate use of psychotropic medications
Knowledge of psychiatric disorders due to medical/surgical conditions (syphilis, renal failure, sepsis, hepatic failure, AIDS, electrolyte abnormalities, pulmonary disease, cardiac disease…)
Knowledge of the evaluation and management of alcohol and benzodiazepine withdrawal
Knowledge of the evaluation and management of delirium, dementia, and other cognitive disorders
Knowledge of the evaluation and management of somatoform disorders and chronic pain
PRACTICE BASED LEARNING AND IMPROVEMENT
Awareness of limits of one’s own knowledge and skills
Utilization of outside sources of information for continuous learning and improvement of patient care
Ability to critically evaluate quality of medical/scientific information
Ability to effectively utilize information technology
Ability to facilitate learning of others, including members of the psychiatric consult team and non-psychiatric health care providers
Provision of accurate and thorough documentation
INTERPERSONAL AND COMMUNICATION SKILLS
Ability to conduct respectful and empathic patient interviews (introduction, open-ended questions, body language, following patient’s lead, empathic statements, transition to MSE, conclusion)
Demonstration of sensitivity to issues such as culture, age, gender, and disability
Ability to give organized, accurate, and thorough patient presentations
Respectful and empathic interactions with health care providers, both psychiatric and non-psychiatric
Respectful and empathic interactions with patients' families (information-gathering, education, family meetings…)
SYSTEMS BASED PRACTICE
Ability to lead a treatment team
Ability to get done, within the medical system, what needs to be done to achieve optimal patient care
Ability to recognize and implement cost effective treatment strategies
Ability to act as a patient advocate
PSYCHOTHERAPY
Ability to identify and maintain a therapeutic focus
Knowledge of the principles underlying CBT (cognitive distortion, automatic thoughts, dysfunctional schemata, cognitive restructuring…)
Ability to recognize and manage his/her own emotional reactions to patients
Ability to facilitate the patients' exploration of his/her inner world
Ability to utilize supportive therapy techniques (encouragement, empathy, problem-solving, affirmation…)
Ability to utilize basic behavior therapy techniques (relaxation, imagery…)
PROFESSIONALISM
Rated in the following areas: Honesty, Ethical behavior, Motivation/Morale, Punctuality, Personal Responsibility, Professional Responsibility, Accountability
Goals and Objectivesof the ER Service in the Six Core Competencies
Every teaching site in the program offers different learning opportunities for Residents. We consider these to be the specific skills that are important to learn in the Psych ER.
A: Patient Care:
1. Differential Diagnosis: Resident is able to rapidly develop an appropriate differential diagnosis for each patient.
2. Psychopharmacolgic Interventions: Resident is able to appropriately prescribe medications to treat psychiatric emergencies.
B. Psychiatric Knowledge:
1. Openness to supervision: Resident appropriately seeks guidance on difficult and/or complicated patients. Resident is responsive to input from Attendings.
2. Ability to teach medical students: Resident takes time to teach medical students assigned to them.
C: Practice Based Learning and Improvement:
1. Demonstrates use of outside sources of information: Resident appropriately seeks and responds to information from ER team members (D&A, RN's, Social Work, Techs, etc.)
2. Ability to critically evaluate quality of information: Resident demonstrates outside reading in psychopharmacology and suicidology relevant to the ER.
D: Interpersonal and Communication Skills:
1. Interviewing ability: Resident is able to adapt their history taking to a wide variety of patients. Resident is able to identify critical information necessary to care for patients and work out a plan to obtain that information. Resident is able to accurately take and report a complete mental status exam.
2. Empathy: Resident is able to exhibit empathy for the difficult patients seen in the ER.
E. Professionalism:
1. Collegiality: Resident develops and maintains a team effort to care for ER patients
2. Respect for patients and their families: Resident is able to appropriately work with patients' families in order to give them a positive impression of the ER.
F: Systems Based Practice:
1. Ability to lead a treatment team: Resident is able appropriately delegate and monitor work assigned to other members of the ER Treatment team.
2. Ability to get done what needs to get done: Resident is able to set and maintain priorities in order to minimize dwell time for patients in the ER
3. Resident demonstrates familiarity with the indigent mental health treatment system in North Texas.
Goals and Objectives of the Parkland Inpatient Service in the Six Core Competencies
I. Patient Care: 1. Ensure treatment of the patient is carried out effectively and completely. 2. Resident does not leave the hospital for the day until that day’s work is done and documented. This includes checking out with the resident’s attending prior to leaving the site.
II. Medical Knowledge: 1. Able to perform, write-up and describe a patient evaluation and psychodynamic formulation. 2. Able to assess fully and thoughtfully the patient’s medical condition, seek the appropriate consultations and manage medical (including neurological) problems.
III. Practice Based Learning and Improvement: 1. Request appropriate, timely and well thought out referrals for psychological testing. 2. Resident generalizes concepts from rounds with team and attending to implement treatment.
IV. Interpersonal and Communication Skills: 1. Demonstrate leadership by carefully gathering and soliciting information from the staff and attending, directing personnel in the care and disposition of the patient and communicate effectively with the third party payers and managed care personnel. 2. Resident will demonstrate communication competence in team-based interactions by being the principal spokesperson for the medical team.
V. Professionalism: 1. Resident will be prompt, dependable and available. 2. Resident will treat and speak of staff members, students and patients with respect. 3. Resident will interact with other physicians in a courteous and collegial manner.
VI. Systems Based Practice: 1. Resident will demonstrate use of resources by formulating a biopsychosocial Master Treatment Plan. 2. Resident will demonstrate competence and knowledge of procedures and resources for disposition from a medical perspective.
Goals and Objectives of the Presbyterian Consult Service in the Six Core Competencies
1.) Patient Care: Ability to perform a comprehensive psychiatric evaluation. Ability to manage psychopharmacologic interventions and treatment planning.
2.) Medical Knowledge: Openness to supervision. Ability to teach medical students.
3.) Practice Based Learning and Improvement: Ability to learn from feedback from primary team and staff. Contributes to other’s learning.
4.) Interpersonal and Communication Skills: Adequacy of documentation. Ability to recognize affect and to be sensitive to patient’s needs.
5.) Professionalism: Personal Integrity. Ability to work well with one’s colleagues.
6.) Systems Based Practice: Ability to function as part of a team. Ability to interact appropriately with patients’ families including gathering information and psychoeducational interventions.
Goals and Objectives of the Eating Disorders Unit at Presbyterian in the Six Core Competencies
Patient care:
1) Resident will be able to complete psychiatric assessment appropriate to eating disorders patients including
use of other than the patient herself sources.
2) Resident will be able to address patients' medical care and nutritional needs,
including asking for consultation from other disciplines.
Medical knowledge:
1) Resident will be able to use DSM IV TR diagnostic criteria, and understand the definitions of the different eating disorders.
2) Resident will demonstrate knowledge of appropriate medications for
common psychiatric conditions and those specific for eating disorders..
Practice Based Learning and Improvement:
1) Resident will be familiar with appropriate levels of care based on
patient symptomatology.
2) Resident will demonstrate learning from other team members based on
the observed therapeutic interactions between patients and therapists.
Interpersonal and Communication Skills:
1) Resident will demonstrate the ability to recognize affective states
of patients.
2) Resident will demonstrate the ability to provide tactful feedback to
patients.
Professionalism:
1) Resident will promptly respond to requested assignments and provide
feedback on assignments completed.
2) Resident will be able to demonstrate good boundaries with patients
and staff.
System Based Practice:
1) Resident will be able to function as the part of the treatment team.
2) Resident will learn the importance of family involvement in the
treatment of patients in the Eating Disorders Program.
Goals and Objectives of Parkland Psychiatric Outpatient Clinic in the Six Core Competencies
General Goals
1. Psychiatry residents will have a continuous supervised clinical experience in the assessment, diagnosis, and treatment of outpatients that emphasizes a developmental, biopsychosocial, and culturally sensitive approach to outpatient psychiatric practice.
2. Residents will have an outpatient experience that includes a wide variety of disorders, patients, and treatment modalities, including biological treatments, psychotherapy, and psychosocial rehabilitation.
3. Residents will demonstrate the ability to gather and organize data, integrate this data with a comprehensive formulation of the problem to support well-reasoned differential diagnosis, formulate a treatment plan, and implement treatment care follow-up in an outpatient setting.
4. Residents will demonstrate professional and ethical behavior in the care of their patients and in their interactions with other health care providers.
6. Residents are expected to gradually develop higher levels of understanding and skills.
Competency-Specific Objectives:
Patient Care: Residents must be able to provide care of outpatients that is compassionate, appropriate, and effective for the treatment of mental illness.
1. Residents will demonstrate the ability to conduct assessments of a wide variety of patients presenting with the full spectrum of psychiatric disorders commonly seen in outpatient psychiatric settings and attending to development, psychological, biological, social and cultural contributions to their illnesses.
2. Residents will communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
3. Residents will counsel and educate patients and their families and demonstrate the ability to convey difficult information.
4. Residents will develop patient formulations that include the following elements:
- DSM-IV diagnoses on all five axis
- Developmental aspects
- Narrative/psychodynamic aspects
- Psychosocial aspects
- Biomedical/neuropharmacologic aspects
- Genetic aspects
5. Residents will formulate and carry out treatment plans based on the above diagnostic formulation and define a rationale for specific treatment goals, considering also patient personal and psychosocial resources and ability to participate in the plan.
6. Residents will implement biomedical treatment strategies, including psychopharmacological treatment with antidepressants, antipsychotics, sedative hypnotics, mood stabilizing medications, stimulants and agents for treatment of sexual disorders and, when indicated, referral for electroconvulsive therapy.
7. Residents will appropriately and proficiently employ commonly used rating scales during the assessment and follow-up of outpatients, including anxiety and depression scales, cognitive measures and neurological scales (e.g., Abnormal Involuntary Movement Scale)
8. Residents will demonstrate the ability to identify outpatients who should be referred for psychological and neuropsychological testing to aid with diagnostic assessment.
9. Residents will understand the risks and benefits of and indications for psychiatric hospitalization and will be able to evaluate patients with a view to determining their psychiatric risk (risk of suicide or otherwise) and need for hospitalization.
10. Residents will collaborate with health professionals, in particular primary care providers, psychotherapists, nurses and case managers, to provide patient-focused care.
11. Residents will use information technology to support patient care decisions and patient education, including on-line literature searches and other computer-based resources.
Medical Knowledge: Residents must demonstrate knowledge of the neurobiological, psychological, and sociocultural underpinnings of mental illness and will apply this knowledge to the care of outpatients.
1. Psychiatry residents will conceptualize mental illness in terms of biological, psychological, and sociocultural factors that determine normal and disordered behavior.
2. Residents will demonstrate advanced knowledge of the epidemiology, prevalence, diagnosis, treatment, and prevention of the psychiatric conditions most likely to affect psychiatric outpatients.
3. Residents will demonstrate knowledge of the biological underpinnings and modern etiological theories of mental illness that integrate recent findings in neuroscience.
4. Residents will understand the psychopharmacological treatment of mental illness, including treatment algorithms, the management of treatment-resistant illness, augmentation strategies and combination therapies.
5. Residents will appreciate that psychopharmacological treatment must take into account the wide variety of interactions with other pharmacologic agents, impact on other medical conditions, and full appreciation of all side effect problems including compliance, sleep, weight, sexual problems, and other organ system difficulties.
6. Residents will appreciate issues arising from the integration of psychopharmacology and psychotherapy.
7. Residents will understand the indications for and limitations of psychological testing and neuropsychological testing, and will understand the nature of various commonly used instruments such as the MMPI, Rorschach, Thematic Apperception Test, WAIS and Wechsler Memory Scale.
Practice-Based Learning and Improvement: Residents will be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.
1. Residents will seek feedback from their supervising faculty, including clinic supervisors, general supervisors and psychotherapy supervisors, about their own practice and will use this feedback to improve their performance.
2. Residents will locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems, including attendance at the monthly Evidence-Based Medicine conferences.
3. Residents will facilitate the learning of third and forth year medical students, And other health care professionals, including psychotherapists and case managers providing services to the residents’ outpatients.
Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families and other health care providers.
1. Residents will create and sustain therapeutic and ethically sound relationships with patients, including the use of open and honest communication, the maintenance of an empathic stance and the establishment of appropriate boundaries.
2. Residents will learn and use effective listening skills in interactions with patients, their family members and other health care providers.
3. Residents will recognize and monitor their emotional responses to patients and adjust their practice accordingly.
Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principals, and sensitivity to a diverse patient population.
1. Residents will provide care to outpatients that takes into account (a) medical record keeping, (b) risk management and quality assurance issues, (c) confidentiality, (d) collaboration with other providers, agencies and family members, (e) financial and health system issues, (f) legal and forensic issues and (g) other ethical concerns.
2. Residents will have appropriate interactions with representatives of the pharmaceutical industry and will appreciate the ways in which these interactions may affect their clinical practice.
3. Residents will demonstrate sensitivity and responsiveness to each patient’s age, gender, culture, ethnicity, religion and disabilities.
Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context of the mental health care system and the ability to effectively call on system resources to provide optimal care to outpatients.
1. Residents will appreciate the economics of outpatient mental health care, including practicing cost-effective health care that does not compromise quality of care.
2. Residents will recognize issues that can arise in outpatient practice, including: (a) interaction with staff members; (b) management of patient records and other information systems; (c) scheduling; (d) cross-coverage among practitioners; (e) various practice styles among practitioners; (f) billing and payors (including Medicare, Medicaid, HMO’s and private insurance); (g) office and space management.
3. Residents will understand the regulation of outpatient psychiatric treatment, including: (a) patient confidentiality and HIPAA; (b) state regulations regarding involuntary treatment; (c) state regulations regarding guardianship; (d) governmental and other regulation of outpatient clinics, including JCAHO and state inspectors; (e) other regulations specific to UW Health and WisPIC.
7. Residents will advocate for quality patient care and assist patients in dealing with the complex mental health system.
Goals and Objectives of the VA Platinum Team in the Six Core Competencies
I. PATIENT CARE:
1) Gain experience with managing acute suicidality, mania, psychosis, and substance intoxication/withdrawal.
2) Gain experience with educating patients on methods (pharmacological and psychosocial) to reduce risk of exacerbation of symptoms.
II. MEDICAL KNOWLEDGE
1) Develop knowledge of psychiatric diagnoses beyond the DSM-IV criteria to include epidemiology, differential diagnosis, disease course, and prognosis.
2) Gain experience with using psychotropic medications, including less commonly used ones (such as clozapine).
III. PROFESSIONALISM
1) Gain experience dealing with veteran population with its own specific challenges.
IV. INTERPERSONAL COMMUNICATIONS
1) Develop skills to communicate effectively with other health care providers and family members.
2) Gain experience with coordinating care among different specialties (non-pscychiatric doctors, psychologists, social workers, etc.)
V. SYSTEMS BASED PRACTICE
1) Develop experience working in a health care system (VA) with its own benefits and limitations.
2) Develop appreciation for relative costs of different treatments and choosing among them appropriately.
VI. PRACTICE BASED LEARNING
1) Develop ability to evaluate when treatment plan needs modification or adaption to patients' particular psychosocial situation.
2) Develop ability to know when to ask for assistance.
Outpatient PGY-3:
I. PATIENT CARE:
1) Gain experience with long-term management of chronic psychiatric illnesses and personality disorders.
2) Gain experience with psychiatric diagnoses less often seen on inpatient units (anxiety, ADHD, sexual disorders, sleep disorders, etc.)
3) Gain experience with educating patients on methods (pharmacological and psychosocial) to reduce risk of exacerbation of symptoms.
II. MEDICAL KNOWLEDGE
1) Develop knowledge of psychiatric diagnoses beyond the DSM-IV criteria to include epidemiology, differential diagnosis, disease course, and prognosis.
2) Gain experience with using psychotropic medications, including when to consider tapering off medication if patient has been asymptomatic.
III. PROFESSIONALISM
1) Gain experience dealing with veteran population with its own specific challenges.
2) Gain experience as semi-independent providers with increased autonomy.
IV. INTERPERSONAL COMMUNICATIONS
1) Develop skills to communicate effectively with other health care providers and family members.
2) Gain experience with coordinating care among different specialties via consults and referrals.
V. SYSTEMS BASED PRACTICE
1) Develop experience working in a health care system (VA) with its own benefits and limitations.
2) Develop appreciation for relative costs of different treatments and how they impact patients.
3) Develop experience with referring to non-hospital based resources (vocational rehab, substance rehab, etc.)
VI. PRACTICE BASED LEARNING
1) Develop ability to evaluate when treatment plan needs modification or adaption to patients' particular psychosocial situation.
2) Develop ability to know when to ask for assistance.
Goals and Objectives of the VA Silver Team in the Six Core Competencies
I. PATIENT CARE:
The residents are assigned to a teaching team which consists of a staff Psychiatrist, Geriatric psychiatry fellow and one medical student. The patient population is roughly 85% male and 15% female. Residents have priority in seeing women patients to ensure that they have an adequate exposure. The patient population includes about 35% African American, 5% Latino and 60% Anglo. They get to see wide range of individual and family Psychopathology. All patients are 62 year and older and about 50% are WWII veterans. They have wide range of socioeconomic statuses. They Gain experience with managing acute suicidality, mania, psychosis, depression, dementia with neurobehavioral problems and substance intoxication/withdrawal. They also gain experience in cognitive and functional rating scales, crisis intervention and integration of support services in collaboration with the Team.
Residents also do 2-3 outpatient initial evaluations per week supervised by assigned attending to improve diagnostic skills, develop a comprehensive treatment plan and this is followed by discussion on psychodynamic formulation.
II. MEDICAL KNOWLEDGE
1) Develop knowledge of psychiatric diagnoses in the elderly beyond the DSM-IV criteria to include epidemiology, differential diagnosis, disease course, and Prognosis. Know what a geriatric psychiatrist does. Know what specialized training is needed/available in this field.
2) Cognitive Disorders: Delirium and Dementia
a. Know the characteristics of delirium.
b. Know predisposing factors for delirium.
c. Know causes and treatment of delirium.
d. Be able to differentiate between delirium and dementia.
e. Know the diagnostic criteria for different dementias.
f. Know how to clinically evaluate delirium and dementia.
g. Gain experience in using rating scales (MOCA, Mini Cog, and MMSE) and their functional correlation. Also gain experience with evaluation and interpretation of formal cognitive tests.
h. Know about current treatments for dementia.
i. Know how to manage neurobehavioral complications of dementia.
3) Cognitive Enhancers and Neuroprotective Agents
a. Know the characteristic brain lesions in Alzheimer’s disease and other dementias.
b. Be familiar with the different hypotheses for the etiology of Alzheimer’s disease and other dementia's.
c. Understand the rationale behind the various agents used to treat Alzheimer’s disease.
d. Polypharmacy.
III. PROFESSIONALISM
1) Gain experience dealing with Geriatric veteran population with its own specific challenges.
IV. INTERPERSONAL COMMUNICATIONS
1) Develop skills to communicate effectively with other health care providers and family members.
2) Gain experience with coordinating care among different specialties (non-psychiatric doctors, psychologists, social workers, etc.)
V. SYSTEMS BASED PRACTICE
1) Develop experience working in a health care system (VA) with its own benefits and limitations.
2) Develop appreciation for relative costs of different treatments and choosing among them appropriately.
VI. PRACTICE BASED LEARNING
1) Develop ability to evaluate when treatment plan needs modification or adaption to patients' particular psychosocial situation.
2) Develop ability to know when to ask for assistance.
3) Develop experience with referring to non-hospital based resources (vocational rehab, substance rehab, day care, Alzheimer's association etc.)
Goals and Objectives of Nexus Recovery Center in the Six Core Competencies
I. Patient Care
1. The resident will learn how to perform a comprehensive dual diagnosis evaluation
2. The resident will learn how to do rational psychopharmacology in dual diagnosis patients and use medications indicated for the treatment of substance use disorders such as alcoholism and opioid dependence
3. The resident will conduct psychoeducational group sessions with dual diagnosis patients
II. Medical Knowledge
1. The resident will increase their fund of knowledge in the recognition and diagnosis of substance abuse and dependence
2. The resident will increase their fund of knowledge in how to differentialte between substanced induced and primary mood and psychotic disorders
3. The resident will increase their fund of knowledge in the proper use of medications in pregnant women and women of child bearing age
III. Professionalism
1. The resident will collaborate in a multidisciplinary team consisting of nursing, addiction counseling and social work staff
2. The resident will perform staff training and education through an inservice lecture
3. The resident will maintain appropriate professional boundaries with staff and clients
IV. Interpersonal Communications
1. The resident will be encouraged to communicate openly and professionally with clients and staff at all levels. Resident will be encouraged to participate in staff meetings and clinic-based morale and cohesion building activities.
V. Systems Based Practice
1. Resident will learn how to provide effective treatment within the parameters of the state medicaid, drug court and private insurance systems.
VI. Practice Based Learning.
1. Resident will work closely with senior clinician and mentor to identify teachable moments and translate clinical experience and guided reading into a practice of life-long learning.
