Education & Research ACGME Accredited Residency Programs Psychiatry Residency Program Program Curriculum and Didactic Inf ...
Program Curriculum and Didactic Information
Curriculum
PGY 1: The first year of residency training is spent rotating both in psychiatry and fulfilling AOA/ACGME required rotations in psychiatry, internal medicine and neurology.
PGY 1: 12 1-month blocks
3 IM Blocks
1 ED Block
2 Neurology Blocks
6 Psychiatry Blocks
Internal medicine blocks are spent on an inpatient general medical team. During these weeks, the resident is trained alongside other residents in the principles of hospital medicine. Emergency Department blocks are spent alongside ED residents taking care of patients with all emergency conditions, including procedures.
Neurology blocks are spent in inpatient and outpatient clinical neurology. Residents are exposed to both inpatient consult neurology as well as outpatient neurology clinic.
Four of the six monthly psychiatry blocks are spent on the Behavioral Health Inpatient Units at ARMC. As part of primary management of acutely ill hospitalized psychiatric patients, residents obtain exposure by working with other staff members of interdisciplinary treatment teams including clinical therapists, social workers, as well as occupational and group therapists. In addition, residents spend two months on the emergency triage service during which they develop skills in stabilization of patients with acute psychiatric issues. They may also be called upon to provide psychiatric consultation to patients on acute medical / surgical services.
At the conclusion of this year of training, PGY-1 residents are required to have met all level 1 ACGME psychiatry milestones. Graduates of US medical schools who complete thirty six months of training are currently eligible to apply for medical licensure in the State of California. (Residents with less than thirty six months of training operate under a Provisional Training License).
PGY 2: The second year of psychiatry training is mostly spent on stabilization of patients with acute psychiatric service prior to inpatient hospitalization. Four months of the second year are spent in the emergency room setting (Triage Service). Two of these six months are spent during regular daytime hours; and, in order to facilitate state dependent learning, two of these six months are spent on night float. Night float months are non-consecutive and require one full month of night duty during each block. Residents have access to immediately available direct supervision at all times with attending psychiatrists on site 24 hours per day.
Two non-consecutive months of the second year are spent providing consultation and liaison services to medical / surgical services. The medical center generates approximately 2200 consults per year. Residents receive indirect supervision with direct supervision immediately available during this experience. Senior residents and rotating residents from other residency programs may also be available on the C/L service to provide intensive liaison activities to the primary services.
One months are spent on the Community Reentry Evaluation Program with the goal of connecting healthcare recipients to intensive services in the community which preempt the need for inpatient hospitalization. In contrast to the Triage service who goal is initial evaluation of patients with acute psychiatric emergencies, the emphasis during the CSU rotation consists of disposition of patients with acute psychiatric crises in treatment in settings providing less restrictive care than in inpatient hospitalization services. During this service, residents may be required to “ride-along” with crisis stabilization teams to stabilize patients in their native environment.
Residents also spend one month on addiction treatment services during which they learn to manage patients whose lives are affected by substance use disorders. Techniques learned during this rotation include acute detoxification (including the use of Buprenorphine), stabilization and intermediate term management of patients with substance use disorders in both inpatient and outpatient settings. Residents will be encouraged to attend process groups involving patients suffering from these disorders.
In addition, residents spend one month on Geriatrics Psychiatry service at our affiliated elder care programs. During this experience, residents learn management of psychiatric disorders affecting patients older than age 55 in an interdisciplinary outpatient setting in concert with primary care geriatricians, geriatric psychologists, social workers, case managers and legal consultants. Residents will also be required to continue to follow their outpatients when these patients are admitted to inpatient services at ARMC in a consultative mode to inpatient primary care services. Faculty at ARMC with geriatric psychiatry qualifications will provide geriatric psychiatry supervision to residents on this service.
The final month of the second year is spent on the Maternal Fetal Medicine service. During this month, residents round with the MFM team learning to recognize and treat emerging psychiatric issues during pregnancy and in the peri-partum period.
At the conclusion of this year of training, current PGY-2 residents are required to have met all level 2 ACGME psychiatry milestones.
PGY 3: The third year of psychiatry training is spent entirely at outpatient psychiatric clinics in which residents learn to modify longitudinal course of psychiatric illnesses in outpatient clinics (Operated by San Bernardino County’s Department of Behavioral Health). Residents are expected with work with an interdisciplinary team of therapists and allied health professionals. While caring for patients in the adult clinics, residents receive indirect supervision with direct supervision available by scheduling with attending faculty. In addition to psychopharmacology, residents learn psychotherapeutic approaches and are encouraged to engage in long-term psychotherapy with selected patients for a period of up to two years. Up to 50% of the patients treated during the third year of training may be mandated by the court system to obtain psychiatric care to fulfill their legal diversion requirements.
During the third year of training, residents also obtain exposure to assessment and management of child & adolescent patients under direct supervision of child psychiatry faculty. This exposure is designed to be longitudinal contact with patients throughout the year. The Child / Adolescent rotation is discrete from the adult outpatient experience and is delineated by days of the week.
At the conclusion of this year of training, PGY-3 residents are required to have met all level 3 ACGME psychiatry milestones, and, after January 1, 2020, apply for licensure in the State of California. By the end of their PGY-3 year of training, residents will have completed all required rotations required by the certifying agencies WITH THE EXCEPTION OF time under training, thus facilitating the transition to combined fellowship training in ABPN certified subspecialties during their PGY-4 year.
PGY 4: The final year of psychiatric training is spent in a combination of supervisory inpatient psychiatry (up to 3 months), C/L Psychiatry with focus on liaison activities (up to 3 months), Administrative Psychiatry (1 month), Quality Improvement and Systems Based Practice (1 month), Supervisory Outpatient Psychiatry (1 month) and Elective time (up to 2 months) including time spent at a dedicated private research unit at a regional private hospital and exposure to electroconvulsive therapies / neuromodulation technologies. Senior residents are required to continue to spend 4 hours per week with long term psychotherapy patients with whom they began to work in their PGY-3 years.
PGY-4 residents are also expected to cover court hearings and testify on legal matters involving all inpatients at ARMC behavioral health and main hospital. Court hearing are held every Tuesday afternoon and Friday mornings, unless modified by holiday schedules as observed by the courts. Supervision for the court activities will consist of indirect supervision with immediately available direct supervision.
PGY – 4 residents will be expected to successfully complete three Clinical Skills Verification Examinations prior to the completion of their training (Some of these examinations may also be undertaken during the PGY-3 year). At the conclusion of this year of training, PGY-4 residents are required to have met a majority of level 4 ACGME psychiatry milestones and attain eligibility to challenge the written examination for board certification by the American Board of Psychiatry and Neurology.
Didactics
Lectures are typically held during one afternoon each week. During this time, residents are excused from psychiatric coverage to attend lectures. Topics include journal club, case presentations, psychopharmacology lectures, board review classes, mock board examinations, DSM review, and the role of psychiatry in society and research methodology. Residents are encouraged to present seminal journal articles as well as interesting cases they have found. In addition to above, residents meet with program director for one hour on a weekly basis to discuss current cases and topics.
Each resident is afforded four hours per week of dedicated research time. This research time is divided into two two-hour blocks which must be spent on campus engaged in active research. A publication / poster presentation grade research project or approved structured quality improvement project is required for graduation from the program.
Finally, each resident is permitted up to two two-hour blocks of time each week (to be arranged beforehand) to attend to medical appointments to care for their own health needs. Psychotherapy will be accommodated under aegis of medical appointments.