PGY-II General Adult Inpatient Rotation

Goal

The PGY-II psychiatric residents will strengthen their identity as responsible physicians caring for seriously ill psychiatric inpatients.

Objectives

The PGY-II residents will refine skills in the diagnosis and treatment of psychiatric inpatients, utilizing a team approach under close faculty supervision.
The PGY-II residents will become proficient in rational psychopharmacology and the indications for and administration of ECT. They will develop skills in empathic listening, interviewing, and psychotherapeutic intervention.
The PGY-II residents will begin to develop an identity as a teacher leading inpatient medication education classes.
The PGY-II residents will supervise University of Chicago medical students assigned to their service.

Locations

MacNeal Hospital Psychiatric Inpatient Service is composed of four units on the third and fourth floors of the North Building . These four units have a 48-bed capacity, divided as follows:

The Structured Treatment Units (35North & 42North) - 12 beds on the third floor and 12 beds on the fourth floor. These units are for the more chronic and severely ill patients.
ITU (32North) - 12 beds on the third floor. This unit is for higher functioning patients.
Geriatric Unit (33North) - 12 beds on the third floor. This unit is for patients over 65 years of age.

University of Chicago residents will have patients on all four units and their patients can be transferred between these units as their condition changes.

Responsible Teachers

House Cases
W. Egan, M.D. (weekdays)
J. Patras, M.D. (weekends)
L. Weiss, M.D. (weekends)
L. Kenfield, M.D. (weekends)

Supervision

Teaching faculty or their designee will round with the resident's six days a week.

Methods

Caseload : Up to six (6) inpatients during the two-month adult rotation. (See rotation outline below for clarification.)

	2 Months	2 Months	2 Months
Resident #1	Chemical Dependency	Geriatrics	General Psychiatry
Resident #2	General Psychiatry	Chemical Dependency	Geriatrics
Resident #3	Geriatrics	General Psychiatry	Chemical Dependency

Hours : Residents will be on the units from 8:00 a.m. to 12:30 p.m. five days per week. The weekend on-call resident will see the new admission(s) and will round Saturday. If there is a Saturday afternoon or evening admission or if a patient is on suicide precautions or in seclusion/restraints, the resident will also round on Sunday.
Documentation : Residents will see their patients a minimum of five days a week with no interval longer than 48 hours between visits. A SOAP progress note will be written documenting each visit.
Staffings : An initial staffing will occur within seventy-two (72) hours of admission, and then at least weekly. Staffings are multidisciplinary, with a case manager and a nursing staff member(s) in attendance.
Call : Each of the three PGY-II residents will be available by phone or pager for their patient's 24 hours a day, Monday through Friday. Weekends (5:00 p.m. Friday until 8:00 a.m. Monday) will be covered by the three PGY-II residents in rotation. The call roster will be arranged by the Chief Resident in collaboration with the PGY-II residents and the MacNeal Academic Director.
Teaching Conference : Dr. Kenfield will lead didactic topics and case presentation with emphasis on biopsychosocial and psychodynamic formulation.
Readings Course : This is a weekly one-hour course of classical readings taught by Dr. Egan. The three PGY-II residents will participate along with the third year medical students. Mock board examination preparation will occur 1-2 weeks per month.
Discharge Summary : Each resident is responsible for completing the Discharge Summary on his or her primary treatment patients. Instructions will be provided during the first week of the rotation.
Evaluation :
1. Ongoing feedback is given to the resident throughout the rotation by the supervising psychiatrist(s).
2. A written evaluation by the supervising attending will be completed prior to the last week of the rotation. This evaluation will be discussed with the resident by the MacNeal Academic Director for Psychiatry before it is sent to the Residency Director's office.
3. A resident's assessment of the rotation should be completed by the last week of the rotation before it is sent to the Residency Director's office. The resident has the option of discussing this assessment of the MacNeal educational experience with the attending.
At the end of this rotation, residents will display the following:
Knowledge and Skills:
1. Knowledge and skills in the diagnoses and treatment of the major psychiatric disorders.
2. Knowledge and skills in the prescribing of psychotropic medications, their indications, side effects and contraindications.
3. Knowledge and skills in the formulation of a biopsychosocial treatment plan.
4. Knowledge and skills in working with a multidisciplinary treatment team.
5. Knowledge and skills in empathic interviewing and psychodynamic understanding of patient's present and past history.
Attitudes
1. Respect for patients and their family.
2. Respect for members of the multidisciplinary treatment team.
3. Respect for fellow residents and faculty.