PGY-2 Continuing Care Clinic CCC (Schizophrenia)

PGY-2 residents spend six months in the  continuing care clinic.  The CCC provides services for patients with chronic severe mental illnesses. The clinic includes a medication management clinic, a support group, and everal psychotherapy groups geared to people at different stages of recovery. Patients are generally stable and the goal is to help them manage setbacks, prevent hospitalization, and progress towards recovery. In addition, the clinician should always be trying to minimize symptoms that previously were not recognized or had been accepted as optimally managed. The clinic relies heavily on making use of other psychosocial rehabilitation services in the Chicagoland area. Besides resident physicians and the attending, the clinic is staffed by a clinical nurse practitioner.

Patient Care:

The resident will competently:

  1. serve in the role as the primary psychiatrist, with attending backup, for 40 patients with chronic severe mental illness.
  2. define target symptoms and then choose an appropriate intervention (e.g. medication, supportive therapy, cognitive behavioral therapy, environmental intervention).
  3. interact with patients, their families, referral agencies and support staff in developing long term treatment plans.
  4. project a sense of optimism, and promote independence without unnecessarily placing patients at a risk of  further disappointment.
  5. Conduct supportive psychotherapy for select patients who are currently going undergoing crises, going through transitions, or otherwise are appropriate for these services.
  6. Identify when countertransference issues or unfair patient demands are interfering with the resident's ability to provide appropriate clinical care.
  7. Identify patients who are unable or unwilling to make use of the clinic environment despite reasonable efforts on the teams’ part, and learn how to refer them to more appropriate settings.

Medical Knowledge:

The resident will know:

  1. Advantages and risks of typical and atypical antipsychotic medications, in particular:
    • learn to identify and treat tardive dyskinesia in its earliest stages.
    • become familiar with means of preventing life-threatening complications of clozapine.
    • become aware of risk factors and clinical significance for the metabolic syndrome and the means of preventing it.
    • identify and treat extrapyramidal syndromes.
  2. Learn about range of medication options for patients with severe mental illness, and what medications are likely to be most effective in diminishing particular symptoms. Learn to monitor for therapeutic efficacy and toxicity for each of these agents.
  3. Learn to monitor and treat side effects of psychotropics, especially EPS, metabolic issues, neutropenia.

Interpersonal and Communication Skills:

The resident will:

  1. Learn to generate short and long term treatment plans for patients, how to communicate them to patients and families, and modify them based on patient feedback.
  2. Learn to deal with difficult patients and family members without rupturing a therapeutic alliance.
  3. Learn to identify the resident's own vulnerabilities and sensitivities in this regard so that he/she cannot be ‘blind-sided’.

Professionalism:

The resident will learn to:

  1. project a sense of optimism, and promote independence without unnecessarily placing patients at a risk of further disappointment.
  2. show concern and compassion with being either patronizing or overly-involved.

Systems-Based Practice

The resident will:

  1. Understand what it is like to have a severe mental illlness, what are the barriers, internal and external, to recovery, and how psychiatrists and institutions can be of assistance