The General Adult Psychiatry Clinics provide diagnostic evaluation and treatment for a range of psychiatric disorders in adults, including bipolar and unipolar affective disorders, anxiety disorders, adjustment disorders, attentional disorders, personality disorders, and some psychotic disorders. The general clinics provide medication management and limited psychotherapy but can refer within the clinic for short and long term psychotherapy and neuropsychiatric testing. The clinics collaborate with primary care providers in the evaluation and treatment of medical problems which may intersect with psychiatric presentations, such as sleep disorders, some cortical and subcortical dementias which are comorbid with affective disorders, and the common renal, thyroid, hematologic and hepatic consequences of medications commonly used in psychiatric practice.  PGY-3 residents spend twelve months in the General Clinics.

Please note the Goals and Objectives listed here apply not only to the General Adult Clinics but also to all the Adult Outpatient Subspecialty Clinics, though the latter may have additional specific Goals related to the subspecialty of each clinic.

PATIENT CARE:

At the end of the twelve-month rotation, the resident will have acquired:

  • the ability to complete a thorough general psychiatric diagnostic assessment
  • the ability to formulate a case, integrating biological, psychological, and social issues
  • the ability to generate and carry out a plan of care, including pharmacological, psychological and social interventions
  • the ability to identify issues and patterns better approached by psychotherapy than by medication

MEDICAL KNOWLEDGE:

The resident will know and understand:

  • the various presentations of depression, bipolar disorder, anxiety disorders, and adjustment disorders and other disorders mentioned above, and how to differentiate among them.
  • the pharmacologic management of these disorders, and the complications attendant to the use of SSRI's TCA's, MAOI's, mood stabilizers, stimulants, and atypical antipsychotics
  • the treatment of refractory mood and anxiety disorders
  • the types of psychotherapy, and their indications, which are effective in managing the problems seen in a general psychiatry clinic.

PRACTICE-BASED LEARNING AND IMPROVEMENT

The resident will be conversant with standards for metabolic screenings, assessment of movement disorders, Depression and Anxiety written inventories, and other standards of care, and will incorporate these measurements into patients' medical records.  The resident will be observed in many patient interactions by the attending and will receive feedback on those observations including issues of rapport, adherence, patient education and formulation of a treatment plan shared with the patient.

INTERPERSONAL AND COMMUNICATIONS SKILLS:

The resident will be able to:

  • create a collaborative relationship with a wide variety of patients, some difficult to engage, so as to gain essential information and build and implement a therapeutic plan
  • educate patients and their families
  • demonstrate an understanding of the stresses involved in having a chronic psychiatric illness
  • supervise and educate medical students about psychiatric illnesses, interviewing techniques and presentation skills.

PROFESSIONALISM:

The resident will demonstrate:

  • respect for patient autonomy and choice
  • willingness to seek supervision for psychotherapeutic and pharmacologic assessments and interventions

SYSTEMS-BASED PRACTICE

When appropriate and only with the written consent of the patient, the resident will communicate with ancillary medical providers, mental health providers, and other relevant sources of information or providers of education, structure and/or care to the patient, to establish and maintain an optimal treatment plan.

The Anxiety Disorders Clinic provides consultation and treatment on treatment-refractory cases that are often referred from the Department, Hospital, and community. The Clinic is composed of one faculty psychiatrist, 1-2 resident psychiatrist(s), one faculty clinical psychologist with cognitive-behavioral therapy expertise, 1-2 clinical psychology interns, and 2 clinical psychology externs. This multidisciplinary team meets weekly in case-based discussions and didactic sessions.

At the end of this rotation, residents will understand and display competence in the following:

PATIENT CARE/MEDICAL KNOWLEDGE

  • Techniques used in the evaluation of adults with anxiety disorders including evaluation of previous pharmacologic, somatic, and psychotherapeutic treatments.
  • Initial and follow-up treatment (both pharmacologic and psychotherapeutic) of anxiety disorders, including strategies for choosing a new treatment based on the previous treatment history and presentation of the patient; Familiarity with the literature related to the effectiveness of these treatment approaches, including newly emerging evidence-based medical practices.
  • Interactions between drugs used in anxiety disorders treatment, as well as interactions with drugs used for medical illnesses; side effects, indications and contraindications of the various treatments, and expected treatment response
  • Techniques used in the evaluation and treatment of adults comorbid presentations of anxiety disorders and other major psychiatric disorders (mood, alcohol/substance abuse, and dependence, etc.).

INTERPERSONAL AND COMMUNICATION SKILLS

  • Education of patients about anxiety disorders
  • Engagement of patients in treatment.

PROFESSIONALISM

  • Collaboration with referring clinicians/professionals and clinical psychologists.

PGY-3 residents spend 6 months in this clinic.  At the end of this rotation, residents will display the following:

PATIENT CARE

  1. An ability to engage, collect information, evaluate, diagnose and establish a treatment plan for geriatric patients who present with dementia, neuropsychiatric and psychiatric symptoms.
  2. Ability to complete in-depth assessments to determine the correct diagnosis while attending to possible co-morbid medical and neuropsychiatric diagnoses.
  3. Ability to treat patients and their families using the mode of treatment most suitable for the patient in their current situation.

MEDICAL KNOWLEDGE:

  1. Knowledge of the techniques and interview styles used in the evaluation of older adults with sensitivity to cognitive disorders what are common in this population.
  2. Knowledge of the multiple medical disorders that are co-morbid with and often precipitate psychiatric symptoms in older adults.
  3. Knowledge of the various pharmacological modalities used in treating psychiatric disorders in older adults and the literature related to their effectiveness.
  4. Knowledge of the psychopharmacologic interventions used in the treatment of cognitive disorders in older adults
  5. Knowledge of the indications and possible side effects for each of the treatments listed above.
  6. Ability to understand and use neuropsychological data, various imaging, and laboratory data to arrive at the correct diagnosis and treatment plan for each individual.

INTERPERSONAL AND COMMUNICATION SKILLS:

  1. Ability to educate patients and families regarding psychiatric and cognitive disorders in the older adult population.
  2. Ability to collaborate effectively with other members of the treatment team, such as primary care physicians and other therapists

PROFESSIONALISM:

  1. Respect for the patient's and the family's stress during evaluation and treatment of psychiatric disorders in older individuals for whom this may be the first contact with psychiatry.
  2. Willingness to explain and discuss findings to patients, caregivers, and their families
  3. Respect for, and communication with referring physicians, therapists, and caregivers to optimize treatment.

SYSTEMS BASED PRACTICE:

  1. Knowledge regarding the multiple systems of families, caregivers and agencies necessary for the treatment of many older adults.

PGY-3 residents spend 12 months in child and adolescent psychiatry clinics

MEDICAL KNOWLEDGE

The resident will be able to:

  • Understand normal growth and development
  • Be familiar with the various diagnostic conditions seen during childhood and adolescence including ADHD, Conduct Disorder, Anxiety Disorders, Substance Abuse Disorders, and Learning Disabilities
  • Understand the difference in symptomatology between children, adolescent, and adults
  • Understand the occurrence of commonalities in children and adolescents
  • Develop competency and appropriately prescribe and manage stimulant medication for ADHD including Ritalin, Dexedrine, and Adderal
  • Develop competency and appropriately prescribe and manage non-stimulant medication for ADHD including Wellbutrin, Clonidine, and Strattera
  • Develop competency and appropriately prescribe and manage SSRI medications for depression and anxiety
  • Understand the use of antipsychotics
  • Understand the use of mood stabilizers
  • Be aware of the various structured diagnostic tests (CBCL, Conners, CDI, etc.)

PATIENT CARE

The resident will be able to:

  • Master techniques and strategies for diagnostic assessment of preschool, school-age, and adolescent patients
  • Understand the importance and impact of family dynamics among children and adolescence
  • Understand the importance and impact of school experiences and peer relationships
  • Become familiar with the various classifications of medications and their appropriate uses with child and adolescent patients
  • Be familiar with techniques and applications of play therapy
  • Gain experience with behavior modification techniques, parent management techniques, brief therapy, and longer-term psychodynamic therapy

INTERPERSONAL AND COMMUNICATIONS SKILLS

The resident will demonstrate an ability to:

  • interview children at various ages including toddlers, latency age, and adolescents, and will understand how to adapt an interviewing style to elicit information
  • interview families so as to elicit important diagnostic information and to provide information, instruction, and reassurance as appropriate

At the end of this rotation, residents will display the following:

PATIENT CARE:

  1. Ability to complete in-depth assessments to determine the correct diagnosis while attending to possible co-morbid medical and neuropsychiatric diagnoses.
  2. Ability to treat patients and their families using the mode of treatment most suitable for the patient in their current situation.
  3. Ability to understand and use neuropsychological data, various imaging, and laboratory data to arrive at the correct diagnosis and treatment plan for each individual.

MEDICAL KNOWLEDGE:

  1. Knowledge of complete and detailed neurological and psychiatric assessments needed for the evaluation of adults with cognitive disorders.
  2. Knowledge of the multiple medical, neurological and psychiatric disorders that underlie cognitive complaints in adults.
  3. Knowledge regarding the various imaging and laboratory tests that are needed to assess cognitive disorders and their stages.
  4. Knowledge of the various types of genetic and acquired cognitive disorders, such as Alzheimer's disease, vascular dementia, frontotemporal dementia and others, their etiology, pathology and clinical presentations.
  5. Knowledge of the psychopharmacologic interventions used in the treatment of cognitive disorders.
  6. Knowledge of the types and indications for various neuropsychological tests and their interpretation.

INTERPERSONAL AND COMMUNICATION SKILLS:

  1. Ability to educate patients and families regarding psychiatric and cognitive disorders in the older adult population.
  2. Ability to collaborate effectively with other members of the treatment team, such as primary care physicians and other therapists

PROFESSIONALISM:

  1. Respect for the patient's and the family's stress during the evaluation and treatment of cognitive disorders in older and middle-aged individuals.
  2. Willingness to explain and discuss findings to patients, caregivers, and their families
  3. Respect for, and communication with referring physicians, therapists, and caregivers to optimize treatment.

The Treatment-Refractory Mood Disorders Clinic provides consultation and treatment for referred patients.

At the end of this rotation, residents will display the following:

PATIENT CARE:

  1. Ability to complete in-depth assessments to determine the diagnosis of Treatment Refractory Mood Disorders (TRMDs).
  2. Ability to treat patients with TRMDs using the mode of treatment most suitable to the particular situation
  3. Ability to educate patients and families regarding TRMDs.
  4. Ability to collaborate effectively with family and referring professionals.
  5. Ability to complete psychopharmacologic assessments of TRMD patients and to follow-up these patients

MEDICAL KNOWLEDGE:

  1. Knowledge of the techniques used in the evaluation of adults with treatment-resistant mood disorders (TRMDs), including evaluation of previous pharmacologic, somatic, and psychotherapeutic treatments.
  2. Knowledge of the various treatments used in TRMDs, strategies for choosing a new treatment based on the previous treatment history and presentation of the patient.  Familiarity with the literature related to their effectiveness, including newly emerging evidence.
  3. Knowledge of interactions between drugs used in mood disorders treatment, as well as interactions with drugs used for common medical disorders. Knowledge of side effects of the various treatments, and available treatment responses to them.
  4. Knowledge of the various psychotherapeutic components of supportive psychotherapy with treatment-resistant mood disorders patients, including teaching the patient self-observation, dealing with suicidal impulses, and recognition of mood swings and their impact on judgment and impulsivity.

INTERPERSONAL AND COMMUNICATION SKILLS:

  1. Ability to form an alliance with patients with TRMDs and their families, in order to collect information, establish a diagnosis, provide education and implement a treatment plan. 

PROFESSIONALISM:

  1. Respect for the patients and the family's' stress during evaluation and treatment
  2. Willingness to seek supervision for all treatments, especially those which engender strong countertransference responses
  3. Respect for the members of the treatment team and their differing roles

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 several 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 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 the 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 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 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 illness, what are the barriers, internal and external, to recovery, and how psychiatrists and institutions can be of assistance

PATIENT CARE:

The resident will demonstrate an:

  1. Ability to deal effectively with the issues and concerns that the college and graduate student population present to psychopharmacological management.
  2. Ability to deal effectively with the concerns of students who are worried about any consequences of long-term medication management but have a clear clinical indication for prolonged pharmacologic treatment.

MEDICAL KNOWLEDGE:

The resident will display a:

  1. Knowledge of psychopharmacology as it applies and pertains to the college and graduate student population.
  2. Knowledge of the particular issues involved with long-term maintenance psychopharmacologic treatment.

INTERPERSONAL AND COMMUNICATIONS SKILLS:

The resident will display a:

  1. Willingness to be flexible so as to be able to accommodate the behaviors that result from the pressures of student life.
  2. Capacity to participate as a team member in a group of mental health professionals responsible for the mental health care of a university student body.

The Behavioral and Substance Addiction Clinic at the University of Chicago evaluates and treats individuals with alcohol and drug problems (including marijuana, cocaine, opiates) as well as those with behavioral addictions – gambling, sex, stealing, spending and internet addictions.  Residents rotate through this clinic for 6-month blocks and see one new diagnostic evaluation and three follow-up patients per clinic.  This clinic is run by Jon Grant, M.D.

PATIENT CARE

Residents will learn to evaluate, diagnose, and manage patients with a range of addictive behaviors, implement evidence-based treatment approaches to addictive behaviors, and address common comorbidities.

MEDICAL KNOWLEDGE

Residents will demonstrate knowledge of evidence-based treatment approaches to addictive behaviors

INTERPERSONAL AND COMMUNICATIONS SKILLS

Residents will create rapport with and patients with histories of addiction and will develop skills at eliciting comprehensive histories from patients with addictive behaviors.

PROFESSIONALISM

Residents will develop and demonstrate a respectful attitude toward patients with addictive disorders

SYSTEMS BASED PRACTICE

Residents will become aware of the range of services for patients with addictive behaviors including inpatient and outpatient substance use programs, self-help groups, and other available resources.

PATIENT CARE:

The resident will learn:

  1. To serve in the role as the primary psychiatrist, with attending backup on-site, for 40 patients with personality disorders and comorbid disorders
  2. To conduct intake interviews thereby establishing diagnoses, generating problem lists and treatment plans, as well as initiating treatment for patients with personality disorders and comorbid disorders
  3. To integrate recent advances in our understanding of personality psychopathology in treatment planning

MEDICAL KNOWLEDGE:

The resident will:

  1. Learn about the range of medication options for patients with personality disorders and comorbid disorders
  2. Learn to monitor weight gain and metabolic issues of commonly prescribed psychotropic medications
  3. 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.

INTERPERSONAL AND COMMUNICATIONS SKILLS:

The resident will Conduct supportive psychotherapy for select patients who are currently going undergoing crises, going through transitions, or otherwise are appropriate for these services.

SYSTEMS-BASED PRACTICE

The resident will learn to coordinate care and treatment plans with the patients, primary care doctors, psychotherapists, and social workers.

PGY-2 residents begin to treat 3 patients in psychotherapy, and PGY-3 residents increase their psychotherapy caseload to 8-10 patients per week in psychodynamic, CBT and supportive psychotherapy.  PGY-4 residents continue to work with psychotherapy patients electively.  The following Goals and Objectives apply to all psychotherapeutic modalities.

PATIENT CARE

The resident will be able to:

  • Establish and maintain a treatment frame (e.g., time, space, outside agencies/relationships, setting schedules and sticking to times)
  • Enable the patient to actively participate in the treatment
  • Establish a treatment focus. Provide a holding environment
  • Recognize and specifically describe affects
  • Tolerate direct expressions of hostility, affection, sexuality and other powerful emotions
  • Identify problems in collaborating with the treatment/therapist
  • Recognize obstacles to change and an understanding of possible ways to address them
  • Maintain focus in treatment when appropriate
  • Confront when appropriate
  • Assess readiness for and manage termination from treatment
  • Assess the patient's readiness for specific interventions
  • Assess the patient's response to specific interventions

MEDICAL KNOWLEDGE

The resident will be able to:

  • Recognize defenses in clinical phenomena
  • Identify aspects of an ongoing case in terms of theories of drive and defense, internalized object relationships, and consideration of the patient's self-experience
  • Link present to past as demonstrated by understanding the patient's present pattern of thought, feeling, action and relationship in terms of his or her past personal experience
  • Identify and elicit automatic thoughts and cognitive errors in thinking, and develop and implement a treatment plan employing CBT strategies and techniques

PROFESSIONALISM

The resident will be able to:

  • Establish and maintain a professional relationship
  • Understand and protect the patient from unnecessary intrusions into privacy and confidentiality
  • Handle financial arrangements with a patient in a manner appropriate to the treatment context.
  • Recognize and tolerate one's uncertainties as a trainee in psychotherapy
  • Recognize, contain and make therapeutic use of countertransference
  • Maintain a therapeutic alliance in the face of transference distortions, using concepts of neutrality, abstinence, empathy, and support in an appropriate manner
  • Manage termination issues within the context of a psychodynamic psychotherapy

INTERPERSONAL AND COMMUNICATION SKILLS

The resident will be able to:

  • Establish rapport
  • Understand and develop a therapeutic alliance with the patient
  • Recognize a variety of forms of therapeutic alliances including negativistic ones
  • Recognize and attempt to repair disturbances in the alliance
  • Listen to nonjudgmentally and with openness
  • Facilitate the patient talking openly and freely
  • Empathize with the patient's feeling states
  • Convey empathic understanding
  • Communicate appropriately with others treaters within the Department of Psychiatry
  • Communicate appropriately with the patient's permission with referring physicians, and others outside the Department of Psychiatry

PROBLEM-BASED LEARNING

The resident will be able to:

  • Recognize and describe (to the supervisor) one's own affective response to the patient
  • Establish an educational alliance with the supervisor
  • Incorporate material discussed in supervision into the psychotherapy

PSYCHOTHERAPY LEARNING OBJECTIVES FOR SPECIFIC PSYCHOTHERAPEUTIC MODALITIES

BRIEF AND CRISIS INTERVENTION

The resident will be able to:

  • Establish a therapeutic alliance with the patient
  • Identify the precipitating event (stressor) and the patient's reactions to
  • Identify history of the patient's usual coping mechanisms facilitate the patient's expression of emotions
  • Normalize the patient's emotional reactions to the event in the setting of crisis, when appropriate
  • Focus the therapy on the precipitating crisis
  • Provide support to the patient
  • Actively listen to the patient to enhance understanding
  • Provide psychoeducation about the crisis
  • Help the patient develop adaptive coping mechanisms and identify additional sources of support
  • Identify patient strengths and to reflect these back to the patient
  • Establish achievable therapeutic goals with the patient
  • Rapidly obtain collateral information where appropriate
  • Know community resources and be able to make timely and safe dispositions

PSYCHODYNAMIC PSYCHOTHERAPY

The resident will be able to:

  • Identify and effectively begin treatment with a suitable patient for psychodynamic psychotherapy
  • Identify aspects of an ongoing case in terms of theories of drive and defense, internalized object relationships, and consideration of the patient's self-experience
  • Link present to past as demonstrated by understanding the patient's present pattern of thought, feelings, action, and relationship in terms of his or her past personal experience
  • Identify and respond appropriately and flexibly to a variety of defenses in the clinical setting
  • Effectively confront, clarify and interpret previously preconscious and unconscious material in the therapeutic setting
  • Facilitate the discovery of latent meaning of clinical material (e.g. dreams, associations, transference material, etc.)
  • Recognize and make therapeutic use of transference
  • Recognize, contain and make therapeutic use of countertransference
  • Maintain a therapeutic alliance in the face of transference distortions, using concepts of neutrality, abstinence, empathy, and support in an appropriate manner
  • Manage termination issues within the context of a psychodynamic psychotherapy

COMBINED PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY

The resident will be able to:

  • Integrate biological and psychological aspects of a patient's history
  • Provide psychoeducation about psychiatric illness and the risks/benefits of commonly prescribed psychotropics
  • Understand how the meaning of a medication to a patient can have a significant impact on its efficacy and learn how to explore what medications mean to a patient
  • Use the placebo effect to more successfully prescribe medications
  • Demonstrate a basic understanding of diagnosis-specific psychotherapy and medication management
  • Have a basic understanding of medico-legal and psychotherapeutic issues in the context of one person prescribing medication and another person providing psychotherapy: confidentiality, informed consent, and collaboration
  • Use the concepts of transference and countertransference in prescribing medications in a therapeutic manner
  • Recognize the ways that prescribing mediation can enhance or hinder psychotherapy and ways that psychotherapy can enhance or hinder medication management
  • Identify the psychological aspects of non-adherence

COGNITIVE BEHAVIORAL PSYCHOTHERAPY

The resident will be able to:

  • State the cognitive model
  • Socialize patient into cognitive model
  • Use structured cognitive-behavioral model including mood check, bridging to prior session, agenda setting, and review of homework, capsule summaries, and patient feedback
  • Identify and elicit automatic thoughts
  • Use Dysfunctional Thought Records as a tool in therapy
  • Use Activity Scheduling as a tool in therapy
  • Identify common cognitive errors in thinking
  • Use behavioral techniques as a tool in therapy
  • Plan booster session's, follow-up, and self help sessions appropriately with patients when terminating active therapy

SUPPORTIVE PSYCHOTHERAPY

The resident will be able to:

  • Assess regressive and adaptive shifts in ego functioning
  • Make interventions specifically in support of a patient's ego functions, including defensive operations
  • Deliberately take a non-interpretative stance in relation to a defensive operation in a patient
  • Recognize internal conflict and help a patient contain it without an emphasis on interpretation
  • Be directive: give advice set limits, and educate when appropriate with a patient. Make appropriate manipulations of the environment or take action on behalf of a patient

The clinical forensic experience is, of necessity, a part-time experience.  At a minimum, the resident should write at least one in-depth medicolegal evaluation in which the relevant legal question is addressed, using medical records, psychological testing and the clinical interview as appropriate to substantiate the opinions offered.  In addition, to the extent possible, the resident is encouraged to witness medicolegal testimony at deposition and/or trial.

 PATIENT CARE

The resident should develop the skills to

  • evaluate individuals treated on other services for issues of decisional capacity.
  • prepare relevant legal documents for purposes of involuntary admission and treatment.

 MEDICAL KNOWLEDGE

The resident should

  • Acquire the knowledge base and skills to appropriately evaluate individuals subject to involuntary commitment and/or involuntary treatment.
  • Be able to relate clinical information (e.g., medical records, psychological testing, clinical interview) to a specific question in the legal context (e.g. competency to stand trial, suitability for conditional release following a successful insanity plea, psychological damages in civil cases, etc.)
  • Be able to explicate the differences in purpose and organization between a clinical and a medicolegal evaluation, including the different ethical responsibilities entailed

PATIENT CARE

The resident will evaluate, diagnose and treat patients with:

  • complex neuropsychiatric problems
  • neurological illness and co-morbid psychiatric disorders
  • psychiatric disorders presenting with neurological symptoms
  • neurological disorders presenting with psychiatric symptoms

MEDICAL KNOWLEDGE

The resident will demonstrate knowledge of:

  • neuroanatomy and neurophysiology as they pertain to patient presentations
  • common neurologic disorders and their management
  • presentations of neuropsychiatric syndromes
  • the intersection of neurology and psychiatry

SYSTEMS BASED PRACTICE

The resident will demonstrate:

  • an understanding of the consultation process, and responsivity to consultation questions and requests
  • an understanding of the resources available to patients at the interface of neurology and psychiatry

PATIENT CARE

The resident will understand and provide the psychiatric care of transplant patients before, during, and after their surgery.  Residents participate in diagnostic evaluations, treatment recommendations, and ongoing management.  Patients awaiting lung, liver, heart, and kidney transplant make up the initial patient population, but the clinic population includes many patients who are post-transplant. 

MEDICAL KNOWLEDGE  

Residents will

  • learn to assess the psychosocial readiness for a major medical procedure, a skill that translates to areas such as bariatric surgery, bone marrow transplant, and HIV care. 
  • gain an increased knowledge of the psychopharmacology considerations in a medically ill population and learn to work with the neuropsychiatric side effects of transplant-related medications. 

INTERPERSONAL AND COMMUNICATIONS SKILL

The resident will learn to work with patients with advanced medical illness and be sensitive to their physical limitations.

SYSTEMS-BASED PRACTICE

Residents will communicate with multidisciplinary transplant teams effectively, and receive feedback from them. 

PATIENT CARE

  • The resident will understand and provide the psychiatric care of cancer patients before, during and upon completion of cancer treatment. Referrals are received from all Medical Center Oncology Services (solid organ and hematological malignancies) and from local as well as regional geographic areas.
  • Residents participate in diagnostic evaluations, treatment recommendations, and ongoing management. 

MEDICAL KNOWLEDGE

Residents will

  • learn to evaluate psychiatric symptomatology in cancer patients and will become adept at distinguishing between symptoms arising directly from cancer or as the result of psychosocial adjustment to a devastating illness. 
  • gain an increased knowledge of the psychopharmacology considerations in a medically ill population and learn to work with the neuropsychiatric side effects of cancer-related treatments.
  • Learn to identify and promote adaptive coping abilities in patients and their families.

PRACTICE-BASED LEARNING AND IMPROVEMENT

  • Residents will have the opportunity to participate in ongoing QA/QI projects and present cases in M&M conferences.

INTERPERSONAL AND COMMUNICATIONS SKILLS

  • The resident will learn to work with patients with advanced medical illness and be sensitive to their physical limitations.
  • The resident will learn to work with the families of patients undergoing cancer treatment. 

PROFESSIONALISM

  • Residents will have a unique opportunity to gain an understanding of the concept of suffering and of compassion (“suffering with”).
  • Residents will have the opportunity to work with patients who are dying and to develop skills dealing with end of life issues.

SYSTEMS-BASED PRACTICE

  • Residents will communicate with multidisciplinary cancer treatment teams effectively and will incorporate feedback from them.
  • Residents will gain experience in liaising with community-based (Cancer resource Centers) and web-based resources (Care Pages, American Cancer Society, and Livestrong)

PATIENT CARE

  • The resident will understand and provide the psychiatric care of patients with complex medical and psychiatric co-morbidities.
  • Referrals are received from all Medical Center specialties and from local as well as regional geographic areas. Many patients have come to UCMC for tertiary treatment of complex multimorbidities.
  • Residents participate in diagnostic evaluations, treatment recommendations, and ongoing management.

MEDICAL KNOWLEDGE

Residents will

  • learn to evaluate psychiatric symptomatology in medical patients and will become adept at distinguishing between symptoms arising directly from medical illness (e.g. Multiple Sclerosis brain involvement) or as the result of psychosocial adjustment to a devastating illness. 
  • gain an increased knowledge of the psychopharmacologic considerations in a medically ill population and learn to work with the neuropsychiatric side effects of complex medical and psychiatric treatments
  • Learn to identify and promote adaptive coping abilities in patients and their families.

PRACTICE BASED LEARNING AND IMPROVEMENT

Residents will have the opportunity to participate in ongoing QA/QI projects and present cases in M&M conferences. 

INTERPERSONAL AND COMMUNICATIONS SKILLS

  • The resident will learn to work with patients with advanced medical illness and be sensitive to their physical limitations.
  • The resident will learn to work with the families of patients undergoing complex treatments.   

PROFESSIONALISM

  • Residents will have a unique opportunity to gain an understanding of the concept of suffering and of compassion (“suffering with”).
  • Residents will have the opportunity to work with patients who are dying and to develop skills dealing with end of life issues. 

SYSTEMS-BASED PRACTICE

  • Residents will communicate with multidisciplinary treatment teams effectively and will incorporate feedback from them.
  • Residents will gain experience in liaising with community based (IBD support groups) and web-based resources.