Education

Psychiatry Residency

The major goal of our residency training program is to prepare our graduates to be competent, well-informed, caring clinicians and scientists who are prepared to manage any challenge in psychiatry by utilizing the latest scientific information and by critically applying sound reasoning skills. We prepare our graduates to be competent in every major area of psychiatric diagnosis and treatment and to be dedicated to their patients, colleagues and to their own continued learning.  In recognition of its high quality and comprehensive clinical and educational programming, the Adult Psychiatry program has received continuing accreditation from the ACGME with no citations.

The Department of Psychiatry and Behavioral Neuroscience at the University of Chicago has a long and highly respected history of clinical, teaching, and scientific excellence. Many of its former graduates are current and former Chairs of Departments of Psychiatry and leading researchers in psychiatry. Our current faculty has leading experts in diverse areas spanning clinical subspecialities and basic neuroscience.

Deborah Spitz, MD, oversees all educational programs in the Department as the Vice Chair for Education and Academic Affairs, and Director of Residency Training. Dr Spitz has been a leader in the field of psychiatric education for many years. A Board Certified adult psychiatrist, she received her MD from the University of Pennsylvania and completed her psychiatric residency and fellowship at the University of Chicago. She was the recipient of an NIMH Junior Faculty Development Award in 1982, and served on the faculty at the University of Chicago until 1988. For the next 12 years, she was on the faculty at Tufts-New England Medical Center, where she directed the adult residency training program. Beginning in 2000, she spent three years in Britain as a Consultant Psychiatrist for the National Health Service and teacher in one of England’s newest medical schools at the University of East Anglia. She re-joined the faculty at the University of Chicago in 2003. Throughout her career she has been active in medical student and resident education, and has received numerous teaching awards both at the University of Chicago and at Tufts-New England Medical Center. She has been the President of the Association for Academic Psychiatry, and has been active in the American Psychiatric Association and the Association for the Advancement of Philosophy and Psychiatry.

The Child and Adolescent Psychiatry Fellowship at the University of Chicago is led by Karam Radwan, MD  He received his MD from Damascus University, did his training in adult psychiatry at the University of Missouri, and completed his child and adolescent training at Northwestern University and at the University of Michigan. He is interested in the integration of psychotherapeutic processes and neuroscience. Historically, many residents in our Adult program have chosen to continue their training in child psychiatry. Our child fellowship accepts 3 fellows per year.

The University of Chicago emphasizes intellectual discourse, interdisciplinary work, and collaborative education and research. Our residents have very close contact with the entire faculty in our Department, as well as access to faculty in other Departments and Schools within the University of Chicago. The Department of Psychiatry has 17 full time MD’s and 19 fulltime PhD’s with varied interests and research areas, as well as 25-30 part-time and voluntary MD or PhD faculty who actively teach, supervise and mentor residents. Nearly all faculty are geographic full-time, salaried professors in the University. Their continuous availability and lack of competing practice demands are important elements contributing to the strength of the psychiatric residency.

The University of Chicago is often known as the teacher of teachers. Education is of central importance in our Department: we are all teachers and students at the same time, for it is through teaching that we learn best. Residents have many opportunities to teach medical students, and receive instruction and mentorship to become better teachers and evaluators. While many residents go on to careers in academia or research, all residents are prepared for a lifetime of learning and teaching by being able critically to assess new information and add it to their knowledge base and skill sets. With the rapid development of knowledge in psychiatry and the neurosciences, this ability is perhaps the most important one a training program can offer its residents.

On this site you will find links to other information about our residency program, including rotation schedules, a message from our Chair, a list of our current residents, and a description of post-residency activities of our recent graduates. Please feel free to contact us, or any of our current residents, to learn more about our program.

          

Deborah Spitz

Professor of Psychiatry and Behavioral Neuroscience

 

Zehra Aftab

Assistant Professor of Psychiatry and Behavioral Neuroscience

 

 

Adult Residency (For PGY-1 Residents)

How to Apply:

Adult Residency (For Transfer Residents)

How to Apply:

  • We require an ERAS (Electronic Residency Application Service).
  • A personal statement should discuss the reason for transfer, and goals in psychiatry training.
  • One of the recommendation letters should be from the program director and document your start and end of training dates, and duration and content of all rotations completed.
  • If you are interested in transferring contact the Education Administrator at education@yoda.bsd.uchicago.edu.

2019-2020 Resident Stipends

PGY-1: $60,000
PGY-2: $63,800
PGY-3: $66,000
PGY-4: $69,000
PGY-5: $72,000
PGY-6: $73,500

Vacation

All residents receive four weeks of paid vacation leave per year to be scheduled by mutual agreement between the resident, chief resident, service chief, and the Program Director.

Sick Leave

Five days of paid sick leave is granted to residents who are absent from work and unable to perform their assigned duties due to illness.

Offices

All residents have individual offices (except PGY-1s who have a group office) to see patients and accomplish other duties in a professional manner. All offices are furnished with a computer.

Computer Access

Universal Workstations are located throughout the Medical Center, through which residents can access the electronic medical record system, intranet, internet, and other online resources.

Call Frequency

PGY-1 and PGY-2 residents are on call an average of 3 times per month. PGY-1 have graded responsibilities with senior residents in the house until they have met the requirements for increased independence. Third and fourth-year residents have the opportunity for in-house moonlighting including supervision of PGY-1s on call.

Medical Leave

Residents are provided a four-week paid leave for maternity-related purposes or other required medical care.

Other Leaves of Absence

Residents may request a personal Leave of Absence from the Program Director who grants such leave in cooperation with Office of Graduate Medical Education. Such a request should be predicated on some unusual and substantial personal situation. In all but rare cases, a leave of absence should not exceed twelve weeks. We also have policies on bereavement and civil leaves.

Educational Meetings

Residents may attend educational meetings at the discretion of the Program Director and relevant service chief. The dates of such meetings must not interfere with good patient care. Excused absence for attending such meetings should not extend beyond the dates of the educational meeting and necessary travel time. Additional days will be considered vacation time and also should be scheduled with the permission of the Program Director.

Benefits

University of Chicago house officers are eligible for a benefits package that includes dental coverage, flexible spending accounts, health insurance coverage, life insurance, long term disability, personal accident insurance, tuition remission for spouses and children, supplemental retirement annuities, and workers' compensation.

Professional Liability Coverage

The Medical Center provides medical malpractice liability coverage for all residents for activities performed in connection with assigned duties as a resident at the University of Chicago and at off-site rotations with prior written approval. The coverage is a composite of self-retained coverage funded by a composite of self-retained coverage funded by a trust fund and purchased excess commercial insurance.

Library Facilities

Residents are granted borrowing privileges at the University of Chicago Libraries, one of the largest libraries in the country with over 10 million volumes. Residents have 24-hour access to The John Crerar Library, the major research library for medicine and the biological sciences on the University campus, containing 570,000 titles and located adjacent to the Medical Center.

Graduate Medical Education (GME) Website

The University of Chicago Residency Training Program in Psychiatry offers a broad range of courses while focusing in particular on several domains of learning within psychiatry:

  • Psychopathology and phenomenology
  • Psychopharmacology and somatic treatments
  • Psychotherapy
  • Neuroscience
  • Research

Training in each domain builds from one year to the next, as each year residents take courses that relate to each domain. Integration among the domains is a major task of psychiatric education and takes place within case conferences, supervision, and individual courses.

The Psychopathology and Phenomenology sequence begins in the PGY-1 year courses focused on an introduction to Psychopathology and Phenomenology, Emergency Psychiatry, and Addictions. Reinforcement of these concepts occurs during Case Conferences on the Inpatient Units and the Consultation/Liaison-Emergency Room Case Conference attended by PGY-1 and PGY-2 residents.  It continues in the PGY-2 year with Developmental Psychiatry, Child Psychopathology, Neuropsychiatry and Geriatric Psychiatry. Further discussion of psychopathology and phenomenology occurs in the general and specialty clinics in PGY-3, and in the PGY-3 forensic psychiatry course.

The Psychopharmacology sequence offers basic psychopharmacology in the PGY-1 year and Psychopharmacology II in the PGY-2 year. Advanced Psychopharmacology is open to all residents but targeted to PGY-3s and 4s, focuses on clinical problem-solving, and integrates non-pharmacologic neuromodulation treatments including ECT, TMS, and DBS. Additional psychopharmacology is taught within specialty clinic settings.

The Neuroscience sequence begins in the PGY-1 year with an Introduction to Neuroanatomy. This is followed by a year-long course spanning parts of PGY-2 and PGY-3 in Neurobiology and Psychiatric Neuroscience.

The Research sequence begins in the PGY-2 year with an introduction to critical thinking and critical reading of the research literature, followed with a course on statistics, and then an introduction to the basic science, translational and clinical research topics and laboratories within the Department. Depending on each residents level of interest in research, there are Clinical Scholar and Research Tracks (described on the Clinical Rotations page). At the end of the PGY-4 year, each resident makes a research presentation to the Department. 

The Psychotherapy sequence begins in the summer of the PGY-2 year and is organized into specialized sequences of courses:

  • supportive psychotherapy—introduced in PGY-2
  • cognitive behavior therapy—introduced at the end of PGY-2 and continuing for six months in PGY-3, including didactics, interactive classroom skills-building sessions and individual and group CBT supervision
  • group therapy—introduced in PGY-3, and augmented by an ongoing process group open to all residents over the course of the entire time of residency
  • family therapy—introduced in PGY-3, with both didactic and supervisory components
  • psychodynamic psychotherapy—introduced in PGY-2 with Introduction Psychotherapies and the two-quarter Psychodynamic Psychotherapy course, continuing in PGY-3 with the Longitudinal Case Conference and Advanced Psychodynamic Theories, and continuing electively in PGY-4 in the Intensive Sequence.

Throughout the four years, residents attend the Clinical Case Conference, CBT Case Conference, and the Interdisciplinary Case Conference, where a variety of psychotherapeutic approaches are discussed.

Courses for all residents

All residents come together on Thursday afternoons for a series of case conferences and seminars. They include the following:

Clinical Case Conference — led by Drs. Tom Kramer and Deborah Spitz, this weekly conference provides a forum for residents to present “problem” cases of all types. Discussion includes diagnostic dilemmas, various psychotherapeutic approaches, transference and countertransference issues, pharmacologic challenges, and other problems residents encounter in treating complex and difficult patients.

Interdisciplinary Case Conference — attended by trainees in psychiatry and psychology and led by interdisciplinary senior faculty, this monthly conference focuses on cases being treated by both residents and trainees in other disciplines. Topics discussed include issues encountered with patients receiving medication and psychotherapy, or individual therapy plus family or couples therapy, from different treatment providers.

CBT Case Conference — led by Dr. Lindsay Brauer and attended by psychology and psychiatry trainees, this seminar considers formulation and treatment issues in cases being treated with cognitive behavior therapy.

Advanced Psychopharmacology and Somatic Treatments — led by Drs. Michael Marcangelo, this weekly conference includes discussions of major psychotropic medication groups, case-based discussions of side effect management and complex pharmacologic approaches to refractory psychiatric disorders of all types. Topics include antidepressants, mood stabilizers, antipsychotics, anxiolytics, sedative-hypnotics, stimulants, and other agents, in adults and child patients. Established and emerging neuromodulation techniques are also included. PGY-3 residents share responsibility for presenting topics and leading discussions.

Journal Club — led by Drs. Jon Grant and Royce Lee, this seminar for all residents critically examines the psychiatric literature.

Cultural Psychiatry — led by Dr. Seeba Anam, this course addresses differences in the understanding, diagnosis, and treatment of psychiatric disorders across cultures and sub-cultures.

Residents as Teachers — led by Drs. Deborah Spitz and Michael Marcangelo, this course introduces residents to the principles of bedside teaching and reviews skills in communicating teaching points, giving and receiving feedback, evaluation, and mentorship. The class includes role-playing and other experiential learning techniques.

Departmental Grand Rounds — held throughout the year from September through June. Attended by all faculty and residents, Grand Rounds offers presentations by national and international leaders in the field as well as presentations by our own faculty, residents and other trainees.

Residents’ Process Group — led by Dr. Jeffrey Roth, this group meets 20 times throughout each academic year. Participation is open to all residents.

Inpatient Psychiatry Case Conference — a weekly conference led by Dr. Deborah Spitz and other rotating faculty, a challenging case on the inpatient unit is reviewed in-depth and interviewed by the faculty member, followed by a discussion of the case.

C/L Case Conference - led by Dr. Marie Tobin and the CL Chief Resident, cases from the Consultation/Liaison service, the Emergency Room, and the Child and Adolescent Consultation/Liaison service are discussed and a relevant topic is reviewed by a trainee on one of these services.

PGY-1 Courses

The clinical rotations and course curriculum in the PGY-1 year foster the resident’s developing identity as a competent and caring physician, through rotations in medicine, neurology, and inpatient and consultation-liaison psychiatry that offer broad clinical experience, excellent teaching, and appropriate levels of responsibility. PGY-1 didactics begin with a Summer Orientation, designed to introduce basic concepts in patient safety and emergency psychiatry. Every Thursday afternoon, the PGY-1s return to the Department for didactics, including during medicine and neurology rotations. Courses are designed to help integrate the knowledge and skills acquired on medicine and neurology into their future practice of psychiatry.

PSYCHOPATHOLOGY/PHENOMENOLOGY SEQUENCE

  • Emergency Psychiatry — Holly Shiao, M.D. and Marie Tobin, M.D.
  • Addictions - Jon Grant, M.D.

Psychopharmacology Sequence

  • Psychopharmacology I  Royce Lee, M.D.

Neuroscience Sequence

  • Neuropsychiatric Medicine Integration- Holly Shiao, M.D. 

Other Courses

  • Clinical Skills  Deborah Spitz, M.D.
  • Medical Issues in Psychiatric Patients - Erin Zahradnik, M.D.

PGY-2 Courses

The PGY-2 year builds on the PGY-1 experiences in medicine and psychiatry, exposing residents to inpatient psychiatric treatment in academic, public and private settings with more complex, dually diagnosed and medically complex patients. Courses in the PGY-2 year are organized to solidify the resident’s understanding of phenomenology, psychopathology, and psychopharmacology, to build a foundation in neuroscience, and to develop an understanding of diverse approaches to psychotherapy. Residents attend the Research Sequence and familiarize themselves with research resources in the Department.

Psychopathology/Phenomenology Sequence

  • Development and Child Psychopathology — Seeba Anam, M.D. and Child faculty
  • Neuropsychiatry — Shoaib Memon, M.D.
  • Geriatric Psychiatry — Erin Zahradnik, M.D.

Psychopharmacology Sequence

  • Psychopharmacology II — Holly Shiao, M.D.

Neuroscience Sequence

  • Neurobiology I — Royce Lee, M.D.

Research Sequence

  • Introduction to Research; Statistics; and Departmental Research — Kristen Jacobsen, Ph.D.

Psychotherapy Sequence

  • Introduction to Supportive and Psychodynamic Psychotherapies — Deborah Spitz, M.D. and Shoaib Memon, M.D.
  • Psychodynamic Psychotherapy — Allen Kodish, M.D., Shoaib Memon, M.D., and Deborah Spitz, M.D.
  • Introduction to Cognitive Behavior Therapy — Lindsay Brauer, Ph.D.
  • Family Therapy and Supervision- Karam Radwan, M.D. and Khalid Afzal, M.D.

Other Courses:

  • Systems of Care — Daniel Yohanna, M.D.
  • Ethical Issues in Psychiatry — Andrea Mann, D.O.

PGY-3 Courses

The PGY-3 year is an outpatient year designed to enable residents to function more independently and to follow a large number of patients longitudinally, Through a year-long experience in the general psychiatry clinics, subspecialty clinics and sessions set aside to see psychotherapy patients, residents gain a sense of the breadth and depth of psychiatric disorders and their treatment. Courses deepen the resident’s understanding of psychopathology, psychopharmacology, neuroscience, and psychotherapy, and further the resident’s understanding and practical experience of research. Third-year residents collaborate with faculty to develop and present lectures in the Advanced Psychopharmacology conference attended by all residents.

Psychopathology Sequence

  • Forensic Psychiatry — Daniel Yohanna, M.D.

Psychopharmacology Sequence

  • Psychopharmacology Conference — Michael Marcangelo, M.D.

Neuroscience Sequence

  • Neurobiology II — Royce Lee, M.D.
  • Psychiatric Neuroscience — Royce Lee, M.D.

Psychotherapy Sequence

  • Cognitive Behavioral Therapy — Lindsay Brauer, Ph.D.
  • Group Psychotherapy — Daniel Fridberg, Ph.D.
  • Longitudinal Case Conference — Deborah Spitz, M.D.
  • Advanced Psychodynamic Theories — Deborah Spitz, M.D.

PGY-4 Courses

In the PGY-4 year, residents solidify administrative and leadership skills, enlarge clinical confidence and autonomy and focus on individual specialized areas of interest. Each resident assumes a Chief Resident position with significant administrative, supervision and teaching components. Each resident completes a research project and makes a presentation to the Department. Residents continue to follow outpatients in a variety of psychotherapeutic modalities and may choose elective clinical experiences in specialized psychotherapies, such as group or family therapy, psychodynamic psychotherapy, or dialectical behavior therapy, to name a few. All residents participate in the ECT service and can choose to spend a greater portion of PGY4 year on the ECT service in order to be eligible to receive a letter certifying advanced training in ECT upon graduation. In conjunction with faculty advisors, each resident develops an individualized schedule for the fourth year that reflects the serious pursuit of particular interests. The year is designed to allow maximum flexibility so that each resident may pursue a meaningful area in depth. Courses reflect the clinical, administrative and research activities of the resident.

  • Research Elective — Emil Coccaro, M.D., Jon Grant, M.D., and other research faculty
  • Intensive Sequence — Harry Trosman, M.D.
  • Electroconvulsive Therapy — TBA
  • Chief Residency Administrative Supervision — individual faculty

University of Chicago -- Block Diagrams of Courses

All Residents
(PGY-1, 2, 3, 4)

Summer

Autumn / Winter / Spring

Residents as Teachers

Clinical Case Conference

Resident Process Group

Resident Process Group

C/L Case Conference

C/L Case Conference

 

CBT Case Conference*

 

Interdisciplinary Case Conference*

 

Advanced Psychopharmacology and Somatic Therapies

*monthly conference

PGY-1

Summer

Autumn

Winter

Spring

Intro to Residency

Patient Safety

Emergency Psychiatry

Phenomenology

Intro to Neuroanatomy

Neurologic Localization

Medical Issues in the Psychiatric Patient

Psychopathology

Psychopharmacology

Psychopharmacology

Psychopharmacology

Addictions

Clinical Skills

Clinical Skills

Clinical Skills

 

PGY-2

Summer

Autumn

Winter

Spring

Intro to Psychotherapy

Intro to Psychodynamic Psychotherapy

Intro to Psychodynamic Psychotherapy

Intro to CBT

Development

Child Psychopathology

Ethics

Family Therapy

Psychopharmacology II

Geriatric Psychiatry

Psychosomatics

Neuropsychiatry

Psychological Testing

Research Statistics

Research Methodology

Neurobiology

Systems of Care

 

 

 

 

PGY-3

Summer

Autumn

Winter

Spring

Group Psychotherapy

Longitudinal Case Conference

Longitudinal Case Conference

Advanced Psychodynamic Therories

Neurobiology

Psychiatric Neuroscience

Psychiatric Neuroscience

CBT Theory and Practice

CBT Group Supervision

Cultural Psychiatry

Forensic Psychiatry

 

PGY-4

Required: Chief Residency with Administrative Supervision

Required: Research Project

Required: Electroconvulsive Therapy Rotation

Elective: Intensive Sequence and readings; teaching and clinical electives arranged individually

PGY-1

The clinical rotations and course curriculum in the PGY-1 year foster the resident’s developing identity as a competent and caring physician, through rotations in medicine, neurology, and psychiatry that offer broad clinical experience, excellent teaching, and appropriate levels of responsibility. In addition, residents begin to develop knowledge and skills in the diagnosis, management, and treatment of severely disturbed and mentally ill inpatients. The PGY-1 year is divided into six months of medicine and neurology, four months of adult inpatient psychiatry, and two months of consult/liaison psychiatry. PGY-1s take call at the University of Chicago while on psychiatry, covering the emergency department and the general hospital for psychiatric emergencies, and providing phone consultation for emergent care issues arising on the University of Chicago inpatient psychiatry service at UChicago Medicine Ingalls Memorial. All PGY-1s begin the year with direct supervision from senior residents and progress to greater degrees of independence with attending backup always available.

Primary Care and Neurology: All residents spend two months on the inpatient general medicine service. Additionally, most residents select one month on the general medicine consultation service and one month in the adult emergency department at the University of Chicago. Residents spend two months on the neurology services at the University of Chicago. Those residents who have a particular interest in child psychiatry may choose to spend up to two months on pediatrics (one month inpatient, one month Peds ED), and/or one month on the child neurology service at the University of Chicago Comer Children’s Hospital.

Northshore University Hospital, Adult Inpatient Psychiatry: Two months each during PGY-1 and PGY-2 year are spent on the adult inpatient psychiatric service. Located in Evanston, Northshore is a large and outstanding community hospital with strong ties to the University of Chicago. The patient population is economically and diagnostically varied and includes some patients receiving electroconvulsive therapy (ECT).

UChicago Medicine Ingalls Memorial, Inpatient Psychiatry: Two months each during PGY-1 and PGY-2 year are spent on the adult inpatient psychiatric service. This general psychiatry unit treats acute patients with all major psychiatric disorders, as well as patients with comorbid substance abuse and dependence, and those with some comorbid medical problems. Patients come from the university community including students and staff, from a wide range of communities in the Chicagoland area, and transfers from the University of Chicago emergency department, inpatient medical/surgical, and outpatient psychiatric services.

Consultation/Liaison: Two months each during PGY-1 and PGY-2 year are spent on the CL service at the University of Chicago. The CL service provides psychiatric consultation upon request to hospitalized, adult, medically ill patients. In addition to general consultation, specialist services exist for oncology, transplantation, and neuropsychiatry. The CL team is comprised of CL attendings, a psychosomatic medicine fellow, psychiatry residents, psychology interns, medical students and senior neurology residents and anesthesia pain fellows on a rotating basis. CL residents gain experience in evaluating and managing highly complex medical and surgical patients in a well-supervised teaching service, coupled with the opportunity to participate actively in a multidisciplinary team. To provide a forum for trainees to present and discuss CL and ER cases, a weekly, joint adult and child psychiatry case conference is held. This provides a forum for detailed case discussion and for the presentation of special topics (e.g The Business of CL, Psychotropic Prescribing in Pregnancy, Autoimmune Neuropsychiatric Syndromes).

PGY-2

The PGY-2 year builds on the PGY-1 experiences in medicine and psychiatry, exposing residents to inpatient and outpatient psychiatric treatment in academic, public and private settings with more complex, dually diagnosed and medically comorbid patients. Residents spend two months each on inpatient psychiatry at Ingalls Hospital, inpatient psychiatry at Northshore University, and on the CL service at the University of Chicago. Residents also spend two months on each of the following services: University of Chicago Emergency Psychiatric Service, Chemical Dependency at UChicago Medicine Ingalls Memorial, and Community Psychiatry, an outpatient rotation at Thresholds. PGY-2 residents develop skills as psychiatric educators through increased responsibility for the teaching and supervision of medical students, and through coursework and supervision on education and educational techniques. Residents take call at the University of Chicago with faculty backup by phone.

Chemical Dependency: Residents spend two months on the Chemical Dependency service at UChicago Medicine Ingalls Memorial, under the direction of Dr. Martin Paisner, where patients are admitted for detoxification from a variety of substances of abuse. Residents participate in groups and individual treatment for addictions, attend sobriety maintenance meetings, become familiar with detoxification protocols, and management of patients with dual diagnoses.

Community Psychiatry: Residents spend two months at Thresholds, one of the nation's largest non-profit providers of mental health services. Thresholds offer case management, education, job training and placement, housing, and operates Assertive Community Treatment (ACT) teams providing services to people with serious and persistent mental illness. Residents evaluate new patients and function as part of a team, providing outreach to people in the community in their homes and on the streets as well as in clinics. One day a week is spent at the community psychiatry clinic at Northshore University.

Emergency Psychiatry: Residents spend two months on our Emergency Psychiatry service under the direction of Drs. Marie Tobin and Holly Shiao. Residents provide consultation to the emergency department for management and recommendations on disposition for psychiatric emergencies.

Outpatients: Residents are expected to treat two to three outpatients per week during the PGY-2 year in weekly psychotherapy. Patients are referred from the University of Chicago student health service, as well as the outpatient clinics and inpatient units at the University of Chicago and UChicago Medicine Ingalls Memorial. Residents have two hours of individual supervision, provided by faculty within the Department and the Student Counseling Center (SCS) on campus. Residents also rotate through the Continuing Care (Psychosis) Clinic at the University of Chicago which provides diagnostic evaluations and ongoing medication management for patients with severe and persistent mental illness. Many patients also have serious economic and social problems and major needs for rehabilitation services. This clinic works collaboratively with Thresholds and other community resources to support patients' independence.  Several research projects are incorporated into the clinic on the nature and treatment of psychotic disorders.

PGY-3

The PGY-3 year is exclusively an outpatient year. Designed to enable residents to function more independently and to follow a large number of patients longitudinally, PGY-3 provides year-long experience in the general psychiatry clinics, several half-day sessions set aside to see psychotherapy patients, and six-month rotations in subspecialty clinics. Subspecialty clinics include neuropsychiatry, geriatrics, child psychiatry, addictions, anxiety disorders, personality disorders, refractory affective disorders, and several medical/psychiatric clinics including a transplant clinic and a psycho-oncology clinic. Residents provide teaching and supervision for medical students and can participate in internal moonlighting call including providing back-up for PGY-1 residents.

The General Clinics: Adult patients are referred to our clinics from within the University of Chicago system, from inpatient stays on our inpatient psychiatry service, from the surrounding community of Hyde Park where students and faculty live, from the population of hospital and university employees, and from the South Side of Chicago and the greater Northwest Indiana area. Problems vary from complex diagnostic issues to more common affective, anxiety and adjustment disorders. Residents are assigned to one general clinic per week, performing intakes and providing psychiatric follow-up. The clinics are designed to enable residents to pick up a large caseload of patients with varied diagnoses and treatments. Residents have ample opportunity to work collaboratively with psychologists in coordinated treatment. Faculty include Drs. Deborah Spitz and Shoaib Memon.

Specialty Clinics: Residents rotate for six months in a variety of specialty clinics:

  • Child Psychiatry—directed by Drs. Khalid Afzal, Seeba Anam, and Stephanie Lichtor, residents provide diagnostic assessment and treatment for children and adolescents with pervasive developmental disorders, disorders of attention, affective disorders, anxiety disorders, psychosis, and eating disorders.
  • Geriatrics—directed by Dr. Erin Zahradnik, residents evaluate and manage disorders of mood, cognition, and psychosis in the geriatric population at University of Chicago and at the University of Chicago's South Shore Clinic, which offers integrated geriatric medical and psychiatric care.
  • Neuropsychiatry—this clinic treats patients with complex neuropsychiatric problems including movement disorders, neurodegenerative disorders, epilepsy, MS, traumatic brain injury as well as conversion disorders.
  • Anxiety Disorders—directed by Dr. Emil Coccaro and staffed by a psychologist and psychology trainees as well as by residents, this clinic serves patients with severe anxiety disorders, obsessional disorders, panic disorders, and other comorbid psychiatric problems. It offers comprehensive evaluating, pharmacologic treatment, and CBT.
  • Medical/Psychiatry—directed by Drs. Marie Tobin, Holly Shiao, Zehra Aftab, and Michael Marcangelo, who attend on the psychiatric consultation/liaison service at the University of Chicago, these clinics offer evaluation and follow-up to patients seen on the C/L service and other patients with comorbid medical and psychiatric problems. Specialized clinics include Transplant with Dr. Aftab and Psycho-oncology with Drs. Tobin and Shiao.
  • Personality Disorders—directed by Dr. Royce Lee, this clinic offers assessment and treatment to complex patients with personality disorders and often comorbid affective disorders.
  • Refractory Affective Disorders—directed by Dr. Elliot Gershon, this clinic offers highly specialized treatment for patients with severe and refractory unipolar and bipolar disorders. It offers residents the opportunity to use sophisticated psychopharmacologic interventions and gain an understanding of the long-term evolution of severe affective illness.
  • Student Counseling Center (SCS)—under the direction of Dr. Erin Hurst, SCS provides emergency consultation, psychoeducation, psychotherapy, and medication management for undergraduate and graduate students at the University of Chicago.
  • Women's Mental Health--directed by Zehra Aftab, MD, this clinic evaluates and treats women during pregnancy and the postpartum period as well as women with psychiatric disorders that intersect with reproductive issues. 

Outpatients: In addition to patients followed within the general and subspecialty clinics, residents are expected to follow eight hours of outpatients in various modalities of psychotherapy, including psychodynamic psychotherapy, supportive psychotherapy, CBT, combined pharmacologic and psychological treatment, and family therapy. Residents are expected to lead or co-lead at least one group, which may be time-limited and focused on a particular diagnostic issue or problem, or open-ended. Residents receive two and a half hours per week of individual supervision, and additional supervision is available for family and marital cases as well as individual cases for those who request it.

PGY-4

In the PGY-4 year, residents solidify administrative and leadership skills, enlarge clinical confidence and autonomy and focus on individual specialized areas of interest. Each resident assumes a Chief Resident position with significant administrative, supervision and teaching components. Each resident completes a research project and makes a presentation to the Department. Residents continue to follow outpatients in a variety of psychotherapeutic modalities and may choose elective clinical experiences in specialized psychotherapies, such as group or family therapy, psychodynamic psychotherapy, or dialectical behavior therapy, to name a few. All residents gain experience on our Electroconvulsive Therapy service. In conjunction with faculty advisors, each resident develops an individualized schedule for the fourth year that reflects the serious pursuit of particular interests. Some residents choose to focus on research, some emphasize clinical experiences, others assume increased teaching responsibility. The year is designed to allow maximum flexibility so that each resident may pursue a meaningful area in depth.

Chief Residencies: Two PGY-4s serve as Administrative Chief residents, leading Residents Meeting and working closely with the Residency Training Directors on administrative issues. Chief residents on the inpatient units, the consultation/liaison service, outpatient clinics, and the emergency service at the University of Chicago provide administrative leadership, teaching and supervision for medical students and junior residents on those services, leading case conferences and designing and teaching specialized courses. There is flexibility in each of these roles, and specific duties may be negotiated with the Program Director, based on the resident’s interests; for example, one fourth-year resident devised a chief residency in Medical Student Education, helping to redesign the psychiatry clerkship and focus on recruitment of medical students into psychiatry.

Research: Under the supervision of faculty research mentors and with the guidance of the Research Seminar led by Dr. Kristen Jacobsen, each resident completes a research project in collaboration with one of several research groups in the Department. The resident presents the research to the Department in June of the PGY-4 year. Some residents choose to spend a large portion of the PGY-4 year on larger research projects, and many have published their work and/or presented at national meetings.

Forensic Psychiatry: All residents evaluate and write up a forensic case under the direction of one of the Department’s forensic psychiatrists, Drs. Daniel Yohanna, Jon Grant, Caroline Shima, and Sandy Finkel.

Electroconvulsive Therapy: Residents gain experience in the outpatient evaluation of patients referred for ECT, the indications and relative contraindications for ECT, the informed consent process, the delivery of treatment and ongoing monitoring of psychiatric, cognitive and medical symptoms during acute course and maintenance phases of ECT. For interested residents, an extended elective experience in ECT, leading to eligibility for certification of advanced training in ECT upon graduation, is available.

Elective Clinical Experiences:

Specialty Clinics: Resident can choose to spend six months in any of the above specialty clinics that they didn't experience in PGY-3.

Intensive Sequence Elective: In conjunction with a course which reviews classic psychoanalytic theory under the direction of Dr. Harry Trosman, a senior psychoanalyst, the resident treats 2-3 patients for one year in intensive (two or three times per week) psychotherapy, with supervision provided by psychoanalysts affiliated with the Chicago Institute for Psychoanalysis.

Family Institute Elective: Residents can take courses and evaluate and treat families at the Family Institute in Downtown Chicago.

Women's Mental Health: Residents can elect an outpatient experience and reading course focused on Women's Mental Health.

Other Electives: Clinical, research, and educational electives are arranged individually.

University of Chicago -- Block Diagrams of Clinical Rotations

PGY-1

6-months Medicine and Neurology (all at U of C)

6-months Psychiatry

2-months Adult Neurology or 
1-month each Adult and Pediatric Neurology

2-months Consult Liaison Psychiatry, U of C

2-months Inpatient Medicine

2-months Inpatient Psychiatry,
U of C Service at Ingalls Hospital

1-month Emergency Medicine (Adult or Peds)

1-month Consult Medicine or 1-month Inpatient Pediatrics

2-months Inpatient Psychiatry, NorthShore University Health System Evanston

 

PGY-2

4 Months

2 Months

2 Months

2 Months

2 Months

2-months Inpatient Psychiatry NorthShore University Health System Evanston

2-months Inpatient Psychiatry U of C Service at Ingalls Hospital

Chemical Dependency InpatientUChicago Medicine Ingalls Memorial

Emergency Psychiatry
U of C

Community Psychiatry--NorthShore Clinic, Thresholds Assertive Community Treatment Team, and U of C Population Mgmt

2-months Consult Liaison Psychiatry U of C

6-months U of C MAC Chronic Care Clinics, plus 2-3 individual psychotherapy outpatients for the year
PGY-1 and -2 ON CALL—cover Adult and Child ER and CL Services

PGY-3

12 Months U of C Outpatient Clinics

12 Months Adult General Clinics

12 Months Child Psychiatry Clinics

 6 months Required Clinics

  •   Geriatrics
  •   One Med/ Psych Clinic
       * General Med / Psych
       * Transplant
       * Psycho-oncology

 6 months Elective Specialty Clinics

  • Neuropsychiatry
  • Personality Disorders
  • Anxiety Disorders
  • Addictions
  • Refractory Affective Disorders
  • Student Counseling
  • Memory Clinic
  • Women's Mental Health
  • 8 hours weekly of ongoing psychotherapy patients including CBT, psychodynamic, supportive psychotherapy, and group therapy, plus 2.5 hours of individual supervision.
  • PGY-3 or PGY-4, evaluate and write up one forensic case under faculty supervision
  • Optional Research Track--do 4 clinics/6 month block instead of 5 clinics, use the extra half-day for research for the year, and do an additional clinic in PGY-4.

PGY-4

12 Months

Required:  Administrative Psychiatry Experience
Chief Residency – Overall Chief at U of C, Service Chiefs on Inpatient Units (NorthShore or Ingalls), Consultation Liaison, Emergency Psychiatry, Outpatient Clinics

Required:  Research in Psychiatry
Research project in clinical or basic science with Department Faculty with a presentation of the research to the Department
Elective:  Resident may spend up to 75% time doing research

Required:  Electroconvulsive Therapy (ECT) rotation
Participate for 1-2 months in pre-ECT evaluations and 3x/wk treatments
Elective: 3-month rotation on ECT service to gain eligibility for certification in ECT competency upon graduation

Elective:  Outpatient Psychiatry
½ day or more per week in clinic, and 8-10 hours a week of ongoing psychotherapy with supervision may see 2-3 patients 2-3 times per week in intensive psychodynamic psychotherapy as part of the Intensive Sequence Course

Other Electives:
Student Counseling Service at the U of C
Rotations in Sleep Medicine, Geriatric Medicine, Pain Clinics at the U of C
Women’s Mental Health
Forensic Psychiatry
Other electives may be arranged in consultation with the Program Director and an individual Faculty members

Elective Institutional Fellowships:

  1. MERITS Fellowship (Medical Education Research, Innovation, Teaching, and Scholarship) focusing on research in medical education, taught by medical educators throughout the University of Chicago Medicine, with a research project
  2. MacLean Center for Medical Ethics summer readings in medical ethics, weekly ethics conferences throughout the year, 1-2 months on the Ethics Consult Service at the U of C, with a research project

The Resident will:

  • Develop an identity as a competent and caring physician during a four-month clinical rotation in either medicine or pediatrics or a combination thereof.  The resident will develop basic skills in the diagnosis and management of medically complex patients.  These rotations at the University of Chicago Medicine and the University of Chicago Children’s Hospital offer broad clinical experience and appropriate responsibility. 
  • Increase knowledge of neurologic disorders to include diagnostic and treatment planning skills during a two-month rotation at the University of Chicago Medicine.  Rotations may be on the general neurology services, the consultation services, and/or on the pediatric neurology service.
  • Develop knowledge and skills in the inpatient management of severely disturbed and mentally ill patients.  Management includes in-depth experiences in diagnosis, treatment planning and case management, family treatment, group therapy, psychological testing, individual psychotherapy, and psychopharmacologic therapies as well as other somatic therapies.  This occurs during the 2-month rotations at Ingalls Hospital and at NorthShore, as well as during the Consultation/Liaison Psychiatry rotation.
  • Develop knowledge and skills in the role as psychiatrist consultant on the consultation liaison service, becoming familiar with the intersection of medical and psychiatric illnesses and collaborating with a multidisciplinary team and physicians and staff throughout University of Chicago Medicine.  Residents will participate in the C/L Case Conference Seminar.
  • Develop knowledge of Emergency Psychiatry to include psychiatric assessment, triage, and immediate intervention and treatment.  This occurs primarily through evening and weekend call, which is supervised on-site by a senior resident directly for the first patients, and on-site indirectly thereafter.
  • Begin to develop skills as a psychiatrist educator through teaching University of Chicago medical students and through teaching colleagues.  This occurs regularly on inpatient services, ER, and Consultation/Liaison services, as well as in scheduled C/L/Emergency Psychiatry case conferences.
  • Begin to develop an identity as a psychiatrist and explore a career plan. To accomplish this, a mentor will be assigned to each incoming PGY I who will assist the resident in exploring the various subspecialties and career paths in Psychiatry and mentor the resident through his/her four years at the University of Chicago.
  • Understand the scientific principles of various disciplines underlying clinical psychiatry, including the neurosciences, behavioral assessment, and other topics.

The Resident will:

  • Develop an identity as a psychiatrist thorough understanding of and empathy toward patients with psychiatric disorders and their families and increasing appreciation of the stigma of mental illness within the society of the hospital, the city, and in the country.
  • Develop an appreciation of scientific thought and methods as applied to the underlying sciences and to practice issues in psychiatry.  This occurs in an in-depth interactive seminar throughout the year, and through optional tutorials with research scientists in the Department.
  • Develop basic knowledge and understanding of available public psychiatric services, including intake and services in the state hospital system, community agencies and their resources, community mental health clinics, mobile assessment units, residential living options as well as the spectrum of care necessary in the treatment planning for chronically disturbed patients including psychosocial treatments in the day hospital setting.  This education occurs primarily during the two-month community psychiatry rotation at Thresholds community mental health programs and on their Assertive Community Treatment teams. 
  • Continue to develop knowledge and experience in Emergency Psychiatry as the full-time daytime consultant to the general and children’s ER at the University of Chicago.  In addition to the necessary general knowledge, knowledge of systems necessary for the psychiatrist consulting to other medical specialties is reinforced.
  • Continue to develop the knowledge and skills necessary to diagnose and treat seriously disturbed patients, both on the inpatient services at Ingalls Hospital and NorthShore Hospitals and on the Consultation Service at University of Chicago Medicine. In addition, the resident will spend 6 months in the Monday Afternoon Clinic at the UofC, a clinic for the seriously and persistently mentally ill.
  • Continue to develop knowledge and skills in the role as psychiatrist consultant on the Consultation Liaison service, becoming familiar with the intersection of medical and psychiatric illnesses and collaborating with a multidisciplinary team and physicians and staff throughout University of Chicago Medicine.  Residents will consult on patients with delirium, dementia, depression among other problems, and will assess psycho-oncology patients as well as those presenting for organ transplantation.  Residents will participate in the C/L Case Conference Seminar. 
  • Develop knowledge of chemical dependency, addiction and their treatments, both inpatient detoxification and outpatient management, including participation in group psychotherapy. 
  • Develop skills as a psychiatrist educator through teaching University of Chicago medical students and through teaching colleagues.  This occurs regularly on inpatient services, ER, Consultation/Liaison services, in outpatient clinics, as well as in scheduled Psychiatry case conferences.
  • Develop in-depth knowledge of psychopharmacology to include advanced psychopharmacologic treatment of major psychiatric disorders, treatment of difficult patients, consulting to non-M.D. therapists.
  • Begin an in-depth study of psychotherapeutic theories to include individual supportive, psychodynamic, family and group therapy, and Cognitive Behavior Therapy.  The resident will treat three patients in weekly psychotherapy in the PGY-2 year, under weekly supervision.
  • Gain an understanding of human development over the life cycle, including a normal and abnormal child and adolescent development, adult development, and geriatrics.
  • Begin to develop a knowledge base in the clinical applications of forensic psychiatry.  
  • Understand the scientific principles of various disciplines underlying clinical psychiatry, including the neurosciences, statistical inference, molecular and population genetics, behavioral assessment, neuropsychiatry, and other topics.

The Resident will:

  • Develop a leadership role in the outpatient clinic setting, with increased numbers of diagnostic evaluations as well as consultation to non-M.D. clinicians, increased teaching and supervision of medical students, and supervision of junior psychiatry residents taking call.
  • Develop an understanding of the diagnostic assessment and ongoing treatment of a wide variety of psychiatric disorders seen in the outpatient clinic, including disorders of mood and anxiety, attention, addiction, memory and aging, neuropsychiatry, personality, and medical/psychiatric disorders including transplant psychiatry and psycho-oncology.  Residents may elect to rotate at the University of Chicago Student Health Clinic.
  • Continue to study psychotherapeutic theories to include short-term dynamic, cognitive, behavioral, and interpersonal models and their applications to patients with particular diagnoses.  Residents will continue to see patients in ongoing therapy with treatment planning based on the patients’ needs and abilities.  Residents will treat several patients with CBT, run at least one brief or long-term psychotherapy group, treat a number of patients in long term psychodynamic psychotherapy, and learn to evaluate families for treatment.
  • Develop the basic knowledge and skills for diagnostic evaluations and treatment planning in a closely supervised child outpatient clinic.  Residents will join in the ongoing care of children and adolescents for one year.  The resident will expand knowledge of diagnostic evaluations to include the multidisciplinary diagnosis of toddlers, and school-age children and adolescents in the context of their families.
  • Develop familiarity with clinical and research interviews, rating scales, and psychological testing used in outpatient child and adolescent clinics.  Residents may elect to take additional Child and Adolescent training in their PGY-4 year.
  • Develop and begin to execute a research project with a faculty mentor, often within the mentor’s research team.
  • Develop an in-depth understanding of the scientific principles of clinical psychiatry and research, through critical study and evaluation of papers in such courses as the PGY-3 Psychopharmacology Conference, and critical presentations of scientific papers at Journal Club.
  • Perform a forensic evaluation under supervision, and write up a full forensic report.  This may occur in PGY-3 or PGY-4.

The Resident will:

  • Develop a special area of expertise within psychiatry.  Some areas chosen include lab or clinical research, psychodynamic psychotherapy, family therapy, the therapy of substance abuse, and student mental health.
  • Advance administrative and leadership capabilities through positions of Department Chief Resident, Inpatient and Outpatient Chief Resident, or CL/ER Chief Resident, under supervision of appropriate faculty.
  • Complete a research project under the supervision of a faculty research mentor, and present that project to all residents and faculty on Research Day at the end of PGY-4.
  • Develop and carry out a Quality Improvement project, usually based on problems noted while carrying out the administrative and clinical responsibilities of a Chief Resident.
  • Develop competence in Electroconvulsive Therapy, both in assessing patients prior to receiving ECT and in administering ECT and monitoring response.  Residents will rotate on the ECT service part-time, for 2 months, but may elect to receive Certification in ECT with a 3-month rotation.

OVERVIEW

The Inpatient General Medicine rotation provides house officers exposure to the diagnosis and treatment of a broad spectrum of medical disease.  This rotation is intended to provide the exposure, clinical knowledge, skills, and professional attitudes needed to care for patients.  The medical team consists of a supervising attending physician, a resident, one intern, and medical student.  PGY-1 residents spend two months on this service.

PATIENT CARE

Interns, under the supervision of a resident and attending, are expected to

  • do initial evaluations of patients as they are admitted from the clinic, the emergency room, directly from home or transferred from other hospitals
  • provide ongoing care to these admissions until the patient's appropriate disposition is implemented
  • document the admission appropriately including a discharge summary.  48-hour discharge summaries are documented by interns. 

MEDICAL KNOWLEDGE

Interns will learn about the diagnosis, evaluation, and treatment of the following major disease categories:

Acute Abdominal Pain,  Asthma , Atrial Fibrillation, Chronic Obstructive Pulmonary Disease,Congestive Heart failure, Coma, Diabetes, Diarrhea, Delirium and Dementia, Diverticulitis,  Electrolyte Abnormalities: Diagnosis and Management,  Endocarditis, Fever of Unknown Origin, Hepatitis,  Intestinal Obstruction and Ischemia, Meningitis, Nephrolithiasis, Pancreatitis, Renal Failure, Sickle Cell Disease, Sleep Apnea, Syncope / Falls, Tuberculosis, Pneumonia, Valvular Heart Disease, Venous Thromboembolism

INTERPERSONAL AND COMMUNICATIONS SKILLS

Interns are expected to demonstrate skills to communicate effectively with

  • patients from a wide variety of ethnic, racial and socioeconomic backgrounds, and their families
  • staff, senior residents and attendings
  • medical students

PROFESSIONALISM

Interns are expected to demonstrate professional behavior such as timeliness, responsibility in follow-through, compassionate patient care, and to provide professional role modeling to medical students.  Interns are expected to attend all teaching activities and to follow a syllabus for self-directed learning that is distributed to house staff at the beginning of their rotation on the Mercy Inpatient General Medicine Service. 

General Syllabus

OVERVIEW

The General Medicine Consultation Service at UCM is a clinical rotation that provides house officers exposure to the diagnosis and treatment of a broad spectrum of medical disease.  This rotation is intended to provide the exposure, clinical knowledge, skills, and professional attitudes needed to care for these patients.  The medical team consists of a supervising attending physician, an intern and a medical student at times; the rotation lasts for two months for those residents who wish to do 4 months of medicine in the PGY-1 year. 

PATIENT CARE

The intern will

  • learn to evaluate, diagnose and treat a broad spectrum of medical disease. 
  • develop the clinical knowledge, skills, and professional attitudes needed to care for a wide variety of medically ill patients
  • provide care for adult patients with general medical comorbidities admitted from the clinic, the emergency room, directly from home or transferred from other hospitals and admitted under other services than General Internal Medicine at UCM

MEDICAL KNOWLEDGE

Interns will learn about the diagnosis, evaluation, and treatment of a wide range of cardiac, pulmonary, endocrine, hematologic, GI and renal disease presentations, among others.

INTERPERSONAL AND COMMUNICATIONS SKILLS

Interns are expected to demonstrate skills to communicate effectively with

  • patients from a wide variety of ethnic, racial and socioeconomic backgrounds, and their families
  • staff, senior residents and attendings on the medicine service and on the consulting services
  • medical students

PROFESSIONALISM

Interns are expected to demonstrate professional behavior such as timeliness, responsibility in follow through, compassionate patient care, and to provide professional role modeling to medical students.  Interns are expected to attend all teaching activities, and to follow a syllabus for self-directed learning that is distributed to housestaff at the beginning of their rotation on the Mercy Inpatient General Medicine Service. 

EDUCATIONAL MATERIALS

General Syllabus

The PGY-I Neurology rotation is a two-month rotation on the adult neurology consultation service at UCM.  Residents may elect to spend one month on the adult neurology service and one month on the pediatric neurology service. The Psychiatry Resident works with the Neurology Resident to evaluate patients as requested by the various inpatient services throughout the medical center. The Resident then rounds with the attending on the consultation service, and all new consults are staffed by an attending neurologist. Patients are followed up as needed.

GOALS AND OBJECTIVES:

Patient Care--The resident will see, examine and evaluate all consults as soon as possible, and will provide feedback to the requesting service as soon as possible.

Medical Knowledge--the resident will evaluate and learn about a broad array of acute and chronic neurological disorders that arise in the hospitalized general medical population.  The resident will continue to refine history and physical, differential diagnosis, and management skills acquired in the PGY-1 year.

Interpersonal and Communication Skills--the resident will learn to interact and communicate effectively with colleagues in other medical disciplines.

Professionalism--the resident will aid in educating other house staff and medical students with respect to neurological diseases.

System Based Practice--the resident will learn to function as a consultant rather than the primary caregiver.

The Inpatient pediatric experience has been designed to develop the needed competencies for an intern to manage patients with a wide array of conditions requiring hospitalization, from the perspective of a general pediatrician. As an intern, the general pediatrics inpatient experience comprises 1-2 months of service  at Comer Children’s Hospital at the University of Chicago.  This monthly rotation is organized with a team consisting of two day senior residents and 4 interns. The four interns are responsible for Q4 in-house 16-hour overnight call on their service and are supervised overnight by two alternating night senior residents to maintain continuity of care.  Residents are required to attend all scheduled meetings and conferences except when detained by a medical emergency on the wards.

While on this rotation the intern is expected to act as a primary physician for the designated patients. The intern is expected to perform a complete history and physical exam, formulate a differential diagnosis and working diagnosis, and develop a treatment plan appropriate to the suspected diagnosis or condition, all under the supervision of a senior resident with whom all aspects of care are discussed. Interns are then expected to follow their patients throughout the length of the rotation, being responsible for the day to day management, follow up, procedures, consultations and discharge planning under the close supervision of the supervising resident and attending physician.

The attending physician has ultimate responsibility for the patients admitted under his/her care. The attending carries out daily rounds with the team and discusses each patient, verifying history and physical findings, and guiding the residents through the discussion of the appropriate management from the perspective of a general pediatrician. Rounds and attending-resident interaction provide the opportunity for the discussion of differential diagnoses, criteria for hospitalization, evidence-based treatment plans, and cost-effective medical care.  Attending physicians are Board Certified in General Pediatrics and act as role models in the intervention and communication with patients. They actively participate in family conferences, the process of delivering difficult information for patients and families, the interpretation of diagnosis and management plans to patients, in obtaining DNR authorizations, and in discussions with consultants, among others. The attending physician is readily available for consultation 24 hours a day, 7 days a week.

The rotation seeks to emphasize several principles essential to the practice of general pediatrics:

  • Patients should be evaluated thoroughly taking into consideration not only medical/organic aspects of disease, but also the psychological, social, and environmental considerations.
  • Although the members of the medical team are the primary caregivers, the residents and attending physicians should work in close collaboration with ancillary staff, such as nutritionists, social workers, nurses, respiratory therapists, rehabilitative services, pharmacists and hospital school teachers, among others.
  • Continuum of care is essential in pediatric care and discharge planning, follow-up, and communication with primary care physicians, either in writing or by telephone, is stressed.
  • Care to the pediatric patient should be of the highest standard, and cost-containment, quality, and risk management should be continually assessed.

COMPETENCY 1. Patient Care – Interns are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, and treatment of disease. To that end, interns will:

  • Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records, and diagnostic/therapeutic procedures
  • Make informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference
  • Develop, negotiate and implement effective patient management plans and integration of patient care
  • Learn to construct an individualized treatment plan for these complex patients

COMPETENCY 2. Medical Knowledge – Interns are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others. Interns are expected to apply an open-minded, analytical approach to acquiring new knowledge, access and critically evaluate current medical information and scientific evidence, and apply this knowledge to clinical problem solving clinical decision making, and critical thinking. Specifically, interns will:

  • Demonstrate knowledge regarding the care of hospitalized patients with acute injury and disease
  • Demonstrate skill in the assessment of the hospitalized child using a problem-based approach in an evidenced-based format
  • Supervise medical students in the assessment of patients using a problem-based approach in an evidence-based format
  • Develop an evidence-based medical and social plan of care
  • Demonstrate cost-effective strategies of narrowing a differential diagnosis utilizing medical tests and appropriate subspecialty consultation
  • Demonstrate competency in relaying the patient’s medical issues in a concise problem-based format
  • Proficiently execute a care plan for a wide variety of childhood illnesses that require hospitalization
  • Adequately interpret of a wide variety of medical tests useful in patient assessment, including, but not limited to, complete blood count, complete metabolic panel, blood gas measurement, inflammatory markers, urinalyses, cerebrospinal fluid studies, coagulation studies, plain radiographs, computed tomography scans, magnetic resonance imaging, and electrocardiography.
  • Demonstrate competence in the management of both routine and urgent clinical scenarios
  • Demonstrate competence in the identification and appropriate intervention for children with urgent or emergent issues and declining clinical status requiring transfer to an intensive care setting

COMPETENCY 3. Practice-Based Learning and Improvement – Interns are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. To that end, interns will:

  • Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes, and processes of care
  • Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice
  • Develop and maintain a willingness to recognize and learn from errors and consequently improve the system or processes of care
  • Use information technology or other available methodologies to access and manage information, support patient care decisions, and enhance both patient and physician education
  • Develop teaching programs for students

COMPETENCY 4. Interpersonal and Communication Skills – Interns are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. To that end, interns will:

  • Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues
  • Demonstrate effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families
  • Interact with consultants in a respectful, timely, and appropriate manner
  • Maintain comprehensive, timely, and legible medical records
  • Complete evaluations of the senior residents, attending physician, medical students, staff, and rotation
  • Give age-appropriate anticipatory guidance including discussions of health promotion and disease prevention and control
  • Give timely feedback to colleagues regarding knowledge, performance, teaching, and communication
  • Develop skills to provide an appropriate sign-out to ensure safe patient care
  • Recognize the importance of transfer of information in the safe care of the hospitalized child

COMPETENCY 5. Professionalism – Interns are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession and society. To that end, interns will:

  • Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues
  • Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors, and disabilities of patients and professional colleagues
  • Adhere to principles of confidentiality, scientific/academic integrity, and informed consent
  • Recognize and identify deficiencies in peer performance and deliver constructive evaluation and criticism

COMPETENCY 6. System-Based Practice – Interns are expected to demonstrate both an understanding of the contexts and systems in which health care is provided and the ability to apply this knowledge to improve and optimize health care. To that end, interns will:

  • Review the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient
  • Apply evidence-based, cost-conscious strategies for prevention, diagnosis and disease management
  • Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care
  • Recognize the signs and symptoms that lead to the early identification of risky behaviors and to gain familiarity with the appropriate interventions including family and community resources
  • Consistently appreciate the cost of medical care and become judicious in the use of medical tests and hospitalization
  • Begin to understand the impact insurance status has on acquisition of appropriate health care as an inpatient and outpatient
  • Effective interaction with multidisciplinary teams required to provide care for patients, including physicians, nurses, case managers, physical therapists, occupational therapists, speech therapists, social workers, and child life specialists
  • Organize and lead the multidisciplinary effort for patient discharge and adequate continuity of care

PGY-1 Residents spend one month electively in the Emergency Department at Comer Children’s Hospital

COMPETENCY 1. Patient Care – Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, and the treatment of disease. To that end, the resident will:

  • Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records, diagnostic/therapeutic procedures, and subspecialist consultation when appropriate.
  • With the assistance of the attending physician, make informed recommendations about preventative, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference
  • Develop, negotiate and implement effective patient management plans and integration of patient care
  • Discuss all evaluations and plans with the ED attending prior to the patient’s discharge

COMPETENCY 2. Medical Knowledge – Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical, and social sciences, and the application of their knowledge to patient care and the education of others, and apply an open-minded, analytical approach to acquiring new knowledge. The resident will access and critically evaluate current medical information and scientific evidence, and apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking.

-> Through clinical experience, attending physician education, and independent reading, resident knowledge should include, but not be limited to, the following disorders, and should emphasize the pathophysiologic correlates of the clinical situations:

  • acute major and minor medical problems, including but not limited to respiratory infection, respiratory failure, cardiopulmonary arrest, dehydration, coma, seizures, diabetic ketoacidosis, asthma, skin disorders, pyelonephritis, sepsis, shock, fever, and childhood exanthems
  • acute manifestations or exacerbations of chronic diseases
  • acute major and minor surgical problems, including but not limited to appendicitis, bowel obstruction, burns, foreign body inhalation and ingestion, abscess drainage, and head trauma;
  • poisonings and ingestion
  • physical and sexual abuse
  • minor trauma (including splinting, casting, and suturing)
  • acute psychiatric, behavioral, and psychosocial problems
  • admission or discharge planning, including communication with the personal physician

-> The resident is expected to review clinical guidelines for the above disorders found on the Chief Resident website as well as review other pertinent literature related to the above conditions

COMPETENCY 3. Practice-Based Learning and Improvement – Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices, and

  • Follow up and record the outcomes of laboratory results and hospital course on all patients to whom they provide care, to learn whether the initial impressions and plans were correct
  • Analyze practice experiences to continually improve the quality of patient practice
  • Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care
  • Use information technology or other available methodologies to access and manageinformation, support patient care decisions and enhance both patient and physician education

COMPETENCY 4. Interpersonal and Communication Skills – Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintainprofessional relationships with patients, families, and other members of health care teams, and

  • Demonstrate respect for the privacy of the patient/family – knock before entering a room, and close the door and curtain prior to evaluating the patient
  • Create an effective clinical environment by turning on the lights and turning off the television
  • Consistently introduce themselves and their role in the patient’s care
  • Sit down and give  undivided attention to the patient and their family
  • Explain to the patient/family the thoughts/plans for their illness, work-up, and management in term they can understand
  • Always explain that the resident will be discussing plans with the supervising doctor whowill be in shortly to re-examine the patient
  • Demonstrate the willingness to discuss risk/benefit/cost options with the patient/family/attending
  • Consistently give written instructions that reinforce verbal instructions

COMPETENCY 5. Professionalism – Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession and society, and

  • Demonstrate respect, compassion, integrity and altruism in relationships with patients, families, and colleagues
  • Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues
  • Adhere to principles of confidentiality, scientific/academic integrity, and informed consent
  • Recognize and identify deficiencies in peer performance and give constructive feedback
  • Refrain from judging families who have chosen the ED as a care location in lieu of a clinic option, but instead re-educate them on the importance of a medical home

COMPETENCY 6. Systems-Based Practice – Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care. The resident should:

  • Discuss the limitations and opportunities inherent in various insurance coverage and delivery systems, and develop strategies to optimize care for the individual patient
  • Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management
  • Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care
  • Describe the necessary components of a comprehensive pediatric emergency room
  • Remain sensitive to the need to provide expeditious care to minimize the number of patients who leave without being seen

PEDIATRIC NEUROLOGY
OVERALL PROGRAM GOALS & EDUCATIONAL OBJECTIVES

  1. To expose the physician to the practice of clinical, pediatric neurology by providing training
  2. based on supervised clinical work with increasing responsibility for inpatients.
  3. To provide a foundation of organized instruction in the basic neurosciences.
  4. To provide an opportunity to develop and maintain an investigative career in the basic neurosciences
  5. To develop the many personal attributes necessary for becoming an effective physician, including honesty,
  6. compassion, reliability and effective communication skills.

GOALS:

  1. To provide concentrated exposure to neurologic disorders commonly encountered in pediatrics, including nervous system disorders requiring a surgical or psychiatric evaluation and management.
  2. To increase the resident's skills at diagnosing infantile and pediatric seizure disorders and selecting appropriate anticonvulsant therapy.
  3. To provide an opportunity for residents to pursue directed readings that focus on pathophysiology of pediatric neurologic disease processes.

EDUCATIONAL OBJECTIVES:

  1. To develop a logical approach in the evaluation and decision-making for children with neurologic problems. Following the rotation, residents should be able to obtain a detailed history, as it pertains to the pediatric population, and conduct comprehensive general and neurological examinations. Patient data should be documented in an organized fashion.
  2. To learn to distinguish abnormal from normal patterns of development in the examination of infants and children.
  3. To learn the indications for and interpretations of cranial CT and MRI scans of pediatric neurologic disorders.
  4. To learn to manage pediatric patients with neurological problems, especially those with intractable epilepsy, neurogenetic disorders, neuromuscular disorders and neurobehavioral disorders. This will include exposure to basic EEG interpretation (routine and long-term monitoring).
  5. To learn to evaluate mental retardation developmental disabilities, headache movement disorders, and neurovascular disease.

PEDIATRIC NEUROLOGY RESIDENT RESPONSIBILITIES:

  1. Patient Care
    Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life. To that end, residents will:
    • Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures.
    • Make informed recommendations about preventative, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference.
    • Develop, negotiate and implement effective patient management plans and integration of patient care.
  2. Medical Knowledge 
    Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care. Residents will apply an openminded, analytical approach to acquiring new knowledge, access and critically evaluate current medical information and scientific evidence and apply this knowledge to clinical problem-solving, clinical decisionmaking and critical thinking.
  3. Practice-Based Learning and Improvement Residents are expected to be able to use scientific evidence and methods to investigate, evaluate and improve patient care practices, and
    • Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care.
    • Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice.
    • Develop and maintain a willingness to learn from errors and use errors to improve the system of processes of care.
    • Use information technology or other methodologies to access and manage information, support patient care decisions and enhance both patient and physician education.
  4. Interpersonal and Communication Skills Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams, and
    • Provide effective and professional consultation to other physician and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families and colleagues.
    • Use effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families.
    • Interact with referring physicians in a respectful, appropriate manner.
    • Maintain comprehensive, timely, and legible medical records.
    • Complete evaluations of the attending, staff and rotation.
    • Learn to give guidance and instruction to families regarding the management of their children with neurological disease.
  5. Professionalism 
    Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession and society, and
    • Demonstrate respect, compassion, integrity and altruism in relationships with patients, families and colleagues.
    • Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.
    • Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
  6. Systems-Based Practice 
    Residents are expected to demonstrate both an understanding of the contexts and systems in which health care provided, and the ability to apply this knowledge to improve and optimize health care, and
    • Understand, access and utilize the resources, providers and systems necessary to provide optimal care.
    • Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient.
    • Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management.
    • Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care.
  7. Specific Topics
    Residents should become familiar with the following topics during their time on the rotation through experience, didactic sessions or reading:
    • Examination of the newborn, child and adolescent
    • Intracranial hemorrhage
    • Brain tumors
    • Pediatric movement disorders
    • Coma and stupor
    • CNS infections
    • Febrile seizures
    • Seizure disorders
    • Pediatric epilepsy surgery
    • Degenerative neurologic diseases
    • Demyelinating disorders
    • Neuromuscular diseases
    • Neurocutaneous diseases (Tuberous sclerosis, Neurofibromatosis)
    • Headaches
    • School problems, learning disabilities and Attention Deficit disorders
    • Cerebral palsy and management of spasticity
    • Critically ill child
  8. Residents have access to the Pediatric Library located on the 5 th floor of the Children's Hospital.
  9. Online Learning centers include the:

PATIENT CARE

The PGY-1 resident will be able to:

  • Obtain information from the patient interview, family contact, old charts, outpatient providers to complete a thorough assessment of the following areas:
    • History of Present Illness-Complete assessment of symptomatology, chronological order of events, recent stressors and precipitants, level of functioning
    • Past Medical History
    • Past Psychiatric History
    • Substance Abuse History
    • Family History
    • Social History
    • Developmental History
  • Complete a comprehensive mental status examination
  • Assess for dangerousness to self and/or others
  • Use precautions appropriately including close observation, suicide precautions, and one to one
  • Understand and appropriately apply criteria for inpatient hospitalization
  • Determine if a patient is medically stable enough for psychiatric hospitalization
  • Formulate a basic treatment plan including the following:
    • Acute stabilization
    • Medication management and/or ECT
    • Psychosocial interventions
    • Group and individual therapy
    • Psychoeducation
    • PT/OT/Art therapy
    • Discharge planning
  • Document the full history, mental status examination, hospital course, basic differential diagnosis, basic diagnostic formulation and basic treatment plan in the discharge summary
  • In addition to the list above, the PGY-2 resident will have participated in ECT assessment and delivery of treatment to at least 2 patients
  • The PGY-2 resident will demonstrate and be able to explain to medical students a basic understanding of individual, group and family treatment as it relates to inpatient psychiatry
  • The PGY-2 resident will be able to discuss and provide appropriate documentation on patients seen in the ER (if applicable) including a complete HPI, MSE, and clinical rationale for triage decisions and treatment recommendations

MEDICAL KNOWLEDGE

The PGY-1 resident will be able to:

  • Make a reasonable differential diagnosis based on a basic understanding of DSM-IV criteria to include all 5 axes
  • In addition, the PGY-2 resident will be able to discuss treatment strategies for major psychiatric disorders such as schizophrenia, bipolar disorder, depression, anxiety disorders, dementia, delirium, and substance abuse, and the management of refractory psychiatric presentations in those diagnostic areas.

SYSTEMS BASED PRACTICE

The PGY-1 resident will be able to:

  • Elicit and utilize information from other disciplines
  • Demonstrate an understanding of the economic and social forces which impact health behaviors and availability of treatment options
  • Demonstrate a basic understanding of medical-legal issues as they relate to inpatient psychiatry, including voluntary and involuntary admission procedures, certification paperwork and issues of confidentiality
  • In addition, the PGY-2 resident should demonstrate a more comprehensive understanding of medical-legal issues including an understanding of the rights of, and obligations toward, court-ordered patients; the use of forced medication; and the process of testifying in hearings
  • The PGY-2 resident should demonstrate an understanding of cost-containment strategies balanced by the clinical needs of the patient, including the length of stay issues, medication panels, generic versus non-generic medications and the rationale for the use of each.
  • The PGY-2 resident should display an understanding of multiple levels of care, including day treatment, supported housing, inpatient and outpatient options, co-morbid substance abuse treatment, and should understand the limitations of treatment based on health care policy and cost.

INTERPERSONAL AND COMMUNICATION SKILLS

The PGY-1 resident will be able to:

  • Demonstrate interdisciplinary team leadership
  • Co-lead community and team meetings on the unit
  • Demonstrate a capacity to be empathic and develop a rapport with patients and their families
  • Demonstrate a capacity to relate and work well as a team player with peers, supervisors and other staff
  • Demonstrate the capacity for introspection
  • In addition, the PGY-2 resident will demonstrate an increased self-awareness, especially in understanding and appreciating transference and countertransference issues

PROFESSIONALISM

The PGY-1 and PGY-2 resident will be able to:

  • Understand and appreciate a biopsychosocial formulation that includes basic psychodynamic, psychosocial and cultural elements
  • Demonstrate adequate supervision of medical students
  • Exemplify personal and intellectual integrity, and demonstrate an understanding of the ethical values and codes of a member of the medical profession

PATIENT CARE

The PGY-1  resident will be able to:

  • Fully gather data from all available sources, including the patient, paper and electronic chart (including physician's notes, nursing staff notes, social work notes, other staff member notes, medication administration records), hospital staff, and family or friends of the patient
  • Adapt his/her interview style to suit the clinical setting and medical and/or psychiatric condition of the patient (i.e. communicate effectively with patients on ventilators, recognize stress and fatigue in patients, communicate effectively with difficult or agitated patients, prioritize questions and perform multiple, brief interviews if necessary)
  • Ascertain all required information related to a patient's family history, personal history, substance history, premorbid personality, allergies, past medical history, current medications, review of systems, detailed past psychiatric history, detailed history of present illness (including history of present medical illness), and mental status examination, including MMSE
  • Thoroughly formulate a patient's case based upon the above information with particular consideration to perspectives of disease, temperament, behaviors, and life story
  • Comprehensively assess self-injury risk, risk of injury to others, dangerousness and appropriate use of constant observation
  • Accurately assess patients for capacity to make medical decisions (“competency”) in medically ill patients
  • Perform routine follow up of already evaluated patients, monitor the patient's course during hospitalization and provide continuing input (both pharmacologic and psychotherapeutic) as needed to the patient and treating team
  • Accurately and fully document all elements described above on the resident physician consultation form as well as the patient's chart, including medical and legal facets, when necessary
  • Remain aware of the overall medical status of the patient and general disposition plans as the patient's hospital course proceeds
  • In addition, the PGY-2 resident will demonstrate improvement in formulative abilities with progressive experience on the consultation service
  • The PGY-2 resident will make initial treatment recommendations and assessments of need for immediate intervention
  • The PGY-2 resident will handle more complex CL cases

INTERPERSONAL AND COMMUNICATION SKILLS

The PGY-1 resident will be able to:

  • Facilitate the consulting service's ability to formulate a clinical question relevant to our capacity to aid in the care of the patient
  • Directly and promptly reply verbally to the consulting service the clinical impression of the patient as well as specific treatment recommendations and guidelines
  • Document in the medical chart all follow up evaluations of patients remaining in the general hospital, including subjective matters, mental status exam and MMSE (if needed in follow up), continued assessment as well as ongoing recommendations
  • Advise and guide consulting services about the role of medical disease in a patient's presentation, further diagnostic testing required to clarify the clinical picture and medications that are accordingly recommended
  • Advise and educate consulting services about the current diagnostic assessment of the patient and, if applicable, how it may be distinguished from the working diagnosis prior to psychiatric consultation
  • Work as a valued member of a multidisciplinary staff to maximize the care of complex medically ill patients
  • Provide appropriate direction to consulting services regarding management of dangerous, agitated and/or psychotic patients who are treated on general hospital units
  • Develop a therapeutic alliance with respect for privacy in medically ill patients
  • In addition, the PGY-2 resident will provide supervision and teaching to the medical students, PGY-1 psychiatry resident and other non-psychiatry residents on the CL service
  • The PGY-2 resident will further develop interdepartmental alliances via serving as a respected medical colleague in the hospital and attending multidisciplinary task-specific meetings about problematic cases

MEDICAL KNOWLEDGE

The PGY-1 resident will be able to:

  • Understand the indications for a variety of somatic therapies in medical and surgical patients
  • Understand the use of psychotropic medications and ECT in medical and surgical patients and appreciate physiologic effects, contraindications, drug interactions, and dosing concerns
  • Understand the use of psychosocial treatments including supportive psychotherapy, behavioral management techniques, family therapy, and psychoeducation
  • Understand risk factors, recent precipitants, classical and atypical presentations, screening tests, etiologies, appropriate medical evaluation, and the comprehensive treatment strategies of delirium
  • Effectively advise medical and surgical teams on the appropriate use of antipsychotics and benzodiazepines in agitated patients
  • Understand how to perform a comprehensive evaluation for organic causes of psychiatric symptoms or syndromes
  • Distinguish demoralization from other depressive syndromes in the medical setting
  • Understand the medications that have psychiatric symptoms as side effects
  • Understand classes of or specific drug interactions between psychotropic medications and non-psychotropic medications
  • Understand the appropriate indications and dosing strategies for psychostimulants in the medically ill
  • Understand the clinical settings that further justify continued medical or surgical inpatient admission while a patient's disposition is coordinated
  • Understand the appropriate use, risks and benefits, and dosing strategies of psychotropic medications in pregnancy
  • Understand the clinical syndrome of NMS and appreciate its evaluation and management
  • Understand how to perform a pre-transplant psychiatric evaluation
  • Understand the differences between somatization disorder, conversion disorder, factitious disorder and malingering
  • Understand the core concepts of competency and the legal process that may be invoked once a patient has been deemed incompetent
  • In addition, the PGY-2 resident will have a more comprehensive knowledge base in the areas outlined above and will be able to convey that knowledge to medical students and medical colleagues.

PROFESSIONALISM

The PGY-1 resident will:

  • Dress in professional business attire at all times defined as:
    • Wearing a clean white coat in all clinical settings involving contact with medical colleagues or patients
    • Replacing scrub outfits with standard professional work attire when post-call
  • Obtain and provide cross-coverage as needed during one's absence or during other scheduled clinical responsibilities
  • Behave collegially and demonstrate a willingness to help other members of the team and other departments
  • Assist with and ask for assistance in the case of emergencies or clinical uncertainty
  • Maintain a thorough list of current patients being followed on the consultation service, addressing pertinent issues for patients, including current medication regimens
  • Demonstrate a commitment to ethical principles when dealing with patients, families, and colleagues
  • In addition, the PGY-2 resident will provide role modeling and supervision for the PGY-1 resident and medical students

SYSTEMS BASED PRACTICE

The PGY-2 resident will:

  • run the Consult Liaison team, supervising schedules, cross-coverage and assignment of patients
  • negotiate workload issues among team members
  • demonstrate an understanding of the role of the CL Team in providing care vs providing consultation to the medical/surgical services, and work effectively and collaboratively with consulting teams.

PATIENT CARE:

The resident will learn how to conduct emergency psychiatric evaluations through the examination, evaluation, and provision of emergency care to patients presenting to the UCMC Emergency Room with emergent psychiatric and substance-related problems, and/or with psychiatric symptoms of medical problems. 

MEDICAL KNOWLEDGE:

The resident will develop a basic knowledge of

  • crisis intervention,
  • acute psychopharmacologic interventions in psychiatric emergencies,
  • the principles and process of involuntary treatment,
  • appropriate assessment of suicidal patients.

The resident will learn to differentiate psychiatric emergencies from medical/surgical emergencies with psychiatric symptoms.

INTERPERSONAL AND COMMUNICATION SKILLS:

The resident will learn to interact with the ER doctors and staff to provide optimum care for psychiatric patients in the ER.

SYSTEMS BASED PRACTICE:

The resident will learn about the State of Illinois Mental Health System including hospitals and community mental health centers, Substance Abuse treatment programs and other community resources for referral purposes.

PATIENT CARE:

PGY-II psychiatric residents will treat substance abuse inpatients for acute detoxification from a large variety of substances, and follow substance abuse rehabilitation patients in inpatient, partial hospital and outpatient programs at UChicago Medicine Ingalls Memorial.  Residents will conduct a "medical aspects of addiction" group for inpatients.

MEDICAL KNOWLEDGE:

Residents will:

  • l learn techniques for acute detoxification from alcohol, opiates, benzodiazepines, and other substances.
  • Gain familiarity with dual diagnosis issues such as differentiating between primary depression and anxiety coexistent with substance abuse versus mood and anxiety disorders subsequent to chronic substance abuse.
  • Observe and participate in available psycho-educational models for rehabilitation, including 12-step programs, group therapy, family therapy.

PROFESSIONALISM:

Residents will develop an attitude of helpfulness, compassion, and empathy toward patients with substance abuse problems, and will develop a realistic understanding of what psychiatry can provide for such patients.  Residents will consider the complex issue of physician impairment.

SYSTEMS BASED PRACTICE:

Residents will develop an understanding of the community resources for people with substance abuse problems. 

LOCATION- UChicago Medicine Ingalls Memorial

HOURS

Five mornings per week halftime, plus one evening per rotation (AA Meeting).  Rounds will be arranged by Dr. Grant

SUPERVISION

Dr. Jon Grant

PATIENT CARE:

PGY-2 residents spend two months in Community Psychiatry, where they perform psychiatric diagnostic evaluations in the community and at a community clinic. They care for patients with chronic psychiatric illness in several community settings:

  • Thresholds, a large not-for-profit psychiatric rehabilitation organization which provides supported housing, vocational rehabilitation, mobile assessment and outreach to the homeless mentally ill, and other psychiatric services
  • The Phoenix Program at Northshore University Health Systems, which provides medication management, vocational programs, and other services.

MEDICAL KNOWLEDGE:

Residents will learn about the special problems of homelessness in the chronically mentally ill, and about mentally ill offenders. They will become familiar with the "recovery model" of mental health care.

INTERPERSONAL AND COMMUNICATION SKILLS

Residents will observe caseworkers interacting with patients in homes, on the streets, and in other public settings.  They will learn and utilize engagement techniques for reaching difficult-to-treat and reluctant patients. 

SYSTEMS BASED PRACTICE:

Residents will:

  • Experience the activities of community treatment of the chronically mentally ill as conducted in a community clinic and in non-institutional settings.
  • Gain experience working as a team member with caseworkers.

PATIENT CARE:

The rotation at UChicago Medicine Ingalls Memorial provides a rich and diverse clinical experience in child and adolescent psychiatry.  The population ranges in age from 6 to 18 years of age and represents a diverse ethnic and cultural mix.  Residents work with patients from 6 to 18 years of age, becoming familiar with evaluation, diagnosis and treatment issues in child psychiatry as well as the family and systemic issues that contribute to a child's hospitalization. 

MEDICAL KNOWLEDGE: 

Residents will become familiar with the presentation of psychiatric illness in children, including the evaluation and treatment of attentional disorders, affective disorders, anxiety disorders, psychoses, and developmental disorders.  Residents will understand the modifications necessary to use the psychotropic medication in child patients, and the particular vulnerabilities and risks in using medications in children. 

INTERPERSONAL AND COMMUNICATION SKILLS

Residents will work collaboratively with staff in a multidisciplinary team format and will learn to present evaluations in teaching rounds. Residents will learn to interview children of different ages and will learn techniques to establish rapport, obtain data and gain cooperation from children who may be difficult to treat or reluctant patients.

SYSTEMS BASED PRACTICE:

Residents will:

  • work with outside systems of care such as schools, extended families and foster parents.  
  • Gain experience working as a team member with other disciplines

Each PGY-4 resident spends all or part of the year as a Chief Resident.  There are one or two Administrative Chiefs, as well as Chief Residencies on the UChicago Medicine Ingalls Memorial Inpatient Unit, the Evanston/Northshore Inpatient Unit, the UCMC Consultation Service, the UCMC Emergency Service, and the Outpatient Department.  Chief Residents meet regularly with the head of the service on which they rotate, and/or with the Program Director.

PATIENT CARE

Chief Residents provide supervision for junior residents and medical students in conducting interviews, evaluating and delivering care to patients.

MEDICAL KNOWLEDGE

The Chief Resident identifies, learns and teaches about areas important to delivering excellent patient care such as diagnosis, evaluation, and treatment of major mental illnesses, personality disorders, substance abuse, delirium and dementia, and process issues in the management of mental health care teams.

PRACTICE-BASED LEARNING AND IMPROVEMENT

The Chief Resident identifies benchmarks for performance in at least one area related to the focus of the Chief Residency, measures it, creates an intervention, and assesses the effect of that intervention in a QA project during the PGY-4 year.  The Chief Resident identifies problems in communication, performance, or outcome in the day-to-day work of the unit he/she supervises, assesses the contributing factors, and intervenes to ameliorate the problems on a regular basis, working with staff, residents, medical students and attending physicians.

INTERPERSONAL AND COMMUNICATIONS SKILLS

The Chief Resident

  • gives feedback to junior residents and medical students about skills, interpersonal interactions, performance
  • teaches junior residents and medical students about diagnosis, formulation, MSE, treatment planning
  • helps residents prioritize interventions
  • meets with attending physicians to discuss administrative issues 

PROFESSIONALISM

The Chief Resident develops a sense of leadership and clinical competence promotes excellence in teaching and models professional behavior for junior residents and medical students.  The Chief learns to deal with interpersonal differences among subordinates and to resolve problems that arise on any busy clinical service

SYSTEMS BASED PRACTICE

The Chief Resident learns how his/her service interfaces with other services in the hospital or the system of mental health care and addresses problems that arise at those interfaces. 

Each PGY-4 resident identifies an area of interest in which to pursue a Quality Improvement project.  Residents address a clinical problem, either already identified by the Department's Quality Assurance Committee or one that emerges in their work as Chief Residents on clinical services.  Under the supervision of the Director of Clinical Services or other faculty, they collect data to establish the nature of the problem, define an intervention, and follow up with a further assessment.  To direct their focus, residents write Goals and Objectives under the supervision of the Program Director.  Residents write up their projects at the end of the year; some have been presented at hospital-wide QA meetings or national meetings.

PRACTICE BASED LEARNING AND IMPROVEMENT

The Chief Resident identifies problems in communication, performance or outcome in the day-to-day work of the unit he/she supervises, assesses the contributing factors, develops benchmarks for performance in at least one area, measures baseline performance, creates an intervention, and assesses the effect of that intervention in a QA project during the PGY-4 year. 

INTERPERSONAL AND COMMUNICATIONS SKILLS

The Chief Resident educates staff, attendings, junior residents and medical students about the identified problems, the process of QA, the intervention proposed and its rationale, and the outcome.

PROFESSIONALISM

The Chief Resident develops his/her own self-critical abilities to identify areas of improvement and models a stance of self-improvement for junior residents and medical students.

SYSTEMS BASED PRACTICE

The Chief Resident addresses issues that arise at the interface of systems of care, usually between institutions, between Departments or between teams.

PGY-4 residents work directly with individual research mentors to carry out and complete a research project.  Following the PGY-2 research course which fosters an increased understanding of issues related to research study design, methods, and statistics, residents identify a research laboratory with which they intend to work.  Supervised by Dr. Kristen Jacobson, residents gain familiarity with the data and research methodologies of the laboratory with which they are working in the PGY-3 year.  In PGY-4, residents meet regularly with research mentors in individual and laboratory meetings to work on formulation of research questions, organization, and analysis of data, and a review of the literature.  Residents present their research project to the Department in the Spring of the PGY-4 year.  Many presentations result in publication.  Residents spend 4-25 hours per week on research.

MEDICAL KNOWLEDGE

The resident will:

  • attend seminars and laboratory meetings in a lab of their choosing
  • define a researchable question
  • review the pertinent literature
  • design a study and conduct a relevant statistical analysis
  • present the completed study and findings to the Department

The resident will learn to apply statistical tools, evaluate and select appropriate methodologies, critically evaluate the literature, and draw conclusions supported by the data. 

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

  1. Techniques used in the evaluation of adults with anxiety disorders including evaluation of previous pharmacologic, somatic, and psychotherapeutic treatments.
  2. 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.
  3. 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
  4. 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

  1. Education of patients about anxiety disorders
  2. Engagement of patients in treatment.

PROFESSIONALISM

  1. 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 cognitve 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.