Education

Rotation and Clinic Goals and Objectives

 

          The ability to comprehensively assess, discuss, document, and intervene in situations concerning patients who have psychiatric illness interfering with medical or surgical illness, or who have psychiatric illness presenting with physical symptoms, e.g. somatoform illness. The resident will be able to:

          • Evaluate procedures including review of physical and neurologic findings, laboratory and radiologic findings, medications, and treatments.
          • Manage crisis/ emergencies of acutely disturbed children and adolescents with medical or surgical illness from outpatient practice.
          • Discuss consultation liaison treatment standards, procedures, psychopharmacology and the differences from outpatient
          • Effectively intervene to implement methods to minimize risk of harm to self or others including psychopharmacologic and mechanical restraints
          • Choose the most appropriate psychotherapeutic treatment for different each consultation.

          MEDICAL KNOWLEDGE

          Residents will demonstrate a solid understanding and grasp of core concepts and knowledge in the following areas:

          1. Understanding of the psychological impact of, and adjustment to, acute and chronic illness in children and their families
          2. Understanding how developmental level affects response to treatment and treatment approaches.
          3. Define the consult process (calling a consult, defining the consult question, evaluation the child and family, working with the medical team.)
          4. Understand the role of the Consult-liaison psychiatist in the medical/ surgical team
          5. Define differences in presentation of common pyschiatric disorders in the medical/ surgical setting.
          6. Describe developmentally appropriate understanding of and responses to death in both children and adolescents, and describe how to identify when supportive or treatment interventions are needed.

          INTERPERSONAL AND COMMUNICATION SKILLS

          Upon completion of the CL rotation, residents will be able to demonstrate the following interpersonal and communication skills:

          1. Help the referring physician articulate and define a practical, useful and answerable consult question.
          2. Help children/ adolescents communicate in developmentally appropriate ways.
          3. Communicate effectively with every member of the family bot individually and in groups to form an effective working alliance.
          4. Form effective working relationships with the entire pediatric treatment team, including generalists and specialists, physicians, nurses, social workers, nutritionists, psychologists, physical/occupational therapists, etc.
          5. Be able to deliver "bad news" effectively, compassionately, and therapeutically; and model this for other members of the team.
          6. The ability to work effectively within a multidisciplinary team structure as a team member and consultant. Be able to lead the team when called for.

          PROFESSIONALISM

          Residents will be sensitive to the sociocultural, socioeconomic, educational issues that arise in the therapeutic relationship. In addition:

          1. Residents will evaluate children and families with sensitivity, empathy, and clinical acumen, while being sensitive to feelings of anger, guilt, anxiety, and hopelessness, or to denial of feeling.
          2. Residents will use developmentally appropriate, comprehensible language in communicating with children and families with physical illness and comorbid psychiatric illness.
          3. Use culturally and socially appropriate language in communicating with children and families.
          4. Wear appropriate professional attire on the C/L service, including an understanding of how the consultant's attire may affect children based on their trauma and medical histories and past experience with medical care.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will evaluate caseload and practice experience in a systematic manner. Daily rounds are held to review the patient's treatment and informal feedback is given. Residents will identify areas of strengths and weakness, and work with the attending to make a performance improvement plan.

          In addition, the resident will:

          1. Know when to update knowledge of pediatric illnesses and treatment.
          2. Identify when to seek additional supervision.
          3. Be able to discuss transference and countertransference with patients and families and identify when this is interfering with treatment.

          SYSTEMS-BASED PRACTICE

          The resident will:

          1. Learn how to advocate for optimal patient care within the limits of the health care delivery system by understanding the resources available for increased outpatient services or residential care including community and school based resources.
          2. Learn how to consult with emergency doctors and other specialist including state agencies around inpatient admissions
          3. Learn how to be the leader in a psychiatric emergency, keeping the patient and staff safety as priority
          4. Review cases with supervisors and other staff in ER/ C-L Rounds, and when appropriate, in quality improvement rounds (M&M)
          5. Understand the different levels of care in acute inpatient, partial hospitalization, intensive outpatient, 23-hour crisis evaluation and management units and be able to define the typical symptomatology that can be best managed in each treatment environment.
          6. Understand what is meant by "systems of care" and use a system of care approach in addressing the comprehensive bio-psycho-social and spiritual needs of physically ill children with psychiatric needs.
          7. Be able to work effectively with all of the relevant care-providers involved in a given case, potentially including pediatricians, nurses, OT/PT, nutritionist, educators, child life specialists, psychologists, patient advocates and others.

          PATIENT CARE

          Residents will demonstrate the ability to comprehensively assess, discuss, document, and intervene in situations concerning patients' potential for self-harm or harm to others.

          This will include:

          • assessment of risk based on known risk factors
          • knowledge of inpatient treatment standards and procedures
          • effective intervention to minimize risk
          • Implement prevention methods for self-harm and harm to others.

          MEDICAL KNOWLEDGE

          Residents will demonstrate knowledge of emergency psychiatry. This includes:

          • suicide
          • crisis interventions
          • differential diagnosis in emergency situations
          • treatment methods in emergency situations
          • violent behaviors

          INTERPERSONAL AND COMMUNICATION SKILLS

          Residents will demonstrate:

          • the ability to work effectively within multidisciplinary team structures as member, consultant, and leader.
          • the ability to form relationships with patients and professionals in a emergency setting.
          • The ability to exhibit professional, ethically sound behavior and attitude in all patient and professional interactions
          • Residents demonstrate the ability to obtain, interpret and evaluate emergency consultations. This will include formulating and clearly communicating consultation questions
          • discussing consultation findings with the consultant in the ER
          • evaluating consultation findings and making recommendations.

          PROFESSIONALISM

          Residents will be empathic, respectful, curious, open, nonjudgmental, collaborative, able to tolerate ambiguity and demonstrate confidence in the efficacy of supportive therapy.

          Residents will be sensitive to the sociocultural, socioeconomic, educational issues that arise in the therapeutic relationship.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will evaluate caseload and practice experience in a systematic manner. The residents will bring certain cases to be discussed in supervision, rounds and M & M meetings.

          SYSTEMS-BASED PRACTICE

          The resident will:

          1. Learn how to advocate for optimal patient care within the limits of the health care delivery system.
          2. Learn how to consult with emergency doctors and other specialist including state agencies around inpatient admissions
          3. Learn how to be the leader in a psychiatric emergency, keeping the patient and staff safety as priority
          4. Review cases with supervisors and other staff in ER/ C-L Rounds, and when appropriate, in quality improvement rounds (M&M)

          PATIENT CARE

          Forensic evaluation of a variety of patients of both genders, including adolescent, who represent a broad range of mental disorders and circumstances, in both civil and criminal contexts.

          MEDICAL KNOWLEDGE

          The resident will participate in consultation to general psychiatric services on issues related to the legal psychiatric practice, such as civil commitment, confidentiality, refusal of treatment, decision-making competence, custody evaluation and guardianship.

          The resident will acquire:

          • Knowledge of child custody laws.
          • Evaluation methodology to perform custody evaluation.
          • Evaluation of adolescents for custody.

          INTERPERSONAL AND COMMUNICATION SKILLS

          The resident will learn to observe evaluations done by experienced professionals in court and the homes of families with regards to custody disputes and visitation rights. Interpersonal skills are defined as the specific techniques and methods, which facilitate effective and empathetic communication between the resident, patients, colleagues, staff, and system.

          PROFESSIONALISM

          The resident will demonstrate respect for patients and colleagues, and respect their age, culture, disabilities, ethnicity, gender, and sexual orientation. The resident will interact professionally with the legal system.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will be able to articulate the basic concepts of forensic child and adolescent psychiatry and how it is used in the legal system. The resident should have a working knowledge of the diverse systems involved in treating children, and adolescents, and understand how to use the systems as part of a comprehensive system of care, in general, and as part of a comprehensive, individualized plan.

          SYSTEMS-BASED PRACTICE

          The resident will be able to:

          1. Work with various members of the hospital, clinical and legal teams including but not limited to lawyers, child protective services, and inpatient unit physicians.
          2. Work to identify system errors, and accurately identify what happened to cause the errors and what outcome the error has caused.

          PATIENT CARE

          Residents will demonstrate the ability to comprehensively assess, discuss, document, and intervene in situations concerning patients' potential for self-harm or harm to others.

          This will include:

          • Knowledge of admission procedures including involuntary admissions and admission orders
          • Crisis/ emergency management of acutely disturbed children and adolescents including assessment of risk based on known risk factors
          • Knowledge of inpatient treatment standards, procedures, and psychopharmacology and the differences from outpatient
          • Effective intervention to minimize risk including psychopharmacologic and mechanical restraints
          • Implement prevention methods for self-harm and harm to others.

          MEDICAL KNOWLEDGE

          Residents will demonstrate knowledge of treatment in acutely disturbed children and adolescents, and recognize the differences from an outpatient practice This includes evaluation and treatment of:

          • Patients with suicidal or homicidal ideation
          • Patients with psychotic disorders
          • Crisis interventions
          • Differential diagnosis in emergency situations, with special emphasis on neurologic and medical presentations mimicking psychiatric illness
          • Treatment methods in emergency situations
          • Patients with violent behaviors

          Residents will also demonstrate knowledge of medical legal and risk management issues pertinent to the practice of inpatient child and adolescent psychiatry, including issues surrounding criteria for involuntary admission, right to consent for treatment and various confidentiality issues.

          INTERPERSONAL AND COMMUNICATION SKILLS

          Residents will demonstrate:

          • The ability to work effectively within a multidisciplinary team structure as a member, consultant, and leader
          • The ability to form relationships with patients and professionals in an acute care setting.
          • Knowledge of liaison techniques related to coordination of care with outpatient mental health professionals, community based agencies, schools, residential treatment programs, and the Department of Children and Family Services.
          • The ability to exhibit professional, ethically sound behavior and attitude in all patient and professional interactions

          PROFESSIONALISM

          Residents will be empathic, respectful, curious, open, nonjudgmental, collaborative, able to tolerate ambiguity and demonstrate confidence in the efficacy of supportive therapy.

          Residents will be sensitive to the sociocultural, socioeconomic, educational issues that arise in the therapeutic relationship.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will evaluate caseload and practice experience in a systematic manner. Daily rounds are held to review the patient's treatment and informal feedback is given. Residents will identify areas of strengths and weakness, and work with the attending to make a performance improvement plan.

          SYSTEMS-BASED PRACTICE

          The resident will:

          1. Learn how to advocate for optimal patient care within the limits of the health care delivery system by understanding the resources available for increased outpatient services or residential care including community and school based resources.
          2. Learn how to consult with emergency doctors and other specialist including state agencies around inpatient admissions
          3. Learn how to be the leader in a psychiatric emergency, keeping the patient and staff safety as a priority
          4. Review cases with supervisors and other staff in ER/ C-L Rounds, and when appropriate, in quality improvement rounds (M&M)
          5. Understand the different levels of care in acute inpatient, partial hospitalization, intensive outpatient, 23-hour crisis evaluation and management units and be able to define the typical symptomatology that can be best managed in each treatment environment.

           

          PATIENT CARE

          1. For residents participating in clinical research projects, the resident will demonstrate the ability to perform a comprehensive psychiatric history utilizing appropriate research evaluations such as the K-SADS and ADOS and/ or standardized rating instrument.  The resident will be able to document this assessment and present in consensus meeting:
            • Psychiatric symptoms and history
            • Social and educational history
            • Family history
            • Substance abuse history
            • Medical history and review of systems
            • Physical and neurological examination, as deemed necessary
            • Developmental history
            • Mental status examination including assessment of cognitive functioning
          2. Residents will learn to differentiate patient care in a research study from those in clinical care and know when to terminate a research project to pursue clinical care.
          3. Residents will learn to work with clinical and research staff and balance the competing demands of each. 

          MEDICAL KNOWLEDGE

          1. The resident will learn the proper techniques of research, including the NIH regulations and ethical guidelines concerning research. 
          2. Residents will learn how to use the medical literature to develop their project and to prepare background for a presentation before the section or the department. 
          3. The resident will learn how to find and utilize resources for research at The University of Chicago such as the Institute or Mind and Body, and the Translational & Molecular Neuroscience research center of our department.
          4. The resident will further their medical knowledge base about their research project. 

          INTERPERSONAL AND COMMUNICATION SKILLS

          1. Residents will work collaboratively with mentors, other researchers, and other support services. 
          2. Residents will demonstrate the ability to communicate effectively with granting agencies, research subjects their families in both written and oral formats. 
          3. Residents will work with their research mentor to develop a presentation to clearly and simply present the work they have been doing. 

          PROFESSIONALISM:

          1. The resident will demonstrate respect for patients and colleagues, and respect their age, culture, disabilities, ethnicity, gender, and sexual orientation.
          2. The resident will interact professionally with the research staff, IRB and Office of Research Support.
          3. The resident will demonstrate a collaborative and nonjudgmental attitude characterized by empathy, curiosity, respect and openness.  Residents also demonstrate the ability to tolerate ambiguity and show confidence in the research process.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          1. The resident will be able to evaluate and incorporate the basic principles underlying clinical, translational, and/or basic science research into their own research and clinical work with patients. 
          2. The resident should be able to identify their personal limitations in research, but also develop a sense of understanding and of their strengths in the contributions they make and continue to make to moving the field forward in research that can continue once they leave training. 
          3. This rotation will support a more in-depth use of the electronic resources and help the resident adopt a system of life-long learning. 
          4. Teaching abilities will be evaluated as the resident works with their mentor on presentation skills, and be students, peers and faculty at their presentation. 

          SYSTEMS-BASED PRACTICE:

          1. Each resident must recognize and accept limitations in his/her knowledge base and clinical skills, and understand the need for life-long learning.
          2. Residents will possess research appropriate skills and demonstrate the ability to obtain current scientific research and clinical practice guidelines to assist in promoting high quality patient care. This will include, but not be limited to:
            • use of medical libraries
            • use of information technology, including Internet-based searches and research databases (e.g., MedLine)
            • use of drug information databases
          3. Residents will evaluate caseloads and practice experience in a systematic manner. This may include:
            • maintenance of patient logs
            • review of patient records and outcomes
            • obtaining appropriate supervision
            • residents will understand how their patient care affects and is affected by other health care providers

          MEDICAL KNOWLEDGE

          • observe normal development in a classroom setting and learn to differentiate variations of normal development from psychopathology across all ages of development
          • learn to understand, define and clarify consultation problems or questions by using clear, and respectful language with school staff,
          • learn to understand the roles played by various mental health and medical professionals in the school, and how to consult with each, respectively
          • learn how to help school personnel plan the most effective, and efficient course of evaluation, especially in emergency situations
          • observe and participate in the IEP process
          • observe a regular classroom setting and develop skill in differentiating typical from atypical development from preschool to high school.

          INTERPERSONAL AND COMMUNICATION SKILLS

          • learn how to provide feedback and recommendations at the time of the consultation
          • learn how to work effectively with community organizations such as DCFS, CMHC, and SASS
          • residents will advocate for quality mental health and help with referrals.

          PROFESSIONALISM

          • Residents will demonstrate sensitivity and responsiveness to school rules, and demonstrate professionalism in dealing with school personals.
          • Residents will be sensitive to the socio-cultural, socioeconomic, educational issues that arise in the rotation.
          • Residents will be empathic, respectful, curious, open, nonjudgmental, collaborative.

          SYSTEMS-BASED PRACTICE

          Demonstrate knowledge of community systems of care and assist students and their respective families to access appropriate psychiatric care and other mental health support services. This requires knowledge of psychiatric treatment settings in the community, which includes ambulatory, consulting, inpatient, partial hospital, substance abuse.  Work with reporting agencies to ensure patient safety.  Work with the UCH child protective team to protect children and still advocate for the family unit when possible.  Realize how health care disparities play a role in injury and psychiatric illness. 

          The resident will demonstrate knowledge of the organization of care in each relevant delivery setting.

          PATIENT CARE:

          The clinic director supervises the chief resident to learn how to run the clinic, manage patients load, and help junior resident in their direct patient care. The chief resident is also responsible on reviewing intake request and deciding the appropriate level of care.

          The clinic serves patients with a broad age range, including a significant number of pre-school patients, as well as the more typical school-aged and adolescent patients. 

          The chief resident is involved in the supervision of patient evaluations (preschool, school aged, and adolescent); Review of diagnoses of disorders diagnosed in toddlers, childhood and adolescence disorders.

          MEDICAL KNOWLEDGE

          The resident will demonstrate knowledge in administrative psychiatry and in systems of health care delivery.

          INTERPERSONAL AND COMMUNICATION SKILLS

          Interpersonal skills are defined as the specific techniques and methods, which facilitate effective and empathetic communication between the psychiatrist, patients, colleagues, staff, and system.

          PROFESSIONALISM:

          The chief  resident insures continuity of care for patients and ensure that the clinic and the staff members respect the rules of the University of Chicago and the Principles of Medical Ethics with Special Annotations for Psychiatry (APA) and the ethics code of the American Academy of Child and Adolescent Psychiatry.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The chief resident acts as the liaison between the residents and the Training Director, runs the weekly resident meeting, and oversees the case loads of the residents, acts as the section liaison to the QA committee. The chief resident attends QA meetings with the vice Chair of the department and weekly meetings with the CAP director to learn about merging challenges from the system and address them appropriately.

          SYSTEMS-BASED PRACTICE

          The chief resident sits on the QA committee for the section and reports back to the section the current projects.  The chief resident represents the residents in the faculty meetings and in the residency education meeting.  They coordinate the resident meetings. 

           

          CAP I General Outpatient Clinic

          PATIENT CARE
          The resident works with approximately 2-4 hours of long-term individual and family based outpatient cases per week during the first year of training and approximately 8-12 hours per week in the second year of training.  Residents manage their own clinical schedules with the supervision of the faculty. Residents become skilled in evaluation and treatment planning for children, adolescents and their families.

          MEDICAL KNOWLEDGE:
          The resident will demonstrate the ability to conduct a range of individual, and family therapies using standard, accepted models that are evidence-based, and integrate these psychotherapies and psychopharmacologic interventions in their daily clinic activities.

          INTERPERSONAL AND COMMUNICATION SKILLS
          The resident will demonstrate the ability to effectively communicate with the patient and their family (while respecting confidentiality):

          • the results of the assessment
          • the risks and benefits of the proposed treatment plan, including possible side-effects of psychotropic medications
          • alternatives (if any) to the proposed treatment plan
          • education concerning the disorder, its prognosis, and prevention strategies

          PROFESSIONALISM
          The resident will demonstrate responsibility for their patients’ care. This includes:

          • responding to patient communications
          • use of the medical record for appropriate documentation of the course of illness and its treatment
          • providing coverage if unavailable, e.g., out of town, on vacation
          • coordinating care with other members of the medical and/or multidisciplinary team
          • providing for appropriate transfer or referral if this is necessary

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will demonstrate an ability to critically evaluate the psychiatric literature. This may include:

          • using knowledge of common methodologies employed in psychiatric research to evaluate studies, particularly drug treatment trials
          • conducting and presenting reviews of current research in such formats as journal clubs, grand rounds, and/ or original publications
          • researching and summarizing a particular problem that derives from the resident’s case load

          SYSTEMS-BASED PRACTICE

          The resident will learn to access systems of care when ongoing therapy cases need more intensive services, and will be able to work with insurance companies and state funding agencies to obtain needed services for their patients.

          PATIENT CARE

          The resident works with approximately 2-4 hours of long-term individual and family based outpatient cases per week during the first year of training and approximately 8-12 hours per week in the second year of training.  Residents manage their own clinical schedules with the supervision of the faculty. In the second year of training, the resident takes on increasingly more complex cases and expands the types of treatment modalities used.  Residents become skilled in evaluation and treatment planning for children, adolescents and their families.

          MEDICAL KNOWLEDGE

          The resident will demonstrate the ability to conduct a range of individual, and family therapies using standard, accepted models that are evidence-based, and integrate these psychotherapies and psychopharmacologic interventions in their daily clinic activities.

          INTERPERSONAL AND COMMUNICATION SKILLS

          The resident will demonstrate the ability to effectively communicate with the patient and their family (while respecting confidentiality):

          • the results of the assessment
          • the risks and benefits of the proposed treatment plan, including possible side-effects of psychotropic medications
          • alternatives (if any) to the proposed treatment plan
          • education concerning the disorder, its prognosis, and prevention strategies

          PROFESSIONALISM

          The resident will demonstrate responsibility for their patients’ care. This includes:

          • responding to patient communications
          • use of the medical record for appropriate documentation of the course of illness and its treatment
          • providing coverage if unavailable, e.g., out of town, on vacation
          • coordinating care with other members of the medical and/or multidisciplinary team
          • providing for appropriate transfer or referral if this is necessary

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will demonstrate an ability to critically evaluate the psychiatric literature. This may include:

          • using knowledge of common methodologies employed in psychiatric research to evaluate studies, particularly drug treatment trials
          • conducting and presenting reviews of current research in such formats as journal clubs, grand rounds, and/ or original publications
          • researching and summarizing a particular problem that derives from the resident’s case load

          SYSTEMS-BASED PRACTICE

          The resident will learn to access systems of care when ongoing therapy cases need more intensive services and will be able to work with insurance companies and state funding agencies to obtain needed services for their patients. 

          PATIENT CARE

          1. Residents will demonstrate the ability to perform and document a comprehensive psychiatric history and examination
            • a complete present and past psychiatric history
            • a social and educational history a family history substance abuse history
            • a medical history and review of systems
            • a physical and neurological examination if necessary
            • a comprehensive mental status examination including the assessment of cognitive functioning
            • a developmental history

          The resident will demonstrate the ability to conduct therapeutic interviews, e.g. enhance the ability to collect and use clinically relevant material through the conduct of supportive interventions, and exploratory interventions and
          clarifications.

          The resident will demonstrate the ability to conduct a range of individual, and family therapies using standard, accepted models that are evidence-based, and integrate these psychotherapies.

          MEDICAL KNOWLEDGE

          Residents will demonstrate knowledge of psychosocial therapies used in the treatment of mood and anxiety disorders in children and adolescents.

          Residents will demonstrate knowledge of psychopharmacological therapies used in the treatment of mood and anxiety disorders in children and adolescents.

          Residents will demonstrate knowledge of patient evaluation and treatment selection.

          This will include:

          • psychological testing
          • laboratory methods
          • mental status evaluation
          • diagnostic interviewing
          • treatment comparison and selection

          Residents will demonstrate knowledge of outpatient psychiatric treatment. This
          will  include:

          • specific syndromes, e.g., stress reactions, PTSD, panic disorder, OCD,  Depression,  Bipolar Disorder, generalized anxiety disorder, and other mood and  anxiety disorders
          • psychiatric aspects of the non-psychiatric illness
          • psychosomatic disorders and other manifestations in children nonetheless.

          INTERPERSONAL AND COMMUNICATION SKILLS

          1. Interpersonal skills refer to the ability of the resident to develop and maintain therapeutic relationships with patients and their respective families.
          2. Residents will demonstrate willingness to continuously self-observe and confront their own respective biases and transferences.
          3. Residents will demonstrate techniques and methods, which facilitate effective and empathetic communication between residents, patients, colleagues, staff, and system.
          4. Residents will demonstrate the following skills:
            • ability to listen to and understand patients
            • ability to communicate effectively with patients, using verbal, nonverbal, and writing skills, as appropriate
            • ability to foster a therapeutic alliance with patients, as indicated by instilling feelings of trust, openness, rapport, and comfort in the relationship with the   physician
            • ability to use negotiation skills to develop an agreed-upon health care management plan with patients’ families.
            • ability to transmit information to patients in a clear and meaningful manner
            • ability to provide explanations of psychiatric disorders and treatment (both verbally and in written form) that are geared to the educational/ intellectual level of the   patients and their families

          PROFESSIONALISM

          Residents will demonstrate responsibility for their patients’ care.

          This includes:

          • use of the medical record for appropriate documentation of the course of illness and its treatment
          • providing coverage if unavailable, e.g., out of town, on vacation
          • coordinating care with other members of the medical and/or multidisciplinary team
          • providing appropriate transfer or referral if this is necessary
          • The resident will demonstrate ethical behavior, as defined in the Principles of
            Medical Ethics with Special Annotations for child and adolescent psychiatry.
          • Residents will be empathic, respectful, curious, open, nonjudgmental, and collaborative.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          1. The resident will have appropriate skills and demonstrate the ability to obtain current information from scientific and practice literature and other sources to assist in providing high quality patient care.
          2. The resident will demonstrate an ability to critically evaluate the psychiatric
            literature regarding the treatment of mood and anxiety disorders in children and adolescent.
          3. The resident will demonstrate an ability to critically evaluate the psychiatric
            literature regarding the treatment of mood and anxiety disorders in children and adolescent.

          SYSTEMS-BASED PRACTICE

          The resident will learn to work with primary care providers and their offices to augment the treatment done at UCH with supportive care/ monitoring for other disease processes and reporting back of vital signs and labs as appropriate.  This is especially important for those patients who can not come in weekly due to distance traveled, problems with transportation. 

          PATIENT CARE

          Patients with pervasive developmental disorders can have complex presentations, including mental retardation.  These patients can present with disruptive or dangerous behaviors requiring intervention.  Residents are educated about the major modalities of treatment in autistic disorder and other PDDs including psychopharmacology, educational intervention, behavioral treatment, family support and psychotherapy.

          MEDICAL KNOWLEDGE

          Required educational experiences include:

          1. Patient evaluations (preschool, school aged, adolescent); 
          2. Diagnosis of toddlers, children and adolescents suffering from mood disorders, anxiety disorders, adjustment disorders, ADHD, disruptive disorders, psychotic, and sleep disorders;
          3. Treatments of preschool, school age, and adolescent patients and supportive care of their respective, paying particular attention to cultural and SES diversity
          4. Treatment modalities including crisis intervention, supportive, and pharmacologic therapies;
          5. Collaboration with other mental health providers, pediatricians, and pediatric specialists and school professionals;
          6. Other experiences on this rotation include psychological testing, pediatric neurology, psychiatric emergencies, acute and seriously emotionally disturbed children and adolescents.
          7. Consultations with pediatricians, the legal system, school system, and community organizations. 

          INTERPERSONAL AND COMMUNICATION SKILLS:

          Residents are able to demonstrate the following skills:

          • ability to listen to and understand patients
          • ability to communicate effectively with patients and their respctive families, using verbal, nonverbal, and writing skills, as appropriate
          • ability to foster a therapeutic alliance with the family, as indicated by instilling feelings of trust, openness, rapport, and comfort in the relationship with the physician

          PROFESSIONALISM

          1. Residents ensure continuity of patient care, ad when appropriate, terminate treatment in a manner that doesn’t leave patients feeling ‘abandoned’.
          2. Residents respond to communications from patients and health professionals in a timely manner. If unavailable, residents negotiate and communicate back-up arrangements. Residents communicate clearly to patients’ families about how to seek emergency care when necessary.
          3. The resident will demonstrate ethical behavior, as defined in the Principles of Medical Ethics.
          4. The resident will demonstrate respect for patients and colleagues as persons, regardless of age, culture, disabilities, ethnicity, gender, and sexual orientation.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          Residents will be able to articulate the basic concepts of systems theory and how it is used in child and adolescent psychiatry.

          Residents demonstrate a working knowledge of the diverse systems involved in treating children with developmental disorders.

          Residents demonstrate an understanding of the use of systems as part of a comprehensive system of care.

          SYSTEMS-BASED PRACTICE

          The resident will interact with multiple specialties including Occupational therapy, Physical therapy, speech and language, neuropsychology, pediatrics, genetics, and neurology.  Residents will learn how to write a formal report that can be used to advocate for services/ placement.  

          PATIENT CARE

          Resident will observe patient evaluations, and attend the feedback session with the parents.

          MEDICAL KNOWLEDGE

          Residents will learn how to appreciate neuropsychological and adaptive function measures by direct supervision in the cases observed.  They will also be supported in learning how to score and then interpret simple measures.  Emphasis is placed on advancing knowledge in the interpretation and understanding of findings.

          INTERPERSONAL AND COMMUNICATION SKILLS

          Interpersonal skills require an underlying attitude of respect for others, especially with differing points of view or from different backgrounds.

          The resident will show:

          • A desire to gain an understanding of another’s position and reasoning
          • A belief in the intrinsic worth of other opinions
          • A desire to build collaboration
          • A will to share information in a consultative fashion

          PROFESSIONALISM

          The resident will respond to communications from patients and health professionals in a timely manner. The resident will demonstrate respect for patients and colleagues.

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          The resident will demonstrate an ability to critically evaluate the psychiatric literature. This may include:

          • using knowledge of common methodologies employed in psychiatric research to evaluate studies, particularly drug treatment trials
          • conducting and presenting reviews of current research in such formats as journal clubs, grand rounds, and/ or original publications
          • researching and summarizing a particular problem that derives from the resident’s case load

          SYSTEMS-BASED PRACTICE

          The resident will learn to work in an interprofessional team and will learn to use scarce resources in the school and other settings to maximize supports for children tested as they sit in on feed-back sessions. 

          PATIENT CARE

          The resident will demonstrate the ability to:

          1. Complete an in-depth psychopharmacologic assessment to determine the diagnosis of an eating disordered patient including:
            • A Psychiatric history
            • A Social and educational history
            • A Family history
            • A Substance abuse history
            • A Medical history and review of systems
            • A Physical and neurological examination, as deemed necessary
            • A Developmental history
            • Mental status examination including assessment of cognitive functioning
            • Laboratory, radiologic, and ECG studies
          2. Identify comorbid diagnoses commonly occurring with eating disorders
          3. Provide on-going medication follow-up
          4. Residents serve as psychiatric consultants for medication evaluations for non-MD clinicians in the clinic

          MEDICAL KNOWLEDGE

          1. The Residents will demonstrate knowledge of psychotropic medications, including antidepressants, antipsychotics, anxiolytics, mood-stabilizers, hypnotics, and stimulants commonly used in the treatment of eating disorders or in their comorbid conditions. This knowledge will be comprised of the following:
            • pharmacological action
            • clinical indications
            • side effects
            • drug interactions
            • toxicity
            • appropriate prescribing practices
          2. Knowledge of the associated medical complications of eating disorders, as well as other co-morbid psychiatric diagnoses
          3. Knowledge of the roles the multimodal treatment team plays in the treatment of many patients with eating disorders.

          INTERPERSONAL AND COMMUNICATION SKILLS

          The resident will develop skills during this time to:

          1. Educate patients and families regarding eating disorders including the risk of morbidity and mortality, and treatment options
          2. Collaborate effectively with other members of the team, primary care physicians and other therapists
          3. Maintain a therapeutic relationship with the patient and their parents/ primary caregivers
          4. Learn to work collaboratively with supervisors and other care providers.
          5. Communicate psychopharmacologic information in a timely, clear and meaningful manner taking into account the developmental and educational level of each family member
          6. Residents will demonstrate the ability to communicate effectively with allied healthcare professionals

          PROFESSIONALISM

          The residents will demonstrate a collaborative and nonjudgmental attitude characterized by empathy, respect, curiosity, and openness. Residents will also demonstrate the ability to tolerate ambiguity and show confidence in the efficacy of supportive therapy.

          Residents will be sensitive to the sociocultural, socioeconomic, and educational issues that arise within the therapeutic relationship as demonstrated by:

          1. Respect for the patient's 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

          PRACTICE-BASED LEARNING AND IMPROVEMENT

          1. The resident will learn how to educate families with eating disordered children and teenagers.
          2. The resident will receive feedback from the supervising attending and incorporate suggestions in the clinical care of patients.
          3. The resident will identify their own strength and weaknesses in dealing with this clinical population and work with the clinic supervisor to develop a plan of care to work on these issues.

          SYSTEMS-BASED PRACTICE

          1. Each resident must recognize and accept limitations in his/her knowledge base and clinical skills, and understand the need for life-long learning.
          2. Residents will possess research appropriate skills and demonstrate the ability to obtain current scientific research and clinical practice guidelines to assist in promoting high quality patient care. This will include, but not be limited to:
            • use of medical libraries
            • use of information technology, including Internet-based searches and research databases (e.g., MedLine)
            • use of drug information databases
          3. Residents will understand how their patient care affects and is affected by other health care providers.
          4. Residents will understand the regulation of outpatient psychiatric treatment including patient confidentiality, HIPAA, state regulations regarding drug prescription and scheduled medications.

          KNOWLEDGE

          1.  Familiarity with the common neurological disorders of infants and children in an outpatient, university-based practice setting
          2. Knowledge of the pediatric neurological examination, presentation style, and differential diagnoses.
          3. Knowledge of the indications for requesting specific diagnostic services and consultation with other services.
          4. Knowledge of interventions, indication, and contraindications of treatments for common neurological disorders in children and adolescent.
          5. Knowledge of community services, including social, educational, respite, intervention, and rehabilitation for infants and children with neurological disabilities and their families.

          SKILLS

          1. Ability to take an accurate history and perform a neurological examination of a child and an adolescent
          2. Ability to integrate clinical findings with other investigations to make a differential diagnosis and formulate a treatment plan
          3. Ability to write a concise chart note regarding the neurological evaluation of the infant or child.
          4. Ability to participate in the parent and child discussions, giving appropriate education regarding the illness, treatment plan, possible course and prognosis.

          ATTITUDES:

          1. Empathy for patients and their families with neurological disabilities.
          2. Desire to work collaboratively with families, other physicians, other medical staff, as well as community services.