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

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

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

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

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 Inpatient General Medicine Service. 

EDUCATIONAL MATERIALS
General Syllabus

  • 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
  • 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
  • Internet Resources

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 the 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:

  • 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 the 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

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 the 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 manage information, 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 maintain professional 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, workup, and management in the term they can understand
  • Always explain that the resident will be discussing plans with the supervising doctor who will 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

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 the 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 decision making 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 5th 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-V 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

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

PATIENT CARE:

The 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 resident will be able to:

    • Make a reasonable differential diagnosis based on a basic understanding of DSM-V 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 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 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-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 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 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 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 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 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 Gateway Foundation Addiction Treatment Center.  Residents will conduct a "medical aspects of addiction" group for inpatients..

MEDICAL KNOWLEDGE:

Residents will:

  • Learn techniques for acute detoxification from alcohol, opiates, benzodiazepines, and other substances.
  • Use medication-assisted treatments for promoting and maintaining sobriety
  • 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 and group 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 and two afternoons per week halftime, plus one evening per rotation (AA Meeting). Rounds will be arranged by Dr. Keith Sarpolis.

SUPERVISION

Dr. Keith Sarpolis and Dr. Roueen Rafeyank

PATIENT CARE:

PGY-2 residents spend two months in Community Psychiatry, where they perform psychiatric diagnostic evaluations and clinical interventions in the community They provide 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.  Residents rotate with the Assertive Community Treatment team, going to residences which house people with severe and persistent mental illness. They also rotate with the Mobile Assessment Team, which reaches out to homeless people in need of psychiatric assessment and care.

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:

Residents will learn to collaborate with social workers and mental health workers in providing assessment and care. They will understand the resources available and confront the lack of needed resources, understand the need for public policy advocacy, and become familiar with how policy decisions impact the poor and disenfranchised patients with whom they work.

PATIENT CARE:

This is an optional 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

https://psychiatry.uchicago.edu/education/clinic-goals-and-objectivies

 

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 the 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:

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

  • 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. 

University of Chicago ECT Rotation Elective Rotations

1-2 month rotation as PGY4

  • Neuromodulation clinic, (goal: at least 2 new ECT evaluations)
  • 3x/wk ECT treatments, (goal: participate in at least 1 titration and 10 treatments in at least 3 distinct patients)

University of Chicago ECT “Certification of Advanced Training” Requirements

3 month rotation as PGY4

  • Neuromodulation clinic, complete at least 5 new ECT evaluations
  • 3x/wk ECT treatments, participate in at least 3 titrations and 30 treatments
  • Receive a rating of at least Level 4 on Milestones PC5 and MK5 on this ECT Rotation evaluation
  • *post-test assessment tool knowledge test, skills assessment by ECT psych md (not yet developed)
  • Demonstrate the ability to educate other psychiatrists and trainees on ECT through a presentation at a residency conference or grand rounds on an ECT-related topic

 

GOALS and OBJECTIVES

PATIENT CARE:

  • The resident will learn to perform ECT including performing pre-ECT outpatient consultations, the informed consent process, pre-procedure evaluations including symptom and cognitive evaluation, the procedural aspects of ECT, and post-ECT evaluation and management including continuation and maintenance ECT.

MEDICAL KNOWLEDGE:

  • The resident will learn the indications for ECT, side effects of treatment, techniques which can minimize cognitive sequelae, anesthetic and other medical concerns related to ECT.

INTERPERSONAL AND COMMUNICATION SKILLS:

  • The resident will learn to interact with anesthesia colleagues and nursing staff (both psychiatric and not-psychiatric nurses) in the PACU setting to provide optimum and safe care from both services in the setting of ECT.
  • Psychoeducation: Education of patients/families, confronting stigma associated with ECT and severe mental illness.

SYSTEMS BASED PRACTICE:

  • The resident will learn about legal, social and cultural barriers to ECT and ways to navigate them while prioritizing patient advocacy.