Curriculum Addiction Curriculum Psychiatry Residency Program Riverside Medical Center

Research Curriculum Addiction Curriculum Psychiatry Residency Program Riverside Medical Center

Rotation Length: One block of four weeks

Description: This rotation at occurs at Riverside Medical Center’s inpatient units, and Hoover Building for second year residents. Residents gain experience in the evaluation and clinical management of patients with substance abuse/dependence problems, including detoxification treatment. Particular attention will be paid to the dual diagnosis and treatment of psychiatric and substance abuse disorders. The resident should be in the hospital for morning report from 7:15 a.m. to 8:00 a.m., Monday – Friday (Thursday at 7:00 a.m.). This will assure the resident is ready for teaching rounds beginning immediately after morning report at the location with the supervising faculty. All residents are expected to attend morning report and noon conference daily. Attendance is taken at these conferences. Thursday conferences occurs from 12:00 p.m. to 5:00 p.m. On post- call days, the resident may leave by 8:30 a.m. if their work is completed and patients have been checked out to the resident on call for that night per transition of care policy. It is expected that residents will be greatly exposed to the bio-psychosocial realities or hospital medicine. This will include collaboration with social workers; care managers; nursing and other personnel who share expertise in this area. The course director throughout the rotation will supervise each resident. Other mentors will be used as needed. Local experts on case management, utilization management, risk management, etc.

Rotation: Prior to the start of the rotation, the resident will contact the attending physician to designate time/place to meet. On the first day of the rotation, the resident should report to the GME Lecture Hall by 7:15 a.m. After the conclusion of morning report, the attending physician will provide orientation on this first day. A list of patients currently on the teaching service will then be provided. Any vacation time to be taken during this rotation must be approved by the GME Department in advance through the usual means.

Ancillary Educational Materials: Additional ancillary educational resources will include formal weekday teaching rounds, Morning Report sessions, other scheduled lectures and monthly conferences, readings as assigned and use of medical library resources including computerized searches.

Evaluation: At the end of the rotation, the resident will be evaluated by the supervising faculty. Personal feedback will be provided and an evaluation form will be completed on New Innovations. The resident will be evaluated by faculty in each of the required general competency areas.

Suggested Reading: “Kaplan and Sadock’s Comprehensive Textbook of Psychiatry” (10th ed.) by Sadock, Sadock and Ruiz; “Stahl’s Essential Psychopharmacology” (4th ed.) by Stephen M. Stahl; and other reading assignments as directed by the attending.

Patient Care

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of addiction. Reporting Milestones: PC1 – Psychiatric Evaluation (A, B, C, D) PC2 – Psychiatric Formulation and Differential Diagnosis (A, B) PC3 – Treatment and Planning (A, B, C) PC4 – Psychotherapy (A, B, C, D) PC5 – Somatic Therapies (A, B, C, D)

Objectives Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Residents must be able to provide patient care that is compassionate, appropriate, and Didactics Resident performance: 2 effective for the treatment of health problems and the promotion of health in the context Board Review Direct and Indirect Observation of addiction psychiatric medicine, including treatment modalities that include Bedside Teaching End of Rotation Evaluation detoxification and overdose management. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

2. Residents will develop competence in: interviewing and assessment skills; developing Didactics Resident performance: 2 rapport with patients; performing all aspects of an evaluation, including eliciting a clear Board Review Direct and Indirect Observation and accurate history; performing physical, neurological and mental status examinations; Bedside Teaching End of Rotation Evaluation and ordering appropriate diagnostic and psychological tests that are applicable to Clinical Teaching Rounds 360 Degree Evaluation particular studies for patients with addiction disorders. Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

3. Residents will develop competence in formulating a diagnosis based on the data they Didactics Resident performance: 2 have obtained, including evaluation of past records regarding previous treatment Board Review Direct and Indirect Observation programs. They will be competent to make a thorough differential diagnosis, and be able Bedside Teaching End of Rotation Evaluation to plan further steps to clarify the diagnoses utilizing the clinical interview. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

4. Residents will develop competence in creating an appropriate and comprehensive Didactics Resident performance: 2 treatment plan based on the establishment of a working alliance based on empathetic Board Review Direct and Indirect Observation doctor-patient interaction. Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

5. Residents will develop competence in the use of therapeutic techniques that address the Didactics Resident performance: 2 psychological and social consequences of addiction, to include confronting and intervening Board Review Direct and Indirect Observation in chronic addiction rehabilitation used in recovery stages from pre-contemplation to Bedside Teaching End of Rotation Evaluation maintenance. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

Medical Knowledge Goal: Residents must demonstrate knowledge about the neurobiological and psychological underpinnings of mental illness and addiction and will apply this knowledge to patient care. This includes assessment of chemical dependency and diagnosis, detoxification, diagnosis and management of co-morbid psychiatric illness, and proper medication management in the recovery setting. Reporting Milestones: MK2 – Psychopathology (A, B, C) MK3 – Clinical Neuroscience (A, B, C, D, E) MK4 – Psychotherapy (A, B, C) MK5 – Somatic Therapies (A, B, C) MK6 – Practice of Psychiatry (A, B, C)

Objectives Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Demonstrate knowledge of the gamut of duel diagnosis, substance-related disorders, Didactics Resident performance: 2 including intoxication states, withdrawal states, use/abuse/dependence conditions, and Board Review Direct and Indirect Observation substance-induced conditions such as mood disorders, delirium, dementia, psychoses, Bedside Teaching End of Rotation Evaluation amnestic states, sleep and sexual disorders. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

2. Demonstrate knowledge of addiction, including: dual diagnosis, theories of etiology, Didactics Resident performance: 2 natural history, epidemiology, neurobiology, brain imaging findings, psychodynamic Board Review Direct and Indirect Observation aspects, socio-cultural and spiritual aspects, and medical complications (including Bedside Teaching End of Rotation Evaluation traumatic-brain injury, HIV, hepatitis C, major organ system dysfunction, nutritional Clinical Teaching Rounds 360 Degree Evaluation deficiencies). Role Modeling Annual PD Evaluation 3

Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination (PRITE) Clinical Skills Exam (CSE)

3. Demonstrate knowledge about the variety of psychopharmacological, psychotherapeutic, Didactics Resident performance: 2 self-help groups, religious, and residential treatments. Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

4. Discuss applications of routine detoxification processes and protocols, both inpatient and Didactics Resident performance: 2 outpatient, and smoking cessation strategies and pharmacology. Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

5. Demonstrate knowledge and application of maintenance pharmacotherapy, including Didactics Resident performance: 2 naltrexone, buprenorphine, methadone, disulfiram, acamprosate and nicotine Board Review Direct and Indirect Observation replacements. Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

Practice-based Learning and Improvement

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self- evaluation and life-long learning. Reporting Milestones: PBLI1 – Development and execution of lifelong learning through constant self-evaluation, including critical evaluation of research and clinical evidence (A, B) PBLI2 – Formal practice-based quality improvement based on established and accepted methodologies (A, B) PBLI3 – Teaching (A, B)

Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Use supervision and feedback to improve clinical skills. Didactics Resident performance: 2 Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

2. Consult medical literature regularly, as well as information technology, to enhance Didactics Resident performance: 2 knowledge base and ongoing clinical trials of addictions treatment research, and apply Board Review Direct and Indirect Observation evidence-based treatments to patient care to provide optimal treatment. Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

3. Participate in quality improvement through their annual project requirement. Didactics Resident performance: 2 Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

Interpersonal and Communication Skills Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Reporting Milestones: ICS1 – Relationship development and conflict management with patients, families, colleagues, and members of the healthcare team (A, B, C) ICS2 – Information sharing and record keeping (A, B, C, D)

Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Communicate effectively with patients, families, and the public, as appropriate, across a Didactics Resident performance: 2 broad range of socioeconomic and cultural backgrounds, including with primary care and Board Review Direct and Indirect Observation other providers regarding pain issues and susceptibility to addiction and the opioid Bedside Teaching End of Rotation Evaluation epidemic. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

2. Communicate effectively with physicians and other health professionals when gathering Didactics Resident performance: 2 previous treatment program participation. Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

3. Work effectively as a member or leader of a health care team or other professional Didactics Resident performance: 2 community treatment program. Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

Professionalism Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Reporting Milestones: PROF1 – Compassion, integrity, respect for others, sensitivity to diverse patient populations, adherence to ethical principles (A, B) PROF2 – Accountability to self, patients, colleagues, and the profession (A, B, C) Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Demonstrate compassion, integrity and respect for others which includes responsiveness Didactics Resident performance: 2 to patients needs that supersedes self-interest, and patient privacy and autonomy. Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

2. Maintain appropriate professional demeanor, attire, and time management in Didactics Resident performance: 2 relationships with both patients and fellow professionals including counselors and Board Review Direct and Indirect Observation supervisors. Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

3. Demonstrate effective skills in interviewing including empathic attunement, diligent Didactics Resident performance: 2 fiduciary responsibility, boundary establishment and maintenance, including at times of Board Review Direct and Indirect Observation patient and family addiction crisis in order to facilitate accurate diagnosis and biological, Bedside Teaching End of Rotation Evaluation psychological and social formulation. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

4. Demonstrate sensitivity and responsiveness to a diverse patient population, including Didactics Resident performance: 2 but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual Board Review Direct and Indirect Observation orientation. Bedside Teaching 7

Clinical Teaching Rounds End of Rotation Evaluation Role Modeling 360 Degree Evaluation Independent Learning Annual PD Evaluation Computer Modules Clinical Competency Committee Annual psychiatry in-training examination (PRITE) Clinical Skills Exam (CSE)

System-Based Practice Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal health care. Reporting Milestones: SBP1 – Patient Safety and the Health care Team (A, B, C) SBP2 – Resource Management (A) SBP3 – Community-Based care (A, B, C, D) SBP4 – Consultation to non-psychiatric medical providers and non-medical systems (A, B, C) Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Demonstrate ability to implement preventative interventions with patients and families. Didactics Resident performance: 2 Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

2. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or Didactics Resident performance: 2 population-based care as appropriate and advocate for quality addiction patient Board Review Direct and Indirect Observation treatment. Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

3. Participate in identifying system errors and implementing potential systems solutions. Didactics Resident performance: 2 Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

4. Practice cost-effective health care and resource allocation that does not compromise Didactics Resident performance: 2 quality of care, including an understanding of the financing and regulation of addictions Board Review Direct and Indirect Observation psychiatric practice, as well as information about the structure of public and private Bedside Teaching End of Rotation Evaluation organizations that influence addiction treatment. Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual PD Evaluation Independent Learning Clinical Competency Committee Computer Modules Annual psychiatry in-training examination

(PRITE) Clinical Skills Exam (CSE)

Sample schedule: Addiction psychiatry rotation

Sites: Riverside Medical Center inpatient and Resolve Center, IOP, Hoover.

0700-0800 Morning Report Morning Report Morning Report Morning Report Morning Report 0900-1200 Hoover Hoover Inpatient units Hoover Hoover 1215-1300 Noon lecture Noon lecture Noon lecture Noon lecture Noon lecture 1300-1700 Hoover Hoover IOP Hoover Hoover

Administrative Curriculum Administrative Curriculum Psychiatry Residency Program Riverside Medical Center

Rotation Length: One rotational block of four weeks Description: The resident in PGY 4 will explore issues and topics necessary to operate and sustain a successful psychiatry practice which meets the needs of patients, as well as supports long-term staff development, during their Administrative Psychiatry rotation for four (4) weeks. Concepts and information related to individual professional practice sustainment, well-being, and legal liability for the practice group, will be discussed, and modeled by faculty, as well. The resident should be in the hospital for morning report from 7:15 a.m. to 8:00 a.m., Monday – Friday (Thursday at 7:00 a.m.). This will assure the resident is ready for daily teaching rounds beginning immediately after morning report with an understanding as to new patient admissions during the night and any significant clinical changes overnight in patients already on the subspecialty teaching service. All residents are expected to attend morning report and noon conference daily. Attendance is taken at these conferences. Noon conference occurs from 12:00 p.m. through 1:00 p.m. On post-call days, the resident may leave by 8:30 a.m. if their work is completed and patients have been checked out to the resident on call for that night per transition of care policy. It is expected that residents will be greatly exposed to the bio-psychosocial realities or hospital medicine. This will include collaboration with social workers; care managers; nursing and other personnel who share expertise in this area. The course director throughout the rotation will supervise each resident. Other mentors will be used as needed. Local experts on case management, utilization management, risk management, etc. will collaborate in this rotation. Rotation: Prior to the start of the rotation, the resident will contact the attending physician to designate time/place to meet. On the first day of the rotation, the resident should report to the GME Lecture Hall by 7:15 a.m. After the conclusion of morning report, resident shall proceed to the attending’s office and the attending physician will provide orientation on this first day. Any vacation time to be taken during this rotation must be approved by the GME Department in advance through the usual means. Ancillary Educational Materials: Scheduled lectures, monthly conferences, readings as assigned and use of medical library resources including computerized searches, and participatory and interactive experiences in office practice. Evaluation: At the end of the rotation, the resident will be evaluated by the supervising faculty. Personal feedback will be provided and an evaluation form will be completed on New Innovations. The resident will be evaluated by faculty in each of the required general competency areas. Suggested Reading: “Policies and Procedures for a Successful Medical Practice” by the American Medical Association; “Risk Adjustment Documentation and Coding” by Sheri Poe Bernard, from the American Medical Association. Site(s): Riverside Medical Center

Patient Care

Goal: Residents must be able to provide patient care that is compassionate, appropriate, safe and effective for the treatment of mental illness and prevention. Reporting Milestones: PC1 – Psychiatric Evaluation (C, D) PC5 – Somatic Therapies (A, B) Objectives Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Discuss government program changes and cuts, and how they are mitigated Didactics Resident performance: 4 without a loss of patient care quality. Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Annual PD Evaluation

Interaction with medical Clinical Competency Committee staff, hospital review and utilization staff Role Modeling Independent Learning Computer Modules 2. Demonstrate their ability to achieve better patient experiences and positive Didactics 4 outcomes with controlled costs through practice improvement strategies such Participatory office Resident performance: as automated systems. experiences Direct and Indirect Observation/Feedback Interaction with medical End of Rotation Evaluation staff, hospital review and Annual PD Evaluation utilization staff Clinical Competency Committee Role Modeling

Independent Learning Computer Modules 3. Review and discuss integrated care benefits for patients and how to manage Didactics Resident performance: 4 with other specialty providers. Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff

Role Modeling Independent Learning Computer Modules 4. Identify the State of Illinois’ major payers stance regarding implementation of Didactics 4 the parity law. Participatory office experiences Resident performance: Interaction with medical Direct and Indirect Observation/Feedback staff, hospital review and End of Rotation Evaluation utilization staff Annual PD Evaluation Role Modeling Clinical Competency Committee Independent Learning

Computer Modules 5. Understand the process of managing patient care with psychiatrists who are on Didactics Resident performance: 4 vacation or leave. Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff

Role Modeling Independent Learning Computer Modules 6. Discuss the nuances of terminating patient relationships with regard to ethical Didactics Resident performance: 4 and legal issues. Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Annual PD Evaluation

Interaction with medical Clinical Competency Committee staff, hospital review and utilization staff Role Modeling Independent Learning Computer Modules 7. Review elements of tele-psychiatry, including benefits versus limitations. Didactics Resident performance: 4 Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff

Role Modeling Independent Learning Computer Modules

Objectives Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Identify specific criteria required for admissions and outpatient services that will Didactics Resident performance: 4 be acceptable to government and commercial payers. Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review Clinical Competency Committee and utilization staff

Role Modeling Independent Learning Computer Modules 2. Identify and utilize appropriate codes in patient assessment and treatment Didactics Resident performance: 4 Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review Clinical Competency Committee and utilization staff

Role Modeling Independent Learning Computer Modules

Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Explore the factors related to practice sustainability, as well as quality Didactics Resident performance: 4 improvement, and evidence-based practice-wide measures that improve Participatory office Direct and Indirect Observation/Feedback outcomes for patients and physicians. experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review Clinical Competency Committee and utilization staff

Role Modeling Independent Learning Computer Modules Service on hospital medical committees 2. Use technology and information to optimize learning for self and other office Didactics Resident performance: 4 staff, fellow psychiatrists. Participatory office Direct and Indirect Observation/Feedback experiences End of Rotation Evaluation Interaction with medical Annual PD Evaluation staff, hospital review Clinical Competency Committee and utilization staff

Role Modeling Independent Learning Computer Modules Epic Training

Reporting Milestones: ICS1 – Relationship development and conflict management with patients, families, colleagues, and members of the healthcare team (B, C)

ICS2 – Information sharing and record keeping (A, C, D)

Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Observe the management of office staff, and how to navigate personnel issues Didactics Direct and Indirect Observation 4 as well as employment benefit issues, within the faculties’ practice. Participatory office 360 Degree Evaluation experiences Feedback from Employees Interaction with medical staff, hospital review and utilization staff Role Modeling Independent Learning Computer Modules 2. Utilize healthcare information systems and electronic medical records in the Didactics Direct and Indirect Observation 4 psychiatry practice to explore patient portals and psychiatrists’ responsibilities Participatory office 360 Degree Evaluation in communicating with patients, and data involved with them. experiences Annual PD Evaluation Interaction with medical staff, hospital review and utilization staff Role Modeling Independent Learning Computer Modules Epic Training 3. Communicate effectively and efficiently with psychologists and other Didactics Direct and Indirect Observation 4 professionals. Participatory office End of Rotation Evaluation experiences 360 Degree Evaluation Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff Certification Exam Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE) Feedback from

psychologists and other professionals 4. Lead practice, group, unit and department meetings. Didactics Direct and Indirect Observation 4 Participatory office End of Rotation Evaluation experiences 360 Degree Evaluation Interaction with medical Annual PD Evaluation staff, hospital review and utilization staff Role Modeling Independent Learning Computer Modules

Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Learn the effect regulatory guidelines have on day-to-day clinical practice and Didactics Direct and Indirect Observation 4 how to avoid burnout as well as administrative staff overload and incorporate Participation on Resident End of Rotation Evaluation aspects of wellbeing and self-care skills into practice and management time as Wellness Committee 360 Degree Evaluation well as off-duty experiences Annual PD Evaluation Clinical Competency Committee

2. Understand how knowledge or practice gaps are addressed in CME events. Didactics 4 Participatory office 360 Degree Evaluation experiences Interaction with medical staff, hospital review and utilization staff Independent Learning Computer Modules CME Coordinator 3. Review the underpinning of liability and litigation, from an individual Didactics Direct and Indirect Observation 4 psychiatrist to an entire practice. Risk Management director End of Rotation Evaluation instruction 360 Degree Evaluation Independent Learning Annual PD Evaluation Computer Modules In-Training Exam Clinical Competency Committee

4. Discuss physician advocacy, member organizations and other groups for Didactics Direct and Indirect Observation 4 psychiatrists as well as the effect on well-being and career life-long learning Independent Learning resources. Computer Modules

System-Based Practice Goal: Residents will practice cost-effective healthcare and resource allocation that is aligned with high quality of care, including an understanding of the financing and regulation of psychiatric practice, and information about the structure of public and private organizations that influence mental health care. Reporting Milestones: SBP1 – Patient Safety and the Health care Team (A, B, C) SBP2 – Resource Management (A)

SBP3 – Community-Based care (A, B, C, D) SBP4 – Consultation to non-psychiatric medical providers and non-medical systems (A, B, C)

Objectives: Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Learn the payment process including existing and emerging payment, Didactics Feedback from Patient Accounts and EMR 4 reimbursement and delivery methods, sources, programs including Medicare Participatory office and Medicaid experiences Interaction with medical staff, hospital review and utilization staff Role Modeling Independent Learning Computer Modules Epic Training 2. Review methods of transparency within all business and financial dealings Didactics Direct and Indirect Observation 4 including with pharmaceutical representatives, government programs and office Participatory office End of Rotation Evaluation management to forge fair and accurate billing systems devoid of waste, fraud experiences 360 Degree Evaluation and abuse. Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff Certification Exam Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

3. Learn of the resources available to implement patient payments and efficient Direct and Indirect Observation 4 collection processes during a revenue cycle. Didactics End of Rotation Evaluation Participatory office 360 Degree Evaluation experiences Annual PD Evaluation Interaction with medical Clinical Competency Committee staff, hospital review and Certification Exam utilization staff Annual psychiatry in-training examination Role Modeling (PRITE) Independent Learning Computer Modules Clinical Skills Exam (CSE)

Didactics Direct and Indirect Observation 4 4. Understand how types of medical practice and delivery systems differ from one another, Participatory office End of Rotation Evaluation including methods of controlling health care cost, ensuring quality, and allocating experiences 360 Degree Evaluation resources. Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff Certification Exam Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

Didactics Direct and Indirect Observation 4 5. Practice cost-effective health care and resource allocation that is aligned with high Participatory office End of Rotation Evaluation quality of care, including an understanding of the financing and regulation of psychiatric experiences 360 Degree Evaluation practice, as well as information about the structure of public and private organizations Interaction with medical Annual PD Evaluation that influence mental health care. staff, hospital review and In-Training Exam utilization staff Clinical Competency Committee Role Modeling Certification Exam Independent Learning Computer Modules Annual psychiatry in-training examination (PRITE) Clinical Skills Exam (CSE)

Didactics Direct and Indirect Observation 4 6. Advocate for the promotion of mental health and the prevention of mental disorders in Participatory office End of Rotation Evaluation the community with alliances and collaboration with community agencies such as experiences 360 Degree Evaluation Suicide Prevention Walk, held annually. Interaction with medical Annual PD Evaluation staff, hospital review and Clinical Competency Committee utilization staff Certification Exam Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

ROTATION SITE(S): Riverside Medical Group Psychiatric Specialists practice (on the main campus of Riverside Medical Center), Kankakee, Ill.

SAMPLE SCHEDULE

Monday Tuesday Wednesday Thursday Friday 0700-0800 Morning Report Morning Report Morning Report Morning Report Morning Report 0900-1200 Office of Psychiatric Office of Psychiatric Office of Psychiatric Office of Psychiatric Office of Psychiatric Specialists Specialists Specialists Specialists Specialists 1200-1300 Noon lecture/conference 1400-1700 Office of Psychiatric Office of Psychiatric Office of Psychiatric Lectures and didactics Office of Psychiatric Specialists Specialists Specialists Specialists

Adult Consultation Liaison Curriculum Adult Psychiatric Consultation Liaison & Forensics Curriculum Psychiatry Residency Program Riverside Medical Center

Rotation Length: Three rotational blocks of four weeks (12 weeks total) Description: Residents will have three (3) four week rotations in adult psychiatric consultation liaison, during which they will gain psychiatric consultative experience in a variety of medical and surgical settings with an inpatient population that is acutely ill and represents a diverse clinical spectrum of diagnoses, ages and genders. The rotation is first introduced in PGY 2. The setting is the inpatient at Riverside Medical Center which includes patients seen in: intensive care units (cardiac, neurological and surgical), surgical and medical services, obstetrics and gynecology services. Residents are able to respond to patients’ needs across medical specialty services within a larger health care system, as they demonstrate the ability to practice competently and independently by the time of graduation. The residents will also gain experience in forensic psychiatry, which includes evaluating a patient’s potential to harm themselves or others, appropriateness for commitment, decisional capacity, disability and competency. The resident should be in the hospital for morning report from 7:15 a.m. to 8:00 a.m., Monday – Friday. This will assure the resident is ready for daily teaching rounds beginning immediately after morning report with an understanding as to new patient admissions during the night and any significant clinical changes overnight in patients already on the subspecialty teaching service. All residents are expected to attend morning report and noon conference on Thursdays weekly. Attendance is taken at these conferences. Thursday conference occurs from 12:00 p.m. through 1:00 p.m. Thursday lectures and didactics occur on Thursdays from 1 p.m. to 5 p.m. weekly. On post-call days, the resident may leave by 8:30 a.m. if their work is completed and patients have been checked out to the resident on call for that night per transition of care policy. It is expected that residents will be greatly exposed to the bio-psychosocial realities or hospital medicine. This will include collaboration with social workers; care managers; nursing and other personnel who share expertise in this area. The course director throughout the rotation will supervise each resident. Other mentors will be used as needed. Local experts on case management, utilization management, risk management, etc. will collaborate in this rotation. Rotation: Prior to the start of the rotation, the resident will contact the attending physician to designate time/place to meet. On the first day of the rotation, the resident should report to the GME Lecture Hall by 7:15 a.m. After the conclusion of morning report, the attending physician will provide orientation on this first day. A list of patients currently on the teaching service will then be provided. Any vacation time to be taken during this rotation must be approved by the GME Department in advance through the usual means Ancillary Educational Materials: Additional ancillary educational resources will include formal weekday teaching rounds, morning report sessions, other scheduled lectures and monthly conferences, readings as assigned and use of medical library resources including computerized searches. Evaluation: At the end of the rotation, the resident will be evaluated by the supervising faculty. Personal feedback will be provided and an evaluation form will be completed on New Innovations. The resident will be evaluated by faculty in each of the required general competency areas. Suggested Reading: “Kaplan & Sadock’s Comprehensive Textbook of Psychiatry” by Sadock, Sadock and Ruiz; “Stahl’s Essential Psychopharmacology” (4th ed.) by Stephen M. Stahl; and other assigned readings.

Patient Care

Goal: Residents must be able to consult on other medical and surgical services, under supervision, with patient care that is compassionate, appropriate, and effective for the treatment of mental illness in all inpatient settings, within the context of a variety of medical specialties. Reporting Milestones: PC1 – Psychiatric Evaluation (A, B, C, D) PC2 – Psychiatric Formulation and Differential Diagnosis (A, B) PC3 – Treatment and Planning (A, B, C) PC4 – Psychotherapy (A, B, C, D) PC5 – Somatic Therapies (A, B, C, D)

Objectives Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Communicate effectively and demonstrate caring and respectful behaviors when Didactics Direct and Indirect Observation 2 interacting with patients and their families. Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Role Modeling Clinical Competency Committee Independent Learning Annual psychiatry in-training examination Computer Modules (PRITE) Clinical Skills Exam (CSE)

2. Quickly develop a therapeutic alliance with medically ill patients and comfortably interview Didactics Direct and Indirect Observation 2 patients in a variety of medical settings. Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

3. Evaluate for psychopathologic processes in patients with concomitant medical and surgical Didactics Direct and Indirect Observation 2 conditions and evaluate cognitive ability in medically ill patients. Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

4. Demonstrate the ability to perform a relevant history on culturally diverse patients, Didactics Direct and Indirect Observation 2 including; chief complaint, history of present illness, past medical history, a Board Review End of Rotation Evaluation comprehensive review of systems, a biological family history, a sociocultural history, a Bedside Teaching 360 Degree Evaluation developmental history and a general and neurological examination. Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

5. Conducts and reports a basic decisional capacity evaluation. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation

Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

6. Interact effectively with a variety of consultees, including determination of consultation Didactics Direct and Indirect Observation 2 questions, and reporting of findings and recommendations. Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

7. Recognize the typical signs and symptoms of psychiatric disorders including substance Didactics Direct and Indirect Observation 2 abuse in medical and surgical patients. Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

8. Assess and interpret laboratory and medical data as it relates to psychiatric illness. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

9. Understand the connections between medical and psychiatric illnesses and the special Didactics Direct and Indirect Observation 2 issues that arise in specific patient populations, including cancer, cardiac disease, HIV Board Review End of Rotation Evaluation disease, organ transplantation, and dementia. Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

10. Monitor the patients’ course during hospitalization and provide continuing input as Didactics Direct and Indirect Observation 2 needed. Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Annual Program Evaluation (APE)

Clinical Teaching Clinical Competency Committee Rounds Annual psychiatry in-training examination Role Modeling (PRITE) Independent Learning Clinical Skills Exam (CSE) Computer Modules

11. Define and prioritize patient’ psychiatric problems and develop a comprehensive database. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam

12. Generate and prioritize full differential diagnoses. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE

13. Make a comprehensive formulation of patient’s problems. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

14. Evaluate suicidal and homicidal potential and respond appropriately to medical and Didactics Direct and Indirect Observation 2 psychiatric emergencies including involuntary commitment petitioning and Board Review End of Rotation Evaluation assessment under close supervision. Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds In-Training Exam Role Modeling Clinical Competency Committee Independent Learning Annual psychiatry in-training examination Computer Modules (PRITE) Clinical Skills Exam (CSE)

15. Develop rational, evidence-based management strategies. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation

Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

16. Convey diagnosis and formulation to patient and family. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

17. Prescribe medications safely and effectively. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

18. Evaluate ongoing treatment effectively. Didactics Direct and Indirect Observation 2 Board Review End of Rotation Evaluation Bedside Teaching 360 Degree Evaluation Clinical Teaching Annual Program Evaluation (APE) Rounds Clinical Competency Committee Role Modeling Annual psychiatry in-training examination Independent Learning (PRITE) Computer Modules Clinical Skills Exam (CSE)

Medical Knowledge Goal: Residents must demonstrate progressive attainment of a knowledge base in the clinical sciences and apply it to inpatients with acute psychiatric needs. They will monitor for acute adverse effects knowledge about the neurobiological and psychological underpinnings of mental illness and will apply this knowledge to patient care in the inpatient setting. Reporting Milestones: MK2 – Psychopathology (A, B, C) MK3 – Clinical Neuroscience (A, B, C, D, E)

MK4 – Psychotherapy (A, B, C) MK5 – Somatic Therapies (A, B, C) MK6 – Practice of Psychiatry (A, B, C)

Objectives Teaching Method Evaluation Method PGY Residents are expected to: Level 1. Demonstrate an understanding of the pathophysiology, epidemiology, diagnostic criteria Didactics Resident performance: 2 and clinical course for common consultation conditions including: Board Review Direct and Indirect Observation a. dementia(s) Bedside Teaching End of Rotation Evaluation b. delirium of multiple etiologies Clinical Teaching Rounds 360 Degree Evaluation c. drug induced psychiatric state Role Modeling Annual Program Evaluation (APE) d. affective change in the face of chronic or life threatening illness Independent Learning In-Training Exam e. factitious disorders Computer Modules Clinical Competency Committee f. malingering g. chronic pain Annual psychiatry in-training examination (PRITE) h. assessment of conversion disorders Clinical Skills Exam (CSE) i. assess drug-drug interactions germane to psychiatry

j. assist in competency assessments k. anxiety disorders in a general medical population l. psychotic disorders in a general medical population m. substance induced disorders

2. Advise and guide consultees about the role of the medical disease and medications in Didactics Resident performance: 2 the patients’ presenting symptoms Board Review Direct and Indirect Observation Bedside Teaching End of Rotation Evaluation Clinical Teaching Rounds 360 Degree Evaluation Role Modeling Annual Program Evaluation (APE) Independent Learning In-Training Exam Computer Modules Clinical Competency Committee