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Department of Psychiatry

Psychiatry Program Goals and Objectives

ACGME COMPETENCIES


  • Clinical Science/Medical Knowledge
  • Patient Care
  • Interpersonal Skills and Communication
  • Practice Based Learning
  • Systems Based Care
  • Professionalism and Ethical Behavior


Clinical Science/Medical Knowledge

Definition

Clinical science/medical knowledge is the knowledge base about established and evolving biomedical, clinical, and cognitive sciences and their application to clinical care. Residents are expected to demonstrate an analytic and investigatory approach to clinical situations. They are also expected to know and apply the basic and clinical sciences appropriate to the discipline of Psychiatry.

Out Come/Goals

At regular intervals, the psychiatric resident should demonstrate progressive attainment of a knowledge base in clinical sciences and the ability to apply this knowledge to the care of patients with psychiatric disorders. Upon graduation, the resident will have attained an adequate knowledge base of clinical science that will allow him/her to practice contemporary Psychiatry efficiently and effectively. The graduate psychiatrists will be versed in modern evidence based psychiatry practices.

Evidence-base practice consists of five well-defined components:

  1. Formatting a proper clinical question.
  2. Conducting a systematic review of the literature (based on the well-formatted clinical question).
  3. Conducting a critical appraisal on the selected research articles and ranking.
  4. Formulating a clinical protocol based on the "best evidence".
  5. Conducting clinical audits to determine if the protocol was implemented properly (and to identify issues and/or problems).


Knowledge Objectives

The resident will demonstrate knowledge of:
  1. Normal growth and development and the biological, psychological, and sociocultural factors that influence it.
  2. The major psychiatric theorists of the past and their contribution to current theories/understanding of human mental functioning.
  3. How neurobiological sciences are relevant to Psychiatry and an appreciation of brain-behavior relationships.
  4. All forms of psychopathology as currently understood. This includes knowledge of the etiology, epidemiology, prevention, diagnosis and treatment of current psychiatric disorders.
  5. The interface of neurology with Psychiatry including the diagnosis and treatment of common neuropsychiatric disorders.
  6. The psychological and neuropsychiatric manifestations of physical illness.
  7. Forensic issues relevant to Psychiatry.
  8. The impact of culture, religion, gender, socioeconomic factors and family systems on the development and maintenance of psychopathological states.
  9. The theoretical basis for the non-somatic therapies utilized in Psychiatry especially psychodynamic, supportive, cognitive-behavioral, brief and combined psychotherapy.
  10. The theoretical basis for the somatic therapies utilized in Psychiatry, especially psychopharmacology and ECT.


Skill Objectives

Residents will demonstrate ability to:
  1. Identify gaps in their knowledge base and create a plan to remedy weaknesses.
  2. Create and implement a plan for lifelong learning.
  3. Critically appraise the scientific literature.
  4. Integrate up-to-date scientific evidence in decision making about patient care.


Attitude Objectives

The resident will demonstrate an analytic and investigatory attitude toward clinical situations by:
  1. Being able to discuss assigned readings by making relevant comments and bringing in knowledge from other readings.
  2. Actively participating in clinical conferences by demonstrating knowledge of clinical sciences relevant to the situation being discussed.
  3. Showing independent pursuit of knowledge through literature searches, other investigative work and research.


Assessment Tools

The clinical science/medical knowledge objectives will be assessed by:

  1. Evaluation of clinical care of patients by assigned supervisors.
  2. Evaluation of research activities performed by the resident.
  3. Performance during clinical presentations as rated by attending faculty.
  4. PRITE written (National Standardized) examinations.
  5. Preparation for and participation in didactic activities as assessed by assigned faculty.
  6. Performance in teaching medical students and/or junior residents.
  7. Oral mock board exams.
  8. Evidence of independent learning observed by faculty.
  9. Regular review of the resident's performance by the training director and the Residency Training Committee.
  10. Annual resident self-evaluation and plan for improvement.
  11. Assessment tools specific to each year of training, such as psychotherapy and systems based practice skills evaluations.


Patient Care

Definition

Patient care is the application of medical knowledge and skills in a compassionate, appropriate and effective manner in order to accomplish the best possible treatment of psychiatric problems and to promote mental and physical health in patients.

Outcome/Goals

At regular intervals, the psychiatric resident should demonstrate progressive attainment of the knowledge, skills and attitudes required to conduct clinically appropriate and effective psychiatric treatment of patients and their families.

Knowledge Objectives

The resident will demonstrate knowledge of:

  1. The tools available for assessment of patient problems including interviews, physical exams, screening instruments, diagnostic scales, and formal psychological testing.
  2. Knowledge of the DSM criteria.
  3. Knowledge of current available treatment methods both psychological and somatic.
  4. Knowledge of current standards of practice.
  5. Knowledge of preventive interventions useful in Psychiatry.


Skill Objectives

Residents will demonstrate ability to:
  1. Establish and maintain an effective treatment alliance with patients and families.
  2. Communicate effectively with patients, families and organizations when necessary.
  3. Demonstrate caring and respectful behaviors when interacting with patients, families, and organizations, while maintaining appropriate boundaries.
  4. Perform a comprehensive psychiatric assessment of patients, to include appropriate diagnostic interviews, indicated physical and neurological examinations, laboratory testing, the ordering of psychological testing, and the collection of collateral data.
  5. Develop a comprehensive biopsychosocial formulation.
  6. Develop an appropriate differential diagnosis using current DSM terminology.
  7. Develop and implement a comprehensive treatment plan based upon current scientific evidence, clinical judgment, and patient preferences. This includes being able to set treatment goals and to have a rationale that guides the selection of the appropriate forms of treatment.
  8. Apply professional practice guidelines when appropriate.
  9. Communicate effectively to the patient and family (when indicated) the results of the assessment, the proposed treatment plan including risks and benefits, any alternatives to the proposed plan, the prognosis, and prevention strategies.
  10. Provide appropriate psychoeducation to patients and families.
  11. Document all assessments, formulations, and treatment in a clear, concise and timely manner.
  12. Use appropriate information technology to support patient care and education.
  13. Competently provide the basic therapeutic modalities utilized in Psychiatry today, including psychotherapy (psychodynamic, cognitive, supportive, brief, and combined), somatic therapies (pharmacotherapy, ECT), substance abuse treatment, and family and couples therapy.
  14. Work with a multidisciplinary team to provide comprehensive care to their patients.
  15. Provide psychiatric services aimed at preventing mental illness and maintaining mental health.


Attitude Objectives

Residents will be able to:
  1. Monitor their personal reactions to patients and show a willingness to seek supervision about these reactions.
  2. Maintain appropriate boundaries with patients.
  3. Be strong advocates for the patient's best interests.
  4. Provide one standard of care for all their patients.
  5. Be sensitive to the patient's culture and how it affects treatment.
  6. Recognize that patients exist within a web of interpersonal relations and systems relations (work, school, legal, medical, etc.) and be sensitive to how these relationships impact the patient's functioning.


Assessment Tools

The clinical science/medical knowledge objectives will be assessed by:
  1. Written evaluations provided by supervisors on the various rotations.
  2. Regular review of the resident's performance by the training director and the Residency Training Committee.
  3. Annual oral examinations.
  4. Resident self-assessment.
  5. Multimodal evaluation of psychotherapy skills.
  6. Performance during the weekly case conferences held on the inpatient unit.
  7. Assessment tools specific to each year of training, such as psychotherapy and systems based practice skills evaluations.


Interpersonal Skills And Communications

Definition

Interpersonal and communication skills are the specific techniques and methods that facilitate effective and empathic communication between the psychiatrist, the patient, colleagues, staff and systems.

Outcome/Goals

At regular intervals the psychiatric resident should demonstrate progressive attainment of the knowledge, skills and attitudes required to develop and maintain effective interpersonal and therapeutic relationships.

Knowledge Objectives

The resident should demonstrate, during training, an adequate understanding of the factors impacting communication between people, including:

  1. How the patient's emotional reactions affect what he/she tells the psychiatrist.
  2. How the psychiatrist's emotional reactions affect his/her interpretation of what the patient says.
  3. How family and cultural belief impact communication between patients and authority figures such as physicians/psychiatrists.
  4. Specific techniques to facilitate communication (open vs. Closed-ended questioning, verbal vs. non-verbal communication, demonstration of empathy, delivering bad news, etc.)
  5. The importance of effective written communication skills.


Skill Objectives

Residents will demonstrate ability to:
  1. Develop and maintain an effective therapeutic relationship with patients.
  2. Use effective listening skills.
  3. Elicit information from the patient by using non-verbal, explanatory and questioning skills.
  4. Use effective written communication by producing documentation that is clear, concise, legible, and timely and that captures all essential clinical information.
  5. Communicate clearly to the patient and family the results of the evaluation, the proposed treatment plan, prognosis and risks/benefits/alternatives to the plan.
  6. Use negotiation to develop a mutually agreeable treatment plan.
  7. Educate patients, family and other professionals about medical, psychological, psychiatric and behavioral issues.
  8. Communicate effectively with allied health and other professionals involved in the patient's care.
  9. Operate effectively within the structure of a multidisciplinary treatment team.
  10. Access and use interpreters when necessary.
  11. Demonstrate leadership skills with multidisciplinary treatment team members, junior residents and medical students.
  12. Serve as an effective consultant to other physicians, mental health professionals, and community agencies. The resident should demonstrate the ability to communicate effectively with consultees to refine the consultation question, maintain the boundaries of the consultant, communicate clear and specific findings and recommendations, and respect the knowledge and expertise of the consultee.
  13. Recognize and manage his/her own emotional reactions well enough that they do not interfere with communication and accomplishment of needed tasks.
  14. Provide constructive feedback and role modeling to students, residents and other professionals in a manner that does not activate their fight-or-flight responses.
  15. Utilize technology to facilitate communication.
  16. Utilize different styles of communication depending on the medium of communication (telephone, e-mail, formal writing, person-to-person).


Attitude Objectives

Residents will be able to:
  1. Maintain an attitude of respect for others, even those with differing points of view or different backgrounds.
  2. Demonstrate an attempt to gain understanding of another's position and reasoning when they differ from that of the resident.
  3. Demonstrate a belief in the intrinsic worth of others.
  4. Demonstrate a willingness to build collaboration and to share information in a collaborative rather than dogmatic fashion.
  5. Demonstrate a willingness to continually self-observe.
  6. Exhibit a sensitivity to the needs of others and respond in a professional and ethical manner.


Assessment Tools


  1. Written evaluations by supervisors on the various rotations.
  2. Regular review of the resident's performance by the training director and the Residency Training Committee.
  3. The ability to communicate effectively during clinical and didactic presentations as rated by the attending faculty.
  4. Ratings of the resident by the medical students he/she teaches.
  5. Performance during oral mock board exams.
  6. Resident self-assessment and plan for improvement.
  7. Assessment tools specific to each year of training, such as psychotherapy and systems based practice skills evaluations.


Practice Based Learning

Definition

Practice based learning is the process by which a psychiatrist continually expands his/her knowledge and skills and evaluates his/her practice to insure that he/she continues to provide competent, high quality evaluation and treatment of his/her patients. This process involves a willingness to develop new knowledge and skills, the ability to recognize gaps in knowledge and skills, and an approach to self-improvement through adherence to "best practices" and regular critical review of the scientific literature.

Outcome/Goals

The resident will demonstrate the knowledge, skills and attitudes necessary to initiate self-directed and independent learning in order to keep abreast of current information and practices relevant to Psychiatry, to correct any information or skills gap, and to improve patient care practices.

Knowledge Objectives

The resident will show knowledge of:

  1. Research methodology, including the critical assessment of professional journal articles.
  2. The principles of evidence-based medicine.
  3. Awareness of available information technologies and the ability to access them.


Skills Objectives

Residents will demonstrate ability to:
  1. Develop a systematic approach to investigating, evaluating and improving their fund of knowledge and clinical practices.
  2. Utilize patient logs to evaluate their caseload and practice experiences.
  3. Examine errors in their practice and initiate steps to eliminate them.
  4. Teach medical students, junior residents, and other professionals the basic principles of Psychiatry.
  5. Utilize the literature to locate, appraise and assimilate evidence relating to their patient's psychiatric problems.
  6. Apply the fund of knowledge obtained through the systematic approach listed in criterion 1 to their current clinical practice.
  7. Use information technology to manage information, access on-line medical information, and support his/her own education.
  8. Use evidence-based medicine principles to appraise scientific articles.
  9. Assessment tools specific to each year of training, such as psychotherapy and systems based practice skills evaluations.


Attitude Objectives

Residents will be able to:
  1. Recognize the need for lifelong learning.
  2. Maintain an attitude of inquiry and scholarship.
  3. Maintain an openness and flexibility in treatment approaches with patients.
  4. Recognize the importance of what patients have to teach us about their illnesses.
  5. Be open to faculty training and role modeling efforts.


Assessment Tools


  1. Performance during their research rotation as evaluated by supervising faculty.
  2. Performance during their journal club presentations and case presentations as evaluated by attending faculty.
  3. Scholarly presentation at a seminar or grand rounds as evaluated by attending faculty.
  4. The optional development of a publishable quality paper that can be evaluated by faculty.
  5. Evidence of self-directed, non-assigned reading of the literature during rounds, supervision and in seminars.


Systems Based Care

Definition

Systems-based care is the treatment of patients with psychiatric problems within the context of multiple, complex and interacting systems which all contribute in some way to the total treatment program of the patient.

Outcome/Goals

At regular intervals during training, the psychiatric resident will demonstrate progressive attainment of the knowledge, skills and attitudes necessary to practice effectively in an environment where multiple, complex systems are interacting with each other to provide effective treatment of patient problems. By the time of graduation, the resident should have achieved the skills necessary to navigate comfortably within such an environment.

Knowledge Objectives

The resident will show knowledge of:

  1. Basic concepts of systems theory.
  2. The role of family and social support systems in the genesis, treatment and improvement of the patient's problems.
  3. Administrative issues in Psychiatry including the structure and function of common health care delivery systems.
  4. Forensic aspects of Psychiatry, especially the common interactions that psychiatrists have with the legal system and the role of the psychiatrist as expert witness.
  5. The role of community mental health services and how to access them.
  6. The role of local and national organizations and agencies involved in advocating and in caring for psychiatric patients.
  7. Managed care theory and practices and how they impact on psychiatric care.
  8. Psychiatric consultation and liaison activities and the role of the psychiatrist may fill in different settings.
  9. The role that physician patient care practices have in determining total cost of patient care.


Skills Objectives

Residents will demonstrate ability to:
  1. Act as a psychiatric consultant in a variety of settings, including medical, legal, school and community.
  2. Educate patients and families about how to work within the variety of systems involved in the patient's care.
  3. Educate community groups and other professionals about psychiatric problems, treatment and prevention.
  4. Treat patients within a family/systems format whenever indicated.
  5. Act as an advocate for their patients within the various systems.
  6. Work with insurance and managed care companies to meet patient's needs.
  7. Practice cost-effective health care and resource allocation that does not compromise the quality of care.
  8. Assist patients in accessing nontraditional avenues of health care such as research projects.


Attitude Objectives

Residents will be able to:
  1. Maintain an attitude of interdisciplinary collaboration, advocacy and cooperation.
  2. Maintain an attitude of flexibility in adapting to the needs and expectations of different systems and settings.
  3. Demonstrate sensitivity to the limitations of different systems.
  4. Maintain an attitude of respect for the expertise of other professionals.
  5. Hold the patient's best interest as his/her top priority.


Assessment Tools

The resident's knowledge, skills and attitudes concerning systems-based care will be assessed by:
  1. Regular written evaluations done by supervisors on the various rotations.
  2. Regular review by the training director and the Residency Training Committee.
  3. The resident's participation and performance in the Administrative Psychiatry seminar, the Forensic Psychiatry seminar and the Managed Care seminar. (Does he/she attend regularly? Does he/she read assigned material and participate in discussion? Does he/she show evidence of extra reading?)
  4. Participation and performance during court commitment hearings.
  5. Participation and performance during his/her consultation-liaison rotation.
  6. Participation and performance in outpatient forensic evaluations during his/her PGY-III and PGY-IV years.
  7. Performance during the resident's Administrative Psychiatry assignment during their PGY-IV year.
  8. Performance in interaction with schools, foster care agencies, Child Protective Services, and the Juvenile Detention System during his/her child and adolescent rotation.
  9. Performance in interaction with local agencies and representatives affiliated with TDSHS.
  10. Performance during case conferences held weekly on the inpatient service.
  11. Assessment tools specific to each year of training, such as psychotherapy and systems based practice skills evaluations.


Professionalism and Ethical Behavior

Definition

Professionalism and ethical behavior encompasses the resident's commitment to professional responsibilities, including demonstration of respect, compassion, and integrity. It includes responsivity to the needs of patients and of society that supersedes self-interest, accountability to patients, society and the profession, and commitment to excellence. Ethical behavior includes the adherence to ethical principles, especially those pertaining to the provision or withholding of care, the confidentiality of patient information, informed consent, sexual practices, and ethical business practice.

Outcome/Goals

At regular intervals during training, the psychiatric resident should demonstrate progressive attainment of the knowledge skills and attitudes necessary to provide legal, ethical, and culturally sensitive care to his/her patients. By the time of graduation, the resident should have demonstrated competency in the fundamental areas of professionalism and ethical behavior.

Knowledge Objectives

The resident will show knowledge of:

  1. Ethical issues in Psychiatry, including confidentiality, informed consent, and patient's rights.
  2. The codes of ethics published by the AMA and the APA.
  3. Ethical issues in the conduct of research with human subjects.
  4. Legal issues pertinent to the practice of Psychiatry, including assessment of competence and commitment laws and procedures.


Skills Objectives

Residents will demonstrate ability to:
  1. Responsible professional behavior, to include:
    1. Prompt response to patient communications.
    2. Being timely and appropriately available for patient care activities.
    3. Being timely and appropriately available for other professional activities
    4. Ensuring coverage when available.
    5. Being truthful and honest in his/her professional interactions.
    6. Adhering to the codes of ethics published by the AMA and the APA.
    7. Recognizing his/her limitations and asking for help or supervision when needed.
  2. Responsible social behavior appropriate for a physician.
  3. The ability to set and keep appropriate professional boundaries in his/her interactions with patients and other professionals.
  4. Respect for all people without consideration of age, gender, race or cultural background.


Attitude Objectives

Residents will:
  1. Show an attitude of respect and regard for the needs of patients and society that supersedes simple self-interest.
  2. Demonstrate a commitment to ethical principles and his/her practice.
  3. Demonstrate an attitude of sensitivity to cultural differences.


Assessment Tools

The resident's commitment to professional and ethical behavior will be assessed by:
  1. Regular written evaluations done by supervisors on the resident's various rotations.
  2. Observation of patient interviews and mock board exams.
  3. Regular review by the training director and the Residency Training Committee.
  4. Feedback from collaborative professional contacts such as medical and non-medical professionals and administrators.
  5. Assessment tools specific to each year of training, such as psychotherapy and systems based practice skills evaluations.

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