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Rotations PGY I
AMBULATORY CARE
Location
VA Boston Healthcare System, Brockton Campus
Educational Objectives
The ambulatory care medicine rotation VABHS is intended to teach the resident to evaluate, diagnose, and treat medical patients in an outpatient setting, including attention to biopsychosocial aspects of ongoing medical problems. The resident is expected to learn the basics of care offered by a primary care physician; undertake the initial clinical and laboratory studies of patients presenting with a broad range of common medical and surgical disorders; diagnose common medical and surgical disorders; and formulate appropriate initial treatment plans. The resident is expected to be especially conversant with medical disorders displaying symptoms likely to be regarded as psychiatric, and with psychiatric disorders displaying symptoms likely to be regarded as medical. The resident is also expected to be especially cognizant of the nature of the interactions between psychiatric treatments and medical and surgical treatments.
Description of Rotation
Residents spend a required, full-time, 1-month rotation at the Ambulatory Care Service in their PGY-I year. The rotation takes place primarily in the Urgent Care Center and in the medical consultation service. The resident evaluates patients who walk in for medical evaluation and also follows patients in the specialty clinics.
The resident is expected to report to the attending on call for the day. The resident sees the patients as they come and will evaluate, diagnose, and treat the patients. The resident will then present the case to the attending prior to the disposition of the patient. The autonomy and independence of the resident's decision-making will be consistent with his/her abilities, teaching needs, and personal comfort in management.
Expected Caseload
Variable.
INPATIENT MEDICINE
Location
MetroWest Medical Center Framingham, MA
Educational Objectives
The inpatient medicine rotation at the MetroWest Medical Center is intended to teach the resident to evaluate, diagnose, and treat medical patients with acute medical issues in an inpatient setting, including biopsychosocial aspects of acute internal medicine problems.
Description of Rotation
Residents spend a required, full-time 3-month rotation on the Internal Medicine Inpatient Unit in their PGY-I year. The medical wards are divided into five teams, each of which is supervised by a Junior Resident and a Senior Resident. The PGY-I resident will be assigned to one of five teams on the wards for the duration of the rotation. He/she will serve as the intern on that team along with a PGY-II or PGY-III resident, an attending physician, and possibly a physician assistant student or a pharmacy student.
The interns are expected to do a full history, physical examination, and laboratory workup on each patient they admit. They are also responsible for writing daily progress notes on each patient in a problem-oriented format. They are expected to know the health details of every patient, especially in terms of progress and any new developments.
Expected Caseload
Variable. All patients admitted to the MetroWest Medical Center will be assigned to an attending physician; the admitting resident of the day (ARD) will decide which patients are acceptable for the teaching service. Interns are on call every 5th night. They are expected to leave by 1:30 PM the following day.
NEUROLOGY – VABHS
Location
VA Boston Healthcare System, Jamaica Plain & West Roxbury Campuses Boston, MA
Educational Objectives
This rotation is intended to teach each resident how to evaluate, diagnose, and follow patients during the treatment and/or evaluation of their neurological illness. The resident is also expected to obtain clinical experience in the diagnosis of neurological conditions that might be encountered in psychiatric practice.
Description of Rotation
Residents complete a required 2-month rotation at either or both of the Beth Israel Deaconess Medical Center or at the VA Boston Healthcare System's Jamaica Plain and West Roxbury Campuses. This neurology rotation utilizes both the Jamaica Plain and the West Roxbury Campuses of the VA Boston Healthcare System. The rotation consists of work both on the Neurology Inpatient Service and with the Neurology Consult Service and Outpatient Clinic.
On the VABHS rotation, the PGY-I resident functions as a full member of the inpatient treatment team, evaluating, diagnosing, and managing all aspects of the patient's inpatient stay under the supervision of the Attending Neurologist. The resident's consult work includes responding to Neurology consults from a variety of services. In the outpatient experience at the Jamaica Plain Campus, the resident works with in a variety of Neurology specialty clinics under the supervision of the Attending Neurologist. In all roles on this rotation, the resident performs initial evaluations, arranges appropriate treatment and follow-up, conducts treatment planning, and where relevant develops discharge planning.
Residents work alongside Harvard Medical School and Boston University and medical students, residents, and trainees. Residents are also expected to attend Tuesday Neurology Teaching Day didactic activities along with these other trainees.
Expected Caseload
Variable inpatient and outpatient.
NEUROLOGY—BETH ISRAEL HOSPITAL
Location
Beth Israel Deaconess Medical Center Boston, MA
Educational Objectives
This rotation is intended to teach each resident how to evaluate, diagnose, and follow patients during the treatment and/or evaluation of their neurological illness. The resident is also expected to obtain clinical experience in the diagnosis of neurological conditions that might be encountered in psychiatric practice.
Description of Rotation
Residents complete a required 2-month rotation at either or both of the Beth Israel Deaconess Medical Center or at the VA Boston Healthcare System's Jamaica Plain and West Roxbury Campuses. Beth Israel is a nationally recognized Harvard Medical School teaching hospital. The hospital offers a variety of inpatient and outpatient services that provide training experiences for residents in the Harvard South Shore Residency Program.
The Beth Israel rotation consists of one month spent either on the Neurology Inpatient Service or with the Neurology Consult Service.
For the inpatient month the PGY-I resident is part of an inpatient treatment team comprised of the Attending Neurologist for the month, a Neurology Chief Resident, 2-3 Neurology Residents/interns, a social worker, and designated nurses and nursing assistants. The resident evaluates, diagnoses, and manages all aspects of the patient's inpatient stay under the supervision of the Attending Neurologist and the Chief Resident. This involves performing initial evaluations, daily follow-up, treatment planning, and discharge planning.
For the consult month of the rotation the PGY-I resident is involved in responding to Neurology consults from the different services in the hospital. The PGY-I resident works with the Neurology Consult Resident and medical students under the supervision of the Consult Attending Neurologist. The resident completes a neurologic assessment and diagnosis and makes recommendations to the service in charge of the case. The Consult Attending Neurologist and Consult Resident review the resident's evaluations and recommendations. The Residents also attend various Neurology Conferences including the combined Longwood Neurology Grand Rounds and Professor's Rounds at BIDMC, presented by the Chairman.
Expected Caseload
The resident carries approximately 3 complex patients in the inpatient service. In the Neurology Consult service the resident can evaluate 1-2 consults in a day.
INPATIENT PSYCHIATRY
Location
VA Boston Healthcare System, Brockton Campus
Educational Objectives
The inpatient psychiatry rotation is intended to teach the resident to conduct a thorough biopsychosocial psychiatric assessment including a complete psychiatric history, mental status examination, and physical examination. The resident is expected to, under attending supervision, initiate appropriate work-up, consultations, and ancillary procedures. The resident will be able to make a biopsychosocial formulation of each case and formulate and implement a treatment plan. The resident will also learn to recognize, analyze, and manage the dynamics in an inpatient setting and learn how to work with an interdisciplinary team. The resident will learn how to provide individual and group psychotherapy and to set appropriate boundaries in a therapeutic relationship. The resident will develop skills in timely, concise, and accurate document, including progress notes, treatment plans, and discharge summaries.
Description of Rotation
PGY-I residents complete a required 3-month, full-time rotation on the Inpatient Psychiatry Teaching Units in their PGY-I year. This rotation may be split between the two Acute Inpatient Psychiatry Wards. Ward 2-3-C has a total of 28 beds, including 8 beds which are dedicated for use by female inpatients in a separate wing of the inpatient unit, and can accept up to 12 female inpatients. The resident evaluates, treats, and follows acute admissions to the inpatient unit. Additional inpatient psychotherapy supervision for the inpatient psychiatry residents on this rotation is provided by several senior psychotherapy-oriented psychiatrists and psychologists.
The 2 teaching units are staffed by a total of 6 psychiatrists, 3 nurse practitioners, one full-time psychologist, two social workers, an occupational therapist, and designated nurses and nursing assistants. Since these wards are teaching units, the trainees can include a PGY-IV level Psychiatry Senior Teaching Resident, up to five PGY-II or PGY-I level Psychiatry Residents, one or two Psychology Interns, a Social Work Intern, and 1-2 Occupational Therapy students. Nursing students from nearby affiliated programs also receive part of their clinical experience on the unit.
The resident will evaluate, diagnose, and manage all aspects of the patient's inpatient stay. The resident will interact with the treatment team in the management of patients. This will involve performing initial evaluations, daily follow-up, team participation, treatment planning, and discharge planning. The resident may also conduct community meetings on a weekly basis and may co-lead medication groups.
The resident will complete all necessary evaluations, paperwork, progress notes, medication adjustments, evaluation of privileges, and discharge summaries. The autonomy and independence of the resident's decision-making will be consistent with his/her abilities, teaching needs, and personal comfort in management. The inpatient attending psychiatrists are ultimately responsible for the clinical decisions jointly made.
Expected Caseload
The PGY-I resident's case load is about 4 patients.
EMERGENCY PSYCHIATRY
Location
VA Boston Healthcare System, Brockton Campus
Educational Objectives
The emergency psychiatry rotation at the VA Medical Center is intended to provide the PGY-I resident with experience in the emergency setting assessing and managing patients presenting in crisis or with unmet clinical needs. This includes developing skills in diagnosing and stabilizing acutely ill patients and arranging acute and follow-up care at the appropriate level of intensity according to clinical status. The resident's acute assessment and management interventions may include biological, psychological, and social components according to patient need.
Description of Rotation
Residents spend a required, full-time, 1-month rotation at the Psychiatry Urgent Care area in their PGY-I year. The residents evaluate, diagnose, and make decisions on the disposition of walk-in outpatients needing psychiatric treatment.
The Psychiatric Urgent Care area is staffed by a psychiatrist and an Urgent Care officer for the day who screen and evaluates all walk-in patients needing psychiatric care for the day. The resident will complete all necessary evaluations, diagnose, and decide on the disposition of his/her patients who need psychiatric care. The resident may release the patient with a scheduled outpatient follow-up appointment or admit him/her to the inpatient service. All evaluations and disposition decisions are discussed with the Attending Psychiatrist-on-duty at Urgent Care. The autonomy and independence of the resident's decision-making will be consistent with his/her abilities, teaching needs, and personal comfort in management. In addition to on-site case-by-case attending supervision, the resident meets individually at least weekly with the rotation director for in-depth case discussions, tutorials and related supervision
Expected Caseload
Complete emergency assessment, triage, and acute treatment plan for at least two patients per day.
GERIATRIC PSYCHIATRY
Location
McLean Hospital Belmont, MA
Educational Objectives
This rotation at the McLean Hospital is intended to teach the PGY-I resident how to conduct a comprehensive, biopsychosocial geriatric psychiatric assessment, enhance interviewing skills with clear and accurate history taking, formulate a differential diagnosis and treatment plan, and provide major types of therapy including short-term individual psychotherapy, pharmacological therapy, and other somatic therapies. This rotation also offers the opportunity to learn fundamental concepts of the neuropsychiatric evaluation. All these skills will be applied to patients suffering from a variety of geriatric mental health disorders with ample exposure to dementia and delirium.
Description of Rotation
The PGY-I resident spends a required 1-month, full-time rotation, including two weeks on the General Geriatric Psychiatry Unit and 2 weeks on the Dementia Unit. The units are staffed by 2 psychiatrists, 2 psychologists, 2 social workers, an occupational therapist, internist, physiatrist and designated nurses and mental health technicians. The resident evaluates and manages all aspects of the patient's inpatient stay. Residents interact with the treatment team in the management of the patients. They perform initial evaluations, daily follow-up, team participation, treatment planning, and discharge planning. The resident conducts daily rounds, writes progress notes, follows laboratory results, and makes changes to treatment as indicated under attending supervision. The residents participate in family meetings and discussions with outpatient providers and primary care physicians. The autonomy and independence of the resident's decision-making will be consistent with his/her abilities, teaching needs, and personal comfort in management.
Expected Caseload
The caseload will not exceed 5 patients.
INPATIENT SUBSTANCE ABUSE
Location
VA Boston Healthcare System, Brockton Campus Educational Objectives The inpatient substance abuse rotation at the VA Medical Center is intended to familiarize the resident with the psychiatric assessment and treatment of substance abuse patients. The resident is expected to: evaluate and diagnose patients who are in withdrawal; treat and order an appropriate detoxification regimen; recognize, assess, and treat patients with co-morbid primary psychiatric disorders; and gain exposure to the various long-term rehabilitation programs available for discharge planning.
Description of Rotation
Residents spend a required, 1-month, full-time rotation on the Substance Abuse Unit in their PGY-I year. There are 14 beds for patients who need detoxification and 11 beds for patients who need further education and rehabilitation from substance abuse (the SAARTP Program). There is also an 8-bed long-term rehabilitation program for drug abusers (Project RISE).
The resident conducts a thorough biopsychosocial assessment and manages all aspects of the patient's inpatient stay. The resident will interact with the treatment team in the management of the patients. This will involve performing initial evaluations, daily follow-up, team participation, treatment planning, and discharge planning. The autonomy and independence of the resident's decision making will be consistent with his/her abilities, teaching needs, and personal comfort in management.
Expected Caseload
The PGY-I resident's caseload will not exceed four patients, while the resident participates in the daily rounds of all patients in order to expand his/her exposure to a variety of cases.