Psychiatry Residency: Rotation Schedule

Rotations at diverse community hospitals and clinics

PGY-1 Rotations
3 3 2 1 1 1 1
HCMC Regions HCMC or Regions HCMC Regions HCMC HCMC
Inpatient Psychiatry Inpatient Psychiatry Internal Medicine Neurology Neurology (consults) Pediatrics Direct Care Clinic/Emergency Medicine
 
PGY-2 Rotations
2 2 3 1 1
Various locations HCMC and Regions Various locations HCMC and Regions HCMC and Regions
Psychiatry Clinic
(Medication Management)
Psychotherapy Clinic ACT Team Child Clinic Scholarly Activity
 
PGY-3 Rotations
2 2 2 2 1 1 1
HCMC Regions HCMC Regions United Hospital or Abbott Northwestern United Hospital HCMC
Inpatient Psychiatry Inpatient Psychiatry Consult Service Consult Service Inpatient Child and Adolescent Inpatient Geropsychiatry Acute Psychiatric Services (APS)
1
Regions
Addiction Medicine
 
PGY-4 Rotations
12
Electives
 

Psychiatry Rotation Descriptions

PGY-1

Direct Care Clinic (HCMC)
Medicine Direct Care Clinic is a primary care clinic that staffed with multiple residents from other services, with supervision provided by Internal Medicine or Family Medicine attending. Residents present each day share the scheduled patient workload. After seeing patients, residents staff with the attending physician. Staff teach on a case-by-case basis, on topics related to patient visits.

Emergency Medicine (HCMC)
This rotation usually includes approximately 20 shifts of eight hours, with most in Team Center A, and the balance in Team Center B, C, or Special Care. We concentrate night shifts in one week. Residents work independently and staff patients with third year Emergency residents (called “Pit Bosses”) in Team Centers A and B. Residents staff patients directly with the attending in Team Center C. Residents carry 3-5 patients at any time, totaling 13-15 patients per shift. Residents sign up for patients, and interview them briefly with the Pit Boss or attending.

Inpatient Psychiatry (HCMC)
Morning report starts at 8 a.m. Residents break into teams at 8:30 and nurses report on patients for 30-60 minutes. Wednesdays are interdisciplinary rounds lasting until 9:30. Residents round on individual patients before the team meets again at 1 p.m. for afternoon rounds. Interdisciplinary rounds are Tuesday mornings. Residents can work on notes and complete orders, etc. after seeing patients. The team meets again at 2 p.m. to go over the list of patients. Residents handle patient admissions daily through 4 p.m.

Inpatient Psychiatry (Regions)
Residents work with 2-4 staff; assigned staff change each week (Tuesday-Monday). Depending on the attending, work starts around 8 a.m. and finishes between 5-6 p.m. Residents carry up to seven patients. Morning starts with a team meeting with attending, social worker, and nurses where staff report any overnight events. Social work updates the team about the patient’s disposition, such as returning home, or to a shelter or treatment facility once stabilized.

Internal Medicine (HCMC)
Interns work six out of seven days a week, averaged across a 4-week period. Residents are expected to be in the hospital from 7:30 a.m. to 5 p.m. except on call days, which are from 7:30 a.m. to 7:30 p.m. Call is every fourth day. Morning report is 8:15-9:00 a.m. Monday through Friday. Noon conference is held 12-1 p.m. Monday through Thursday. Each team includes: senior medicine resident (PGY-2 or PGY-3), two interns (one medicine and one off service), and 1-2 medical students. Residents are responsible for approximately five patients on a daily basis. Residents must pre-round on assigned patients, write orders, write a progress note, and update the sign-out document.

Internal Medicine (Regions)
Work begins with 7:30 a.m. sign-outs and morning report from 9:30-10:15 a.m., Monday through Friday. Residents should see assigned patients before morning report. Team rounds start at 10:30 a.m. On weekends, teams may round earlier or later. Residents should plan to be onsite most days from 10-12 hours, with one day off per week, determined with the team. Teams include: one senior medicine resident, one medicine intern, and may include an off service intern. The senior resident follows medical student patients, handles discharge summaries, and follows their own patients. Psychiatry residents typically handle 4-6 patients and internal medicine residents handle 6-8 patients.

Neurology (HCMC)
Residents work with a senior neurology resident, neurology intern, and medical students. Residents divide the patient load, typically seeing new patients from overnight and follow-ups from previous days before rounding with the staff attending. The team splits new consults as they come in, staffing with attendings as possible. Residents must write their own notes and see patients individually, however the patient’s primary team often places orders, as recommended by the resident consult team.

Neurology-Stroke (HCMC)
While on the stroke team, residents serve as the primary team for each patient. Residents see new overnight admits and follow up with existing patients before rounding with the staff attending. Residents write your own orders on the stroke team and are responsible for all medical management of each patient. Residents will write admission notes, progress notes, and discharge notes.

Neurology (Regions)
Residents work directly with the attending and a medical student or other residents (neurology, foot and ankle, pharmacy, internal medicine, psych NP/PA). This rotation functions as a consult service, with low workload for an intern, averaging 2-8 new consults daily. Attending physicians handle most consults and write their own notes; residents are expected to see 1-3 patients individually each day.

Pediatrics (HCMC)
All weeks on pediatrics are very different. Wards includes admitting and setting up a patient’s treatment plan, daily notes, and writing discharge summaries. Overnights includes admitting patients and covering the ward, but usually includes time to sleep. PICU workload depends on patient volume; residents typically carry 1-2 patients in PICU.

PGY-2

Assertive Community Treatment (ACT) Teams
The ACT experience provides residents a chance to work with clients in their own environment. Activities include: team meetings to discuss the entire list of ACT clients, treatment planning to determine how to proceed over the next six months, and client visits.

Most visits occur in the clients’ homes, but can occur in other community settings, such as a library. The team psychiatrist or another team member accompanies residents during initial visits, and residents meet with clients weekly or every other week, depending on the client’s stability and needs. Residents can expect a case load of about eight clients during the year.

Residents work with clients on psychiatric issues and daily living skills to help them function more independently and avoid hospitalizations. The multidisciplinary ACT team works together to develop comprehensive treatment plans. Each ACT team includes: nurses, social workers, case managers, and vocational rehabilitation specialists. The team sees each client up to six times per week.

Outpatient Child and Adolescent Psychiatry (HCMC)
A review of the day’s schedule with the attending starts the day. For the first weeks, residents observe follow up and new patient appointments to learn the elements of the child and adolescent psychiatric history and mental status exam, presentation of common diagnoses, developmental milestones, and the importance of attentiveness to family dynamics. After the second week, the clinic will schedule follow up and new patient appointments with residents. Residents will initially see to 1-2 follow up and one new patient per half day, with workload increasing over the year. The attending also sees and staffs all resident patients. Time is reserved at day’s end to discuss aspects of patient care and child psychiatry from the day’s patients. Residents must complete documentation within 24 hours of the clinic visit.

Outpatient Child and Adolescent Psychiatry (Regions)
Clinic orientation occurs for four hours the first week of July. Residents then spend the first month observing and learning to document using the Electronic Health Record system. Orientation covers aspects of the child MSE, intake process, EHR, documentation, and legal aspects of child psychiatry such as custody and guardianship. In month two, residents begin seeing patients. Each resident sees either 2-3 follow ups, or one new patient with 1-2 follow ups, for a half day clinic. Clinic starts at 12:45 and ends at 6 p.m. Before clinic, residents review the schedule with the attending and receive patient assignments. All patients that are seen by a resident are also seen and staffed by the attending psychiatrist. The attending also sees and staffs all resident patients. Time is reserved at day’s end to discuss aspects of patient care and child psychiatry from the day’s patients. Residents must complete dictation and documentation within 24 hours of the clinic visit.

Psychiatry Clinic
We assign residents to selected community outpatient clients, ensuring a variety of year-long longitudinal outpatient experiences which include private sector clinics, hospital-based outpatient services, and publicly funded agencies such as Assertive Community Treatment (ACT) teams.

Clinics include:

  • Outpatient Adult Clinic (Ramsey County Mental Health)
    Ramsey County offers a variety of behavioral health services, including ACT teams and a crisis center.
    Residents will have their own schedule with 30 minute follow-up visits and one hour for new patient follow-ups. New patients will have a two-hour appointment, with one hour for patient interview followed by 30 minutes to staff the patient with the resident’s supervisor. After staffing, the resident and attending will meet with patient together to discuss treatment planning. After the intake appointment, the attending psychiatrist does not need to meet with follow-ups. Residents will meet with staff on a weekly basis to discuss follow-up patients and any pending issues. Residents receive an overhead page indicating patient arrival for appointments. Clinic staff can handle any urgent issues that arise. We expect residents to check their mailbox weekly for correspondence. Resident must responsible complete patient documentation in the EHR or dictating intakes, as well as writing for any necessary medications.
  • Outpatient Adult Clinic (Regions Hospital Discharge Clinic)
    This clinic provides short-term outpatient follow-up for patients whose next appointment is too far in the future. We schedule discharge clinic patients after a stay on inpatient behavioral health, or a review by the psychiatry consultation service. Clinic begins at 8 a.m.; residents should arrive early to review the day’s patient roster. The schedule currently consists of 18 double-booked slots of 20 minutes each, ending at 11 a.m. This will change to 16 double-booked slots of 30 minutes each, ending at noon.
    Residents should perform a brief chart review on each patient, then obtain a focused history from the patient directly (i.e., events since hospital discharge). Residents should briefly assess mood/suicidal ideation, anxiety, sleep, psychosis/homicidal ideation, mania, and chemical use. Other key points include: whether medications are working, whether refills of medications are needed, and what follow-up plans have been made. While most patients are voluntary, every patient’s legal status should also be documented. In addition, residents should order any routine monitoring labs for patients taking antipsychotics or mood stabilizers, which patients can complete at Regions Hospital or any HealthPartners clinic that has a lab.
    After resident interviews, attending physicians, usually Dr. James Black, staff the patients. For straightforward patients with simple medication regimens (particularly SSRIs), follow-up with primary care is acceptable. Patients on antipsychotics and mood stabilizers should generally have follow-up with a psychiatrist. Most patients will already have follow-up visits scheduled, either within HealthPartners or elsewhere, prior to their visit to Discharge Clinic. For patients who are not doing well, have a long wait for outside follow-up, or whose Medical Assistance is not in effect, second and occasionally third visits in Discharge Clinic may be necessary.
  • Psychiatry Clinic (Hamm Clinic)
    Hamm Clinic is a non-profit community mental health center in St. Paul that provides mental health care to adults who cannot afford the full cost. Hamm Clinic focuses on psychotherapy, with on-site medication support from within our multidisciplinary team. In the Hamm model for outpatient care, psychiatrists, psychologists, social workers, and nurses collaborate daily in care delivery, including consultation, formal team discussion, benchmark psychological testing/assessment, and thoughtful referrals. Hamm’s educational program is rigorous: thoughtful diagnostic assessment, generous staff supervision, treatment teams, weekly teaching and seminars, and additional conference and in-service. They provide patient care/contact, supervision, consultation, and extensive topical seminars.
  • Behavioral Health Clinics (HealthPartners/Regions)
    Residents will work at one of these adult outpatient behavioral health clinics operated by the HealthPartners/Regions network, located in these Twin Cities suburbs: Inver Grove Heights, Maplewood, or St. Louis Park (West Clinic). These clinics provide assessment and treatment of mental health and chemical dependency problems at several metropolitan offices. Staff are highly skilled in caring for adults, adolescents, and children, and are dedicated to serving special needs and concerns.
  • Outpatient Clinic (HealthPartners Riverside)
    Residents usually work with Dr. Jeffrey Richards. The work in clinic includes new evaluations and follow-up visits for patients with a variety of psychiatric concerns, including mood disorders, anxiety disorders, ADD/ADHD, and psychotic disorders. Typically, one hour is scheduled for a new evaluation, with 30 minutes allotted for follow-up patients. The schedule includes breaks for staffing, but patients can also be staffed during their visit time, depending on Dr. Richards’ schedule.
  • Outpatient Adult Clinic (Schwieters Medical)
    Schwieters Medical is a private practice in psychiatry located in Eagan, Minnesota. Residents will have their own schedule, with 30-minute follow-up visits and one hour for new patients. Residents will see new patients, who will then be staffed with Dr. Bryan Schwieters, and then will be seen again by both resident and Dr. Schwieters to discuss treatment planning. The resident will meet with the staff on a weekly basis to discuss patients, any pending issues, and for didactic sessions. When a patient arrives for their appointment, the resident will receive a call from the front desk indicating the patient has arrived. Any urgent issues that arise through the course of the clinic can be handled by clinic staff. For each visit, the resident is responsible for documentation, as well as writing any necessary medications and/or other orders.

Psychotherapy Clinic (HCMC and Regions)
Therapy clinic enables residents to practice various modalities of individual therapy. The patient’s needs and abilities should determine the type of therapy used. Residents schedule their own visits of 60 minutes for new and ongoing therapy patients. Staff do not conduct direct supervision in therapy clinic. Therapy lectures, held weekly, provide residents a chance to discuss cases. When a patient arrives for an appointment, residents receive a page from the front desk. During orientation, residents will receive a handbook of local outpatient resources. For each visit, residents must enter necessary documentation that corresponds with the level of visit, and any necessary orders. The resident must close each encounter in Epic.

Scholarly Activity
Residents enjoy a weekly half day of protected time for independent scholarly activity. We encourage research culminating in publishable works, development of Quality Improvement projects within our hospitals and clinics, or leading enhancements in medical education for students and residents.

PGY-3

Acute Psychiatric Services (HCMC)
Residents work with an attending provider on a particular day to identify and sign up for patients ready to be seen by a provider. Residents will review charts, documentation from nursing and social work staff, interview patients independently, formulate an assessment and treatment plan, and discuss their findings with the attending. Residents will gather collateral information as needed (if not completed by support staff) and handle documentation on their patients.

Residents will also work with attending providers to manage needed orders and assessments for patients who are agitated, intoxicated, uncooperative, have altered mental status, or other conditions.

Addiction Medicine
Residents maintain a clinic schedule of Alcohol and Drug Addiction Program (ADAP) patients who need either a psychiatric evaluation or follow-up care and when not seeing patients, participate in treatment center activities, such as observing psychological and intake evaluations or attending treatment groups. In 2014, residents will facilitate a smoking cessation group designed to address nicotine addiction concurrently with other disorders treated. Residents complete a paper on motivational interviewing, involving a case the resident is involved in.

Dr. Scott Oakman oversees residents, staffs patients from the clinic half days during the week, and is available by phone for questions or concerns.

Consultation Liaison Service (HCMC)
Each morning, the consult team discusses the consult list, assigns new consults, and engages in informal didactics. Tuesday mornings begin at 7:30 a.m. for journal club. After the morning meeting, residents see new consults and follow up on previous consults as indicated, then staff with the attending psychiatrist until 4 p.m. Each resident must write a new consult note for each patient, as well as a follow-up note when patients are seen on subsequent days.

Consultation Liaison Service (Regions)
Each morning, the consult team discusses the consult list and assigns new consults. After the morning meeting, residents see new consults and follow up on previous consults as indicated, then staff with the attending psychiatrist until 4 p.m. Each resident must write a new consult note for each patient, as well as a follow-up note when patients are seen on subsequent days. Informal education opportunities exist and will reinforce what residents learn on consults.

Staff see Emergency Department consultations, however, residents may be asked to help, depending on the day’s workload.

Inpatient Child and Adolescent (Abbott Northwestern Hospital)
Residents work primarily with Dr. Timothy Gibbs at Abbott Northwestern Hospital in Minneapolis. Duties begin at 8 a.m. and include patient assessment and medication management (H&P, progress notes, and discharge summaries), presentations, observation, participation in group therapies, and occupational therapy. Attending physicians assign patients. After seeing patients or participating in groups, residents report to the attending. Residents must complete required documentation for each assigned patient.

Inpatient Child and Adolescent (United Hospital)
Residents work from United Hospital in St. Paul. Duties begin at 8 a.m. and include patient assessment and medication management (H&P, progress notes, and discharge summaries), presentations, observation, participation in group therapies, and occupational therapy. Attending physicians assign patients. After seeing patients or participating in groups, residents report to the attending. Residents must complete required documentation for each assigned patient.

Inpatient Geropsychiatry (United Hospital)
Residents work from the inpatient geriatric psychiatry unit at United Hospital in St. Paul. Duties begin at 8 a.m. and include the inpatient geriatric psychiatry unit and working on inpatient geriatric consults, staffed by Dr. Sarah Kottke and Dr. Ramesh Sairam. After seeing patients or participating in groups, residents report to the attending. Residents must complete required documentation for each assigned patient. Dr. Sairam conducts didactics individually each day, usually in the afternoon. Following didactics, residents may see an additional consult, receive new admissions who arrive during the day, or have time for reading.

Inpatient Psychiatry (HCMC)
Senior residents take a leadership role in discussions and discharge planning for all of the patients on their respective teams, follow their own set of patients, and serve as resources for the interns and medical students on the service. Senior residents hold the admission pager from 8 a.m. to 4 p.m., receive alerts to incoming admissions, and assign new patients to a rotating resident/intern, with a maximum of two admissions per resident per day. Senior residents take part in performing new admissions and take on additional responsibility with patients. The actual role is discussed with the attending psychiatrist at the beginning of the rotation.

Inpatient Psychiatry (Regions)
Senior residents take on additional responsibility with patients, including a leadership role in discussions and discharge planning for all of the patients on their respective teams and following their own set of patients. Senior residents should help teach and be available to interns rotating on other units and medical students on the inpatient service, for any questions that may arise. The actual role is discussed with the attending psychiatrist at the beginning of the rotation.

We encourage residents devote one of their inpatient months to an ECT Intensive, which includes assisting the ECT team in evaluations, consultations, and performance of this procedure.

PGY-4

Electives
The PGY-4 year is a flexible period for residents to hone skills directly related to their individual career interests. Residents can choose from a wide variety of electives: Addictions, Alternative Medicine, Consults, Day Treatment Programs, ECT, Inpatient/Outpatient, Neuro-Psychology, Research, or other pre-defined rotations and clinics. Residents can also create their own elective rotations with program director approval. We offer two international electives annually, with salary and benefits.