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Psychiatry Residency Program Manual (2022-2023)
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University of Minnesota

 

Psychiatry Policy & Procedure Manual (PPPM)

2022-2023

 

 

Department of

Psychiatry and Behavioral Sciences Psychiatry Residency Program


Table of Contents

Table of Contents        2

Introduction        6

Purpose        6

Institutional Profile        6

Statement of Commitment        6

Statement of Goals for Graduate Medical Education        6

Statement of Diversity, Equity and Inclusion        6

Institutional Responsibilities        7

Statement of Inclusion of Fellowship Programs        7

Departmental Mission Statement        7

Program Description and Aims        9

Departmental Organization Chart        10

Appointment and Reappointments        11

Eligibility Requirements        11

Non-discrimination Statement        11

Program Specific Visa Policies        12

Appointment and Promotion        12

Requirements for Completion of Training and Graduation        12

Policy on Effect of Leave for Satisfying Completion of Program        12

Failure to Advance        13

Trainee Responsibilities and Supervision        14

Clinical Responsibilities        14

Non-clinical and Administrative Responsibilities        20

Trainee Supervision        21

Monitoring of Well-Being        22

Conference Attendance Requirements        22

Program Curriculum        23

ACGME General Competencies        23

Clinical Rotations and Block Schedule        23

PGY1        23

PGY2        23

PGY3        23

PGY4        23

Competency-based Goals & Objectives        24

YEAR 1        24

YEAR 2        27

YEAR 3        31

YEAR 4        34

ELECTIVES        35

Psychotherapy Training        38

PGY1        39

PGY2        39

PGY3        39

PGY4        40

Psychotherapy Optional Activities        41

Clinical Skills Assessments (CSAs)        44

Clinical Skills Verifications (CSEs)        45

Didactics        45

Tracks        45

Clinical Neuroscience Track        45

Development Across the Lifespan Track        47

Global Community Psychiatry Track        49

Training Examinations        51

Step 3 Requirement        51

Specialty-specific Curricula        52

Clinical Education Requirements        52

Research Requirements        55

Quality Improvement Project Requirements        55

Evaluations and Outcomes Assessment        56

Resident Evaluation Process        56

Milestones Evaluation and Resident Promotion based on ACGME Competencies        56

ACGME Competencies and Milestones        57

Clinical Competency Committee (CCC) Charter        59

Overview and Composition        59

Meetings        59

Responsibilities        60

Residents        60

Formative Evaluation        60

Summative Evaluation        61

Program Evaluation Tools        62

ACLS/BLS/PALS Certification Requirements        62

Annual evaluation of program goals and objectives        63

LCME Requirement        65

Program Procedures        66

Attendance - expectations and reporting instructions        66

Clinical and Educational Work Hours - requirements and reporting mechanism        66

Requirements        66

Reporting        68

UMN GME Leave Policies        69

UMN Psychiatry Residency Program procedures for requesting and documenting.        69

Scheduled (Vacation) Leave        69

Unscheduled (Health) Leave        70

Holidays        72

Inclement Weather        72

Professional Leave        72

Parental        73

Departmental Disaster Plan        74

Moonlighting - program limitations and reporting requirements        74

Impairment        75

Grievance / Due Process        76

Residents Experiencing Difficulties:        78

Employee Assistance Program (EAP)        83

State Medical Board Licensure Requirements        84

Medical Records Procedures        84

Pharmacy Procedures        84

Clinic Procedures        85

Needle Stick Procedures - Infection Control        85

Patient Safety Procedures        85

Training        85

Reporting and Review        85

Residency Management System        85

Institutional Committees        86

Benefits, Information, and Resources        86

Paychecks/Payroll        86

Insurance        87

Health        87

Dental        87

Professional Liability        87

Disability        88

Worker’s Compensation        88

Systems and Communication        89

Email        89

Campus mail        89

Cell Phone        89

Pager        89

Access to institutional programs and databases        89

Stipends        89

Laundry Services        90

Parking        90

On-Call        90

Schedule        90

Room information        91

Outpatient Note Delinquency Policy        91

Rules and Guidelines for Medical Students and Residents on Interactions with Industry Representatives        92

Administrative Support Services        93

Lactation Services        93

Laboratory/Pathology/Radiology Services        94

Security/Personal Safety        94

Lab coats and scrubs        95

Meal Tickets        95

Departmental funding for travel, book and educational funds        96

Employee-Student Health Services        96

Medical Library and Services        96

Local Information and Links        96

Confirmation of Receipt of your Program Policy Manual and Fellowship addendum        97


Introduction

Purpose

The program manual is a tool with key policies and required procedures as well as general information to ensure a smooth transition to your institution and pro­gram.

At the department level, the Program Direc­tor is responsible for providing train­ees with program-specific policies and proce­dures. This includes items such as Accreditation Council on Graduate Medical Education (ACGME) Program Requirements, procedures to follow institution­al policies, and other information specific to the Department of Psychiatry and Behavioral Sciences and the Graduate Medical Education (GME) program.

Institutional Profile

Information about graduate medical education at the University of Minnesota is available on this webpage.  The webpage includes our Statement of Commitment, Goals for Graduate Medical Education and our Diversity Statement.

Statement of Commitment

The University of Minnesota Medical School is committed to graduate medical education, which emphasizes education and training of physicians to meet the healthcare needs of our region, advancement of knowledge, and leadership in the biomedical sciences and in academic medicine.

With this commitment, the University of Minnesota Medical School will provide adequate funding for administration, personnel, educational, clinical resources, and faculty teaching time to be certain that every program under our institutional sponsorship offers the best possible training environment and educational opportunities.

Statement of Goals for Graduate Medical Education

Our goal is to provide the highest quality of graduate and post-graduate medical, professional and educational training to prepare physicians for the practice of specialty and/or subspecialty training, or for the pursuit of academic and research medicine.

The University of Minnesota is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, color, creed, religion, national origin, sex, marital status, disability, public assistance status, veteran status, or sexual orientation.

Statement of Diversity, Equity and Inclusion

The University of Minnesota Medical School is committed to excellence in fulfilling its mission. We uphold that an environment of inclusiveness, equal opportunity, and respect for the similarities and differences in our community fosters excellence, and that institutional diversity fuels the scholarly advancement of knowledge. An atmosphere where differences are valued leads to the training of a culturally competent healthcare workforce qualified to meet the needs of the varied populations we serve.

The Medical School, as part of the University of Minnesota, shall provide equal access to and opportunity in its programs, facilities, and employment without regard to race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.

The Medical School seeks to attain a diverse learning environment through the recruitment, enrollment, hiring, and retention/graduation of students, faculty, and staff who are underrepresented in medicine and may also be underrepresented in Minnesota.

We strive especially to have our learning community better reflect the demographics of the state by increasing the representation of African-Americans/Blacks, Hispanics/Latinos, Native Americans, Native Hawaiians/Pacific Islanders, Native Alaskans, Hmong, individuals from rural backgrounds, first generation college students, or those from economically disadvantaged backgrounds.

Institutional Responsibilities

The Institution Manual http://z.umn.edu/gmeim is designed to be an umbrella policy manual. Some programs may have policies that are more specific and clearly defined than the Institution Manual, in which case the program policy will be followed.  Should a policy in a Program Manual conflict with the Institution Manual, the Institution Manual will take precedence.

Statement of Inclusion of Fellowship Programs

The information contained in this Policy Manual pertains to everyone in the department’s graduate medical education programs except as otherwise identified.

Departmental Mission Statement

The Department of Psychiatry and Behavioral Sciences at the University of Minnesota strives to fulfill the tripartite mission of the Medical School: excellence in teaching, research, and clinical service.

Our mission is to:

Anti-racism, discrimination and opression statement:

The Department of Psychiatry and Behavioral Sciences condemns racism, discrimination, and oppression in all forms. We affirm that racism and oppression are public health crises with serious mental health consequences for the communities we serve.

We commit to listen to and promote Black, Indigenous and people of color. We also commit to amplify their calls for change. We have work to do. We are part of a system that has allowed racial disparities in medical outcomes to persist for far too long.

Our work is guided by the following principles:

In line with these departmental principles, the UMN Psychiatry and Behavioral Sciences Education Council commits to the following actions:

Residency Program Mission, Vision and Values Statement

Program Description and Aims

The ACGME Accredited psychiatry residency at the University of Minnesota is a categorical four-year program grounded in the medical identity of psychiatry and emphasizing the interplay of heredity and experience in producing psychiatric disorders. Our training and curriculum aims to prepare all graduates to achieve American Board of Psychiatry and Neurology (ABPN) Certification.


Departmental Organization Chart

Link to the department organization chart: Org Chart

Department Chair:

Sophia Vinogradov, MD

Director of Psychiatry Education:

Phil Luber, MD

Interim Residency Program Director:

Phil Luber, MD

Associate Program Director (Physician-Scientist Track):

Matej Bajzer, MD, PhD

Associate Program Director

Felicia Hansell, MD

Assistant Program Director (Psychotherapy):

Richelle Moen, PhD

        

Program Administrator:

Rachel Talcott

Core Faculty:

Cristina Albott, MD, MA

Matej Bajzer, MD, PhD

Deanna Bass, MD

Quentin Gabor, MD

Matthew Kruse, MD, MBA

Michael Langley-DeGroot, BA, MD

Laura Pientka, DO

Lidia Zylowska, MD


Appointment and Reappointments

Eligibility Requirements

All prerequisite postgraduate clinical education required for initial entry or transfer into ACGME-accredited residency programs must be completed in ACGME-accredited residency programs, or in Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada. Residency programs must receive verification of each applicant’s level of competency in the required clinical field using ACGME or CanMEDS Milestones assessments from the prior training program.

A physician who has completed a residency program that was not accredited by ACGME, RCPSC, or CFPC may enter an ACGME-accredited residency program in the same specialty at the PGY-1 level and, at the discretion of the program director at the ACGME-accredited program may be advanced to the PGY-2 level based on ACGME Milestones assessments at the ACGME-accredited program. This provision applies only to entry into residency in those specialties for which an initial clinical year is not required for entry.

A Review Committee may grant the exception to the eligibility requirements specified in Section III.A.2.b) of the ACGME Program Requirements for residency programs that require completion of a prerequisite residency program prior to admission. Review Committees will grant no other exceptions to these eligibility requirements for residency education.

Prior to appointment in the program, applicants must demonstrate sufficient command of English to permit accurate and unimpeded communication. Prior to entry in the program, each resident must be notified, in writing, of the required length of education for which the program is accredited.

Non-discrimination Statement

The University is committed to the policy that all persons shall have equal access

to its programs, facilities, and employment without regard to race, color, creed, religion, national origin, sex, age, marital status, disability, public assistance status, veteran’s status, sexual orientation, gender identity or gender expression. Harassment based on sex, race or any other ground listed here is a form of discrimination prohibited under this policy. Residents/Fellows who believe they have been subjected to discrimination or harassment on any of these grounds are urged to contact their program director or department chair. Complaints also may be pursued through the Associate Dean for Graduate Medical Education, the Medical School Ombudsman or the University of Minnesota Office of Equal Opportunity and Affirmative Action, as set forth in the GME Institution Policy Manual.

Program Specific Visa Policies

The J-1 alien physician visa sponsored by ECFMG is the preferred visa status for foreign national trainees in all UMN graduate medical education programs; therefore, the Department of Psychiatry and Behavioral Sciences sponsors only J-1 visas. We do not sponsor H-1B visas, except in clearly defined circumstances in which a resident is not eligible for a J-1 visa.. More information on the J-1 visa can be found on the UMN-GME webpage: International Medical Graduates & Visas

Appointment and Promotion

Requirements for Completion of Training and Graduation

Policy on Effect of Leave for Satisfying Completion of Program

The American Board of Psychiatry and Neurology (ABPN) requires 48 months of psychiatry residency training, several months are designated as required content. Several forms of approved paid leave are described earlier in the policy manual. Circumstances may arise where a resident requests permission from the Program Director for time away from training which falls outside of parental leave, vacation, conference days, sick leave, or witness duty. (for example, time requested to extend time away from training due to unforeseen personal circumstances, or for illnesses which exceed the approved number of sick days).

With permission from the program director, Residents may request time away from training. This time is typically unpaid (although short or long-term disability benefits may apply in individual cases). Time away from training will require additional time to be made up following their expected end of training date in order to meet the requirements of the residency and ensure ABPN eligibility.

Requirements for making-up time-away from training in a given year are as follows:

Note: Health insurance and other benefits continue during approved time away from training; however, the resident may be required to pay for both their portion and the employer’s portion of their health insurance premium in accordance with Human Resources policy.

ACGME guidelines require 48 months of residency training in psychiatry.  In addition, they stipulate that specific periods of time be spent engaged in defined clinical activities (e.g. two months full time equivalent in Consultation-Liaison Psychiatry).  The duration of training can be extended to complete program requirements missed because of leave or failure for academic reasons.

Failure to Advance

In instances where a trainee fails to advance, the University of Minnesota Medical School ensures that its ACGME accredited programs provide the trainee with a written notice of intent not to advance a trainee’s agreement no later than four months prior to the end of the trainee’s current agreement. However, if the primary reason(s) for the failure to advance occurs within the four months prior to the end of the agreement, the University of Minnesota Medical School ensures that its ACGME-accredited programs provide the trainees with as much written notice of the intent not to advance as the circumstances will reasonably allow, prior to the end of the agreement. Trainees will be allowed to implement the institution’s grievance procedures if they have received a written notice of intent not to advance them in the program.

Trainee Responsibilities and Supervision

Clinical Responsibilities

Non-clinical and Administrative Responsibilities

Residents are expected to complete administrative activities upon request of the ACGME, University of Minnesota Office of Graduate Medical Education, The Department of Psychiatry and Behavioral Sciences, and site-specific administrative requests. This includes, but is not limited to requested evaluations, attestations, surveys, tracking logs, and onboarding paperwork.

Trainee Supervision

Clinical training must include adequate, regularly scheduled supervision which complies with ACGME regulations.  Each resident must have at least two hours of supervision weekly, one of which should be one on one psychotherapy or competency supervision.  

Supervision, authority and reporting requirements are summarized in the table below.

Monitoring of Well-Being

It is the responsibility of the residency program to monitor resident well-being.  This is done through graded responsibility and face-to-face supervision.  The program director receives feedback from supervisors, course directors, hospital and clinic staff and meets with residents on a twice yearly basis. The RMS evaluation form completed by faculty contains specific items regarding magnitude of service demands and the individual fellow’s fatigue and stress level. The resident is surveyed in RMS after each rotation regarding levels of program related stress and personal stress.

Residents will be educated on the negative effects of fatigue on patient care and                 learning, including the specific skills of alertness management and fatigue mitigation         processes during the required PGY1 Institutional Orientation conducted by the University of Minnesota Graduate Medical Education Office. Residents are encouraged to adopt fatigue mitigation processes. In the case of fatigue during a duty shift, or when patient care responsibilities are unusually difficult or prolonged, back-up service can be arranged by contacting the chief resident or the faculty member on-call. Additionally, the University of Minnesota Medical Center, Fairview provides reimbursement of taxi fare for residents who require transportation due to issues related to fatigue following duty shifts. UMN GME Health Resources can be found here. Wellbeing is also monitored in conjunction with duty hour assessment and attestation.

Conference Attendance Requirements

RTC Representatives (or their designee) for each class will complete a weekly written Attendance Log Form.  The log will indicate the date, whether class was held and status of each assigned resident (present or absent).  Present will mean attendance for at least 2/3rds of the teaching activity.  Attendance Log will be turned into Residency Coordinator weekly.  The Residency Coordinator will reconcile Log Form with approved vacation requests and VA and UMMC psychiatry call schedules.  The Residency Coordinator produces quarterly reports for each course.

Ad hoc sick leave (not associated with parental leave), conference leave, administrative leave and post-moonlighting are not approved justifications and will be considered absences.  Parental leave, extended medical leave that exceeds the 10 day yearly allotment, and Family Medical Leave are not covered by this policy.  These situations will be considered on a case by case basis by the Program Director and the resident.

Residents must have attended 70% of class activities that take place minus scheduled vacation days, structural duty hour absences (post assigned UMMC and MVAHS psychiatry overnight call and night float).


Program Curriculum

ACGME General Competencies

Clinical Rotations and Block Schedule

(A month is defined as one 4-week session, 13 total per academic year)

PGY1

Primary Care, Internal Medicine                 UMMC, MVAHCS                        2 months

Primary Care, Pediatrics                Masonic Children’s Hospital                1 month

Emergency Medicine                        UMMC                                        1 month

Neurology                                MVAHCS                                2 months

General Inpatient Psychiatry                MVAHCS                                1 month

General Inpatient Psychiatry                 UMMC                                        6 months

PGY2

Child-Adolescent Psychiatry (Inpatient)        UMMC                                        2 months

Consultation-Liaison Psychiatry                 MVAHCS                                1 month

Consultation-Liaison Psychiatry                 ABNW                                        1 month

Substance Use Disorders                   UMMC                                        1 month

Geropsychiatry                                MVAHCS                                1 month

Emergency Psychiatry                         UMMC                                        1 months

Night Float Call Rotations                UMMC                                        1 months

Inpatient Psychiatry                         UMMC                                        3 months

Neuromodulation                        UMMC                                        1 month

Forensic Psychiatry                        AMRTC                                        1 month

PGY3

12 months continuous outpatient with community rotation, individual, group, and family therapy components.

PGY4

Electives and Jr. Attending responsibilities

Electives that require a new financial agreement will need to be approved by the Psychiatry Residency Operations Committee by March 1st of the prior academic year.


Competency-based Goals & Objectives

Program Goals and Objectives        

The clinical responsibilities for each resident will be based on PGY-level, patient safety, resident education, severity and complexity of patient illness/condition and availability of supervisory and support services.  PGY1-2 years involve primarily inpatient activities.  One month is equivalent to a 4-week session (13 sessions per academic year). The PGY3 year is ambulatory and the PGY4 year allows the resident to explore specific areas anticipating his/her transition to independent practice.  Residents are expected to be knowledgeable about the level of supervision required, their scope of authority and events that entail a reporting obligation.

YEAR 1

Patient Care

Evidence-Based

Medical Knowledge

Practice-based Learning and Improvement

Interpersonal and Communication Skills

Professionalism

Systems-based Practice

GENERIC

A PGY1 takes appropriate clinical responsibility for diagnosing and managing acutely ill medical, neurological and psychiatric inpatients with close and redundant supervision.  During the PGY1 year, residents will exercise graded authority with conditional independence, beginning with direct supervision and progressing to indirect supervision with direct supervision immediately available.  A central focus of the first year is developing the judgment and ability to recognize when and willingness to ask for help.

A = ATTITUDE

S = SKILL

K = KNOWLEDGE

University of Minnesota Medical Center - Fairview (UMMC)

Minneapolis Veterans Affairs Health Care System (MVAHCS)

Perform a thorough assessment of patients in standardized settings.S

With supervision create a hospital-based acute treatment plan for medical, neurological and psychiatric conditions.and participate in designing an appropriate discharge treatment planS

Consider scientific data and patient preferences in developing a treatment plan.S

Assume responsibility for care in inpatient settings with direct supervision immediately available.S/A

Generate appropriate documentation for admission, progress and discharge.S/A

Perform appropriate laboratory assessment to support diagnosis and treatment.S

Form a basic therapeutic alliance and use supportive psychotherapy methods.S/A

Assess patients for suicide and dangerousness and develop an effective safety plan.S/K

Perform a full mental status.S/K

Recognizes scope of their authority in application of clinical care.K

Knows reporting obligations.K

Knows level of supervision required.K

Use medical knowledge to analyze medical problems.K

Develop appropriate differential diagnoses for common medical, psychiatry and neurological complaints.K/S

Maintaining up-to-date medical knowledge.A

Mastery of criteria-based diagnosis in psychiatry.K

Knowledge of the therapeutic use of standard psychotropic agents, including their toxicities, drug-drug interactions and side effects.K

Describes the neuropharmacology of psychotropic agents.K

Knowledge of supportive psychotherapeutic methods.K

Beginning knowledge of psychodynamic principles.K

Knowledge of environmental and genetic risks for psychiatric disorders.K

Assumes responsibility for critical assessment of the quality of the care delivered.A

Seeks appropriate supervision.A/K

Recognizes and corrects limits of his/her knowledge or skills.A/K

Knows when consultation is indicated.A/K

Consults appropriate summary sources including web-based searches.A/K

Able to create and present a brief teaching lecture on a basic aspect of psychiatric practice suitable for presentation to a medical students.K/S

Able to use electronic medical records to improve patient care.S/K

Communicate findings to other health care workers.S/A

Demonstrates ability to interact constructively with patients, families colleagues, other health professionals to obtain history, and create and implement treatment plans.S

Aware of patient and provider variables that impact communication and information gathering.K

Beginning ability to discuss brain and behavior relationships with patients and families.K/S

Able to use bilingual translators to communicate with patients and families.S

Understand his or her own empathic response to patients and their families.A

Able to supervise the clinical activities of medical student clerks.S/K

Comfortable asking for assistance.A/S

Timely completion of professional tasks.A/K

Provides appropriate supervision/teaching to trainees.A/K

Able to recognize and monitor illness, stress and fatigue  in self in colleagues.A/K

Displays integrity and ethical conduct in completion of tasks.A/K

Respects the rights and privileges of others, including an understanding of patient rights.A/K

Sensitive to patient culture, age, gender and disability.K/A

Identifies situations that produce a conflict of interest.K/A

Understands policies regarding duty hours.K

Understands University of Minnesota disciplinary and grievance procedures.K

Understands physician reporting obligations.K

Understands HIPAA policies and procedures especially related to protection of personal health information.K

Understands informed consent.K

Aware of how health care is reimbursed and how this impacts inpatient care.K

Understands the policies, procedures and duties regarding 72 hour holds, transport holds, commitments, court orders, stayed commitments, etc.K

Understands the role of the ACGME and the RRC.K  

Understands how to access support services for self and colleagues.K

Identifies ways in which systems affect care quality and patient safety.K

Use system resources to provide cost-conscious care.K

DIDACTICS

Thursday Afternoons from 1pm to 4pm.  PGY1 didactics aim to provide an early practical orientation to the inpatient care environment and basic knowledge about common diagnoses and standard treatments.

ASSIGNED SUPERVISION

In addition to ongoing clinical supervision, there will be one hour of individual competency supervision a week.

ROTATIONS

Note that there are 13 four week rotations during the first year.

PGY1 residents will not take in house call unless direct supervision is immediately available on site from a PGY2 or higher resident or a faculty member.  The duty period of a PGY1 resident will not exceed 16 hours in duration.  For all trainees strategic napping, especially after 16 hours of continuous duty and between the hours of 2200 and 0800 is strongly suggested unless the trainee experiences significant sleep inertia.

Primary Care – UMMC & Mpls MVAHCS

(4 mths)

Two months internal medicine at MVAHCS.  One month of pediatrics at UMMC. One month of emergency medicine at UMMC

Adapt the psychiatric assessment to a medical setting (inpatient or primary care).S

Understand the impact of medical illness on a patient’s life history and mental health. S/A

Recognize the medical complications of common overdoses - acetaminophen, aspirin, etc. S

Recognize intoxication and withdrawal in the medical setting. S

Knowledge of psychiatric symptoms common to consultation patients – e.g. delirium, insomnia, pain.K

Generate a differential diagnosis for psychiatric symptoms commonly encounter in general hospital settings or community settings.K

Knowledge of pertinent psychotropic medication side effects and interactions in medically ill patients.K

Ability to independently research, organize and present a 1 hour academic presentation that qualifies attendees for continuing medical education credit.S/K

Ability to initiate a quality improvement/quality improvement  project.K/A

Ability to explain psychiatric findings and recommendations to non-psychiatric personnel.S

Interact in patient care settings not dedicated to care of psychiatric patients.S

Understand the priorities of medical and surgical services and how these affect the consultants’ role.K/A

Inpatient Neurology

(2 months) –MVAHCS

Conduct a competent neurological examination.S

Recognize neurological emergencies.S

Recognize neurological consequences of traumatic brain injury.S

Describe the presenting symptoms of common neurological diseases.K

Generate differential diagnosis for common neurological symptoms.K

Appropriately order and interpret neurological studies.K

See generic

Be able to adapt interview to persons with neurological impairment.K/A

See generic

Knowledge of rehabilitation for neurological patients.K

Inpatient Psychiatry (7 mths) – UMMC – West Bank & MVAHCS

At least one month at the MVAHCS

Take a competent and comprehensive psychiatric history.S/A  

Assess potential for immediate self harm (suicide) and implement appropriate protective measures.S

Create effective treatment plans for psychosis, mania, depression, intoxication and withdrawal.S

Month at MVAHCS involves consulting to and providing supervised assessments to a full time 24x7 emergency room with the direct backup of a PGY2 resident.S/A

Describe the presenting symptoms of common psychiatric diseases – schizophrenia, bipolar disorder, major depression, anxiety disorders, impulse control disorders, PTSD, personality disorders, delirium, dementia and the common substance related disorders.K

Generate a differential diagnosis for common psychiatric symptoms.K

Appropriately order and interpret psychological and neuropsychological studies.K

Learn the indications and contraindications for electroconvulsive therapy.K

See generic

Be able to adapt interview to persons with acute psychiatric symptoms.S/A

See generic

Knowledge of community resources for patients discharged from an acute care psychiatric hospital.K

Understand service related benefits.

Call Assignments

PGY1 residents do not take call independently.  A PGY2 or higher is always physically present on the same campus when a PGY1 resident sees a patient.  Call assignments are compliant with ACGME Duty Hour Rules.  

Triage and prioritize clinical problems including needs of new patients and continuity of care to current patients

Align clinical problems with the appropriate methods of clinical handoff.S/K

Knowledge of what factors to consider in triaging a clinical problem.K

How to grade the urgency of a clinical handoff.K

Identify areas of knowledge, skill or attitude deficiency in context of providing urgent psychiatry, medical, pediatric and neurological care.

Identify and communicate effectively with stakeholders in urgent clinical situations.K/S/A

Complete clinical documentation in thorough and complete manner.

Work collaboratively with hospital staff including intake workers, emergency room personnel, RNs, supervisors  to address system issues in patient cares.K/S/A

Advocate for appropriate level of patient care.K/S/A

Research Elective

(1 mth) UMMC or MVAHCS)

A PGY1 resident may qualify for one month of research elective to advance research projects and goals well established prior to residency, as approved by the program director and residency training committee.

Allow the trainee to advance research projects and scholarly inquiry already established prior to starting residency. K/S/A

See generic

See generic

Present scholarly activities in a peer-reviewed format. S

A faculty mentor will be assigned to enhance academic professional development. S

Interact with Institutional Review Board. S

YEAR 2

Patient Care

Evidence-Based

Medical Knowledge

Practice-based Learning and Improvement

Interpersonal and Communication Skills

Professionalism

Systems-based Practice

GENERIC

A PGY2 assumes responsibility for diagnosis and management patient populations associated with specialty training (CL, Child Adolescent, Addiction and Geropsychiatry).

Elaboration of call activities to include assessment of the appropriateness of patients for hospitalization on a psychiatric unit.  Supervision is immediately available by phone or pager, but the level of supervision depends on the resident’s need.  Will provide immediately available supervision for PGY1 residents.

Assume responsibility for care of special populations on inpatient psychiatry and medical services settings with immediate supervision available.S

Assess patient safety issues (medical and behavioral) for patients being admitted to an acute psychiatry service.S

Ability to provide supportive psychotherapy and beginning ability to understand the principles of psychodynamic therapy.S

Aware of  events which must be communicated to supervising faculty.K

Knows circumstances under which he/she is permitted to act with conditional independence.K

See Year 1

See Year 1.

More likely to explore questions using primary rather than summary sources.K/S

Able to create and present a grand rounds with support from teaching faculty (MVAHCS).K/S

See Year 1

Serve in a supervisory role of PGY1 residents.

Recognizing and dealing with issues regarding hospital census, Emergency Medical Treatment and Active Labor Act requirements, and appropriateness of patients for specific clinical settings.K/S/A

Problem solving with Fairview Mental Health Intake, emergency department physicians and nursing to place patients in appropriate settings.K/S/A

DIDACTICS

Thursday Afternoons from 1pm to 4pm.  Core topics are revisited with greater specialty focus and psychotherapeutic methods are introduced.

ASSIGNED

SUPERVISION

In addition to ongoing clinical supervision, there will be one hour of individual psychotherapy supervision a week.

ROTATIONS

Note that there are 13 four week rotations during the second year.

Duty hours must be limited to 80 hours per week, averaged over a four-week period – inclusive of all in-house activities and both external and internal moonlighting.  A duty period cannot exceed 24 hours.  Residents are allowed to remain on-site for an additional four hours to accomplish effective transitions of care.  There may be no additional clinical responsibilities assigned.  There must be 8 hours between scheduled duty periods and there must be at least 14 hours free of duty after 24 hours of in-house duty [not applicable to moonlighting].  In-house call must be scheduled more frequently than every third night and there must be one day (24 continuous hours) in seven free of duty [both averaged over a four-week period].

Consultation-liaison Psychiatry

(2 mth) –Minneapolis Veterans Affairs Health Care Center, UMMC, and Abbott Northwestern Hospital

Adapt the psychiatric assessment to a medical setting.S

Understand the impact of medical illness on a patient’s life history and mental health.S/A

Recognize the medical complications of common overdoses – acetaminophen, aspirin, etc.S

Recognize intoxication and withdrawal in the medical setting.S

Knowledge of psychiatric symptoms common to consultation patients – e.g. delirium, insomnia, pain.K

Generate a differential diagnosis for psychiatric symptoms commonly encounter in general hospital settings.K

Knowledge of pertinent psychotropic medication side effects and interactions in medically ill patients.K

Knowledgeable of substances frequently used in suicide attempts.K

See generic

Ability to explain psychiatric findings and recommendations to non-psychiatric personnel.S

Interact in patient care settings not dedicated to care of psychiatric patients.S

Understand the priorities of medical and surgical services and how these affect the consultants’ role.K/A

Substance Use

(1 mth) UMMC and VAMC

Learn the procedures and practice of administering ECT.S

Learn to provide patient care in a day hospital setting with a multi-disciplinary team.S

Learn the use of psychotropic medications in patients with a history of chemical dependency.K

Learn the indications and contraindications of electroconvulsive therapy.K

See generic

See generic

Able to explain ECT to patients and families.S/K/A

Ability to function therapeutically in group therapy for substance abuse.S/A/K

Demonstrates simple interventions for chemical dependency.S/K

See generic

Structure and role of day programs in managing chemical dependency.K

Interface with other care settings (e.g. board and care, halfway houses, detox)K/S

Child Adolescent Psychiatry

(2 mths) UMMC

Assignment to Stations 6A or 7A – a combined child-adolescent acute inpatient unit.

Possible additional month outpatient and day hospital at Allina.

Take a competent and comprehensive psychiatric history from a child and adolescent patient.S

Communicate findings to both patient and family.S/A

Knowledge of psychiatric symptoms common to child, adolescent patients.K

Generate a differential diagnosis for psychiatric symptoms in the children and adolescents.K

Knowledge of pertinent psychotropic medication side effects and interactions in children and adolescents.K

Order and interpret the results of psychological testing in children and adolescents.K

See generic

Ability to assess family dynamics and family-child interactions.K/S/A

See generic

Understand the reporting obligations related to child protection.K

Understand structure and function of residential treatment settings.K

Coordinate treatment planning with schools.S/K/A

PUBLIC and/or Forensic Psychiatry

(1 month) (Anoka Metro Regional Treatment Center)

Assume responsibility for care of patients in the state hospitals and state run facilities. Display the ability to create a therapeutic alliance with the most severely ill patients.  S

Aware of  events which must be communicated to supervising faculty.K

Knows circumstances under which he/she is permitted to act with conditional independence.K

Describe the presenting symptoms of

common psychiatric diseases –

schizophrenia, bipolar disorder, major

depression, anxiety disorders, impulse

control disorders, PTSD, personality

disorders, delirium, dementia and the

common substance related disorders.K

Generate a differential diagnosis for

common psychiatric symptoms.K

Appropriately order and interpret

psychological and neuropsychological

studies.K

Learn the indications and contraindications

for electroconvulsive therapy.K

See Generic

Communicate findings to other health care

workers.S/A

Demonstrates ability to interact constructively with patients, families

colleagues, other health professionals to

obtain history, and create and implement

treatment plans.S

Aware of patient and provider variables

that impact communication and information gathering.K

Beginning ability to discuss brain and behavior relationships with patients and families.K/S

Able to use bilingual translators to

communicate with patients and families.S

Understand his or her own empathic response to patients and their families.A

Able to supervise the clinical activities of medical student clerks.S/K

Comfortable asking for assistance.A/S

See PGY-1 Generic

Knowledge of community based resources such specialized programming to support those transitioning from forensic settings. K

Emergency

(1.5 mths) UMMC

See generic

See generic

Use electronic databases after hours to access guidance about differential diagnosis and management of acutely ill psychiatric patients.S/K/A

See generic

Working with emergency and intake personnel to accomplish optimal care for patients.S/A

Knowledge of internal and external policies and procedures that control hospital admissions.K

Night Float

(1.5 mths) UMMC

Develop a treatment plan that addresses immediate and potential risks related to the patient's’ medical and psychiatric conditions.S/A

Ability to manage complex psychiatric/medical problems and determine when supervision is necessary.A/S/K

Use electronic databases after hours to access guidance about differential diagnosis and management of acutely ill psychiatric patients.S/K/A

Ability to determine when to apply or lift an emergency hold.S/K

Working with emergency and intake personnel to accomplish optimal care for patients.S/A

Working with physicians from other specialties to determine site of optimal care.S/A

Knowledge of internal and external policies and procedures that control hospital admissions.K

Geropsychiatry

(1 mth) MVAHCS

This is an outpatient rotation.

Complete comprehensive psychiatric hx and exam in pts > 65 yo, including assessment of cognition, family/caregiver, medical status and function.A

Work effectively with multidisciplinary team.S/A

Recognize vulnerability in elderly patients.S

Formulate treatment plan to manage common symptoms in the elderly.S

Knowledge of psychiatric symptoms common to elderly patients – e.g. dementia, delirium, depression.K

Generate a differential diagnosis for psychiatric symptoms in the elderly such as agitation, aggression and wandering.K

Knowledge of pertinent psychotropic medication indications, side effects, and interactions  with medical comorbidities in the elderly.K

Consult evidence based sources for presentation to the Geropsychiatry Journal Club.S/K

Ability to interact with adult children and guardians.S/A

Obtain pertinent clinical data from a variety of sources including medical providers, families, long-term care and social service agencies.K/A

Appropriately refer of neuropsychological, OT/PT, driving/home safety evaluations.K/S

See generic

Structure and role of nursing home and other supportive settings for the elderly.K

The capacity to determine and communicate a patient’s competence to the care system.K/A

Neuromodulation

Learn the procedures and practice of administering ECT and TMS.S

Learn the use of psychotropic medications in patients with a history of treatment resistant depression.K

Learn the indications and contraindications of electroconvulsive therapy and TMS.K

See generic

See generic

Able to explain ECT and TMS to patients and families.S/K/A

See generic

Inpatient Psychiatry (3 mths) UMMC

See Year 1

See Year 1

See generic

See generic

See generic

See generic

Outpatient Psychotherapy  UMMC

(0.5 d x 10 mths)

Beginning competence in supportive and psychodynamic psychotherapy.S

Understands methods and indications for supportive and psychodynamic psychotherapy.K

See generic

See generic

See generic

See generic

Call Assignments

PGY2 residents take call with direct supervision available by means of telephonic and/or electronic modalities. They may work independently and are expected to provide supervision to PGY1 residents. Call assignments are  compliant with ACGME Duty Hour Rules

Triage and prioritize clinical problems including needs of new patients and continuity of care to current patients

Align clinical problems with the appropriate methods of clinical handoff.S,K

Principles of prioritizing clinical problems and addressing those of greatest clinical relevance.K

Identify and effective address areas of knowledge, skill or attitude deficiency in context of providing urgent psychiatry and medical care.A,K

Identify and communicate effectively with stakeholders in urgent clinical situations.K,S,A

Complete clinical documentation in thorough and complete manner.

Work collaboratively with hospital staff including intake workers, emergency room personnel, RNs, supervisors  to address system issues in patient cares.K,S,A

Advocate for appropriate level of patient care.K,S,A

Research Elective

(1 mth) UMMC or MVAHCS)

A PGY2 resident may qualify for a research elective to advance research projects and goals well established prior to residency, as approved by the program director and residency training committee.

Allow the trainee to advance research projects and scholarly inquiry already established prior to starting residency. K/S/A

See generic

See generic

Present scholarly activities in a peer-reviewed format. S

A faculty mentor will be assigned to enhance academic professional development. S

Interact with Institutional Review Board. S

MVAHCS (% varies)

Special populations in ambulatory settings

(PTSD, addictions, psychotherapy, primary care/mental health integration, geropsychiatry, sleep)

See generic

See generic

See generic

See generic

Explore professional opportunities at MVAHCS.A

Understand organization and services offered at a MVAHCS.K

YEAR 3

Patient Care

Evidence-Based

Medical Knowledge

Practice-based Learning and Improvement

Interpersonal and Communication Skills

Professionalism

Systems-based Practice

GENERIC

A PGY3 assumes responsibility for care of adult patients in outpatient settings – a hospital based clinic and a community mental health clinic.  Supervision is immediately available.  Year 3 also introduces group therapy.

Assume responsibility for care in ambulatory settings with immediate supervision available.S

Ability to apply and integrate psychosocial and biological therapies over a time course of months (in contrast to days and weeks on an inpatient service).S

Ability to assess dangerous to self and others in an outpatient setting.S

Ability to formulate a safety plan for ambulatory patients.S/K

Beginning to exercise independent judgment in treatment planning and implementation in representative cases.S/A

Ability to apply psychodynamic and cognitive behavioral principles in ambulatory settings.S

Determining when to alert call physicians about a patient situation.K

Capacity to recognize and distinguish subtle presentations of medical and psychiatric conditions including those related to undetected substance use.K

Knowledge of CPT codes and what documentation is appropriate for a level of service.K

Knowledge of how to adjust treatment plan in light of economic and insurance variations.

Familiarity with and use of evidence-based treatment guidelines for familiar psychiatric syndromes.K/S

Ability to create treatment options in refractory cases by researching the literature.S/K/A

Ability to participate in a quality assurance/quality improvement project.A/K

Able to communicate effectively using a variety of modalities – face to face, phone, FAX, email, letter.S

Recognizes advantages and limitations of each method of communication.K/A.

Able to recognize and manage personal responses to highly disturbing situations.S/A/K

Ability to assist others – colleagues, patients, staff, families - in their response to disturbing situations.S/A/K

Completes outpatient notes in the electronic medical record in an appropriate timeframe.A/S/K

Begins to plan for his/her career development.K/A/S

Skill in accessing and advocating for patient-care related resources.A/K/S

Communicating and collaborating with external agencies to support patient treatment and recovery.S/K

DIDACTICS

Tuesday Afternoons from 1pm to 4pm.  Didactic focus focuses on behavioral methods in psychotherapy and psychodynamic content as well as public psychiatry.

ASSIGNED SUPERVISION

In addition to ongoing clinical supervision, there will be one hour of individual psychotherapy supervision a week and one hour of clinical rotation supervision a week.

ROTATIONS

Timed by the month

Duty hours must be limited to 80 hours per week, averaged over a four-week period – inclusive of all in-house activities and both external and internal moonlighting.  A duty period cannot exceed 24 hours.  Residents are allowed to remain on-site for an additional four hours to accomplish effective transitions of care.  There may be no additional clinical responsibilities assigned.  There must be 8 hours between scheduled duty periods and there must be at least 14 hours free of duty after 24 hours of in-house duty [not applicable to moonlighting].  In-house call must be scheduled more frequently than every third night and there must be one day (24 continuous hours) in seven free of duty [both averaged over a four-week period].

Outpatient Care – UMMC

(12 mths)

Ability to integrate medication management with psychotherapeutic approaches.S

Manage chronically suicidal patients in an ambulatory setting.S

Beginning competence in supportive, cognitive behavioral and dynamic psychotherapy.S

Ability to initiate and adjust standard psychotropic treatments and to develop treatment strategies that respond to the unique characteristics of the patient.K

See generic

Ability to compose a comprehensive, written outpatient evaluation.S

Able to construct a succinct biopsychosocial formulation.S

See generic

Coordinate outpatient care across multiple providers and settings.S/A  

Assist patients in resolving problems with insurance, drug benefit plans, disability carriers, etc.S/A/K

Community Mental Health –

Community University Health Care Center

Or

Guild Assertive Community Treatment Services

Or

Fairview Integrated Primary Care Clinic

Or

Canvas Health

(0.5 day x 6 mths for PGY3s)

Providing care for patients in community mental health sites – Hennepin County Mental Health Center or the Fairview Integrated Primary Care Clinic or the Community University Health Care Center or Guild ACT team.S

Ability to delineate life stressors and traumatic events in immigrant and underserved populations.K/S

Knowledge of differences in pharmacodynamics and pharmacokinetics in ethnically distinct populations being served in community mental health systems.K

Taking responsibility for learning to work with underserved populations (e.g. their cultural beliefs and concerns).K/S/A

Communicating effectively with persons who do not speak English.K/S

Recognizing and accommodating the cultural practices of populations being served in the community.K/S

Develop sensitivity and responsiveness to a diverse patient population, particularly those from non-traditional , immigrant or underserved populations.K/S/A

Advocating for quality patient care in underserved patient populations.A/K/S

Working with case managers and community agencies in treatment planning and delivery.K/S

Working with bilingual health support staff in gathering information and implementing treatment plans in non-English speaking populations.K/S

Advocating for disabled patients with respect to income, insurance, personal care attendants, housing etc.K/S/A

Group Therapy  - UMMC

(2 hr/wk x 4 mths)

Ability to lead a group with supervision.S

Knowledge of the indications for and limitations of group therapy.K

See generic

See generic

See generic

See generic

Family Therapy – UMMC

(2 hr/wk x 4 mths)

Ability to treat a family psycho therapeutically with supervision.S

Knowledge of the indications for and limitations of family therapy.K

See generic

See generic

See generic

See generic

QAQI Group Project

Address an aspect of clinical practice that impacts patient care outcomes.K/A

See generic

Explore variables that impact clinical care.K/A

Present findings to the Department of Psychiatry in a Grand Rounds.S/K/A

Working on group project.S/K/A

Impact of interfacing systems – clinical, financial, administrative, etc. on patient care activities.K/A

ELECTIVES

Research Elective

(0.5day x 12 mths)

Introduce the trainee to research.K/S/A

See generic

See generic

Present scholarly activities in a peer-reviewed format. S

A faculty mentor will be assigned to enhance academic professional development. S

Interact with Institutional Review Board. S

Clinical Elective (see PGY4)

(0.5day x 12 mths)

Introduce the resident to a special population – childhood anxiety, eating disorders, first-episode psychosis, mental health/primary care integration, etc.  By arrangement with supervisor and approval of program.S

Knowledge related to the medical care  of a special population or treatment setting.K

See generic

See generic

See generic

See generic

Administrative Elective

(0.5day x 12 mths)

Serves as a liaison for the inpatient referral process.S

Serves as a liaison between clinic staff and residents. S

Knowledge of clinic and administrative/regulatory practices and guidelines.K

See generic

Organizes the quality assessment and improvement project.S/A

Ability to intervene at either an individual or group level to address resident concerns.S/K

Works closely with the clinic medical director in addressing system and individual clinical issues as pertains to residents.S/K/A

Knowledge of system and administrative issues, including quality of care.K

Impact of interfacing systems – clinical, financial, administrative, etc. on patient care activities.

Organizational Elective

(0.5day x 12 mths)

Serves as a liaison for psychiatry advocacy and leadership organizations.S

Knowledge of legislative and administrative/regulatory practices and developments.K

See generic

Organizes a project to enhance psychiatry organizational involvement and advocacy.S/A

Ability to intervene at either an individual or group level to address resident concerns as applies to organizational leadership.S/K

Works closely with the residency program in addressing organizational and legislative  issues as pertains to residents.S/K/A

Knowledge of organizational and legislative issues.K

Impact of interfacing systems – clinical, financial, legislative, organizational etc. on patient care, program, institutional and societal activities.

YEAR 4

Patient Care

Evidence-Based

Medical Knowledge

Practice-based Learning and Improvement

Interpersonal and Communication Skills

Professionalism

Systems-based Practice

GENERIC

Other than the Continuity Clinic, forensics and Consult-Liaison rotation, the PGY4 experience is shaped to meet a resident’s interests.  Residents may elect a single additional activity or several.  Supervision for their activities may be provided by phone contact.

Assume responsibility for patient care in a variety of settings at an independent level.S

Ability to build a therapeutic alliance in complex cases.S/A

Able to exercise independent judgment in treatment planning and implementation in representative cases.S/A

Knowledgeable about recent developments in the field.K/A  

Routinely reads primary sources in areas of interest.K/A

Ability to independently research, organize and present a 1 hour academic presentation that qualifies attendees for continuing medical education credit.S/K

Ability to initiate a quality improvement/quality improvement project.K/A

Ability to resolve complex issues using empathy and education.S/A/K

Determination of professional interests and career goals.K/A

Ability to identify and evaluate post-residency professional opportunities.K/S/A

Ability to supervise the functions of a mental health team.A/S/K

DIDACTICS

Tuesday Afternoons from 1pm to 4pm.  Focus on professional development and preparation for board certification examinations.

ASSIGNED SUPERVISION

In addition to ongoing clinical supervision, there will be one hour of individual psychotherapy supervision a week and one hour of clinical rotation supervision a week.

ROTATIONS

Duty hours must be limited to 80 hours per week, averaged over a four-week period – inclusive of all in-house activities and both external and internal moonlighting.  A duty period cannot exceed 24 hours.  Residents are allowed to remain on-site for an additional four hours to accomplish effective transitions of care.  There may be no additional clinical responsibilities assigned.  There must be 8 hours between scheduled duty periods and there must be at least 14 hours free of duty after 24 hours of in-house duty [not applicable to moonlighting].  In-house call must be scheduled more frequently than every third night and there must be one day (24 continuous hours) in seven free of duty [both averaged over a four-week period].

Continuity Clinic

UMMC

(0.5 day x 12 mths)

Develop long term psychotherapy skills involving psychodynamic, cognitive behavioral and supportive methods.S

Development of ability to adjust psychopharmacological agents to maximize long-term patient function.K/S

See generic

See generic

See generic

See generic

See generic

Forensic Clinic – St. Peter State Hospital and/or Hennepin County Courts

(0.5 day x 1 mth)

Ability to assess a patient for competence.S

Able to contribute psychiatric expertise to a multidisciplinary forensic evaluation.S

Able to define the components that determine a patient’s competence to make decisions.K

Knowledgeable of the literature in forensic psychiatry.K

Ability to communicate psychiatric knowledge to members of the legal profession.S/A

Knowledgeable of the nature of expert testimony.K

Able to describe the role of the courts in commitment, forced treatment, competence and responsibility for criminal acts.K

Consultation-liaison Psychiatry

(1 mth) –MVAHCS

(Not required if 2 months of consult liaison psychiatry have already been previously obtained)

Adapt the psychiatric assessment to a medical setting.S

Understand the impact of medical illness on a patient’s life history and mental health.S/A

Recognize the medical complications of common overdoses – acetaminophen, aspirin, etc.S

Recognize intoxication and withdrawal in the medical setting.S

Knowledge of psychiatric symptoms common to consultation patients – e.g. delirium, insomnia, pain.K

Generate a differential diagnosis for psychiatric symptoms commonly encounter in general hospital settings.K

Knowledge of pertinent psychotropic medication side effects and interactions in medically ill patients.K

Knowledgeable of substances frequently used in suicide attempts.K

See generic

Ability to explain psychiatric findings and recommendations to non-psychiatric personnel.S

Interact in patient care settings not dedicated to care of psychiatric patients.S

Understand the priorities of medical and surgical services and how these affect the consultants’ role.K/A

ELECTIVES

Consultation-liaison Psychiatry

(% varies) –MVAHCS, Smiley’s Clinic, Fairview Integrated Health Care Clinic, OB outpatient, UMMC inpatient, Phalen Village, Bethesda)

Adapt the psychiatric assessment to a medical setting (inpatient or primary care).S

Understand the impact of medical illness on a patient’s life history and mental health.S/A

Recognize the medical complications of common overdoses – acetaminophen, aspirin, etc.S

Recognize intoxication and withdrawal in the medical setting.S

Knowledge of psychiatric symptoms common to consultation patients – e.g. delirium, insomnia, pain.K

Generate a differential diagnosis for psychiatric symptoms commonly encounter in general hospital settings or community settings.K

Knowledge of pertinent psychotropic medication side effects and interactions in medically ill patients.K

See generic

Ability to explain psychiatric findings and recommendations to non-psychiatric personnel.S

Interact in patient care settings not dedicated to care of psychiatric patients.S

Understand the priorities of medical and surgical services and how these affect the consultants’ role.K/A

Chief Resident

(50%)

Cross cover for junior residents during their didactics.S

See generic

Organizes and presides over all resident meetings.S/A

Ability to intervene at either an individual or group level to address resident concerns.S/K

Works closely with the training director in administering the program.S/K/A

Provides academic counseling to and determines the need for personal counseling to junior residents.S/A

Works with senior residents in other programs in creating resident rotation schedules.S/A

Oversees call assignments and internal moonlighting bidding.S/A

Research Activity (% varies)

Adaptation of patient care to research settings and protocols.S

Design and methods involved in clinical trials and other research models.K

See generic

See generic

Knowledge of the ethics of clinical research.K/A

Understanding of how health care costs and availability impact on clinical research.K

MVAHCS (% varies)

Special populations in ambulatory settings

(PTSD, addictions, psychotherapy, primary care/mental health integration, geropsychiatry, sleep)

See generic

See generic

See generic

See generic

Explore professional opportunities at MVAHCS.A

Understand organization and services offered at a MVAHCS.K

UMMC Fairview Palliative Care

Develop skill in assessment, diagnosis and treatment of patients with pain and end-of-life issues.S

Gain knowledge regarding presentation, complications and course of pain and end-of-life issues.K

See generic

See generic

See generic

See generic

ECT (UMMC or MVAHCS, % varies)

Develop skill in assessment, diagnosis and treatment of patients with severe mental illness and evaluate for indication of treatment with ECT.S

Gain knowledge regarding presentation, complications and course severe mental illness and ECT treatment course and methodologies.K

See generic

Communicate with inpatient treatment teams to conduct patient assessments and coordinate care between the inpatient setting and the ECT suite.S/A

See generic

See generic

Inpatient Psychiatry (UMMC or MVAHCS, % varies)

Develop comprehensive psychiatric formulations if psychiatric inpatients.S/A  

Create effective treatment plans for psychosis, mania, depression, intoxication and withdrawal with greater autonomy than in the G1 and G2 years.S

Apply comprehensive psychiatric knowledge in the inpatient setting.K/A

Coordinate care with community providers and facilitate family meetings.S

Determine the presence of indications and contraindications for electroconvulsive therapy and other somatic therapies.K

See generic

Implement psychotherapeutic communication skills with psychiatric inpatients.S/A

Identify appropriate post-hospitalization treatment referrals, including day treatment, residential treatment facilities and outpatient psychotherapy and community help-groups.

Knowledge of community resources for patients discharged from an acute care psychiatric hospital.K

Understand service related benefits.K

Community-based ambulatory psychiatry (CUHCC, Associated Clinic of Psychology, Rural community sites)

Learn to apply community-based treatment methods.S

See generic

See generic

See generic

Explore professional opportunities for practice in public sector psychiatry.A

Knowledge of community based resources such as Active Community Treatment (ACT) and other support programs.K

Perinatal Psychiatry

(HCMC or Abbott Northwestern Hospital)

Develop the ability to assess and treat peripartum patients with co-morbid psychiatric needs. S

Build a knowledge-based framework for evidence based interventions to meet the psychiatric needs of high-risk obstetric patients. K

See generic

Be involved in the multidisciplinary treatment of these patients by being in communication with Obstetric and Pediatric colleagues. S, A

Explore professional opportunities for practice in peripartum health. A

Knowledge of community based resources such specialized programming to support mothers and infants. K

Addiction Psychiatry Clinic

Assume responsibility for patient care in the addiction psychiatry clinic progressing to an independent level.S. Make accurate psychiatric and substance use diagnoses and incorporate collateral sources in making treatment plans.

Ability to build a therapeutic alliance in complex cases.S/A

Able to exercise independent judgement in treatment planning and implementation in representative cases.S/A. Work within an interdisciplinary team to provide addiction services

Knowledgeable about recent developments in the field.K/A  

Routinely reads primary sources in areas of interest.K/A

Describes and utilizes evidence-based treatments in addiction  treatment including pharmacotherapies (eg naltrexone, disulfiram, buprenorphine, acamprosate)

Ability to independently research, organize and present a 1 hour academic presentation (during noon didactics) to learners and faculty.S/K

Ability to initiate  quality improvement/quality improvement project.K/A

Ability to resolve complex issues using empathy and education.S/A/K

Effectively use motivational strategies to engage the patient.

Determination of professional interests and career goals.K/A

Ability to identify and evaluate post-residency professional opportunities.K/S/A

Complete complex evaluations timely

Ability to supervise the functions of a mental health team.A/S/K and include multiple disciplines in treatment planning.

PUBLIC and/or forensic PSYCHIATRY

(Anoka Metro Regional Treatment Center, Community Based sites, St. Peter State Forensic hospital)

Assume responsibility for care of patients in the state hospitals and state run facilities. Display the ability to create a therapeutic alliance with the most severely ill patients.  S

Build a knowledge-based framework for evidence based interventions to meet the psychiatric needs of patients being cared for in state institutions K

See generic

Be involved in the multidisciplinary treatment of these patients by coordinating with legal representation and primary care. S, A

Explore professional opportunities for practice in forensic psychiatry. A

Knowledge of community based resources such specialized programming to support those transitioning from forensic settings. K

Guild Assertive Community Treatment Services

See Generic. Also, residents will assume greater independence in patient care, including full prescribing privileges in the Guild system, while remaining under the supervision of the Team psychiatrist.

See Generic. Also, ability to gain knowledge in areas of policy, insurance and cost- effective treatment for underserved patients population.

Taking responsibility for learning to work with underserved populations (e.g. their cultural beliefs and concerns).in a variety of settings including practicing in community. Also learning skills to serve as a senior resident on the team by mentoring and creating an environment of learning and inquiry with PGY3 residents. K/S/A (Would the senior resident mentoring role fit better under the “Professionalism” area? I’m not sure)

As schedule allows, resident will participate in additional community psychiatry related activities, such as attending civil commitment court and attending client group treatment.

See Generic. Recognizing and accommodating the cultural practices of populations being served in the community.K/S Communicate effectively with, not only patients, but also team members. Efforts will be made to ensure several clients on the resident’s case load with speak English as a second language. Resident ikely will need to arrange for and use translator services in her work with at least one client.

See Generic. Continue to develop sensitivity and responsiveness to a diverse patient population, particularly those from non-traditional , immigrant or underserved populations. K/S/A

See generic. advocating for quality patient care in underserved patient populations. A/K/S

Working with case managers and community agencies in treatment planning and delivery.K/S

Working with bilingual health support staff in gathering information and implementing treatment plans in non-English speaking populations.K/S

Advocating for disabled patients with respect to income, insurance, personal care attendants, housing etc.K/S/A

Center for Sexual Health – UMMC (% varies)

Take a competent and comprehensive

medical history.S

Conduct a competent and complete

physical examination.S

Manage sexual health medical disease states.S

Recognize medical emergencies.S

Initiate treatment of emergent, acute and subacute medical conditions.S

Develop knowledge regarding medical conditions regarding sexual disorders.K/A

See generic

See generic

Explore professional opportunities related to the care of patients with psychosexual disorders.A

Ability to manage sexual-health concerns in the broader medical community.A/S/K

PharmD - UMMC

Observe and participate in PharmD patient evaluations, medication regimen review, and formulation of medical recommendations to patients and primary teams.

Gain a broadened understanding of the resources utilized by PharmD by researching and answering specific drug information questions posed to PharmD team.

See generic

Facilitate communication between PharmD team, patients, and providers by completing documentation and communicating recommendations directly to providers.

See generic

See generic

Psychotherapy Training

The University of Minnesota, Department of Psychiatry, is committed to a strong education program both in short and longer term psychotherapies.  We emphasize that even the briefest medication management may reveal important dynamic issues.  In this sense, all patient contacts become an important ground for learning about and applying psychotherapeutic principles.  

These principles are presented in courses on the theory and practice of psychotherapy, given during the four years of psychiatry training.  Topics include supportive psychotherapy, psychodynamic theory and psychotherapy, cognitive behavioral therapy, group and family therapy, dialectical behavioral therapy, and motivational interviewing.  

Psychotherapeutic Practice

Psychotherapy Supervision

Psychotherapy Didactics

PGY1

- Residents learn psychotherapeutic approaches to inpatient interviews which promote development of rapport, patient engagement, and advancement of hospitalization goals.

- Suicide assessment and crisis management

- De-escalation and violence prevention techniques

-Weekly “competency supervision” discussing the 6 ACGME competencies:

- Patient Care 

- Medical Knowledge      

- Practice Based Learning and Improvement

- Systems Based Practice

- Professionalism

- Interpersonal Skills &  

   Communication

- Suicide assessment and acute intervention during orientation.

- The Prevention and Management of Disruptive Behavior course at the VAMC during orientation

- Clinical Skills Course (12 hours) including topics related to professionalism, impairment, basic psychotherapeutic skills, documentation, mentoring, use of supervision.

- Explicit skills taught include validation and reflective listening.

- Treatment of Major Disorders course (12 hours) discusses indications for both medication management and psychotherapeutic modalities

- Human Development, Child Disorders & Treatment (12 hrs) by Dr. Murray

PGY2

Supportive psychotherapy

Clinic:  1-5PM Tuesday afternoons in the outpatient clinic.

Minimum Requirements:

Each G-2 resident is to complete 42 face-to face individual supportive sessions (50-55 minutes). This is equivalent to 7 months (28 weeks) of two 50-55 minute supportive therapy patients each week (75%). If cases go biweekly,the expectation is to add a 3rd or 4th patient.

Exception: Residents continue to see patients on night float blocks. Residents are not expected to take on new cases during this period.

Optional: Residents may pursue training in Dialectical Behavioral Therapy (DBT)

-Weekly supportive psychotherapy supervision (videotaping sessions is suggested)

*If the G-2 resident is unable to complete these minimal psychotherapy requirements of 42 sessions then he/she will need to make them up during his/her G-3 year. Each resident is responsible to keep track of how many hours are completed and share this with Dr. Moen who is a representative of the PROPS and RTC  who will track this.

Optional: Weekly Dialectical Behavioral Therapy Study Group.

-Introduction to Supportive Psychotherapy (3) modudules by Dr. Moen.

-Introduction to Psychotherapy (3 modules) by Psychotherapy Resident Lead

-Psychodynamic Theory (12 hours) taught by Dr. Kyle Cedarmark

-Family therapy (12 hours) taught by Dr. Moen.

-Dialectical Behavioral Therapy (12 hour course) taught by Drs.Helen Valenstein-Mau and Merav Silverman

-Cultural Competency (6 hour) Dr.Shores

- Spirituality (3 hours) by Dr. Gabor

- Optional: Weekly Dialectical Behavioral Therapy Study Group.  

PGY3

Minimum Requirements:

Psychodynamic Psychotherapy (main emphasis during PGY3 year)-

 

Each G-3 resident to complete 70 face-to-face individual therapy sessions (50-55 minutes) with at least 2 of these cases being psychodynamic.  (2 psychodynamic sessions and 1 supportive or 3 psychodynamic sessions per week) .  This  is equivalent to 44 weeks of 3 sessions (75%).

     -Ideally at least one of these patients  comes weekly (i.e., same patient one time per week for the entire year)

 

Psychodynamic/Supportive

  • 70 face-to-face hours minimum, ideally cases lasting more than 3 months (long term)

 

Cognitive Behavioral Therapy 

  • Complete 3 CBT cases/
  • Requirement of 21 hours/ sessions minimum  (32 weeks x 66%)
  • Requirement of 8 months weekly CBT supervision (even if not an active case).
  • Additional CBT case/med management with CBT focus

Group Psychotherapy

  • 4 month rotation in Women’s or Mixed Gender Therapy Groups serving as Dr. Moen’s co-therapist

Family Therapy /Family Meetings

  • 1 Family Therapy case beginning to end (8-10 sessions) serving as Dr. Moen’s co-therapist.
  • 5 Family meetings with med management patients.
  • (see below Family Therapy and Family Meetings descriptions and outline)

Motivational Interviewing

  • 2 day MI Training and monthly teaching/coaching circle by Fran Lesicko, MA
  • Provide one 15 minute audio or video recording to the course instructor. Can be a med management case with MI intervention or taped role-play.

Optional: Residents may pursue  training in Dialectical Behavioral Therapy (DBT) or (IPT)

-- Weekly psychodynamic psychotherapy supervision all year.

 

**Clinic is Open until 6pm Monday-Thursday. 4pm & 5pm are the best times to do therapy with high functioning patients (psychodynamic) and when we do family therapy cases Tues and Thursdays  4pm-6pm.

 

*If the G-3 resident is unable to complete these minimal psychotherapy requirements of 70 sessions, then he/she will need to make them up during his/her G-4 year. Each resident is responsible to keep track of how many hours are completed and share this with Dr. Moen who is a representative of PEC who will track this.

 

- weekly CBT supervision for 8 months, Supervision will be in dyads so you can learn from your partner’s case too.

- Family and Group Therapy Supervision provided by Dr. Moen during the clinical rotation. (Before and after the session is part of the 2 hour block for the rotation)

 

-Complete 5 family meetings following the outline presented below. One of the family meetings with Dr. Moen or Social worker (prepare & process after)

- Motivational Interviewing group supervision/”coaching circle” monthly for 6 sessions., each resident is to bring at least one recording  of a MI session to review and share with the group.

Optional: Weekly Dialectical Behavioral Therapy Study Group. IPT supervision as arranged.

-Psychodynamic Psychotherapy II & III (24 hours) by Dr. Kevin Cedarmark

-Cognitive Behavioral Therapy (12 hours) by Dr. Zagoloff and Sabine Schmid

-Group therapy teaching and experiential learning as co-therapist with Dr.  Moen. ”Live Supervision” and processing.

2-hour block includes didactic material following the Yalom Interpersonal Group Psychotherapy Model (2008)

Family Meetings Seminar (Moen) in Sept. 1 hour. Family meetings with structure and guidance on how to include the patient.

-Motivational Interviewing (2-day training) by Fran Lesiko, MA

PGY4

Emphasis is on psychodynamic psychotherapy.  

Continuation of Supportive, Psychodynamic, CBT, DBT, IPT and Motivational Interviewing cases.

(2-6+ hours per week)

Minimum Requirements:

Psychodynamic Psychotherapy-

  1. 2-4 ongoing 50 minute weekly therapy cases.  
  2. At least one of these patients MUST come weekly (i.e., same patient one time per week for the entire year).  The other patient should also come weekly, but if they go biweekly then you must add a 3rd or 4th psychodynamic psychotherapy patient.

Additional supportive, DBT, CBT, and IPT cases are encouraged.

Complete the Family Therapy requirement if you were unable to do so during the PGY3 year.


Optional: Residents may pursue training in Dialectical Behavioral Therapy (DBT), Interpersonal Therapy (IPT), or VA psychotherapy electives

-Weekly psychodynamic psychotherapy supervision all year.

Additional supervisors are arranged depending on therapy cases-if DBT /CBT then an additional DBT /CBT supervisor will be arranged.

Recommended Options: Weekly Dialectical Behavioral Therapy Study Group.  IPT supervision as arranged. VA psychotherapy electives can be arranged.

The psychodynamic psychotherapy supervisor provides education, readings and Integration of Psychodynamic concepts.

        Psychotherapy Optional Activities

These are primarily 4th year electives, mostly offered at the MVAHCS, unless otherwise specified:

Interpersonal Therapy: Individual experience supervised by Carol Peterson (UMMC).

Psychological Assessment Training Clinic: Through this year-long group training experience, trainees conduct a range of assessments for the purpose of psychodiagnosis. Competencies emphasized include diagnostic interviewing, intellectual assessment, personality assessment using the MMPI-2, the Rorschach, and other instruments, and the provision of consultation and peer supervision. Trainees can expect to become familiar with the relevant research. Supervisors: Drs. Arbisi (ABPP) and Siegel (ABPP).Acceptance and Commitment Therapy (ACT): ACT is a functional contextual therapy that views psychological problems dominantly as problems of psychological inflexibility. ACT uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility. Training includes didactic presentations, experiential exercises, and review of clinical material including audio- or videotapes in weekly small group supervision. Trainees can serve as individual ACT therapists or group therapists. Supervisor: Drs. Billig (ABPP)and Hess.

Family Psychoeducation: Family Psychoeducation is an evidence-based approach for working with individuals with serious mental illness (schizophrenia, bipolar disorder, recurrent depression) and their significant others.  A bio-psycho-social model of mental illness guides our conceptualization of cases and treatment recommendations.  Individual family and group interventions provide education about the illness, teach all participants adaptive coping skills, and provide the family unit with support and crisis intervention.  Training in family psychoeducation models (Behavioral Family Therapy and Multifamily Group) is provided primarily through co-facilitation of multiple family group or individual family sessions.   Trainees may also become involved with family education interventions either as a presenter at educational workshops or as a co-facilitator of an educational seminar for family members only - Support and Family Education (SAFE).  Weekly meetings are held for case consultation and to discuss the relevant empirical literature.  Supervisor:  Dr. Nienow.

Family Therapy Training Clinic (FTTC): Social Constructionist therapy including Solution Focused and Narrative approaches are presented in the FTTC. This clinic provides training for staff, postdoctoral residents, and trainees in the assessment and treatment of couples and family-related concerns. The clinic format includes didactic presentations (augmented through videotapes), and experience using solution-focused, and narrative techniques. All sessions are videotaped, and supervision occurs in a group setting. Skills acquired include case conceptualization, basic techniques, and provision of peer supervision. Training is augmented by consultation with a community family therapy expert. Supervisors: Drs. Erbes and Leskela.

The Anxiety Interventions Clinic (AIC): AIC is a national VA award-winning training program which employs distinctive, empirically-supported approaches to treat social and simple phobias, panic disorder with and without agoraphobia, generalized anxiety disorder, and obsessive-compulsive disorder. Techniques include but are not limited to diagnostic assessment, psychoeducation, relaxation training, cognitive restructuring, exposure and response prevention. Residents can expect to develop competence in assessment and differential diagnosis of anxiety disorders using standardized forms and structured interviews, and in the application a CBT approach to specific anxiety disorders. Trainees become familiar with the empirical literature regarding the application of CBT strategies with anxiety disorders, and are encouraged to utilize process and outcome measures to track therapy progress as a part of standard care. Critical thinking and professional development are emphasized. The training setting is interdisciplinary and a peer consultation/ supervision model is used. Supervisor: Dr. Olson (ABPP).

Cognitive Behavioral Social Skills Training (CBSST): This training is targeted towards individuals with serious mental illness (SMI), including schizophrenia and other psychotic disorders. The program utilizes techniques from cognitive behavioral therapy and social skills training that are implemented within a group format, which is augmented with individual sessions and consultation with other involved providers. Specific targets include modifying maladaptive thoughts, coping with persistent symptoms, identifying and monitoring warning signs of relapse, increasing problem-solving skills, promoting effective conflict management and improving communication skills. This differs from traditional supportive group therapy in that veterans' current concerns are addressed through learning and applying new skills to their everyday experiences. The intention is to improve quality of life and social functioning in our veterans with SMI, thus we work primarily within a "recovery" model. In addition, there is an emphasis on family education and involvement with the National Alliance for the Mentally Ill (NAMI). Skills acquired include case conceptualization from a CBT approach, techniques of the CBSST intervention, assessment of psychotic symptoms and other areas of patients' functioning, familiarity with relevant empirical literature, peer supervision, and multidisciplinary consultation. Supervisor: Drs. Hegeman and Hoffman-Konn.

Cognitive Processing Therapy (CPT): CPT is an evidenced-based, manualized, time-limited (12-17 weeks) treatment approach for trauma-related symptoms. Symptoms are conceptualized as developing from an inability to resolve conflicts between the traumatic event and prior beliefs about the self or others, as well as the consequent avoidance of a range of strong affects such as anger, shame, guilt, and fear. CPT treats trauma-related symptoms within the framework of a “recovery” model. The primary focus is on cognitive interventions, and treatment is structured such that skills are systematically built upon throughout the course of therapy. Treatment elements include psychoeducation, emotional processing, and cognitive interventions. Process and treatment outcome measures are used to track therapy progress as part of standard care. The CPT clinic provides training consisting of didactics, a video instruction series, bi-weekly case consultation, and participation as a CPT therapist. Opportunities are available for trainees to also serve as a group co-facilitator for both the men’s and women’s groups. Supervisors: Drs. Curry, Meyers (ABPP), and Petska.

Prolonged Exposure (PE): PE is an evidence-based, cognitive behavioral treatment for PTSD. The program consists of a course of individual therapy designed to help clients process traumatic events and thus reduce trauma-induced psychological disturbances. Twenty years of research have shown that PE significantly reduces the symptoms of PTSD, depression, anger, and general anxiety. The standard treatment program consists of nine to twelve, 90-minute sessions. Treatment components include psychoeducation, in-vivo and imaginal exposure procedures. The PE clinic provides training consisting of didactics, a video instruction series, and weekly multidisciplinary case consultation. Opportunities are available for trainees to serve as individual therapists. Supervisors: Drs. Polusny, Strom, and Voller.

Time-Limited Dynamic Psychotherapy (TLDP): Trainees participate in a group supervision model of training to learn and apply TLDP with a minimum of one patient during the course of the 6-month training clinic. Competencies acquired include case conceptualization and application of TLDP as well as peer supervision/consultation. Supervisor: Dr. Wagner.

Motivational Interviewing (MI): MI is a directive, client-centered therapeutic style for eliciting behavioral change by helping clients explore and resolve ambivalence about making changes. The therapist assesses the client's level of readiness for change and uses MI to help the client define treatment goals, time frames, and the strategies to achieve those goals. The MI training will consist of learning the basic MI goals and principles, traps to avoid, and opening strategies, eliciting self-motivational statements, handling resistance, and assessing readiness for change. The process will include readings and discussions of didactic material, review of video and audiotapes of interactions with patients, and role-playing. Supervisor: Dr. Isenhart (ABPP).

Dialectical Behavioral Therapy (DBT). DBT is the empirically-supported, manualized cognitive behavioral approach to treat male and female patients who share key features with those diagnosed with Borderline Personality Disorder, specifically emotion dysregulation, distress tolerance, and interpersonal difficulties. Patients commit to weekly individual therapy and group skills training. Training includes didactic presentations and review of clinical material, including videotapes, in weekly small group supervision. Trainees can serve as individual DBT therapists, skills group co-leaders, and/or ACES group co-leaders (i.e., an advanced DBT group to assist patients with returning to work or school, establishing normative social relationships, and exiting the mental health system). They also participate in a weekly Consultation Group. Supervisors: Dr. Meyers (ABPP).

Psychoanalytic Clinic: This yearlong clinic is intended to give trainees experience with psychoanalytic-informed approaches to psychotherapy with individuals. Trainees participating in this clinic usually carry one to two cases, meeting once or twice weekly, for a total of two clinical hours per week. Trainees can expect to write process notes for use in a weekly group supervision meeting. Additionally, readings covering various psychoanalytic ways of thinking about and working with people are assigned and discussed in supervision. Supervisor: Dr. Walden.

Clinical Skills Assessments (CSAs)

Oversight of CSAs is conducted by Dr. Lidia Zylowska. This is a program requirement. This evaluation is not used for the purpose of the American Board of Psychiatry and Neurology Clinical Skills Verification (CSV), but is preparatory for this activity.

Clinical Skills Verifications (CSEs)

In order to be eligible for ABPN certification, three clinical skills evaluations must be completed.  Two evaluations should take place during PGY3 year. One evaluation will take place in the first 6 months of the G4 year, completed by Dr. Atkinson at the MVAHCS. If a resident enters the child/adol fellowship for their G4 year, the G4 verification will be completed prior to transfer to the fellowship.  All documentation will be provided to the ABPN using an approved format.  Multiple attempts are allowed until three skills verifications reach the level of being satisfactory.

Didactics

Didactic coursework is offered in four 10-week blocks to each resident class. Course materials, including syllabi, slides and articles, will be updated regularly and posted on the program Google Drive.

Tracks

A longitudinal training track tailored to the area of interest.  All track days are scheduled once a quarter for all residents and can be found on the program Google Drive.

Clinical Neuroscience Track

Introduction:

During the Psychiatric Neuroscience track, we will deepen our knowledge of advances in psychiatric neuroscience. We will also examine how these scientific advances might change clinical care.

Exploration Meetings:

We will offer informational sessions, discussion groups, and presentations relevant to Psychiatric Neuroscience during the Quarterly Track Sessions and during Independent Learning Time.

Curricular Components:

Requirements & Goals:

Resources

Faculty Mentorship:

Conferences to Attend:

Scholarships/Awards/Organizations:

Development Across the Lifespan Track

Introduction:

The purpose of the Development Across the Lifespan track is to harness the power of development to deepen our knowledge of our patients and their environments. We seek to pursue this through:

Our goals are to:

Exploration Meetings:

Example Didactic & Curricular Components:

Requirements & Goals:

Resources

Faculty Members:

Conferences to Attend:

Scholarships/Awards/Organizations:

Global Community Psychiatry Track

Introduction:

The purpose of this track is to provide a robust learning experience for in-training psychiatrists who are interested in community psychiatry, forensic psychiatry, health equity, socio-cultural psychiatry, advocacy and care for immigrants, refugees and asylum seekers.  

Trainees in the Global Community Psychiatry track will gain expertise in the practice of delivering and improving mental health care on a local and global level, and related scholarly activities. They will acquire proficiency in understanding social determinants of health, trauma-informed care, mental health laws, policies and systems and understand how they affect the lives of diverse populations of people and how to provide optimal psychiatric care within this broader social context.

Exploration Meetings:

Meetings will be announced at regular intervals and will include informational sessions, discussions, and presentations relevant to Global Community Psychiatry.

Example Didactic & Curricular Components:

Requirements & Goals:

Resources

Faculty Members:

Conferences to Attend:

Scholarships/Awards/Organizations:

Training Examinations

The PRITE Exam (Psychiatry Resident In-Training Examination sponsored by the American College of Psychiatry) is given each fall to all psychiatry residents and child fellows.  The PRITE exam has a strict policy and only 1 make-up exam can be given.  In order to miss this exam it will need to be approved by the PEC committee.  The Psychodynamic Psychotherapy Competency Test (constructed by Columbia University in New York) is provided to all residents in the spring.

Step 3 Requirement

All trainees must pass the USMLE Step 3 or an equivalent licensing examination (i.e. COMLEX) by January 1 of their PGY-2 year to be eligible for a resident contract at the PGY-3 level or beyond. Trainees are encouraged to take the appropriate licensing examination early in their training to permit adequate time to retake the exam if more than one attempt is needed.  Trainees should register for the USMLE Step 3 or equivalent licensing examination no later than November 1st of the PGY-2 year to allow for scheduling, grading and notification of exam results by the March 1 deadline. Trainees who do not notify their program of a passing score by January 1 of their PGY-2 year forfeit their continuing position in the training program and are subject to contract non-renewal.  https://med.umn.edu/residents-fellows/current-residents-fellows/employment-related-information/institutional-manual

Specialty-specific Curricula

Specialty-specific curricula can be found here.

Clinical Education Requirements

Required Clinical Experiences:

Research Requirements

The program must provide residents with opportunities for research and development of research skills for residents interested in conducting research in psychiatry or related fields.

The program must provide interested residents access to and the opportunity to participate actively in ongoing research under a mentor.

All residents must be educated in research literacy and in the concepts and process of evidence-based clinical practice to develop skills in question formulation, information searching, critical appraisal, and medical decision-making.

https://www.med.umn.edu/psychiatry/research

Quality Improvement Project Requirements

Evaluations and Outcomes Assessment

Resident Evaluation Process

Milestones Evaluation and Resident Promotion based on ACGME Competencies        

The psychiatry residency program adheres to the general competencies to assess resident progress.  Goals and objectives and observations by supervisors are organized according to the six areas of competency. 

The six competencies are:

-Patient Care 

-Medical Knowledge

-Practice Based Learning and Improvement

-Systems Based Practice 

-Professionalism 

-Interpersonal Skills and Communication 

The ACGME Psychiatry Residency Review Committee (RRC) has established a set of psychiatry-specific Milestones to assess an individual resident’s developmental progress throughout training based on the six competencies. The Clinical Competency Committee (CCC) will meet twice a year (December and May) to determine each resident’s progress with respect to the Milestones. See below for the CCC Charter.  Clinical observations, informal reports, formal evaluations and other sources of performance data, as summarized in the evaluation grid will be utilized to determine specific Milestone rankings. Individual Milestone reports will be presented at the twice annual meetings of the resident and Program Director or Associate Program Director. Throughout the academic year, the training director is available to meet individually with residents as difficulties or problems are encountered.        

The Milestones will be used descriptively to track resident developmental progress and serve as a vehicle for identifying resident strengths and growth points. There is no set numerical cut-off score or ranking required for promotion, graduation, or special privileges; however, based on the discussion of the CCC, academic issues may be identified that result in remediation plans, academic probation, non-advancement, extension of residency training or termination. The Milestones will be distributed electronically through the Residency Management Suite (RMS) Review Portfolio.

The Milestones data will be deidentified and aggregated using WedAds Software and provided to the ACGME for ongoing monitoring of program quality and evidence of resident progress.

A PGY1 resident is expected to have foundational skills to offer sound inpatient care initially with direct supervision and transitioning to indirect with direct immediately available.  At the beginning of their PGY1 year, residents are evaluated for their ability and willingness to ask for help when indicated, gather an appropriate history, ability to perform an emergent psychiatric assessment, and present patient findings and date accurately to a supervisor who has not seen the patient.  PGY2 residents are evaluated at the beginning of the year for their capacity to supervise PGY1 residents.  With progress and promotion, residents are granted advancing responsibilities over the course of 48 months of training.

A PGY4 resident is expected to independently develop a sound and practical plan for managing routine clinical problems.  Residents at all levels must know when they need consultation and be motivated to improve their knowledge, skills, and attitude using practice-based learning. Areas of conditional independence are determined by the level of the trainee, the nature of the clinical problem, the supervision available and the skills of the individual trainee.

ACGME Competencies and Milestones                                

Resident evaluation is conceptualized as a dynamic process in which there is frequent communication between the resident and supervisor.  We feel strongly that it is important for the resident to receive guidance at the time of their clinical or didactics experience, rather than being entirely dependent upon a formal review process at the end of a rotation cycle.  At the conclusion of each rotation or formal didactic experience a supervisor evaluation of the resident is completed.  

More specific to psychiatry, the evaluation process contains the following elements:  How well the resident relates to patients and staff; whether the resident makes good use of supervision; whether the resident works independently; has good diagnostic skills; makes appropriate use of labs, psychological tests, and other diagnostic procedures; uses psychopharmacologic agents effectively; maintains adequate records; is able to handle a reasonable patient load; is knowledgeable about psychiatric literature; understands psychodynamic issues; provides appropriate supportive therapy; recognizes countertransference issues; and understands uses of cognitive/behavioral therapies.


The Evaluation Methods Grid summarizes activities used by the educational program and its instructors to collect information about and provide formal feedback to trainees regarding achievement of the competencies outlined in the Goals and Objectives of the training program:

#

Method

Frequency per Academic Year

Level

Competencies Assessed

Patient Care

Medical Knowledge

Practice-based Learning

Interpersonal and Communication Skills

Professionalism

System-based Practice

1

Attending Rating (RMS)

13

ALL

X

X

X

X

X

X

2

Competency Supervisor Ratings (RMS)

3

PGY1

X

X

X

X

X

X

3

Psychotherapy supervisor Ratings (RMS)

3

PGY2-4

X

X

X

X

X

X

4

Psychotherapy Supervision Plan and Log

1

PGY2-4

X

5

Clinical Skills Assessment

1

PGY1,2,4

X

X

X

X

X

6

Clinical Skills Evaluation

3

PGY3

X

X

X

X

X

7

PRITE

1

ALL

X

9

Medical Student Feedback

8

ALL

X

X

X

X

10

Spontaneous Patient Comments to Program

Variable

ALL

X

X

X

11

QA/QI Presentation

1

PGY3

X

X

X

X

X

12

Grand Rounds Feedback

1

PGY4

X

X

X

X

X

13

RMS Duty Hour Attestation

13

ALL

X

14

UMP Clinic deficiencies Report

Weekly

PGY1-2

X

X

15

Moonlighting Report Form

Variable

PGY2-4

X

16

Didactic Attendance

4

PGY1-4

X

17

Semi Annual Meeting with Milestones Reviewed and Discussed

Twice

PGY1-4

X

X

X

X

X

X

18

Final Summative Evaluation with Milestones Reviewed and Discussed

Final Year

PGY3 or 4

X

X

X

X

X

X

19

Resident Outpatient Scheduling Report

4

PGY2-4

X

Residents will use RMS, a web-based system, to evaluate their attending physician, supervisor, their specific rotation, the site, didactics, and lecturers.  Residents are notified each month via email that they have evaluations to complete.

Attending physicians will be able to view information on themselves after three or more evaluations have been completed by a resident or medical student. The information will be an accumulation of comments rather than individual comments to guarantee anonymity for the residents and medical students. Residents and medical students will be able to view an evaluation on themselves completed by an attending physician once that resident or medical student has completed an evaluation on that particular attending physician.

On any resident’s departure from the program, the program director prepares a letter describing the nature and length of the rotations for which the resident has been given credit.   When the resident leaves the program (including by graduation), the program director affirms in the record that there is no documented evidence of unethical behavior or unprofessional behavior or a serious question of clinical competence.

        Clinical Competency Committee (CCC) Charter

Overview and Composition

Per ACGME requirements, the Department of Psychiatry and Behavioral Sciences CCC has been developed to to review resident evaluations, prepare and assure the reporting of resident Milestones evaluations to the ACGME, and advise the Program Director on special issues related to resident progress, including promotion, remediation, and dismissal.

The following have been appointed the following faculty members to the Clinical Competency Committee:

  1. Lora Wichser, MD (Chair)
  2. Alexandra Zagoloff, PhD
  3. Steve Olson, MD
  4. Deanna Bass, MD
  5. Megan Press, MD
  6. Patricia Dickmann, MD
  7. Richelle Moen, PhD
  8. David Atkinson, MD
  9. David Bond, MD
  10. Quentin Gabor, MD
  11. Lidia Zylowska, MD
  12. Matej Bajzer, MD
  13. Michael Langley-DeGroot, MD
  14. Katie Steen, MD
  15. Alex Hubble, MD
  16. Kaz Nelson, MD

Program Administrator, Rachel Talcott, will also attend all CCC meetings.

Meetings

Responsibilities

Residents

Formative Evaluation 

The faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment, and document this evaluation at completion of the assignment.

The program must:

The evaluations of resident performance must be accessible for review by the resident, in accordance with institutional policy.

The program must conduct an annual formal evaluation of the core medical knowledge of each resident in the second, third, and fourth years, and conduct an examination across biological, psychological, and social spheres that are defined in the program’s written goals and objectives.

The program must formally conduct a clinical skills examination for

each resident.

The program must monitor clinical records on major rotations to assess resident competence to:

Residents’ teaching abilities must be documented by evaluations from faculty members and/or learners.

 

Summative Evaluation

The specialty-specific Milestones must be used as one of the tools to ensure residents are able to practice core professional activities without supervision upon completion of the program.

The program director must provide a summative evaluation for each resident upon completion of the program.

This evaluation must:

In at least three evaluations with any patient type, in any clinical setting, and at any time during the program, residents must demonstrate satisfactory competence in: establishing an appropriate doctor/patient relationship, psychiatric interviewing, performing the mental status examination, and case presentation.

Program Evaluation Tools

As required by the ACGME, The Residency Program is evaluated formally on an annual basis by the Program Evaluation Committee (PEC) and a formal Annual Program Evaluation (APE) is generated by the Program Director. The Institutional requirements and charter is presented separately by the U of MN Graduate Medical Education Committee (GMEC). Formative and Summative evaluations will be administered through RMS.

ACLS/BLS/PALS Certification Requirements

Required institutional and hospital certification in BLS and ACLS will be provided to PGY1 residents during orientation.  If you are rotating at the Minneapolis VA Health Care System you must have a current BLS certification. Initial and renewal cards must be submitted to the program coordinator at respsych@umn.edu.

Annual evaluation of program goals and objectives

As required by the ACGME, The Residency Program is evaluated formally on an annual basis by the Program Evaluation Committee (PEC) and a formal Annual Program Evaluation (APE) is generated by the Program Director. The Institutional requirements and charter is presented separately by the U of MN Graduate Medical Education Committee (GMEC).

PEC members and charter:

ACGME

Common Program Requirement

Summary

Action

VC

core

Program Evaluation and Improvement

The Program Director and Program Coordinator must know and be able to apply the Common Program Requirements and their Program Requirements in the Psychiatry Residency Program

VC1,

VC1a1

Core

Program Director must appointment the PEC

(required: Program Director

2 Full-time program faculty,

1 Resident/fellow).

As appointed by the Program Director, PEC members will be the Program Director, Associate Program Director, Assistant Program Director, Chief Resident, Incoming chief Resident (for the 6 months preceding their term), and the Residency Coordinator.

The Program director serves as chair of the committee and is responsible for assessing for a quorum, developing the agenda, bringing new or revised policies to the Residency Training Committee (RTC), and completion of the annual program evaluation report. 

A quorum shall consist of at least three of six members, if less than three members are available, the meeting will be cancelled.

Members sign a statement of confidentiality

The PEC meets weekly for one hour.

This PEC charter was developed by GME Administration in consultation with the GMEC and edited by the Psychiatry Program Director.

VC1a2

core

Develop a written description of responsibilities

See VC1a3, VC2, VC2a-VC2e for list of responsibilities.

The PEC also responsible for responding to special reviews if GMEC determines a special review is warranted.

VC1a3

detail

        Actively participate in:

The psychiatry Residency PEC members actively participate in:

Planning, developing, implementing, and evaluation education activities of the program.

Reviewing and making recommendations for revision of competency-based curriculum goals and objectives.

Addressing areas on non-compliance with ACGME standards; and

Reviewing the program annually using evaluations of faculty, residents and others

The PEC develops policy changes and makes recommendations to the Residency Training Committee, which meets on a monthly basis.        

VC2

Annual formal documentation of Annual Program Evaluation (APE)

The Program Director, with assistance from the PEC will document formal, systematic evaluation of the curriculum annually, and will render a written and Annual Program Evaluation (APE) report.

VC2a-VC2e

The Program must monitor and track specific elements.

        

The components of the APE will include:

-Resident performance as determined by components of the Evaluation Methods Grid. 

-Faculty development

-Graduate performance, including performance of program graduates on the ABPN certification examination

-Program quality 

-Residents and faculty annual confidential survey evaluations.  

-The PEC will use results of the resident and faculty assessments of the program together with other program evaluation results to improve the program determine a set of action items on which to improve the program during the following academic year.

-The APE will report on progress on the previous year’s action plans

Required metrics will be developed by GME Administration in consultation with the GMEC.

The PEC must use GME Admin/GMEC metrics to monitor and track program quality.

VC3

core

PEC must prepare a written plan of action to document initiatives to improve performance in one or more of the areas listed in section VC2 as well as delineate how they will be measured and monitored

The Psychiatry Program Director and PEC will use the APE report outline template developed by GME Admin in consultation with the GMEC

        

VC3a

core

The action plan must be reviewed and approved by the teaching faculty ad documented in the meeting minutes

The APE report, including action plan, will be presented for approval to the RTC and documented in the meeting minutes at the August meeting (second Wednesday of the month at 12:15).

The Psychiatry Residency Program will provide the APE report (that includes an action plan) to the GMEC annually.

LCME Requirement

LCME Requirement: Residency programs that participate in the teaching and education of medical students are expected to comply with relevant Liaison Committee on Medical Education (LCME) Accreditation requirements as they relate to the educational program. The requirements (in the form of Elements) related to residents ensure they are aware of their role in education, which includes:

In order to meet these requirements, residency programs should:

  1. Provide residents with copies of all education program objectives (Graduation Competencies) and course/clerkship learning objectives for each required course or clerkship where residents provide teaching/supervision. (Accreditation Element 6.1.). The objectives for ADPY 7500 can be found here.
  2. Ensure residents are made aware of required clinical encounters and skills. (Accreditation Element 6.2)The required encounters for ADPY 7500 can be found here
  3. Provide residents with relevant policies addressing the standards of conduct, including mistreatment policies, and the mechanisms for reporting and responding to allegations of mistreatment. (Accreditation Element 3.6.)
  4. Ensure residents are aware of, or have copies of, policies related to clinical and educational work hours, including on-call requirements. (Accreditation Element 8.8.)

Program Procedures

Attendance - expectations and reporting instructions

Trainees are expected to be in attendance everyday of their rotation unless prior approval was granted by the rotation or site director for an approved leave or holiday. The process for reporting absences is described below.

Clinical and Educational Work Hours - requirements and reporting mechanism

Clinical experience and education, previously known as “duty hours” are defined as all clinical and academic activities related to the program. This includes patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as didactics or conferences. Work hours do not include reading and preparation time spent away from the clinical site, research activity, or paper writing.

Requirements

All programs are required to adhere to and monitor compliance of their trainees with the ACGME clinical and educational work hours standards as outlined in the ACGME Common Program Requirements. Training programs must also follow program-specific guidelines as outlined by their individual Review Committees. The sponsoring institution monitors training program adherence to the clinical and educational work hour requirements.

Management of clinical and educational work hours is a shared responsibility of programs and trainees.  The trainees must adhere to the policy and report violations. The program must structure clinical activities to adhere to, monitor and enforce compliance with the requirements. The institution must provide oversight to the programs and address non-compliance.

The Psychiatry Residency Program at the University of Minnesota is committed to ensuring that all residents are compliant with the most recent [Common Program Requirements – Effective: July 1, 2017] duty hour requirements set forth by the ACGME as well as the Psychiatry Residency Review Committee. Importantly these guidelines require that external moonlighting be counted in terms of the 80 hour rule and that, effective July 1, 2017, the duty period for PGY1 residents must [present without fail] not exceed 16 hours in duration.

The duration of the workday on Psychiatry rotations at the University of Minnesota Medical Center will vary according to the year of training and service assignment.  It is delineated by the Duty Hour Guidelines.

The standard workday is 8am to 5pm.  Residents assigned to UMMC Department of Psychiatry services are expected to be on site first responders to those services.  This can be extended by call assignments, individual supervision, clinical conferences or tasks related to patient care as long as duty hour regulations are not violated.


Residents may need to adjust arrival or departure times in order to avoid 10 hour violations when switching from evening to night float shifts or if they remain past 10pm Mon-Thur or come in to do rounds prior to 8am. Residents that are at risk of violating work hour rules have an obligation to inform program leadership so that coverage can be arranged to avoid violation. Programs must provide alternative coverage for a resident’s clinical responsibilities if they are found to be too fatigued to continue.

Patient contact in the Outpatient Clinic will be scheduled up to 5pm, with occasional extension into the evening, as is the case with Family Therapy cases, which are scheduled until 6:30pm.

The cutoff for working up new admissions on the Inpatient Services at UMMC is 4:00pm (arrival of the patient on the unit, or accessible in the Emergency Department, or behavioral Emergency Center).  Residents may remain beyond 5pm as long as it does not incur a Duty Hour violation.

Non emergent patient care tasks that become known during assigned didactics should be attended to either between or after didactics.  They are not a sufficient reason to be absent from didactics.

In rare instances residents may remain past their duty hours limit of their own accord to care for a single patient.  Acceptable reasons to work beyond duty hours are limited to required continuity of a single severely ill or unstable patient, academic importance of events that are transpiring, or humanistic attention to the needs of a patient or family.  In these situations the resident will hand over care of all patients and will document the reason for remaining to care for the individual patient in RMS.   If a resident stays beyond their scheduled duty, they must record the justification for the extended time in the “comments” box of their duty hour entry in RMS consistent with MMCGME/RMS software protocol.  The program director will review all comments during the regular duty hour review process.

Reporting

All residents are required to use the Residency Management Suite [RMS] to update and approve their assignments and hours in the duty hours module for all training related activities, including external moonlighting, in a timely manner.  Compliance is considered a part of professional competence.

It is the policy of the Department of Psychiatry that if a resident or fellow does not complete RMS by noon on the 4th working day of the month his or her UMMC Campus parking card will be turned off.  The department will not reimburse parking charges incurred following suspension of a parking card.  The parking card will not be turned on again until RMS is completed.

Program compliance with work hour requirements will be monitored using the following methods:

  1. Annual University of Minnesota Graduate Medical Education Committee survey of resident duty hours.  Violations identified for a specific month require a written response to the GMEC explaining the violation and the measures to be taken to correct the area of non-compliance
  2. Annual ACGME Resident Survey generates confidential reports from residents regarding duty hour compliance.  Violations identified by this process require a written response to the GMEC.
  3. Monthly RMS Duty Hour Violation Reports will be generated by the Program Coordinator for review by the Program Director.  These reports with annotation by the Program Director will be maintained as a continuous log in the coordinator’s office.

 

Repeat nonadherence to this policy by a resident may be reported to the file and may result in a report of a negative event to the resident’s permanent academic file. Resident concerns about continuous work hour violations not adequately addressed by the program can be reported to the Designated Institutional Official at gme@umn.edu. Anonymous reporting of work hour violations can occur via a Qualtrics form. Trainees may also report violations directly to the ACGME.  

This policy is consistent with the Institutional Policy Manual of the University of Minnesota Graduate Education Committee.


UMN GME Leave Policies

Our program adheres to the Institutional Leave Policies as outlined on the linked site.

UMN Psychiatry Residency Program procedures for requesting and documenting.

Scheduled (Vacation) Leave

Unscheduled (Health) Leave

Unscheduled leave shall be granted upon request for up to 10 workdays per year.  Unscheduled leave is not cumulative.  The minimum unit of unscheduled leave is half-day increments. You may use unscheduled (health) leave for scheduled health care.

*Note, it is understood that circumstances may arise in which you are too ill to send an email as directed in this set of procedures. In these cases, please do your best to access urgent medical care and communicate with the program regarding your status as soon as possible.

Please email psychresidencysick@umn.edu by 7AM.

In the title box, put the following - first name, last name and the word OUT

Sample – John Doe OUT

Include the following:

Using unscheduled leave day for UMN Clinic Day (PGY2-4):

In addition to the above steps, there is an additional responsibility when you take unscheduled days from clinic. Please include the following recommendations within the email.

Here are those steps:

  1. Resident will also:

*in a few rare cases, a resident may be too incapacitated to do # 1, in which case we move to #2 Emergency slots or admin time should not automatically be used outside of plan outlined by resident, as resident may be aware of other pts who will likely need these slots.

 

  1. Intake staff calls patients to cancel and communicate f/u recommendation. If the pt is not okay with f/u recommendation, Jeff passes the call to RN for triage to assess needs (#3).

  1. RN calls patient and one of the following steps occurs, depending on RN evaluation

This procedure is NOT for issues involving night float, emergency or call duties.  These need to be managed in context by consulting peers, the chief or designated faculty on call.

Holidays

When on University (UMMC) based services, Residents and Fellows will follow the University’s holiday schedule except when covering on-call services on University of Minnesota Inpatient rotations.  When assigned to other training sites [e.g. MVAHCS] the holiday schedule at that site will govern. Residents are not eligible to use University floating holidays, but when rotating on a University site on the University’s designated floating holiday they do honor that holiday.

Inclement Weather

In the event of inclement weather, trainees should consult with their rotation director/attending to determine how to proceed. Program Administration will email trainees to notify them of University-wide closures.

Professional Leave

All trainees accrue 5 workdays of conference/educational/professional development leave per year, no rollover.  Requests should be submitted to the Chief Resident ASAP for no less than 30 days. One resident is designated to cover. Only one resident may be on vacation or conference leave off a UMMC inpatient adult geographical unit at a specific time (priority goes to earliest date submitted). Title of conference, location and scheduled hours will be requested. If less than 30 days’ notice, the service attending must approve.

A conference is defined as an organized presentation designed to enhance professional development that lasts at least five hours in a day including travel time. Conference time is not granted for self-study or for board prep courses; however, during the PGY1 and PGY2 years, up to (5) days of conference time may be used for studying and taking the USMLE Step-3 exam.  The intent of the use of these days is professional development and education.  If a conference is to be attended to present scholarly work, additional days may be requested if your total number of conference days have been used.  

Occasionally, required or elective rotations, or fellowships, may include off-site educational activities or conferences; for example, attendance at a prolonged exposure training as part of a PTSD clinical elective or presenting a poster at a conference as the outcome of a research elective. These types of activities may not require use of a conference day, per the discretion of the program director.

Mental Health Day on the Hill won’t be charged as a conference day but does require the resident to opt in to go.  This conference is scheduled for the second Thursday of March each year.

Leave Allowances

Year

Scheduled Leave

No rollover

Workdays

[1 day minimum]

Unscheduled Leave

No rollover

Workdays

[0.5 day min]

Conference

Workdays

[0.5 day min]

Military

Workdays

G1

15

10

5

15

G2

15

10

5

15

G3

20

10

5

15

G4

20

10

5

15

Parental

In accordance with University of Minnesota Human Resources policies, parental leave shall be granted upon request as follows:

Leave Type

Duration

Compensation

Parental Leave (maternity, paternity, adoption)

Determined by your fund source.  U of MN = six weeks.

Paid in full

Sick and vacation days (may be used concurrently with parental leave and/or maternity leave)

Variable, depending on resident choice and available days

Paid in full

Additional time away from training

Variable, depending on resident choice and will extend residency according to the ‘time away from training’ policy. Requires program director approval.

Unpaid. Benefits continue. The resident may be required to pay both their portion and the employer’s contribution towards health insurance premiums.

If a trainee has enough leave time, parental leave can be taken up to 12 weeks without having to extend training. If during these 12 weeks they will have any time unpaid (not including the 5 day grace period), their training will be extended. For example, if a trainee takes 6 weeks of parental leave plus 3 weeks of scheduled leave and one week of unscheduled leave (for a total of 10 weeks), they would be unpaid for 2 weeks. They would need to extend their training by only one week since they are given a grace period.

In the case that two or more parental leaves are requested over the course of residency training (including the first year of the child/adol fellowship), all but the first maternity leave periods will extend residency training commensurate with duration of the entire parental leave. The extension of the leave will be no greater than a total of 36 months of training for those residents who enter a Child/Adolescent Fellowship program in their 4th year, and a total of 48 months of training for those residents who complete 4 years in the adult residency program.

In order to ensure ABPN eligibility, the program director will determine if sufficient time has been spent in a given rotation in order to sufficiently meet an ABPN requirement. Leave time may not be used to decrease the length of training.

Departmental Disaster Plan

The department follows the GME Policy: Disaster Planning.

Moonlighting - program limitations and reporting requirements

According to ACGME Psychiatry RRC Guidelines the residency program should not allow activities outside the residency that interfere with education, clinical performance, or clinical patient care responsibilities related to training. Such activities would include all moonlighting [both internal and external, whether on site or home call] commitments and accordingly the program needs accurate information about such activities and needs to give approval.

 

A Moonlighting form must be completed and approved prior to initiation of a moonlighting activity and should be resubmitted if the maximal number of hours per 4 week period changes.   One form should be submitted for each moonlighting site.  Moonlighting activities should not overlap with training activities or schedules [i.e. involve clinical responsibilities (clinical phone calls) during normal work hours (8am-5pm M-F on weekdays excluding vacations, holidays and post-call periods) and should not take the resident away from service duties during normal work hours (8am to 5pm).]

 

All moonlighting activities count towards the 80 hour work week limit averaged over a four week period.

University malpractice insurance does not cover moonlighting activities.  The moonlighting employer must provide malpractice insurance. Moonlighting is not allowed on weekdays between 8:00 a.m. and 5:00 p.m. as residents are expected to be involved with residency matters during that time.

PGY-1 residents are not permitted to moonlight.

UMN GME Moonlighting Policy

Impairment

It is the policy of the University of Minnesota that University personnel will be free of controlled substances.  Chemical abuse affects the health, safety and well being of all members of the University community and restricts the ability of the University to carry out its mission. Similarly, the Department of Psychiatry and Behavioral Sciences recognizes that chemical/ substance abuse or dependency may adversely affect the physician-in-training’s ability to perform efficiently, effectively and in a professional manner.   The department believes that early detection and intervention in these cases constitutes the best means for dealing with this social problem and creates the best environment for providing improved patient care.  Accordingly, the following policy has been adopted.

  1. No resident shall report for assigned duties under the influence of alcohol,

marijuana, controlled substances, or other drugs including those prescribed by a physician that affect his/her alertness, coordination, reaction, response, judgment, decision-making abilities, or adversely impact his/her ability to properly care for patients.

  1. Engaging in the use, sale, possession, distribution, dispensation, transfer or manufacture of illegal drugs or controlled substances may have a negative impact on fellow’s ability to perform his/her duties; therefore, no fellow shall use, sell, possess, distribute, dispense, transfer or manufacture any illegal drug, including marijuana, nor any prescription drug (except as medically prescribed and directed) during working hours, while on rotation at any hospital or institution participating in the training program.
  2. Any violation of this policy may subject the resident to discipline including, but not limited to, suspension and/or termination.
  3. When there is reasonable cause to believe that a fellow may be using, selling, possessing, distributing, dispensing, transferring, or manufacturing any illegal drug, controlled substance, or alcohol, the fellow may be required to undergo medical evaluation and assessment.  The resident’s ability to continue participation in the program will be determined by the Residency Program Director in consultation with attending faculty or the Fellowship Training Committee and the Chairperson, and the Vice Chair of Education.  Actions may include, but are not limited to, recommendation for treatment and return to duty, suspension from duty with pay, suspension from duty without pay, and/or termination.
  4. Depending upon the circumstances, the department may notify appropriate law

enforcement agencies and/or medical licensing boards of any violation of this policy.

  1. Residents who are convicted of a criminal drug statute violation (including DWI, boating tickets, etc.) are required to inform the Residency Program Director or Resident Training Committee or department head of the conviction (in writing) within five (5) calendar days thereof.
  2. Other residents who have reasonable cause to believe that a colleague is using a substance that adversely impacts on the fellow’s performance in the training program must report the factual basis for their concerns to the Residency Program Director.
  3. If a resident is taking a medically authorized substance which may impair his or her job performance, the resident must notify the Residency Director of his or her temporary inability to perform assigned duties.
  4. Residents are encouraged to seek assistance in addressing any problems they might have related to alcohol or substance abuse. The Employee Assistance Program is available to all fellows and their families.  (Please refer to Institutional Manual for contact numbers and descriptive information on these programs.)
  5. Residents must be aware that there are significant criminal penalties, under state and federal law, for the unlawful possession or distribution of alcohol and illicit drugs.  Penalties include prison terms, property forfeiture, and fines.

Grievance / Due Process

The following is an outline of the general scheme proposed for the resolution of grievances which may arise within the residency program.  Detail and clarification must be added as the various elements of these proposals are accepted or rejected or replaced with alternatives.  These guidelines or policies are confined to the process within the Department of Psychiatry with the assumption that appeal of the final action or decision coming from the intradepartmental process will remain a viable option once the departmental grievance process has been completed.

  1. Principles
  1. Definition of the legitimate areas of disagreement to be covered by these procedures.
  2. Provision of ascending levels of recourse with potential for final resolution of the conflict at each of these levels without prejudice to any rights of the involved individuals.
  3. Adherence to the principles of due process, academic freedom and fairness.
  4. Procedures to be readily available and expeditiously executed.
  5. Inclusion of a system of advocacy.
  6. Process to be fully documented.
  1. Grievance Committee for the Psychiatry Residency Program
  1. The committee is ad hoc, appointed by the head of the department with representation of faculty, and affiliated hospital if pertinent, and one or all of three program level ranks of the residency program as well as chief residents as appropriate.
  2. All actions of this committee are considered advisory to the head of the Department of Psychiatry.
  3. All actions of this committee are by a simple majority vote with a quorum present.  A quorum consists of one-half of all the named members of the committee, plus one.
  1. Areas of Potential Grievance Covered by these Guidelines

The areas of possible grievance to be resolved by the following procedures will include, but not be limited to, the following:

  1. Evaluation of resident performance by the faculty.
  2. Assignment or definition of house staff duties.
  3. Interpretation and implementation of other policies and guidelines, such as those  included in this document.
  4. Resident-resident conflicts.
  5. Resident-Chief resident conflicts.
  6. Resident-fellow conflicts.
  7. Resident-faculty conflicts.
  8. Chief resident-faculty conflicts.
  1. Potential Parties to the Process:
  1. Principals in the complaint.
  2. Mentors, as advisors and advocates.
  3. Grievance committee.
  4. Department head and/or a designee.
  1. Grievance Resolution Process

As defined here, resolution will be considered an outcome deemed acceptable to the principals to the complaint.  When resolution is reached, no further steps in the process will be taken and the matter will be considered closed.  This policy assumes that any single principal to the grievance retains the right to carry the process forward by denial of resolution, and to appeal the intradepartmental decision to extra-departmental grievance procedures.

Steps in the process:

  1. Review of complaint with mentor or other ad hoc advisor.

Outcome:  resolved OR taken to step (b)

  1. Informal discussion with other persons deemed appropriate by parties to the complaint.

Outcome:  resolved OR taken to step (c)

  1. Formulation of a formal written complaint.
  2. Forwarding of complaint to the grievance committee, with copies to principals to the complaint and to the head of the department.
  3. Committee review of the complaint with consultation and written minutes, but without tape recording.

Outcome:  resolved with report to the head of the department OR taken to step (f)

  1. Department head reviews the grievance committee actions and recommendations and then advises the parties to the complaint of his decision as to the dispensation of the complaint action.

Outcome:  resolved OR taken to step (g)

  1. If a grievance cannot be settled at the department level, the program leadership or trainee can appeal to the GME office as explained in “GME Policy: Discipline, Dismissal, Failure to Advance”.

Residents Experiencing Difficulties:

Residents may experience a number of different types of difficulties throughout their residency training. In order to ensure a supportive and nurturing training environment, the residency program is responsible for assessing competencies, and providing timely evaluations regularly to the residents. If there is a concern regarding resident performance or wellbeing, the program director may intervene at any time in a variety of ways to provide support, evaluation, and options regarding further training in the program. Concerns regarding resident performance and wellbeing will always be kept as confidential from peers and faculty as possible, involving peers and faculty only as needed for schedule changes, monitoring performance, and providing support and supervision. It is the goal of this process to provide support and feedback while maintaining the dignity of the resident. This process will be used when a resident is not meeting the academic, professional, or administrative expectations of the program. The goal of this process is the success of the resident. Any resident committing an egregious act may be dismissed from direct patient care or from the program outside of the guidelines described herein.

For Physician Scientist Track residents, see this document for processes.

Example sequence of events:

  1. Peer or supervisor notices that a resident is not doing well or having difficulties and checks in with the resident.
  2. Support and direct feedback is offered and the resident is advised to meet with their attending supervisor along with the chief resident.
  3. Once support and direct feedback has been offered to the resident, the peer or the attending supervisor can simultaneously involve the Program Director for guidance and to ensure follow through.
  4. A meeting is then facilitated between the resident, the attending supervisor, Chief Resident and the Program Director to determine how best to support the resident.
  5. Program director meets with the resident individually or with their attending   supervisor / chief resident to assess difficulty.
  6. An Individualized Learning Plan (ILP) is formulated.while moving forward to improve performance within a certain timeframe. This plan is placed in the resident’s file.  If the resident is in the Physician Scientist Track, research will be put on hold while the ILP is in place.
  7. Program director, chief, and supervisor monitor plan.
  8. If successful, specific planned intervention can be ceased.
  9. If not successful, Program Director brings the situation to the Clinical        Competency Committee (CCC - see above for details) for review and recommendations.
  10. Program Director meets with the resident to discuss Academic Probation Plan recommendations from CCC. This plan is placed in the resident’s file.  If the resident is in the Physician Scientist Track, they will be removed from this track when placed on probation.
  11. Program director, chief, and supervisor monitor the Academic Probation plan.
  12. If successful, specific probationary intervention can be ceased.
  13. If not successful, Program Director brings the situation back to CCC, may consider additional probationary period to see improvement or consider resident exiting the program.
  14. Formal probation requires report to future licensing and credentialing bodies.

Example options presented to resident upon discussion of concern:

  1. Enact Individualized Learning Plan (ILP) with the guidance of Program Director, chief, and supervisors.
  2. Regular meetings with chief, supervisors, or Program Director to provide support.
  3. Change in schedule to accommodate medical condition or special situation.
  4. Leave of absence
  5. Resignation
  6. Termination

Individualized Learning Plan: This letter provides the resident with (a) notice of the specific areas of concern, (b) an opportunity to improve with a plan and timeline.

The issuance of an Individualized Learning Plan does not trigger a report to any outside agencies. If the resident satisfactorily resolves the concerns noted in the Individualized Learning Plan, and continues to perform acceptably thereafter, the period of unacceptable academic performance does not affect the resident’s intended career development.

The issuance of an Individualized Learning Plan is not subject to appeal.

Academic probation is a resultant action when an Individualized Learning Plan (ILP) at the departmental level has not been successful and continuation of the resident in the training program is in jeopardy.  The resident may be placed on probation by the Program Director for severe infractions of program rules or if the resident’s performance does not meet the standards set by their residency program. This may be based upon poor academic performance, unprofessional attitude, inattention to responsibilities or other inadequacies.

The resident will receive written notification that he/she has been placed on probation. This will include the reasons for this action, the detailed areas of concern, a specific planned intervention, and an end date for an evaluation of the probationary period. The resident has the right to appeal this decision as described in the Grievance and Due Process Policy. During the Grievance and Due Process procedure the resident must abide by the stipulations of the probation. After the probation period, the Program Director will re-evaluate the resident and recommend one of the following:

  1. Removal of probation
  2. Continuation of probation
  3. Election not to promote to the next PGY level
  4. Required repetition of a rotation that in turn extends the required period of   training
  5. Denial of credit for previously completed rotations
  6. Dismissal/termination

In cases of termination, training certification shall be granted for a period of months of acceptable service.

Medical Conditions: Residents who have a medical condition which affects performance, or for which accommodations are needed, must go through the UReturn office. The UReturn office will provide the Program Director with a letter requesting accommodations from the program, as directed by the resident’s medical provider or therapist.

Residents are allowed to implement the institution’s grievance procedures if they have received a written notice of non-promotion or non-renewal of their contract, unless the reason for non- renewal or non-promotion is non-compliance with the USMLE Step 2 & 3 / COMLEX Level 2 & 3 policy.

Reportable actions: Reportable Actions are those actions that the Program must disclose to others upon request, including without limitation, future employers, privileging hospitals, and licensing and specialty boards. House officers who are subject to a Reportable Action may request an appeal of the decision as provided in the Policy for Grievance and Due Process.

  1. Non-promotion to the next PGY level
  2. Extension of a contract in order to complete required training
  3. Probation
  4. Nonrenewal of contract
  5. Dismissal

Conflict of Interest:  In any case of a potential conflict of interest on the part of the Program Director or Assistant Dean for Academic Affairs, the Chair of the Graduate Academic Affairs Committee and the Dean of the College will select an appropriate replacement.

DISMISSAL

  1. A Program Director may direct that a housestaff member be dismissed during the term of his/her contract for unsatisfactory performance or conduct. Reasons for dismissal may include but are not limited to:

a. Failure to achieve the learning objectives of the program in which the individual is training.

b. Substandard clinical practice and judgment which may present a compromise to acceptable standards of patient care, or jeopardizes patient welfare.

c. Failure to develop sufficient technical skills.

d. Failure to develop sufficient supervisory skills.

e. Excessive tardiness and/or absenteeism, which effectively disrupts training.

f. Unethical, illegal, or unprofessional conduct.

g. Non-compliance with AHS policies and standards.

h. Non-compliance with the State Board of Medical Examiners regulations.

     2.  The recommendation of the Program Director for dismissal shall be in writing to

resident/fellow, with a copy to the DIO, outlining the areas deemed unsatisfactory and the reasons for dismissal. Dismissal in these situations implies poor performance or malfeasance and is subject to the Medical School appeal policy.  

     3. The Designated Institutional Official will be notified in advance of this action.

Scenario Example 1:

Aaron is a single parent and is having difficulty balancing his clinical responsibilities and the care of his children. It is noticed by his attendings and peers that he is often late to his clinical rotation, may not be prepared for seeing patients, and appears fatigued and inattentive at times. His colleagues have also noticed that he appears stressed. Aaron’s on-site attending checks in with him about the above observations.  Aaron is tearful and admits to having a difficult time coping with the stress of residency while being a single parent. Because of individual privacy concerns related to his employment in the residency program, steps taken to offer support and complete an evaluation of Aaron’s clinical performance will not be disclosed to his peers, but will take place with discretion. The attending offers support and recommends that Aaron and the chief resident meet with the Program Director together to figure out how best to support him.  At this meeting, Aaron is connected with mental health services.  When asked, Aaron states that he feels that he would be able to safely manage his patients with some accommodations.  An accommodation is formulated at this meeting.  This includes, a late-start clinic schedule allowing Aaron to drop his kids off at school. He would still see the same number of patients/day but the timing could be changed to adjust to his needs to be successful. He may consider seeing a therapist, and he would be excused from clinical duties to attend these appointments. Aaron may have regular check-in meetings with the chief and his attending supervisor to review how these accommodations are going and assess for further needs.

At one of these check-in meetings, Aaron admits to still having difficulty coping with the stress despite the above accommodations. His evaluations also show that he is requiring a higher level of supervision due to errors which might risk patient safety. After discussion between Aaron and the Program Director, Aaron chooses to take a leave of absence from the program to attend to his personal life and determine a plan moving forward. He agrees to continue seeing his therapist. His patients are dispersed to other residents, and some of his peers may be asked to cover some of his call shifts. Aaron is asked how the program should disclose his leave of absence and he states that he would prefer to tell his peers on a need to know basis  Being mindful of Aaron’s request for privacy, the program only announces that he is taking a leave of absence from the program while keeping the details private.

After his leave of absence, Aaron was able to enact a change to his schedule with his children, allowing him to engage more fully with work. Upon return to the program, Aaron’s performance continued to be monitored for a few months to ensure patient safety. When the performance concern was determined to be resolved, he returned to the program without the need for additional monitoring or supervision.

Scenario Example 2:

Suzette is found by security to be smoking marijuana in the call room one night during her night float shift. This is reported to the program director by security the next day. The program director along with the chief resident meets with Suzette who admitted to having a stressful time in her marriage and with the responsibilities of being a resident. She stated that she has been using cannabis recreationally for a long time but until now had not used cannabis while at work until now. She is extremely apologetic and distraught. The Program Director offers her support and connects her to counselling services. The Program Director explains the obligation of the program to patient safety given her substance use.  The remediation policy is reviewed with Suzette in detail and she is removed from duty.  Because of the severity of the infraction, the program director places Suzette in probation and encourages her to report herself to the Health Professionals Service Program (www.hpsp.state.mn.us), which she does so that they can guide the program and Suzette about her resume her duties moving forward. She will likely need to see a physician to address any medical problems which are contributing to this event. The Program Director will convene the CCC to discuss the Probation plan and a copy of the probation plan will be given to the resident.

 

Employee Assistance Program (EAP)

Physicians Wellness Collaborative, a program of Physicians Serving Physicians, provides independent, confidential counseling and peer support resources for all Minnesota physicians, residents, and medical students.

The support you need as a physician, resident or medical student is just a phone call away. It's safe, confidential and offered at no cost to you and your family members. There is no judgment, only help from an organization with over 35 years of experience offering confidential peer support to physicians. If you or someone you know could benefit, we are available 24/7 for urgent consultation and ongoing support.

Wellness Support: Minnesota physicians, residents, medical students, and their immediate family members qualify for five confidential counseling sessions at no cost to them. Sessions may address stressors such as depression and anxiety, relationship issues, job stress, financial concerns, and loss and grief.

Substance Use Support: Physicians Serving Physicians was formed in 1981 by a group of physicians in recovery to help other physicians and their families with substance use disorders. We have supported over 1,000 physicians through their recovery to return to successful practice.

Phone: 612-362-3747

Physicians Wellness Collaborative Website

The VITAL WorkLife Program, a free resource generously purchased for all M Physicians for ALL UMN residents and fellows, is now available! The program aims to provide you resources to assist with childcare and eldercare, financial and legal advice, job coaching and leadership training, retirement planning, and identifying counselors for you and your family members.

-Peer Coaching

-Finding Joy, Meaning & Purpose in Medicine

-Communication & Conflict Resolution

-Stress & Burnout

-Work/Life Integration

-Identifying Limits & Setting Boundaries

-Establishing Healthy Habits

-Leadership Development

In-Person and Phone Counseling: Confidential, non-diagnostic counseling with our master’s and doctorate level professionals.

Legal & Financial Consultations and Resources

You may reference their website or give them a call at (877) 731-3949.

Vital Worklife Flyer

Other resources for health of residents and fellows may be found at this website.

Post-incident support and debriefing

We do have a critical incident support and debriefing procedures, in the case that the resident experiences the death of a patient or an unintended or poor patient outcome, or any kind of stressful event in their professional or personal life. To activate this process, please contact the chief resident or the residency administrator.

State Medical Board Licensure Requirements

A Minnesota State License is only required if the resident will be moonlighting.

Medical Records Procedures

Residents will be trained in using the Electronic Medical Record at UMMC and MVAHCS for inpatient and outpatient activities.  Medical records may be accessed 24 hours a day through the electronic medical record. It is not permitted to use the EMR for any purpose that is not directly work-related, for example checking files of self or family members, people for whom there is not a clinical necessity, or for messaging purposes with clinicians for the purposes of coordinating your own care, or the care of family members.

Pharmacy Procedures

The resident is required to follow the pharmacy procedures outlined at the clinical site at which they are assigned.

Clinic Procedures

The resident is required to follow the clinic procedures outlined at the clinical site at which they are assigned.

Needle Stick Procedures - Infection Control

Please refer to the Needle Sticks and Blood Borne Pathogen Exposure Management Process.

Patient Safety Procedures

Training

Safety Always training is a requirement for all faculty, learners and all hospital employees.

Reporting and Review

Any individual who witnesses a safety event is strongly encouraged to complete an incident report so that the event can be appropriately reviewed. In addition to incident reporting, learners are encouraged to attend Root Cause Analyses, Case-based Conference, Safety Huddles, and other activities to review and improve patient safety. Immediate and pressing safety concerns should always be escalated in the moment to appropriate attending physicians or unit nurse managers.

The Resident Chief Resident or Fellowship Program Director can supply additional site or specialty specific safety information. Thi website contains information about how to file an incident report at different clinical sites: z.umn.edu/ReportGuide.

Residency Management System

Residents will use New Innovations (RMS), a web-based system, to evaluate their attending physician, supervisor, their specific rotation, the site, didactics, and lecturers.  Residents are notified each month via email that they have evaluations to complete. Once notified, residents can access computers at each hospital site or from home and can log onto the Internet to complete their evaluations.

Attending physicians will be able to view information on themselves after three or more evaluations have been completed by a resident or medical student. The information will be an accumulation of comments rather than individual comments to guarantee anonymity for the residents and medical students. Residents and medical students will be able to view an evaluation on themselves completed by an attending physician once that resident or medical student has completed an evaluation on that particular attending physician.

New Innovations will also be used for your semi-annual reviews with the program director.  In addition you will be able to log scholarly activity, view didactic schedules, complete didactic surveys and view rotation schedules.  

Institutional Committees

The Graduate Medical Education Committee (GMEC) exists to provide administrative oversight to graduate medical education programs at the University of Minnesota. This includes maintenance of individual program accreditation and assuring adequate institutional support.

Our GMEC voting membership includes a representative sample of program directors (from residency and fellowship programs, and from across sizes and specialties of program), GMEC Resident Leadership Council members, an education manager, a program coordinator, representatives from affiliated training sites, and select positions across the UMN Medical School.  Refer to the GMEC charter for a full list of membership.  Given the nature of work conducted by the group it is important that voting members (or their designee) attend on a regular basis.  All interested individuals are also welcome to attend.

The GMEC meetings are held the 4th Tuesday of each month. The meeting takes place from 3:30-4:30 PM in B-646 Mayo. Immediately following the meeting there is a 30 minute faculty developement session from 4:30-5:00 PM.

Benefits, Information, and Resources

Paychecks/Payroll

Effective June, 2022, for Residents in the Department of Psychiatry, stipends are as noted below.  Paychecks are biweekly.  Pay statements are available online through the Employee/Staff self-serve website (http://www.hrss.umn.edu/).

PGY Year

BASE STIPEND

PGY-1

$61,281

PGY-2

$63,167

PGY-3

$65,313

PGY-4

$67,403

http://www.med.umn.edu/residents-fellows/current-residents-fellows/stipends-benefits

Trainees are paid an annual stipend as stated in the Residency/Fellowship Agreement and in the program's Policy Manual.  Trainees receive their stipend via a biweekly paycheck.  Trainees are encouraged to use the direct deposit system, as physical checks have the potential of being lost or delayed in the mail.  Paychecks are mailed or credited to bank accounts of those using the direct-deposit system on these payroll dates.

Insurance

Health

Beginning July 1, your medical coverage will be provided by Blue Cross and Blue Shield of Minnesota. If you have questions regarding medical coverage or your policy information, contact Blue Cross at 651-662-5004 or visit www.bluecrossmn.com/umnrfi.

Dental

Delta Dental of MN provides dental network and claims administration services for University of Minnesota Medical School residents and fellows. Delta Dental members have access to both PPO and Premier providers. Medical School residents and fellows who enroll in the University-sponsored Delta Dental plan (and enrolled dependents) are automatically eligible for Continuation of care through COBRA at the end of their residency or fellowship.   This benefit is administered by the Office of Student Health Benefits (http://www.shb.umn.edu/).

Life

Medical School residents and fellows are automatically enrolled in a $50,000 standard life Minnesota Life insurance policy. Enrollment is no cost to Medical School residents and fellows (the cost is covered by your department). In addition to the standard plan, residents and fellows have the option to purchase voluntary life insurance for themselves or their dependents at low group rates through Minnesota Life. Medical School residents and fellows are automatically eligible for Continuation of life insurance coverage through COBRA at the end of their residency or fellowship.   This benefit is administered by the Office of Student Health Benefits (http://www.shb.umn.edu/).

Professional Liability

Professional liability insurance is provided by the Regents of the University of Minnesota. The insurance carrier is RUMINO Limited. Coverage limits are $1,000,000 each claim/$3,000,000 each occurrence and form of insurance is claims made. “Tail” coverage is automatically provided. The policy number is RUM-1005-14. Coverage is in effect only while acting within the scope of your duties as a trainee. Claims arising out of extracurricular professional activities (i.e. internal or external moonlighting) are not covered.  Coverage is not provided during unpaid leaves of absence.   Professional Liability Insurance Information:  https://sites.google.com/a/umn.edu/medcred/

Disability

Medical School residents and fellows are automatically enrolled in a long and short term disability insurance policy. Short-term disability insurance provides you with income protection of 70% of your income up to $1,000 weekly benefit maximum when an injury, sickness, or pregnancy results in your continuous disability. Benefits are paid from the 15th day of a disability after a 14-day waiting period. The maximum duration of short-term disability benefits is 11 weeks. Long-term disability insurance provides you with income protection of 80% of your income up to $5,000 monthly benefit maximum if you are continuously disabled for more than 90 days. Coverage continues as long as you are certified disabled by Guardian. The maximum period that you are eligible to receive benefits is up to your Social Security normal retirement age.

Optional Individual Disability Policy:

The University of Minnesota offers a Guaranteed Standard Issue (GSI) plan from Foster Klima. This plan allows you to convert the group disability insurance you had as a resident or fellow to an individual disability policy, regardless of any pre-existing medical conditions. Under this plan, residents/fellows could receive benefits of up to $10,000 per month if one becomes disabled. The cost of individual coverage is guaranteed for the life of the policy. Cost of living protection can be added to your coverage (additional premium applies). Retirement assets would be protected. This individual coverage is fully portable, meaning it goes with after leaving the University. Residents/fellows may optionally enroll in the GSI plan at any time during residency or fellowship and up to six months after completion of training.

Enrollment is no cost to Medical School residents and fellows (the cost is covered by your department). Guardian offers Medical School residents and fellows up to $10,000 per month of individual coverage. In addition, Guardian offers a Student Loan Payoff benefit effective if you become disabled while you are a resident. Guardian also offers a unique Guaranteed Standard Issue Plan option. Residents and fellows have the options to purchase long term disability coverage that you can take with you upon completion of your residency/fellowship regardless of any pre-existing medical conditions—25-30 percent of residents and fellows would not otherwise qualify for this type of coverage due to pre-existing medical conditions.  This benefit is administered by the Office of Student Health Benefits (http://shb.umn.edu/health-plans/rfi)

Worker’s Compensation

Worker’s Compensation is available through the department.  The University of Minnesota UReturn Office will serve as an intermediary for all medical and disability related issues to protect the privacy of the resident. See the program coordinator for assistance.

Systems and Communication

Email

Resident/Fellow e-mail addresses are not activated until initiation of the account with a password.  This is completed at https://www.umn.edu/initiate.  Computer workstations are provided in the Residency Room [F248] so that residents can access their e-mail and complete required RMS applications.  It is expected that residents will check their University e-mail account daily during the workweek.  Required notices as well as surveys and requests are distributed through the University e-mail account.

Campus mail

A campus and U.S. mailbox is located in the psychiatry department.  

Campus mail stop address:  Department of Psychiatry, UMMC-Riverside, F282/2A West.  

US Mail address: Department of Psychiatry, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454-1495.

Physical Location address (for deliveries or giving directions): University of Minnesota Medical Center, Fairview, Department of Psychiatry, 2312 South 6th St., Minneapolis, MN 55454-1495

Cell Phone

Cell phone numbers will be entered into RMS and will be used as back-up for communication.

Pager

Upon entering the Residency Training Program, pagers are obtained from the Residency Administrator after the appropriate paperwork is completed. All pagers must be returned to the Residency Office when the resident’s training period has been completed. If a resident prefers to have pages electronically transferred to their smartphone, please discuss with the residency administrator.  The current fee for a lost pager is $65 plus tax.

Access to institutional programs and databases

Link to GME website

Stipends

Trainees are paid an annual stipend as stated in the Residency/Fellowship Agreement and in the program's Policy Manual.  Trainees receive their stipend via a biweekly paycheck.  Trainees are encouraged to use the direct deposit system, as physical checks have the potential of being lost or delayed in the mail.  Paychecks are mailed or credited to bank accounts of those using the direct-deposit system on these payroll dates.

Laundry Services

Laundry service is not provided.

Parking

The resident/fellow will pay a $25 refundable deposit for a parking card that gives them complimentary access to the Riverside Campus Parking Ramps.  Other University parking will have to be arranged with the Parking Office. The parking card may be disabled by a program representative per policy for failure to complete duty hour documentation in the RMS system or failure to complete clinical documentation in a timely manner.  www.pts.umn.edu

On-Call

At the University of Minnesota Medical Center (UMMC) there are two types of off-hour assignments.  One is designated “on-call” because it is assigned for specific daily periods.  The second is Emergency (ER) and Night Float assignments, which are formal training rotations.

Schedule

The Call Schedule is constructed to provide 24-hour responsibilities of trainees to admit patients to the hospital, accept crisis telephone calls from outpatients and address urgent inpatient care matters.  The assignments have been designated as follows:

 

ER Resident (formal training rotation):  Duty shift is from 5p-1am, except when transitioning from the night float rotation to allow 10 hours between shifts, Monday through Thursday.  On Friday night, the ER resident call shift is from 5p-8am.  Saturday and Sunday are free of duty.  In the event the emergency resident is ill on Monday through Thursday the resident for that evening will serve from 5p-8am and provide supervision for the short call resident.  On Friday the night float resident will take the 5pm to 8am shift.

Night Float (formal training rotation): Duty shift is from 9:00pm-8:00am on Sunday through Thursday night.  No duty periods are scheduled for Friday and Saturday.  In the event the night float resident is ill on Monday through Thursday the ER resident will remain until 8am (if there is a following ER shift this will begin at 6pm).  If the float resident is ill on Sunday, the solo call resident assigned for Sunday will remain until 8am the following day.  They will assume no new patients after 8AM and their shift will end no later than noon on the following day.

Day Float: The Day float provides back-up coverage for residents serving on the adult inpatient units who may be sick or on vacation Monday through Thursday.  The Day Float resident also covers call on Sunday 8a-9pm and participates in Holiday call on a rotating basis.  No other call is taken during this rotation. 

 

PGY2 residents serving on UMMC Inpatient rotations provide in house on-call coverage in 12-24 hour shifts on Saturdays and Holidays.  At least one day per week on average over the course of 4 weeks is free of call.

 

PGY1 residents serving on UMMC Inpatient rotations provide in house on-call coverage Mon-Thurs 5pm-9pm and on Fridays, 5pm to midnight.  Residents serve concurrently with and are supervised by the ER resident [a PGY2 resident].

 

If the on-call resident is ill, (Day Float, PGY1s and PGY2s serving the inpatient psychiatry rotations) it is that resident’s responsibility to find his/her replacement.  In most instances this would involve arranging to trade call assignments with another resident.  To facilitate this process, the Residency Coordinator will create a resident contact list to be distributed by email to all residents.  In the unusual circumstance that a resident is unable to contact other residents the Chief Resident (or their designee) will facilitate this process.  The Chief Resident will maintain a log of duty changes.

 

When possible, the PGY1 MVAHCS inpatient assignment will align with a PGY2 geropsychiatry or consult-liaison rotation, with call duties to be assigned concurrently to allow the PGY2 resident to supervise the PGY1 resident.  When this is not possible, PGY1 residents on call will be supervised by the psychiatrist on duty who is a PGY2 or above in the University of Minnesota residency program.  This individual is in-house during the entire call period and will directly supervise the PGY1 resident. Call assignments will comply with all ACGME regulations.

 

Call while serving on Pediatrics, Neurology and Internal Medicine rotations is determined by these services and must comply with ACGME regulations.

 

Residents in the PGY3 and 4 years do not provide call coverage.  Internal and external moonlighting must be approved by the Program Director and logged on RMS.  Moonlighting commitments cannot lead to duty hour violations or interfere with training activities.  The Program Director receives a comprehensive written report of all duty hour violations for each 4-week rotation period and determines the cause and solution for each violation.

Room information

The Trainee workroom located on the second floor of the UMMC Riverside West Building is locked with a keypad and is accessible at all times for residents to work and/or rest.

Outpatient Note Delinquency Policy

Outpatient EMR notes are required to be ready for attending signature by the end of 48 hours for evaluations and progress notes.  Compliance is considered aspects of Professionalism and Patient Care.  Depending on circumstances, failure to remediate deficiencies can lead to a negative report to the academic file, withdrawal of approval for moonlighting activities, probation, non-credit for rotation and dismissal.  

Parking cards will be shut off for Residents who have five or greater encounters that are greater than seven days old.

1) The administrative resident will review the clinic managers weekly list of open encounters.

2) If a general adult resident has five or more open encounters that are greater than a week old, the administrative resident will identify the encounter and verify whether the resident has completed all necessary components. Residents will not be penalized if an encounter remains open because faculty has not signed the note (this will not be counted to the five or greater threshold). 

3) The administrative resident will send a page to residents who do not meet this expectation and alert them that their parking card will be turned off.

4) Residents can resolve open encounters through Tuesday morning. If encounters have not been routed to attending physicians by Tuesday morning, the administrative resident will turn off parking cards.

5) To turn parking cards back on, residents will need to alert me by email, page, or in person that the open encounters have been resolved.

Rules and Guidelines for Medical Students and Residents on Interactions with Industry Representatives

The Medical School, Graduate Medical Education Committee, Department of Psychiatry and the University of Minnesota do not have specific policies regarding interaction with industry representatives (hereafter representatives).  The University of Minnesota Medical Center and the Minneapolis VA Medical Center do have policies.  There are no Department of Psychiatry  restrictions regarding the access of representatives to public areas that are assigned to the Department of Psychiatry.

Interactions with Industry occur in a variety of contexts, including marketing of new pharmaceutical products, medical devices, and hospital and research equipment and supplies on-site, on-site training of newly purchased devices, the development of new devices, educational support of medical students and trainees, and continuing medical education. These interactions must be ethical and cannot create conflicts of interest (COI) that could endanger patient safety, data integrity, the integrity of our education and training programs, or the reputation of either the faculty member or the institution. 

Residents may not accept gifts from Industry in the context of their assigned duties. It is strongly advised that no form of personal gift from Industry be accepted under any circumstances. Individuals should be aware of other applicable policies, such as the AMA Statement on Gifts to Physicians from Industry and the Accreditation Council for Continuing Medical Education Standards for Commercial Support. Free drug samples are considered gifts under this policy and may not be accepted.

The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. The Centers for Medicare & Medicaid Services (CMS) has been charged with implementing the Sunshine Act and has called it the Open Payments Program. As part of this program, manufacturers now are required to submit annual data on payment and other transfers of value that they make to covered recipients. This data is publicly available.

Sales and marketing representatives are not permitted in any patient care areas except to provide in-service training on devices and other equipment and then only by appointment. During work hours, residents may only interact with industry representatives in the presence of a faculty member. Presentations will not be facilitated by the residency program.

Personal information (pager, address, cell phone) about students or residents will not be distributed to representatives.

Representatives will not be given access to the resident room (F248) or the student room (F228).

Students and residents should not take items bearing the name of a product into patient care areas (this includes notebooks, pens, clipboards, etc.).

Administrative Support Services

There are no dedicated clerical services available to residents and fellows.  There are computers available with software to support most needs.  For projects that may require support see the Psychiatry Residency Coordinator

Lactation Services

Residents are encouraged to alert the program if they are planning lactation needs while at work. For UMMC clinical assignments, the residency observes the Departmental lactation policy. If there are needs beyond this policy, residents may contact UReturn, with a letter from their medical provider describing their needs. UReturn will send a letter of accommodation request to the residency which will allow the residency to further adjust the resident’s schedule to meet their lactation needs.  The residency strongly encourages new lactating residents to meet with the residency director to plan out possible lactation needs so that the schedule can be planned out to support the needs of the resident as successfully as possible.

University of Minnesota Resources

Medical School Resources

Laboratory/Pathology/Radiology Services

There are in-hospital laboratory, pathology and radiology services available to residents and fellows for patient care.  The lab is open 24-hours a day.

Security/Personal Safety

UMMC has an in-house security staff.  Campus Courtesy phones located throughout the campus can be used to report emergencies or to request assistance.  Dial 9-1-1- or 888 for Security.  To reach Campus Police dial-6000. Escort service is also available 24-hours a day on the Riverside Campus by dialing 612-273-4544.  The resident’s room and call room is kept locked 24-hours a day.

The Residency Program acknowledges the utmost importance of promoting a safe and healthy training environment with the goals of minimizing the risk of injury in training, providing procedures to report unsafe training conditions, and providing mechanisms to take corrective action.

 

Psychiatry residents undergo safety training as part of their orientation, including techniques to de-escalate anger and aggression.  All psychiatry residents’ experiences of verbal threats, physical intimidation, and physical assault by patients are monitored and reported to the Training Office.  In case of an assault:

  1. The psychiatry resident notifies his/her primary attending at the appropriate training site, and/or the on-call attending in case the incident happened while the resident was on-call.
  2. The primary attending works with the psychiatry resident to decide if a medical evaluation is indicated. At that time a decision is made whether the resident should continue with their duty or be discharged from their duty for the remainder of the day or call.
  3. The primary attending then notifies: the Vice Chair for Clinical Affairs, the program chief resident and the training director.
  4. The chief of clinical service considers an alternative disposition and/or provider for the patient who initiated the threat or assault. The patient is assessed for continuous dangerousness.
  5. The training program immediately assesses the resident’s needs following an assault (with more serious events requiring a more prompt response). The training program in collaboration with the resident will assess whether ongoing supervision with a chosen supervisor or a referral for psychiatric evaluation and/or care is indicated. In addition, the training director with the chief resident may determine whether provision of debriefing and support for all residents in the program is indicated.
  6. The training program coordinates administrative issues that may arise such as scheduling time off or changing the call schedule. The training office checks that these procedures have been followed and addressed, so that the burden is removed from the resident.

Lab coats and scrubs

All designated individuals shall wear a photo identification badge issued by the medical center. The photo identification is to be worn above the waist, with the photograph visible, and with no alteration to the photo or information on the badge. It is to be worn at all times except when removal is necessary for safety during Behavioral Control procedures.  Good personal hygiene is required.  Footwear and stockings will be worn at all times on inpatient units.  Stockings are optional in outpatient programs.  Clothing must be consistent with a professional image appropriate to a health care setting.  Clothing is to be neat, pressed, clean, non-transparent and will comfortably allow full range of motion.  Scrubs are acceptable but should be distinct from the type given to our patients.  Clothing that exposes midriff, hips, lower back, buttocks, breasts, chest, cleavage, and underwear of all types are unacceptable in the workplace.  In addition the following items are not to be worn:  halter tops, tank tops, sweatpants, shorts, workout clothes, shirts with pictures, symbols or writing beyond brand identification and clothing that is un-hemmed, torn, frayed, ripped or in disrepair.  Tattoos which have disturbing, violent, provocative, or frightening content are not to be visible.  Jewelry including piercings must be limited for safety and must present a professional image to our patients, families, and others.  Artificial fingernails, enhancements or extenders are prohibited for direct physical caregivers. Anything applied to natural other than polish is considered an enhancement. This includes, but not limited to artificial nails, tips, wraps, appliqués, acrylics, gels and any additional items applied to the nail surface. Gloves are not an acceptable alternative.  It is each employee’s responsibility to adhere to these guidelines.  It is not practical to attempt to delineate every unacceptable clothing option. Managers will intervene when they have a concern that the goals of safety, infection prevention, professionalism and healing environment are being compromised by dress choices of questionable taste or appropriateness.  Intervention may include counseling, corrective action or requiring the employee to change into scrubs.

Meal Tickets

Residents and Fellows who are on-call for a service and are required to remain in the hospital are eligible to receive complimentary evening and morning meals (noon meals on weekends) in the hospital cafeteria. A swipe card will be provided to residents serving this function.  In addition, residents/fellows may receive complimentary meals when special scheduling requires their presence beyond the normal duty hours, based on the following criteria:

  1. The breakfast meal, when called into the hospital after hours and remaining in the hospital overnight.
  2. Other exceptional circumstances when a program deems complimentary meals as an integral component of education and practice, upon request to UMMC.

Departmental funding for travel, book and educational funds

Residents may be reimbursed for education or travel expenses incurred related to program activities. Technology, of any kind, is not a reimbursable expense.

Appropriate documentation, including receipts will be required for reimbursement. These funds are dependent on current funding and will be assessed at the end of each academic year.  The following table summarizes the amount of eligible reimbursement per PG year for this academic year:

PGY-1

$350.00

PGY -2

$200.00

PGY-3

$200.00

PGY-4

$200.00

The cost of resident academic poster printing will be reimbursed through the University of Minnesota Foundation Eric Brown Resident Fund, if funds are available.

Also, in thanks to the generosity of the Nissen fund to support psychiatry trainee research, psychiatry residents, fellows, psychology trainees rotating within our department, and medical students highly committed to the field of psychiatry are eligible to receive up to $1000 in grant support for academic conference participation (travel, registration fees, lodging, and/or transportation). Trainees must provide evidence they are presenting scholarly work, such as a poster, workshop, or other similar activity. There is a limited number of grants per academic year based on available funds. Travel grants are not guaranteed and will vary based on number of interested trainees, and previous grant awards. Criteria is subject to change. The Department of Psychiatry Education Council serves as the administering body of these grants and will make any necessary determinations related to the nature of the scholarly work and if a sufficient minimal threshold of eligibility is met. Grants may be requested by completing the request form available on the residency website.

Employee-Student Health Services

https://shb.umn.edu/health-plans/rfi

Medical Library and Services

https://hsl.lib.umn.edu/

Local Information and Links

https://www.minneapolis.org/

https://www.visitsaintpaul.com/

Confirmation of Receipt of your Program Policy Manual and Fellowship addendum

 

By signing this document you are confirming that you have received and reviewed your Program Policy Manual and Fellowship addendum, if applicable, for this academic year.  This policy manual contains policies and procedures pertinent to your training program.  This receipt will be kept in your personnel file.

Academic Year __________________

 

Trainee Name (Please print) _______________________________________________

 

 

Trainee Signature ________________________________________________________

 

Date __________________

 

 

 

Coordinator Initials ________________

 

Date __________________