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First Year (PGY-1) Rotations
In the first post-graduate year (PGY-1), psychiatry residents will rotate through Scripps Mercy Hospital’s acute care inpatient program for 28 weeks. This 36-bed unit is divided into the psychiatric ICU and the main unit and offers trainees an opportunity to master acute management of psychiatric conditions through their work with the diverse patient population and the multidisciplinary team, involving psychiatrists, physicians from other specialties, psychologists, nurses, social workers and other providers. Residents will be exposed to and learn a wide spectrum of psychiatric illnesses gaining competence in the use of comprehensive biopsychosocial assessment characterized by cultural diversity, gender and/or sexual orientation, age and socioeconomic status. In this acute setting, residents will learn commitment laws, management of emergency psychiatric situations through the use of psychopharmacology and de-escalation, psychopathology and substance misuse. Gaining knowledge in supportive psychotherapy and group psychotherapy will be a focus during this rotation. Residents are always under the direct clinical responsibility and supervision of a board‐certified psychiatry faculty/attending and/or senior resident physician when seeing patients.
Inpatient Internal Medicine
PGY-1 residents will complete eight weeks of inpatient internal medicine during at Scripps Mercy Hospital San Diego. The residents will acquire general medicine skills, build foundational knowledge relevant to the practice of psychiatry and develop patient care skills through exposure to medically hospitalized patients with a full scope of common medical problems. Interns will have the opportunity to work as part of a four-member physician team consisting of a family medicine intern and a senior family medicine resident, practicing under the supervision of a board-certified internist. Residents will round on patients, perform history and physicals, order appropriate diagnostic and laboratory tests, formulate differential diagnoses and develop treatment plans, with the main aim of providing compassionate, evidence‐based, cost‐effective patient-centered care as a member of a multidisciplinary team.
Family Medicine Outpatient Clinic
The family medicine rotation is an eight-week, full-time equivalent rotation that will occur during the PGY‐1 year. Residents will rotate through the family medicine outpatient clinic at City Heights Family Health Center and will work closely with a board-certified family medicine physician.
Residents will gain knowledge and understanding in preventive medicine, as well as different medical disorders in the adult population such as infectious diseases, cardiovascular, gastrointestinal tract, pulmonary diseases, family planning/prenatal care and their management. This will also entail working with other disciplines. Residents will be able to obtain history from patients and their families, perform thorough physical examinations, order appropriate investigative tests and appropriately interpret them and diagnose different medical disorders. Residents will also collaborate with other specialists and providers to help patients address their medical needs.
Neurology Outpatient Clinic
The outpatient neurology psychiatry experience is an eight-week, full-time equivalent rotation that will occur during the PGY‐1 year. Residents will rotate through the neurology clinic at Hillcrest Family Health Center and will work closely with a board-certified neurologist to gain knowledge and understanding in neurological disorders and their overlap with psychiatric conditions.
Residents will gain experience and develop proficiency in data gathering from patients and their families struggling with different neurological disorders such as headache, strokes, traumatic brain injury, epilepsy, movement disorders, neuromuscular and/or genetic diseases. Residents will be able to learn comprehensive neurological examination, order appropriate investigative tests and appropriately interpret them. Residents will also learn pharmacological and non-pharmacological treatment options.
Residents will also gain knowledge in neuroimaging including EEG, MRI and head CT scan through their rotation once a month at Scripps Mercy neurology service.
Second Year (PGY-2) Rotations
The PGY‐2 resident will continue to develop proficiency in comprehensive biopsychosocial assessment and continuous, evidence-based management of patients with conditions commonly found in the inpatient setting through their significant responsibility for the assessment and treatment of acutely ill adult psychiatric patients. During this rotation, residents will gain deeper understanding of family structure and family therapy, as well as other psychotherapeutic techniques. In addition, residents will gain leadership rules by offering supervision and guidance to the junior residents.
Residents will have an eight-week consult‐liaison (C‐L) experience during PGY‐2 at Scripps Mercy Hospital. The residents will learn to diagnose and treat psychiatric disorders, understand the interaction between medical and psychiatric conditions and develop skills in identifying high risk patients in need of psychiatric admission. Under the supervision of a board‐certified psychiatrist, residents will interact directly with other medical and surgical disciplines in inpatient and emergency settings. They will perform comprehensive biopsychosocial assessment to develop differential diagnoses and comprehensive treatment plans. Trainees will be working as part of a multidisciplinary team to facilitate safe and effective patient care including the Psychiatric Liaison Team (PLT) and the Substance Use Disorder Service (SUDS) provided by nurses. Residents will also liaise with treating physicians, nursing and other disciplines and families. While on the C‐L Service, residents work closely with psychiatry and psychology faculty and actively teach residents and other learners from different medical specialties.
Residents will complete eight weeks of emergency psychiatry at Scripps Mercy Hospital during PGY‐2. The psychiatric emergency room consists of four acute beds with fast turnaround. The residents will develop skills in managing psychiatric emergencies including safety assessment, crisis intervention and training in commitment laws, and substance use disorders. Under the supervision of a board‐certified psychiatrist, residents will perform comprehensive biopsychosocial assessments, obtain collateral information, conduct risk assessments (suicidality and/or homicidally) and conduct 5150 evaluations.
This geriatric rotation will consist of an eight-week block. This will occur at Sharp Mesa Vista Hospital – Geriatric Inpatient Unit located in proximity to FHCSD clinics. This rotation will give residents opportunities to work with the older population who have medically complex disorders. This will include safety assessment and understanding the interaction effects between psychiatric, neurological and medical conditions. The geriatric psychiatry rotation will be supervised by psychiatrists with enhanced knowledge and skills in geriatric psychiatry.
During this eight-week rotation, residents gain knowledge through their work at PACE one day a week. This program manages geriatric patients who are older than 55 years of age living with chronic conditions that require coordinated care and support. Through this rotation, trainees will learn about different psychiatric conditions such as depression, anxiety, psychosis and cognitive disorders including dementia amongst other conditions. They will also develop an understanding of neuropsychological testing as it relates to cognitive functioning in the elderly. Residents will learn about unique pharmacokinetic and pharmacodynamic considerations encountered in the elderly along with drug interactions.
Child & Adolescent Outpatient Psychiatry Clinic
The child and adolescent outpatient psychiatry experience is an eight-week, full-time equivalent rotation during the second year. The PGY-2 rotation will occur at FamilyHealth-Youth Counseling Center location. In the first two weeks, residents will observe the child and adolescent psychiatrist managing children and their caregivers then will take ownership of patients subsequently.
Resident will have the opportunity to develop competence in assessing child development, conduct a comprehensive child and adolescent assessment using the biopsychosocial model and continuous, evidence-based management of patients with affective disorder, behavioral conditions and substance use disorders. Residents will work under the supervision of a board-certified child psychiatrist and will learn to work with both children and their families and appropriately refer to other ancillary services whenever required.
Residents rotate through community psychiatry program for a four-week, full-time equivalent of an outpatient psychiatry experience occurring during their PGY-2. This rotation will occur at Hillcrest Family Health Center on Third Avenue.
Resident will have opportunity to work closely with individuals who need higher level of care including concentrated programs in which patients attend a group therapy focused on dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), codependency (self-esteem, boundaries and communication issues), co-occurring disorders (harm reduction, PTSD, SUD), psychosis (social skills, concrete CBT) and mind-body syndrome (DBT with somatic awareness). Patients usually attend 60-90 minute groups one to two times/week, and residents will have the opportunity to participate in leading some of these groups. In addition, some of these patients might be enrolled in long-acting antipsychotic medication (LAI) program as well as the Clozaril clinic in which residents will have the opportunity to administer and gain experience with LAIs, as well as doing half a day of Clozaril clinic weekly. Residents will work under the supervision of a board-certified psychiatrist, as well as other providers who serve this population.
Residents rotate through the addiction psychiatric services for a four-week, full-time equivalent of an outpatient psychiatry experience. Residents will master assessing patients with comorbid substance use, including evaluating their willingness for change, motivational interviewing, and the use of Medication Assisted Treatment (MAT). In addition, trainees will learn psychotherapy for individuals struggling with substance use, including use of contingency management and CBT.
Third Year (PGY-3) Rotations
PGY-3 psychiatry residents will have a minimum of 12-month, full-time equivalence of organized, continuous and supervised clinical experience in the assessment, diagnosis and treatment of outpatients with a wide variety of disorders and treatment modalities, with experience in both brief and long-term care of patients. During this rotation, trainees will learn and understand how to evaluate and manage patients who are more stable in an outpatient setting. Residents will formulate a diagnosis and treatment plan using the biopsychosocial model. Residents will also have two to four therapy cases of their choice to gain knowledge and experience in different types of psychotherapeutic techniques including CBT, supportive, psychodynamic and others.
Fourth Year (PGY-4) Rotations
The population health clinic is an eight-week, full-time equivalent rotation in the outpatient psychiatry setting. This rotation will occur at different FHCSD clinics, including Hillcrest and City Heights.
Resident will have opportunity to work closely with refugees and immigrants from different cultural background, LGBTQ community, weight management clinic, individuals diagnosed with HIV and homeless population. Residents will rotate half a day to one day through the week in these different clinics to develop competence in assessing this special population and conducting a comprehensive biopsychosocial formulation using evidence-based management. Residents will work under the supervision of a board-certified psychiatrist, as well as other providers who serve this population.
Seriously Mentally Ill Clinic
Residents rotate through seriously mentally ill (SMI) clinic for an eight-week, full-time equivalent of an outpatient psychiatry experience occurring during their PGY-4. This rotation will occur at FHCSD’s City Heights and Hillcrest clinics.
Residents will have the opportunity to work closely with individuals who need a higher level of care. This will include working with the Assertive Community Treatment (ACT) team, concentrated group-therapy program, LAI and Clozaril clinic. During this rotation, residents will work closely with patients struggling with major depressive disorder, bipolar disorder and schizophrenia. Residents will offer patient-centered care involving both psychopharmacological interventions and therapy. Residents will work under the supervision of a board-certified psychiatrist, as well as other providers who serve this population.
Residents are expected to participate in at least one quality improvement project, individually or with their colleagues, during the four years of training. This will constitute 5% of the time during PGY-2 to PGY-4. However, there will be an eight-week PGY-4 elective for residents who are completing their scholarly activity and preparing for poster presentation, finalizing their written manuscript for submission or needing extra time for finishing their project. PGY-4 can also allocate half a day longitudinally instead of the eight-week block if their project is in its early stages.
Residents will have the opportunity to identify gaps in the system of care, including defining the problem, assessment/mapping a plan, interventions and using the Plan, Do, Study and Act method (PDSC) to test the performance outcome using SMART objectives (specific, measurable, achievable, relevant, and time-bound). Residents can choose their projects from both the inpatient side and/or the outpatient sites. Residents will work under the supervision of a board-certified child psychiatrist, administration and statistician to help understand and improve the outcome measures.
Residents are encouraged to participate in research projects during their residency. They can collaborate on these projects with their colleagues and faculty during the four years of training. PGY-4 will be offered an eight-week elective to initiate and complete their scholarly activity and prepare for poster presentation, finalize their written manuscript for submission, or extra time to finish their project. PGY-4 can also allocate half a day longitudinally instead of the eight-week block if their project is in its early stages. Residents will work under the supervision of a board-certified child psychiatrist and statistician and utilize resources from FHCSD Laura Rodriguez Research Institute.
The telepsychiatry rotation will span eight weeks during PGY-4 year. During the rotation, each resident will see at least six to eight patients on the day they are conducting the telepsychiatry visits to gain knowledge in a variety of illnesses and medication management. This includes the use of video-based and/or audio-based conference with the patient to develop a comprehensive biopsychosocial formulation and treatment plan that incorporates medication management, psychosocial rehabilitation and focused psychotherapy. Residents will understand the cost-effectiveness and other advantages to the use of telepsychiatry, as well as the limitations of this modality. Residents will be under the supervision of a qualified faculty/attending.
Health Systems Management
This four-week rotation takes place in PGY‐4 at City Heights Family Health Center. The residents will gain skills and knowledge necessary to lead and improve all elements of health care delivery, particularly those related to psychiatry through exposure to practice management, utilization review and quality assurance/performance improvement, and other components of psychiatric administration. The rotation will consist of hands‐on work in the business office, required reading and discussion on various practice management topics, including regulatory agencies and accreditation requirements.
Residents are expected to rotate through Sharp Mesa Vista Hospital to gain training in electroconvulsive therapy (ECT). Residents will gain knowledge in assessing patients requiring ECT, learn how to administer ECT and monitor different parameters during this treatment modality. Trainees are expected to spend half a day longitudinally through their PGY-4 year.
Through our contract with a private psychiatrist, residents will have an opportunity to evaluate and treat patients using ketamine, esketamine and transcranial magnetic stimulation (TMS) treatments.
Residents are allotted up-to five four-week electives that would be dedicated to each resident’s own interests. These experiences can be curtailed depending on individual interests to enhance certain areas of knowledge and career progression. This list is suggestive and can be expanded depending on each trainees’ needs.