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Educational Purpose and Goals

The four-year educational program aims to prepare physicians for a career in general psychiatry with board certification. The following description of the educational program or curriculum outlines the expected acquisition of knowledge and skills by residents in the program. The faculty endorses a team approach to patient care. Since every patient has an attending physician who is legally responsible for that person’s care, the effectiveness of the residency depends upon shared responsibility by both the residents and the attending staff. The program recognizes that residents must have opportunities for learning and practicing critical decision-making and endorses meaningful patient responsibility as defined by the Accreditation Council for Graduate Medical Education (ACGME).

The goal of the NSU-KPCOM/Orlando VA Medical Center Psychiatry Residency Program is to prepare residents with the knowledge, skills, and attitude needed to provide patient care in the field of psychiatry. Emphasis is on the humane application of scientific knowledge and preparation of graduates for continuing lifelong self-directed learning; the cost-effective utilization of public resources; the responsiveness to needs of individuals and the community; and the highest standards of academic excellence and professional ethics.

The program graduate will demonstrate the knowledge, skills and attitudes necessary to provide independent patient-centered care in multiple mental health settings in the specialty of Psychiatry. Competence is demonstrated in the domains described in the Program Requirements of the ACGME: Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-based Practice.

The program provides flexibility in curriculum focus to allow the accommodation of each trainee’s individual learning needs in order to maximize achievement. The curriculum will encompass the following psychiatric care settings in order to give a broad and diverse educational experience, as well as improving patient quality of care by training well-rounded and diversely experienced physicians.

Rotation Schedule:

PGY-1

  • Consultation Liaison 8 weeks
  • Inpatient Medicine 8 weeks
  • Inpatient Psychiatry 20 weeks
  • Neurology 8 weeks
  • Primary Care 8 weeks

PGY-2

  • Addiction Psychiatry 8 weeks
  • Child/Adolescent Psychiatry 8 weeks
  • Community Psychiatry 4 weeks
  • Emergency Psychiatry weeks
  • Gero-psychiatry 4 weeks
  • Inpatient Psychiatry 16 weeks
  • Elective 4 weeks

PGY-3

  • Outpatient Psychiatry 52 weeks

PGY-4

  • Consultation Liaison 8 weeks
  • Inpatient Psychiatry 20 weeks
  • Electives 24 weeks

Example Block Schedule

Required Psychiatric Rotations:

Inpatient Psychiatric Care: The resident will focus on care in the inpatient psychiatric setting with responsibility to the patient’s psychiatric and functional improvement, and to the diagnosis and management of acute psychiatric illness. The resident will evaluate and treat patients who are refractory to treatment and may require additional psychosocial services to live successfully in the community. This practice setting will also allow the resident to see unique presentations and more severe illness presentations, and to observe the available methods of treatment for refractory illness. This is a Baker Act (Florida involuntary commitment statute) receiving facility.

Outpatient Psychiatric Care: The resident will focus on treating psychiatric conditions over the long term and learn to appreciate how psychosocial factors play a role in a patient’s functional recovery. Residents will learn to use pharmacological regimens in an outpatient setting, including the concurrent use of medications and psychotherapy under supervision.

Consultation-Liaison Psychiatry: The resident will practice becoming effective psychiatric consultants to other healthcare providers in order to maximize patient quality of care in the healthcare system. The resident will learn about the interplay between medical and psychiatric illnesses.

Intensive Outpatient Care/Partial-hospitalization: The resident will manage patients who require an elevated level of psychiatric treatment and appreciate the need for lesser restrictive means of treatment for patients who require longer-term transformational care and who do not meet the acute psychiatric admission criteria of an inpatient unit.

Child and Adolescent Psychiatry: The resident will focus on treating psychiatric conditions in children and adolescents in both inpatient and outpatient settings. While participating as an active member of a behavioral health team, the resident will serve in a consultative role for a variety of pediatric inpatient services. The resident will also rotate through a variety of outpatient Child and Adolescent clinics, including general and specialty clinics (i.e. an Autism Spectrum Disorders clinic and an intensive, outpatient, pain management program. Residents will be exposed to unique techniques as it relates to psychotherapy and psychopharmacology in this population. More globally, residents will gain a greater appreciation for how psychosocial and developmental factors play a role in a patient’s distress and recovery.

Geriatric Psychiatry: The resident will evaluate and treat older adults in a VA nursing home setting and participate in home visits with the unit psychiatrist. By evaluating and treating older adults, the resident will gain an appreciation for special medical needs in this population resulting from changing metabolism, increasing medical comorbidities, and unique psychosocial issues (e.g. retirement, bereavement, isolation, dementia).

Community Psychiatry: Residents will participate in the evaluation and treatment of patients receiving their care from community sources. Residents will gain a greater appreciation for the cost of treatment, available community resources, and how such challenges can contribute to patient frustration, well-being, and ultimately recovery. Additionally, residents will learn to work collaboratively with other mental health providers.

Psychiatry Emergency Services: The resident will work in partnership with other mental health providers in the evaluation and treatment of individuals presenting to the Osceola Regional Medical Center Emergency Department. Once cleared medically, patients will present for evaluation by the resident (with supervision provided by an attending). The resident will work to ensure the safety of all involved, obtain as complete an evaluation as possible, and formulate a treatment plan that may include discharge, admission to the inpatient unit, referral to community resources and/or continued observation in the Psychiatry Intake area. Residents will become comfortable with treating psychiatric emergencies, including but not limited to catatonia, aggression/agitation, self-injury, and NMS.

Addiction Psychiatry: The resident will work with faculty (Board Certified Psychiatrists and those certified in Addiction Medicine) to evaluate and treat individuals with substance use disorders. The resident will work in the VA domiciliary, a 30-day program for veterans suffered from drug and/or alcohol addiction. Residents will learn evidence-based psychotherapeutic and psychopharmacological therapies for managing a variety of addictions, including but not limited to, alcohol and opiates.

Elective Rotations:

Forensic Psychiatry: The resident will be supervised by a Board-Certified Forensic Psychiatrist in a variety of settings. The resident will gain experience by providing Forensic consultation to the inpatient psychiatric unit, evaluating individuals in the outpatient setting for civil and criminal matters and by participating in mock trials, involuntary commitment hearings and shadowing the attending during any testimony/courtroom appearances. Lastly, the resident will be encouraged to participate in local, national, and global professional organizations and research contemporary policy relevant to the practice of psychiatry.

Neuro-modulation (Elective): The resident will manage patients who are receiving neuromodulation for psychiatric illness. The resident will be given opportunities to practice procedures in the field of psychiatry and will be educated about the efficacy of different forms of neuromodulation including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS).

Junior Attending (Inpatient Setting, Elective): This rotation will occur on the inpatient unit. The senior resident will function as the unit attending, with supervision available. In acting as the unit attending, the resident will lead a multidisciplinary team in the evaluation and treatment of adult patients with a variety of presentations and mental disorders. The resident will be exposed to the clinical and administrative aspects of inpatient psychiatry. Residents will gain sufficient experience to practice independently in similar settings.

Research (Elective): Participation in scholarly activities is strongly supported. Residents are strongly encouraged to spend at least one designated month in scientific inquiry. Residents will work closely with a research mentor in various stages of project design, implementation, data collection, analysis and preparations for publication and/or presentation. Residents will submit regular updates to the Program Director, regarding project progress. The expectation is that residents will have a publishable and/or presentable product by rotation and/or year end, to be determined prior to the Research Elective month.

Administrative Psychiatry/Chief Resident: One or two appointed senior residents will serve as Chief Residents; if two Chief Residents, each will serve for a 6-month period. In this role, the Chief Resident will participate in the planning and scheduling of PGY4 lectures, take a leadership role in resident affairs, cover any clinical needs in the event of an emergency, and be a vital member of the chain of command for addressing any resident specific issues. The Chief Resident will work closely with the Program Director and Associate Program Director. This designated month will occur at the start of any such leadership appointment to allow for adequate planning and preparation for the remainder of the year. In addition to the duties listed above, the Chief Resident will be invited to shadow Attendings in leadership roles. In doing so, residents will gain an appreciation for the infrastructure of psychiatric care delivery.

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