Curriculum

PGY-1

4 months - Inpatient Psychiatry

2 months - Emergency Psychiatry “Triage”

3 months - Internal Medicine

1 month - Emergency Medicine

2 months (consecutive) - Neurology

All rotations at ARMC

Call schedule while In-service: 24-hour shift every 6 days, followed by a post-call day off. Separate call schedules for outside rotations

Weekends & holidays are off while In-service, unless you’re on call

Internal medicine blocks are spent on an inpatient general medical team, working alongside other residents in the principles of hospital medicine and learning how to accurately assess and treat acute exacerbationsns of chronic medical conditions.

The emergency medicine block is spent alongside ED residents taking care of patients with a variety of emergent medical conditions, practicing how to quickly diagnose and triage patients for appropriate care.

Neurology blocks are spent working with the neurology consult team, gaining experience in recognizing subtle differences and similarities between psychiatric and neurological cases, in the context of brain anatomy, physiology, and pathology.

Four of the six monthly psychiatry blocks are spent on the Behavioral Health Inpatient Units at ARMC. As part of primary management of acutely ill hospitalized psychiatric patients, residents obtain exposure by working with other staff members of interdisciplinary treatment teams, including clinical therapists, social workers, as well as occupational and group therapists.

In addition, residents spend two months on the emergency triage service during which they develop skills in stabilization of patients with acute psychiatric issues, having the opportunity to formulate their treatment plans for decompensated patients.

PGY-2

2 months - Inpatient Psychiatry

2 months - Emergency Psychiatry “Triage”

2 months - Community Re-Entry Evaluation, Maternal-Fetal Medicine clinic, Behavioral Health court

2 months - Consultation & Liaison (with Child & Adolescent exposure)

1 month - Addiction Psychiatry (at Loma Linda University)

1 month - Geriatrics Psychiatry (at InnovAge center)

2 months - Night Float

Call schedule: Friday & Saturday night call (8 pm - 8 am) every 6-7 weeks

The second year of psychiatry training is mostly spent on stabilization of patients with acute psychiatric service prior to inpatient hospitalization. Four months of the second year are spent in the emergency room setting (Triage Service). Two of these six months are spent during regular daytime hours, and, in order to facilitate state dependent learning, two of these six months are spent on night float. Night float months are non-consecutive and require one full month of night duty during each block. Residents have access to immediately available direct supervision at all times with attending psychiatrists on site 24 hours per day.

Two non-consecutive months of the second year are spent providing consultation and liaison services to medical/surgical services. The medical center generates approximately 2200 consults per year. Residents receive indirect supervision, with direct supervision immediately available during this experience. Senior residents and rotating residents from other residency programs may also be available on the C/L service to provide intensive liaison activities to the primary services.

Two months are spent on the Community Reentry Evaluation Program with the goal of connecting healthcare recipients to intensive services in the community which preempt the need for inpatient hospitalization. In contrast to the Triage service, whose goal is initial evaluation of patients with acute psychiatric emergencies, the emphasis during the CSU rotation consists of disposition of patients with acute psychiatric crises in treatment settings providing less restrictive care than in inpatient hospitalization services. This will be the first exposure to San Bernardino’s Department of Behavioral Health (DBH) resources as well. With this rotation, you also will attend a weekly maternal fetal medicine (MFM) clinic, to help evaluate women intrapartum at higher risk for mood disorders and/or psychosis, and also assist with the behavioral health court. Here, you have the opportunity to see the legal side of psychiatry and how to navigate involuntary holds, medication hearings, and conservatorships.

Residents also spend one month on addiction treatment services, during which they learn to manage patients whose lives are affected by substance use disorders. Techniques learned during this rotation include acute detoxification (including the use of Buprenorphine), stabilization, and intermediate-term management of patients with substance use disorders in both inpatient and outpatient settings. Residents will be encouraged to attend process groups involving patients suffering from these disorders to help build therapy skills.

In addition, residents spend one month on Geriatrics Psychiatry service at our affiliated elder care programs. During this experience, residents learn management of psychiatric disorders affecting patients older than age 55 in an interdisciplinary outpatient setting in concert with primary care geriatricians, geriatric psychologists, social workers, case managers, and legal consultants. Faculty at ARMC with geriatric psychiatry qualifications will provide geriatric psychiatry supervision to residents on this service.

The final month of the second year is spent on the Maternal Fetal Medicine service. During this month, residents round with the MFM team learning to recognize and treat emerging psychiatric issues during pregnancy and in the peri-partum period

PGY-3

12 months - Outpatient/Ambulatory clinic with Psychotherapy (DBH clinics)

1 day weekly of child & adolescent patients

Call schedule: Saturday & Sunday day call (8 am - 8 pm) every 6-7 weeks

Can begin moonlighting (with PD approval)

The third year of psychiatry training is spent entirely at outpatient psychiatric clinics in which residents learn to modify the longitudinal course of psychiatric illnesses in outpatient clinics (Operated by San Bernardino County’s Department of Behavioral Health). Residents are expected to work with an interdisciplinary team of therapists and allied health professionals. While caring for patients in the adult clinics, residents receive indirect supervision with direct supervision available by scheduling with attending faculty. In addition to psychopharmacology, residents learn psychotherapeutic approaches and are encouraged to engage in long-term psychotherapy with selected patients for a period of up to two years. Up to 50% of the patients treated during the third year of training may be mandated by the court system to obtain psychiatric care to fulfill their legal diversion requirements.

During the third year of training, residents also obtain exposure to assessment and management of child & adolescent patients under the direct supervision of child psychiatry faculty. This exposure is designed to be a longitudinal contact with patients throughout the year. The Child / Adolescent rotation is discrete from the adult outpatient experience and is delineated by days of the week.

PGY-4

6 months - Outpatient/Ambulatory clinic with Psychotherapy (DBH clinics)

2 months - Electives

2 months - DBH electives

Opportunity for things such as Ketamine/ECT/TMS/Forensic Psychiatry, & more

No call schedule

The final year of psychiatric training is spent in a combination of inpatient & outpatient services, some being prior experiences from prior years of residency that offer a chance to further refine skills, and others being new opportunities to develop skills before you venture out as an attending after graduating. Some exciting opportunities include ketamine-assistated psychotherapy, learning interventional modalities such as ECT or TMS, connecting with forensic psychiatry, and more. The curriculum is flexible to allow residents to fully explore their interests.

PGY – 4 residents will be expected to successfully complete three Clinical Skills Verification Examinations prior to the completion of their training (Some of these examinations may also be undertaken during the PGY-3 year). At the conclusion of this year of training, PGY-4 residents are required to have met a majority of level 4 ACGME psychiatry milestones and attain eligibility to challenge the written examination for board certification by the American Board of Psychiatry and Neurology.

Didactics & General Curriculum Statements

Lectures are typically held on Thursday afternoons each week. During this time, residents are excused from psychiatric coverage to attend lectures. Topics include journal club, case presentations, psychopharmacology lectures, board review classes, mock board examinations, DSM review, and the role of psychiatry in society and research methodology. Residents are encouraged to present seminal journal articles as well as interesting cases they have found. In addition to the above, PGY-1 & 2 residents meet with the program director for one hour on a weekly basis to discuss current cases and topics.

Call consists of mainly helping the emergency psychiatry triage service, as a PGY-1 you will always have overhead supervision with a senior resident and/or attending physician. Also, welcome to join the research committee to have an organized approach to creating literature reviews and meta-analyses on Interesting & pertinent topics.