Psychiatry (VAMC)
Site:
- VAMC, Amarillo
Instructors:
- Que Nguyen, M.D. and Gwen Fagala, M.D.
Makeup of team:
- The resident will interact with the psychiatry department including psychiatrists, psychologists, nurses and case workers. Resident will see both inpatient and outpatient patients with a wide range of psychiatric problems.
Days per week (night call):
- five days per week, no night call
Usual Time of Attending Rounds:
- 0900-1200, 1300-1630
Types of patients encountered: The service includes a broad range of psychiatric disorders. The service is comprised of mainly males due to being a veteran population, but a broad range of ethnicities are encountered.
Educational Goals/Competencies
Patient care:
- Residents will gain experience and competence in employing the history and physical exams to generate the diagnosis of psychiatric problems. These include major depression, dementia, bipolar disorder, generalized anxiety disorder, panic attacks, post traumatic stress disorder, alcohol abuse and dependency, drug abuse and dependency and delusion.
- Residents will become familiar with the management of these problems, including the detection of the suicidal patient. Residents will be exposed to psychiatric crisis and learn intervention care.
- Thus the expected competences will include crisis intervention; suicidal detection and prevention; the detection of alcohol and drug abuse and the detoxification of these patients.
Medical knowledge:
Residents will have knowledge of the diagnosis and treatment of major depression, dementia, bipolar disorders, generalized anxiety disorder, panic attacks, post traumatic stress disorder, alcohol abuse and dependency, drug abuse and dependency and delirium. Residents will learn symptoms of schizophrenia and also suicide prevention and detection.
The side effects and interactions of psychotropic medications and their treatment will be emphasized.
Interpersonal/Communication Skills:
Since history-taking is the physician's most important tool, residents will spend sufficient time with the patient to obtain a complete and coherent history. Residents will be aware of non verbal cues (i.e. pain behavior), idiomatic expressions and obtain the input of other caregivers (i.e. family members, nursing home staff), and review medication history.
Residents will develop an effective style of communicating with psychiatric patients; learn how to deal with an angry or hateful patient and how to determine the patient's decision-making capacity.
Professionalism:
The foundation of professionalism is respect, and the resident is expected to treat the patient as if he/she were a member of the resident's own family. Residents will have opportunity to deal with patients who do not share the resident's ethnic groups, religious beliefs, sexual orientation, and attitudes toward drug use, alcohol use, sexuality, etc. Residents will treat these diverse patients with respect.
Residents will treat other members of the health care team with respect. All are encouraged to listen to and obtain input from nurses, therapists, technicians, etc. in the decision-making process.
Practice-based learning and improvement:
No one knows everything all the time. Residents will develop habits of life-long learning on this rotation. Residents will recognize when they are "in over their heads" and need to obtain help from the faculty member or consultants. Residents on this rotation will learn to use current journals and on-line resources to obtain up-to-date information. This will be especially important for the upper level resident. Mistakes will be honestly acknowledged, never "covered up". Errors will be analyzed so that the resident can learn from his/her mistakes. Residents will be open to input from nurses, respiratory therapists, etc. about how the residents' care may be more effective and more humane.
Systems-based practice:
Resident will understand and follow the VA formulary for medications available and for treatment options.
Text/references to be consulted:
- DSM IV edition
- Pocket Handbook of Psychiatry, Kaplan & Sadock (current edition)
Methods of Evaluation:
Following daily rotation of residents in both inpatient, outpatient and consult service, the standard departmental evaluations forms will be completed appropriately.