Our curriculum follows the ACGME and RRC requirements for psychiatry residency programs based on scientific and professional mandates to ensure the quality of our graduate's training. Our faculty are skilled teachers and are committed to the education and mentoring of the next generation of psychiatrists. Faculty work "side-by-side" with the residents in the treatment of patients, and in so doing teach by modeling, apprenticeship, mentorship, formal supervision, and classroom didactic teaching. The residency program uses a web-based administration and evaluation system called "New Innovations" that provides evaluations, schedules, rotation descriptions, requirements, and manuals for residents at the touch of a keyboard. Our educational materials are posted on a shared drive and multi-media educational material is hosted on the medical school blackboard platform.
Clinical rotations and didactic seminars are coordinated over the four years to provide a rational developmental sequence. In the first year, residents complete their 4-month medicine (or pediatrics) requirement, one month of neurology, one month of emergency psychiatry, and spend 5 months on inpatient psychiatry under the close supervision of hospital-based psychiatrists. In the second year, they spend 4 additional months on inpatient psychiatry, fulfill their one-month addiction and geriatric requirements, complete the second month of their neurology requirement, and have one elective month. Also in the PGY2 year, residents spend two to three months on consultation psychiatry, begin taking on long-term psychotherapy cases under individual supervision and have the opportunity to do a Global Mental Health rotation in Uganda. (Note: suspended due to COVID, replacement rotation for now is Vermont Psychiatric Care Hospital). The third year is devoted to outpatient adult, community, and child/adolescent psychiatry with residents increasing their psychotherapy caseload while obtaining more intensive individual and group supervision. Two third-year residents defer their community day and spend time at the outpatient VA clinic in our VA track for their core adult outpatient exposure.
Fourth-year residents in the combined adult/child program follow the curriculum outlined on the child psychiatry website. General PGY4 residents continue with their outpatient caseloads, learn collaborative care models in the consult to primary care clinic, and spend time at the VA. The rest of the year is elective time, which residents can design to suit their interests and future practice needs. In their fourth year, residents are encouraged to take a leadership role in the teaching and mentoring of medical students and junior residents. They may return to the hospital-based psychiatry rotations in a junior attending role. A chief resident is selected who serves as a liaison between the department and residency group, sitting on a number of committees, teaching students, recruiting new residents, and running the resident lunches and retreats.
All residents select an area of scholarly interest (e.g. a research, curriculum, or quality improvement project) that they will research and develop under the mentoring guide of a faculty member across the four years of residency. This work culminates in a scholarly project and presentation in the PGY4 year (or PGY5 year if in the integrated track).
Throughout residency training, Tuesday mornings are dedicated to didactics, beginning with one of two Balint Groups and ending with a resident lunch meeting. The Balint groups focus on the dynamics of the doctor-patient relationship and are led by experienced faculty. Two seminar sessions, which often combine two residency levels in one classroom, follow the Balint Group.
The didactic outline (PDF) illustrates the curriculum design for each level of training. Until COVID interrupted in-person didactics, they occurred in newly renovated conference rooms at UVM Medical Center in the PGY1 year, and at UHC for the PGY2, 3 and 4 years. Now they occur virtually using the Zoom platform. Additional weekly educational activities include a lunchtime journal club, a weekly intensive services case conference, monthly morbidity and mortality rounds, and individual supervision. Beginning in 2020, we initiated a Cross-Cultural Dialogue Series in which a cultural expert from one of our local New American communities comes to speak with us about their psychiatric illness. Also in 2020, we plan to begin Tuesday morning case conferences with our psychiatry colleagues in Uganda.
Residents as Teachers
The Department is committed to the philosophy that an effective physician is a good teacher. On each clinical service, residents actively participate in the clinical instruction of third and fourth-year medical students. Residents also teach other physicians and professional staff through daily interactions and formal presentations. A seminar series entitled "Residents as Teacher" is held across all residency years to review teaching theory and develop specific teaching skills (e.g. bedside teaching, lectures and mini-lectures, how to give feedback, and other topics). Senior residents join the PGY1 and 2 resident to share "best practice" teaching techniques appropriate to our clinical services and call. Residents are also encouraged to attend the Residency Training Committee, sit on various hospital committees, participate in departmental workshops, and proctor standardized patient exercises at the medical school that teach interview skills to first and second-year students. As part of their selective experience in their PGY4 year, residents assume an even larger teaching role within the Department. Residents can attend the annual “Essentials of Teaching” bootcamp put on by our Teaching Academy (TA) once a year and residents interested in a teaching career can join the TA as protégé members and be mentored on an educational project.
Quality Improvement and Patient Safety (QI/PS) Curriculum
Residents are active participants in the ongoing effort at all clinical sites to provide high-quality care to our patients. They are required to initiate at least one "mini" QI project to address systems flaws, oversights, or inefficiencies. Service leaders and the Program Director welcome and support this feedback, and as a group, we have implemented many important changes to improve quality and patient safety. In addition, residents in the PGY2 and 3 year have a formal curriculum about QI/PS that culminates in the design of a group quality improvement project that they work on across two years. Residents also sit on departmental and service QI/PS committees.
Educational objectives are written for all clinical rotations and didactic seminars. Competency-based evaluations are completed monthly in the first two years and quarterly in the third and fourth year. Milestone reviews are conducted twice yearly by the Clinical Competency Committee and the Training Director meets semi-annually with each resident to review their educational progress on an individual basis.
Evaluation of the program occurs in several venues. During two yearly retreats, residents are asked to review selected aspects of the training program experience and report back to the Education Committee. Residents from all years of training are encouraged to participate on the monthly Residency Training Committee, which discusses proposed innovations and changes in the program. There is an anonymous on-line annual program review that both residents and faculty complete and a means of reporting real-time issues anonymously via GME platform.
Our program has a night float and short call system that has been in place since ACGME duty hours changes in July 2011. Residents spend a total of two and one-half months on nightfloat during their residency, which occurs from 8 p.m.-8 a.m. Sunday through Thursday. PGY1 residents do one month of night float as a block rotation in the later half of the year, the PGY2 class takes July and August, then November and December. And our five PGY3 residents split the months of September and October to minimize the disruption to the building of a longitudinal caseload of outpatients.
The remaining call shifts include short call from 5 p.m. until 8 p.m. Monday to Thursday, long call on Friday from 5 p.m. to 8 a.m., and three 12-hour weekend shifts (8 a.m.-8 p.m. Saturday and Sunday and 8 p.m. to 8 a.m. Saturday night). Residents average 2 short call and 1-2 weekend shifts a month when on service; they are not in the call pool for their 4 medicine/pediatrics months in the PGY1 year and their addiction and Global Mental Health months in the PGY2 year. PGY1 residents are accompanied in-house by a PGY4 resident for their first several calls and are closely mentored by senior residents during hand-offs and in the Emergency Psychiatry seminar that occurs in July and August of the first year. After supervision of intern call is completed, there is no call during the PGY4 year except under rare emergency situations.
The on-call/nightfloat resident works closely with crisis clinicians and a medical student while on call. Sometimes, there is a fourth year medical student doing an acting internship who is of additional help. The crisis clinician screens patients presenting to the Emergency Department before the psychiatric evaluation. As the only fully staffed psychiatric emergency service in the northern part of the state, the resident sees a diverse population with a broad range of psychopathology. Duties of the on-call/nightfloat resident include evaluating psychiatric and medical concerns of psychiatric inpatients, completing urgent psychiatric consultations from medical and surgical floors, and evaluating all patients triaged to her/him by the crisis clinician.
Supervision of the on-call/nightfloat residents occurs by phone with the assigned full-time faculty member. On weekends and holidays, the faculty member on call spends most of Saturday and Sunday (or holidays) in the hospital with the resident and medical student. The resident may consult on any case with the supervisor and must consult on those cases specified in the On-Call Policy. Each morning (except for Tuesday, which is didactic day), post-call/nightfloat residents sign-out to the incoming inpatient/consult/call residents at 8 a.m. Our sign-out is verbal and in-person, as well as written using a modified I-PASS protocol in our electronic medical record (Epic).
|Didactic Outline||Download PDF|
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