Millcreek Community Hospital Psychiatry Program

Program Director: Max W. Gottesman, D.O.
Telephone: (814) 868-8217
Email: mchmeded@mch1.org

Mission
The mission of the Millcreek Community
Hospital Psychiatry Residency Program is to provide Residents with a comprehensive structured cognitive and procedural clinical education in both inpatient and outpatient settings that will enable them to become competent, proficient, and professional osteopathic psychiatrists.

Program Overview

G. Renee Thomas-Clark, D.O., F.A.C.N. Child Psychiatrist

Millcreek community Hospital is the largest psychiatric inpatient facility in Northwestern Pennsylvania (and only D.O. Hospital). Residents are exposed to all facets of Psychiatry that allow the Residents to be well rounded in the field. The program also is active in the multiple supportive services of mental health such as Crisis and Case Management.

The rotation schedule represents a multifaceted approach which thoroughly accommodates the requirements for Residency as put forth by the American College of Osteopathic Neurologists and Psychiatrists. Residents enjoy the opportunity to gain proficiency of practice in a variety of clinical settings, including to work in the public, private and rural sector. Also, the entire patient spectrum is represented in terms of working with children/adolescents, adults and the elderly.

Rotation Requirements:

2 months Neurology – inpatient or outpatient

12 months – 24 hour Resident responsibility for diagnoses, treatment (inpatient, partial)
for OGME-4 –

12 months - outpatient (ambulatory) psychiatry training –
community mental health, community based programs, individual, cognitive, behavioral, biological

2 months – clinical and adolescent outpatient

4 months – consultation – liaison (medical & outpatient)

2 months – E/R Psychiatry

2 months – Geriatric Psychiatry

2 months – substance abuse and dual diagnosis

1 month – forensic – elective
Neuropsychological testing – didactic
Managed Care – hand on experience

4 months – Internal Medicine

2 month – Geriatrics

3 months – VA (Surgery, Internal Medicine, E/R)

Residency Evaluations: are written after rotation with Resident present and co-signed by attending, Resident and Residency director. Resident and program director will meet every month. “Mock Boards” Part II will be part of didactic teaching in outpatient clinic. Residents use the provided program policy and rotation description. Residents are provided written information regarding stipends, benefits and hospital policy.

2. Educational Program

In addition to the curriculum, Residents are expected to attend a monthly journal club in which articles from The American Journal of Psychiatry are reviewed. We have a monthly board review program in which we review PRITE questions to help Residents prepare for the written boards. Every month we have a four-hour didactic classes for Residents to attend that covers requirements for Residency.We also have two-hour weekly didactic sessions specific to teaching psychotherapy for all Residents in their OGME-2 year and beyond.Also to assist with the practice of psychotherapy, Residents meet weekly with an assigned psychotherapy supervisor to discuss their individual case load. Mentors provide sessions with both on-site and off-site supervisors that can provide resources and discussion for the Residents.

Resident Responsibilities

1. Logs
Each Resident is expected to keep a monthly log consisting of the patients they see at each of their identified sites, a list of reading material they have covered, and a list of didactic sessions, conferences, meetings, and supervision sessions they have each attended. These logs are submitted to the program director and to the Department of Medical Education monthly.

2. Evaluations
Residents obtain evaluations based on the core-competencies of Residency training from each of their supervisors every two months and are to be submitted as they are obtained throughout the academic year to the medical education department. The program director will review the evaluations with the Residents quarterly.In addition, the Residency director will fill out an evaluation quarterly for each Resident. Residents are given evaluations with the evaluator (one on one interaction) and are encouraged to have discussions regarding their progress in the Residency.

3. Residents must submit an annual report to the American College of Osteopathic Neurologists and Psychiatrists.

4. Residents must have a professional paper for the American College of Osteopathic Neurologists and Psychiatrists (ACONP) during the last year of training.

5. The call schedule is formulated by the senior Residents and reflects a fair approach to call distribution which allows for less time on call as each Resident progresses through the program. The Resident on-call has around the clock access to an attending psychiatrist functioning as a back-up for discussion of complicated cases or special circumstances.

6. Residents must participate in the annual in-service examination (PRITE) that simulates Part II of the AOBNP Board Certification Examination.

Affiliated Institutions

Millcreek Community Hospital in conjunction primarily with Dual, Stairways Behavioral Health, and many other agencies of Erie County, participates in the education of Psychiatry Residents by offering specialty rotations to enhance the scope, volume, and variety of cases for both core and elective rotations.

Goals and Objectives

General

• Provide an educational program that offers a thorough understanding of the development, assessment, treatment, and prevention of psychopathology as it appears from infancy through adulthood.
• Provide an introduction to this knowledge base in psychiatry.
• Psychiatry for medical students and general psychiatry residents.
• Provide an interdisciplinary setting for the training of Psychiatrists to take a leadership role in working with other mental health professionals in the prevention and treatment of mental disorders in patients and understand the role of an effective consultant.
• Integrate findings in developmental neurobiology and neuroscience to develop an understanding of fundamental processes that may be involved in the etiology and treatment of psychiatric disturbances and developmental disorders.
• Provide treatment to patients and families on a non-discriminatory basis, always considering the welfare and perspective of the patient, family, community and utilizing evidence based approaches to clinical problem solving.

Educational

• Skill in diagnostic interviewing, formulation, treatment planning, and implementation of psychotherapeutic and pharmacological management.
• Familiarity with the theories of development pertaining to patients of all social and cultural backgrounds.
• Skill in consultation with primary care, non-psychiatrist mental health providers, schools, community agencies, and other programs serving patients.
• Skill in administration and teaching
• Knowledge of the principles of research to encourage a scientific approach to clinical problems and skill in critical reading of the literature as it pertains to psychiatry and psychology
• Familiarity with the function and organizations of health, education and welfare institutions to promote normal development.
• Understanding of legal and ethical issues in the practice of Psychiatry.

Psychiatry Inpatient Unit

Patient Care
• Interviewing skills/data gathering skills
• Recognize/manage psychiatric emergencies
• Preparation for treatment and disposition

Clinical Knowledge
• Differential diagnosis
• Pharmacological interventions in acute care setting
• Non-pharmacologic interventions in acute care setting
• Interaction between psychiatric diagnosis and psychosocial problems

Interpersonal Skills and Communication
• Effective relationships with multidisciplinary staff
• Therapeutic relationships with patients/families
• Succinct and thorough oral presentations
• Written reports and documentation

Professionalism and Ethical Behavior
• Demonstrates professional appearance/respectfulness/courtesy
• Punctuality/arranges coverage appropriately
• Maintains equilibrium under stress

Practice-Based Learning
• Self-evaluation/knows limits of own knowledge
• Incorporates new info into practice/seeks out supervision and guidance
• Independently motivated/uses available resources

Systems-Based Practice
• Effective with outside agencies/aware of resources and obstacles
• Advocates for patient/family
• Understands role of inpatient hospitalization in continuum of care

Affective Disorders Service

Patient Care
• Perform comprehensive psychiatric interviewing and history gathering

Clinical Knowledge
• Diagnosis/formulation of affectively ill patients
• Pharmacologic interventions with affectively ill patients
• Non-pharmacologic interventions with affectively ill patients and families
• Interaction of affective illness and psychosocial problems

Interpersonal Skills and Communication
• Effective relationships with patients and families
• Succinct and thorough oral presentations
• Written reports and documentation
• Maintain effective relationships with multidisciplinary staff

Professionalism
• Demonstrates professional appearance/respectfulness/courtesy
• Punctuality
• Maintains equilibrium under stress

Practice-Based Learning
• Self-evaluation/recognizes limits of won knowledge
• Incorporates new info into practice/seeks out supervision and guidance
• Independently motivated/uses available resources

Systems-Based Practice
• Understands role of inpatient unit for affectively ill
• Effective use of resources for Patient Care/understands system of care
• Effective with outside agencies and advocates for patient/family

Consultation Liaison Service

Patient Care
• Perform psychiatric interviews on medically ill
• Recognize/manage psychiatric emergencies in medically ill

Clinical Knowledge
• Differential diagnosis and treatment planning for medically ill
• Pharmacologic/Non-pharmacologic interventions for medically ill
• Recognize the interaction between medical and psychiatric and psychological problems

Interpersonal Skills and Communication
• Effective relationships with patients and families
• Effective relationships with primary care team
• Succinct and thorough oral presentations
• Written reports and documentation

Professional and Ethical Behavior
• Demonstrate professional appearance/respectfulness/courtesy
• Punctuality/arranges coverage appropriately
• Maintains equilibrium under stress

Practice-Based Learning
• Self-evaluation/knows limits of won knowledge
• Incorporates new info into practice/seeks out supervision and guidance
• Independently motivated/uses available resources

Systems-Based Practice
• Understands role of psychiatry consultant
• Effective use of resources for Patient Care

On-Call

Patient Care
• Provide focused emergency assessments of patient and families in crisis
• Ensure patient safety
• Identify at-risk situations

Clinical Knowledge
• Awareness of types of emergency situations in patients and families
• Ability to diffuse and manage a crisis situation
• Understanding of statues regarding custody and guardianship as it relates to emergency assessment, emergency petition, and voluntary/involuntary admissions process

Interpersonal Skills and Communication
• Rapid establishment of therapeutic relationship in an emergency care setting
• Succinct written reports
• Cooperation with referral sources and disposition resources
• Clear communication with staff

Professionalism and Ethical Behavior
• Maintain professional appearance and demeanor
• Demonstrate respect, compassion, integrity, and honesty
• Respond punctually to requests for consultation
• Recognize limits of own knowledge/skills
• Arrange coverage as needed

Practice-Based Learning
• Seek out supervision
• Re-evaluate performance based on feedback

Systems-Based Practice
• Learn about the resources available for patients in need of acute psychiatric intervention
• Understand the public mental health care system and obstacles to accessing care
• Learn about the relationship between pediatric care providers and specialty services in an emergency care setting
• Learn to identify the need for adjunct services

First and Second Year Resident Continuity Clinic (Outpatient Clinic)

Patient Care
• Interviewing/data gathering
• Engagement in treatment/effective relationships with patients and families

Clinical Knowledge
• Diagnosis and formulation
• Treatment implementation and sequencing
• Pharmacological and psychotherapy interventions
• Balancing family/patient needs
• Management of transference/counter-transference

Interpersonal Skills and Communication
• Succinct and thorough oral and written presentation
• Manages relationship with supervisor

Professionalism and Ethical Behavior
• Maintains equilibrium under stress
• Availability to patients/families
• Arranges coverage appropriately

Practice-Based Learning
• Self-evaluation/seeks out supervision
• Utilizes/incorporates new information

Systems-Based Practice
• Effective use of resources for Patient Care
• Aware of complex system of care

Second Year Clinical Rotations Educational Goals

Specialty Clinics

Patient Care
• Conduct comprehensive interviews and data gathering
• Recognizes and manages psychiatric emergencies
• Provides pharmacological and psycho educational interventions in integrated manner

Clinical Knowledge
• Diagnosis/formulation/treatment planning
• Recognizes relationship between diagnosis and impairment
• Recognizes role of various interventions including individual, family, CBT, and parent management training
• Aware of pertinent literature

Interpersonal Skills and Communication
• Effective relationships with patient and families
• Succinct and thorough oral presentations and written reports
• Effective relationships with referral sources

Professionalism and Ethical Behavior
• Demonstrate professional appearance/respectfulness/courtesy
• Punctuality/arranges coverage appropriately
• Maintains equilibrium under stress

Practice-Based Learning
• Self-evaluation/recognizes own limits
• Incorporates new info into practice/seeks out supervision and guidance
• Independently motivated/uses available resources

Systems-Based Practice
• Aware of complex system of care
• Effective use of resources for Patient Care
• Advocates for patient and family

Community Psychiatry Program

CMHC Rotation:

Patient Care
• Perform comprehensive interviewing skills and data gathering
• Recognition/management of psychiatric emergencies
• Provides pharmacologic management and psycho education to patients and families

Clinical Knowledge
• Understands role of child psychiatrist in community setting
• Diagnosis/formulation/treatment planning

Interpersonal Skills and Communication
• Effective relationships with non-M.D. clinicians
• Team participation/oral presentations
• Written reports/routine documentation

Professionalism and Ethical Behavior
• Demonstrates professional appearance/courtesy/respectfulness
• Maintains equilibrium under stress
• Punctuality/arranges coverage appropriately

Practice-Based Learning
• Self-evaluation/recognizes limits of own knowledge
• Incorporates new information into practice/seeks out supervision
• Independently motivated/uses available resources

Systems-Based Practice
• Recognition of obstacles to care in community care setting/understands system of care
• Aware of COMAR and other regulatory bodies in community mental health
• Effective use of resources for patients/families

Psychiatry Program

Patient Care
• Perform comprehensive interviewing skills and data gathering
• Recognition/management of psychiatric emergencies
• Provides pharmacologic management and psycho education to patients and families

• Clinical Knowledge
• Recognize the interplay between psychiatric and learning problems
• Understands role of psychiatric consultant in school setting and limits of school-based services
• Diagnosis/formulation/treatment planning

• Interpersonal Skills and Communication
• Effective relationships with clinicians
• Team participation/oral presentations
• Written reports

• Professionalism and Ethical Behavior
• Demonstrates professional appearance/courtesy/respectfulness
• Maintains equilibrium under stress
• Punctuality/arranges coverage appropriately

Practice-Based Learning
• Self-evaluation/recognizes limits of own knowledge
• Incorporates new information into practice/seeks out supervision and guidance
• Independently motivated/uses available resources

F. Systems-Based Practice

• Indentifies obstacles to accessing care
• Aware of COMAR and other regulatory bodies regarding services
• Recognizes obstacles to care

Forensics

Patient Care
• Provide comprehensive clinical assessments patient and family before the court
• Manage relationships with patients and families in court setting

Clinical Knowledge
• Understand the difference between a clinical evaluation and a forensic evaluation
• Understand the different types of forensic evaluations and reports
• Understand the legal statutes as they relate to patients and families

Interpersonal Skills and Communication
• Ability to write reports that convey the appropriate information for judges
• Maintain relationships with court offices

Professionalism and Ethical Behavior
• Demonstrate respect, compassion, integrity, and honesty
• Maintain equilibrium under stress
• Complete paperwork in a timely manner
• Prioritizes appropriately

Practice-Based Learning
• Self-evaluation/seeks out supervision
• Incorporates new information into practice
• Demonstrates initiative

Systems-Based Practice
• Work effectively in coordination with outside agencies
• Understand the interrelationships between the multiple social agencies and the court system as it affects patients and families

Millcreek Community Hospital

Patient Care
• To interview, diagnose and effectively manage patients in need of detoxification from substances
• To provide continuous follow-up care of these patients during their substance abuse treatment episode at Millcreek Community Hospital

Clinical Knowledge
• To acquire Clinical Knowledge of Substance Use Disorders
• To develop a multimodal treatment plan for patients with substance use disorders and co-occurring psychiatric disorders.

Interpersonal Skills and Communication
• Routinely provide/accept input to/for multidisciplinary team
• Respond to patient/family questions/concerns appropriately and in timely fashion

Professionalism and Ethical Behavior
• To demonstrate respectful, courteous, compassionate, and ethical behavior with patients, MCH staff, and related personnel
• Complete all necessary paperwork in a timely manner

Practice-Based Learning
• To implement empirically supported behavioral interventions in the management of patients substance use disorders
• Direct the services of the multidisciplinary team incorporating feedback

Systems-Based Practice
• Coordinate input from related systems of care (e.g. previous treatment provider, family, etc.)
• Develop an appropriate plan for further treatment, disposition, academic/vocational rehabilitation, as directed

Please contact the following Psychiatry Resident for further information:

• Jamie Fuhrer, D.O. jfuhrer@mch1.org

To apply to MCH's Internships, OGME1 Programs, log onto the ERAS Website: www.aamc.org/audienceeras.htm.

Students need to register with National Matching at: www.natmatch.com.

For more information, contact:

Marilyn Tracy,
Medical Education Coordinator
Medical Education
Millcreek Community Hospital
5515 Peach Street
Erie, PA 16509
(814) 868-8217
mchmeded@mch1.org