Integrative Psychiatry Elective Track

IMR-Psychiatry I

Course Director: Noshene Ranjbar M.D.
Co-director: Amelia Villagomez, M.D.

This Track is open for Child & Adolescent Psychiatry fellows as well as PGY3 & 4 residents in general psychiatry.  

ACGME Milestones for Psychiatry training emphasize competency in the area of patient care, medical knowledge, practice-based learning and improvement, and professionalism.  One goal for training is to become a psychiatrist who serves as a role model and teacher of compassion, integrity, respect for others, and sensitivity to diverse patient populations. A goal under medical knowledge includes knowing drug-supplement/herb interactions. One milestone that is evaluated for residents is “accountability to self, patients, colleagues and the profession” with subsection for fatigue management and work balance.

Integrative Medicine broadly defines a clinical paradigm that is patient-centered, healing-oriented, health promoting, and embracing of appropriate therapeutic approaches whether they originate in conventional or complementary medicine (Dodds et al, 2013). It reaffirms the importance of the therapeutic relationship, focuses comprehensively on the whole person, and renews attention to healing (Institute of Medicine, 2009b). Practitioners are called to exemplify and commit themselves to self-exploration and self-development. Mind body medicine, which is an important component of integrative medicine, particularly emphasizes and provides skills for provider wellness, self-awareness, reflection, and compassion toward the self and others.

Psychiatry Integrative Medicine in Residency Letter of Interestpsychimrloi.docx

2018-2019 Course Description

Goals of the IMR-Psychiatry I:

Goal 1: Improve resident knowledge of evidence-based Integrative Medicine in Psychiatry

The primary goal of the curriculum is to introduce the resident/fellow to the field of evidence-based integrative medicine as it related to mental health. Many patients have questions about integrative therapies. It is important for psychiatrists in training to have an understanding of this emerging field, and to have familiarity with evidence-based integrative medicine research and resources, whether they will use integrative medicine or not. As the resident participates through the curriculum he/she will see that some areas of integrative medicine have strong supporting research and others areas may not. We will delineate the boundaries of the current research.

Goal 2: Improve Resident Wellness and Self-Awareness of their own wellbeing

A second essential goal of the IMR-Psychiatry curriculum is to raise awareness about the importance of resident health and wellness. For this reason, the resident will find a blend of pediatric and adult evidence-based integrative curriculum throughout the IMR-Psychiatry, especially in the areas of preventative health, integrative mental health and mind-body medicine. A core philosophy of the Arizona Center for Integrative Medicine is self-care for the physician-learner, with an eye to helping them become better role models and more effective counselors to their patients and families.

During IMR-Psychiatry the resident/trainee will also receive an introduction to evidence-based mind-body medicine with a strong foundation in mindfulness in medicine. This topic is emphasized deliberately in large part due to the emerging literature in mindfulness in medicine, and in response to the newly revised core competencies in training in the areas of personal and professional development. This new core competency specifically calls for the development and evaluation of resident skills in self-awareness, effective stress management, and self-regulation. The IMR-Psychiatry curriculum in this area is designed to provide a robust research background in addition to experiential exercises. This was done to provide a multi-dimensional approach to a topic that may be new to many in the medical field.

Goal 3: Incorporating knowledge of Integrative Medicine in the clinical setting

Finally, IMR-Psychiatry has the goal of training residents/fellows in incorporating their emerging knowledge of integrative medicine in the clinical setting. Therefore, in addition to role-playing, case-conferences, journal clubs, online interactive modules, and experiential didactics, residents also participate in patient care using integrative medicine principles. Some residents, according to their available time, may elect to receive additional direct and indirect supervision in the outpatient psychiatry clinic by one of the integrative psychiatry faculty. This will provide a multi-dimensional, hands-on training for these residents to gain clinical experience in this expanding field. 

In-person Didactic and Experiential Sessions:

Mind-Body Skills Groups: Each resident/fellow will participate in a series of mind body skills groups (2-hour group weekly for 10 sessions). Each group generally consists of 7-10 participants and 1 facilitator trained by the Center for Mind-Body Medicine (cmbm.org). The skills include deep breathing techniques, meditation, biofeedback, guided imagery, mindful eating/nutrition, and the therapeutic use of creative arts, music and movement. The goal of the group is to give hands-on experience within a mind-body skills group to the participants, enhancing knowledge of mind-body medicine techniques; even more importantly, the goal is to encourage gaining experience in the practice of self-care, self-awareness, and to enhance a sense of well-being and resiliency.

Experiential sessions:  Participants will visit various community-based integrative medicine practitioners in order to experience a wide array of modalities. These may include but are not limited to motivational interviewing, biofeedback, Tai Chi, meditation, clinical hypnosis, Traditional Chinese Medicine, Reiki, Qi Gong/Chi Nei Tsang, environmental health, accelerated resolution therapy (ART), internal family systems therapy (IFS), supplement/herb store visit, grocery store visit, and aromatherapy.

Role-playing sessions: Each session is designed to provide opportunity for participants to practice discussing various topics within integrative medicine with patients by using role-play. Topics include motivational interviewing practice, discussion of nutrition, physical activity, mind body medicine techniques, and the appropriate use of herbs and supplements, etc.

On-line Interactive Modules: Provided through the University of Arizona Center for Integrative Medicine (azcim.org), this unique on-line interactive curriculum provides information on evidence-based interventions applicable to psychiatric care.

Scholarly Project: This will include two writing assignments.  One is a reflection paper about a personal or professional awareness, realization, or deeper understanding regarding integrative medicine. The reflection paper will provide an opportunity for the trainee to reflect on his/her own process of personal and professional growth through participation in the curriculum.  The second is a research paper based on a literature review of any topic in integrative medicine related to mental health, chosen based on interest. 

Clinical Practice:

PGY3 Residents: Expectation is 1-2 new intakes per month and follow-up visits at the Banner-University Medicine Integrative Psychiatry Clinic (http://psychiatry.arizona.edu/patient-care/banner-university-medicine-in...). All intakes and clinical time will count towards already existing PGY3 residency requirements. Patient Intakes with Group Case Discussion: Residents will participate in a series of educational intakes done thru a one-way mirror followed by a discussion session including a comprehensive biopsychosocial case formulation and treatment planning.

PGY4 Residents: Flexible number of hours; intakes with integrative psychiatry faculty and follow-ups at the Banner-University Medicine Integrative Psychiatry Clinic. Expectation is approximately 2 new intakes per month.

Child Psychiatry Fellows: Intakes and follow-ups will be with attending supervision as part of already-existing Child and Adolescent Psychiatry Fellowship training curriculum.

Evaluation: A Pre- and Post- evaluation survey of the knowledge base of trainees in the field of integrative medicine, as well as assessments of self-care, quality of life, stress management, and level of career satisfaction will be performed. 

Completion of 80% of on-line course materials, participation in 80% of in-person sessions and passing the final exam is required; participants meeting this requirement will receive a completion certificate co-sponsored by the Arizona Center for Integrative Medicine and the University of Arizona Department of Psychiatry.

IMR-Psychiatry II (Advanced Psychiatry Integrative Medicine in Residency)

Course Director: Noshene Ranjbar M.D.
Co-director: Amelia Villagomez, M.D.

Goals of IMR-Psychiatry II:

  1. To apply knowledge of evidence-based integrative medicine in the comprehensive psychiatric evaluation of child and/or adult psychiatry patients
  2. To apply knowledge of evidence-based integrative medicine in the biopsychosocial case formulation of intakes in child and/or adult psychiatry
  3. To apply knowledge of evidence-based integrative medicine in the comprehensive treatment planning and follow-up of child and/or adult psychiatry patients
  4. To enhance adult and/or child psychiatry patient care based on up-to-date literature searches of integrative approaches for the treatment of mental health conditions
  5. To enhance the resident/fellow’s ability to refer to community providers for appropriate evidence-based integrative medicine approaches
  6. To continue to practice integrative medicine approaches to enhance resident/fellow well-being, self-awareness, and mindfulness in medical practice

Components:

Mind-Body Skills Groups (Optional)

Adult and/or Child Patient Intakes: Resident/fellow will perform comprehensive patient intakes and follow-ups with attending supervision.

Case Conference Presentations: Resident/fellow will present 1-2 times over the course of the year during monthly integrative psychiatry journal club/case conference open to all trainees and faculty in the department of psychiatry

Group Supervision: Resident/fellow will participate in weekly group supervision where new and follow-up cases are presented and discussed with supervising attending.

Teaching opportunities: Resident/fellow will have the opportunity to conduct one or more of the experiential sessions for IMR-Psychiatry I participants.  This may involve giving an interactive case presentation, designing and facilitating an experiential session based on one of the integrative medicine modalities, leading a role-playing, journal club, or case presentation session for IMR-Psychiatry I participants in collaboration with the supervising attending.

Research opportunities: With approval of elective directors, resident/fellow may take part in the data gathering, analysis, and/or publication of a quality improvement program related to the IMR-Psychiatry I curriculum; may also include a resident-initiated research project, literature review, case report, etc.

Table: IMR-Psychiatry I & II Requirements