The following is a general depiction of the rotation schedule. The rotations listed may be in any order during the year. Also, changes may be made to accommodate the needs of particular residents within ACGME guidelines. Most rotations take place at UAMC at South Campus unless otherwise specified.
Year 1
- Outpatient Family Medicine, 1 month
- Inpatient Internal Medicine, 2 month
- Emergency Medicine, 1 month
- Inpatient Psychiatry, 4 months
- Geriatric Psychiatry, 2 months
- Neurology, 2 months
Year 2
- Inpatient Psychiatry, 3 months (1 month South Campus, 1 month Crisis Response Center, 1 Month Southern Arizona VA Health Care System)
- Emergency Psychiatry (Crisis Response Center), 1 month
- Psychosomatic Medicine (Consult-Liaison), 3 months (2 months South Campus, 1 month University Campus)
- Addiction Psychiatry (Southern Arizona VA Health Care System), 2 months
- Child Psychiatry (University of Arizona Medical Center), 2 months
- Night Float/Emergency Psychiatry, 2 month
Year 3
- Outpatient Psychiatry, 12 months
Year 4
- Psychosomatic Medicine (Consult-Liaison), 1 month
- Electroconvulsive Therapy (Northwest Medical Center) and Forensic Psychiatry (University Medical Center), 1 month
- Elective Rotations, 10 months
OUTPATIENT FAMILY MEDICINE
Residents spend one month in Outpatient Family Medicine. Residents are assigned to a single supervising Family Medicine faculty in each clinic session. During these clinics, the residents, see, evaluate, and develop a treatment plan for 3-5 patients per half-day. The resident has protected time to attend psychiatry seminars on Wednesday afternoons. Residents also participate in weekly Family Medicine didactic seminars on Thursdays. All supervision is provided by faculty from the Department of Family Medicine. The resident attends medical conferences and Family Medicine Grand Rounds and other scheduled conferences. Residents are assigned in-house call based at UAMC at South Campus.
During the two months on the Internal Medicine service at UAMC at South Campus, residents develop skills in treating a wide variety of medical problems. The Resident is a member of a team of medical students, Internal Medicine residents, and an Internal Medicine attending. Residents treat a wide variety of common and complex medical problems in individuals who range from ages 18 to over 90. The resident completes the initial evaluation of a patient and is primarily responsible for patient management under the supervision of the senior resident and attending. A medical team rounds six days a week. Average caseloads consist of about 6-8 patients at any given time during the rotation.
During this month-long rotation, residents diagnose and treat a wide variety of acute medical problems in an active emergency department at UAMC at South Campus. Residents work in the context of a medical team of residents, medical students, and an attending. Residents are exposed to and treat a wide variety of common and complex medical problems in individuals who range from newborns to over 90 years. The majority of the patients are Caucasian and Hispanic. There are fewer Native American, African-American, and Asian Americans. There is an equal balance between males and females. All supervision is provided by faculty from the Department of Emergency Medicine. The resident attends Emergency Medicine conferences Grand Rounds, and any other medical conferences that the E.D. residents typically attend during rotation.
Residents spend a total of six months in inpatient psychiatry at UAMC at South Campus during their PGY-1 and PGY-2 years. UAMC at South Campus has 64 inpatient beds, making it one of the largest psychiatric hospitals in Arizona. It is also the primary setting for involuntary admissions and contains a court room for involuntary treatment hearings. Residents gain exposure to these areas of forensic psychiatry as part of their inpatient experience. An average resident caseload consists of 6-8 patients, with the maximum caseload not to exceed 8 patients at any given time during the rotation.
Residents meet daily with the attending to round and review all inpatient cases assigned to the residents. The attending and residents also round with the nursing staff and other attendings each morning and actively participate in treatment team meetings. The treatment team includes the resident, a medical student, nurses, the attending physician, social workers, and staff from outside mental health agencies. The resident has protected time to attend seminars on Wednesday afternoons. Residents also attend monthly Journal Club and Case Conferences. Residents are assigned in-house call based at UAMC at South Campus.
Residents receive ample exposure to emergency psychiatry during their residency. During the PGY-1 year, residents spend two months on Emergency Psychiatry on week shifts. The Emergency Psychiatry rotation takes place in the ED where these patients can be evaluated and treated. UAMC at South Campus serves a large number of psychiatric patients and has an active ED. Psychiatry works closely with the emergency department to co-manage these patients. Residents consult on between 5 and 10 cases per shift. The Emergency Psychiatry resident is directly supervised by the attending on the service, and the evaluations and treatment plans of all newly assessed patients and follow-up visits are evaluated upon completion. Supervisory sessions are devoted to patient management and evaluation, and often include other topics in psychopharmacology, psychotherapy, as well as reviews of relevant literature.
Night Call is generally at UAMC at South Campus during the PGY-2 and 3 years. There is no night call in the PGY-4 year. Residents on the Addiction Psychiatry and Child and Adolescent Psychiatry rotations do not take call, but have different call responsibilities on these respective rotations. Due to the Night Float rotation, residents who are not on this rotation generally take night call only on Friday and Saturday nights and during the day on weekends. Night Float is two discontinuous months in the PG-2 year from 8 PM to 8 AM. Weekend day is covered by PG-1 residents from 8 AM to 8 PM.
PGY-1 residents spend two months on the Neurology service, working one-on-one with neurology attendings. Most of the experience is in the neurology outpatient clinic. However, the service also performs consultations on medical inpatients and manages their own inpatients when admitted to the hospital. Outpatient cases are screened to focus on headache and other pain, movement disorders, epilepsy, and behavioral neurology. Inpatient consultations are screened by the neurology resident so as to provide a broad range of neurological problems relevant to the practice of psychiatry. Residents use diagnostic modalities such as EEG, radiologic procedures (CT, MRI, etc.), nuclear medicine scans, lumbar punctures, physical therapy, psychologic and neuropsychiatric testing, and social service intervention as deemed appropriate by the treatment team. Each case is staffed by an attending neurologist. The neurology coordinator for this rotation is board certified in psychiatry as well as neurology. The individual interests and skills of the rotating psychiatry resident will be taken into account in order to provide the optimum educational experience. There is one case conference per week and one neurology grand rounds presentation at University Campus. The resident has protected time to attend seminars on Wednesday afternoons. Residents also attend monthly Journal Club and Case Conferences. Residents are assigned in-house call based at UAMC at South Campus.
INPATIENT PSYCHIATRY (CRISIS RESPONSE CENTER)
Information to follow.
Residents fully evaluate, diagnose, and provide treatment for the patients admitted to the Geriatric Psychiatry service under the daily supervision of a psychiatry attending. Often this involves recommending and facilitating outreach to community resources for the patients and their families. The average caseload is approximately 6-8 patients. Residents participate in family meetings to educate caretakers and relatives. Residents also attend interdisciplinary treatment team planning meetings. Common principle diagnoses include medical, neurological, and psyhiatric problems of the elderly, especially depression and dementia. Residents are assigned in-house call based at UAMC at South Campus.
PSYCHOSOMATIC MEDICINE (CONSULTATION-LIAISON)
Residents receive training experience in Psychosomatic Medicine during their PGY-2 and PGY-4 year. Residents perform psychiatry consults on patients on the internal medicine, family medicine, and surgery inpatient units. Residents round with the Psychiatry Attending daily, typically in the afternoon. Every new case is presented to the attending and the attending will often interview patients as well. Attendings discuss the case with the residents and medical students rotating on the service. UAMC at South Campus has 72 medical and surgical inpatient beds, with a diverse patient population. The leading diagnoses on the Psychosomatic Medicine service include delirium, dementia, other organic mental disorders, major depression, and adjustment disorder with depressed mood, substance abuse, and somatoform disorders. A substantial proportion of patients present with symptoms of depression and/or anxiety attributable to organic causes. Primary treatment is psychopharmacologic in nature, supplemented by supportive psychotherapy and behavioral psychotherapeutic modalities such as relaxation and self-hypnosis. Residents often also assist in providing recommendations for behavioral techniques useful in managing patients. Residents are assigned in-house call based at UAMC at South Campus.
This 2-month PGY-2 rotation takes place at the Southern Arizona VA Healthcare System. Residents spend about 40 hours each week assessing patients for both acute and long-term substance abuse treatment. They meet daily with the rotation's supervisor and are monitored by numerous other treatment team members throughout the duration of the experience. Residents are generally assigned to care for six patients on the acute detoxification service, though the number of patients followed by the resident can reach eight depending on the census of the inpatient unit. Residents are also involved in outpatient treatment services, including the co-facilitation of substance abuse groups, and assist eith general counseling for patients inolved in the program. The rotation coordinator directly supervises residents and provides both clinical information regarding patient management and both educational and theoretical discussions about topics in the subspecialty area of substance abuse. During this rotation, residents do not take night call at UPH Hospital. Instead, they participate in a weekend (daytime only) call system at the VA.
CHILD/ADOLESCENT PSYCHIATRY (THE UNIVERSITY OF ARIZONA MEDICAL CENTER)
Residents receive training in Child and Adolescent Psychiatry both at The University of Arizona Medical Center. Residents develop clinical skills with seriously disturbed hospitalized children, adolescents on the inpatient psychiatric unit, supervised by a Child and Adolescent Psychiatrist. Residents develop clinical skills with seriously disturbed hospitalized children, adolescents and their families. Residents participate in staff meetings, group therapy sessions, chemical dependency sessions, and family meetings. All residents have supervision two hours each day, consisting of one hour of individual supervision during teaching rounds and one hour of group supervision. Residents rotate through various outpatient clinics, perform consultations, and attend didactic seminars. Residents take specialized at home Child call, consisting of one week each month.
The outpatient psychiatry experience takes place at the UAMC at South Campus Psychiatry Clinic. During the outpatient rotation, which constitutes the entire PGY-3 year, residents develop primarily long and short-term dynamic, supportive, cognitive behavioral psychotherapy skills, as well as enhance their psychopharmacologic knowledge. They also develop group, and family and couples therapy skills, and they become experienced in psychopharmacologic management of outpatients. Residents learn to blend medication management with psychotherapeutic approaches. In addition, residents attend seminars, case conferences, and weekly supervision.
The average caseload for residents in the general outpatient clinic includes 12-14 hours per week of individual adult psychotherapy or medication management. In addition, residents co-facilitate a group. Residents also follow an ongoing couple or family during the PGY-3 year. Residents follow patients representing diverse backgrounds in terms of gender, diagnosis, age, phase of life, developmental level, and cognitive style. All new patient intakes and consultations are reviewed and supervised by a full-time faculty psychiatrist, and psychiatric residents are assigned individual supervisors. These supervisors participate in the intakes with the residents on assigned patients and are familiar with residents' caseloads. They also meet with patients as needed. In addition, residents have 1.5 hours per week for group psychotherapy supervision, and 1/2 hour per week for family or couples therapy supervision, and 1 hour per week of cognitive behavioral therapy supervision. Residents are assigned in-house call based at UAMC at South Campus.
ECT ROTATION (NORTHWEST HOSPITAL) AND FORENSIC PSYCHIATRY (UMC)
Residents spend one month in the PGY-4 year in a combination of ECT and forensic psychiatry experiences. The ECT portion provides the "hands-on" exposure required to obtain ECT-privileges in most practice settings after graduation. The resident attends ECT treatments three days per week during the month of their rotation. At a minimum, each resident actively participates in at least 10 ECT treatments directly supervised by a privileged treating psychiatrist and involving at least three spearate cases. Each resident participates in the initial evaluation and care of at least two patients including the primary management of their ECT work-up and course of treatment. At the end of this rotation, residents are eligible for ECT privileges in their clinical practices upon graduation. Individual supervision is provided by the ECT privileged Northwest Hospital Psychiatrists, (who are affiliated faculty on a part-time basis) and the ECT nurse assigned to the team. The resident participates actively in the weekly ECT case conference held on Fridays. A list of suggested readings is provided, which complements earlier lectures on ECT during the PGY-1 and PGY-2 years.
During the Forensic Psychiatry portion, residents develop forensic skills by observing civil and criminal evaluations in a variety of forensic settings, preparing parallel forensic psychiatric reports, witnessing courtroom testimony or depositions, and discussing with faculty ethical issues relevant to the practice of general and forensic psychiatry. Forensic evaluations occur at different times at the Outpatient Psychiatric Clinic of University Campus. Residents are offered an opportunity to spend time working in nearby correctional facilities (state or federal prisons), or at the sex offender treatment unit at The Arizona State Hospital in Phoenix. Residents gain exposure to a wide variety of common and complex forensic psychiatric issues. The resident observes several forensic evaluations and is provided with the opportunity to conduct a forensic interview and prepare a "parallel" forensic report. On average, residents observe 6 evaluations for the month, but the number can vary from 4 to 20. PGY-4 residents do not have call responsibilities within the program.
Elective rotations may be designed by individual residents based on areas of interest, the desire to further training in certain areas, and the development of research projects. Residents identify a faculty member who will coordinate and act as a mentor/supervisor for their specific elective rotation. The resident can draw on the entire faculty, including those off-site, to create their elective rotation. Some examples of elective rotations include telepsychiatry, Women's Mental Health Clinic, Forensic psychiatry, Geriatric psychiatry, Addiction psychiatry, Administrative psychiatry, work with Native American populations, and psychiatric research.
Throughout the PGY-4 year, residents continue to follow a select group of outpatients from their PGY-3 year. Typically, these are long-term psychotherapy cases in which an extended period of treatment was considered beneficial for the patient and the resident. In addition to their elective rotations, then, residents continue with some time in the clinic and receive therapy supervision as well. Residents also spend approximately 4 hours weekly in seminars and case conferences. Residents in the PGY-4 year do not have any night or weekend call.