Goals and Objectives:

The training during the fourth post graduate year further expands the knowledge base of the general psychiatric resident and provides further opportunities for development of their clinical skills. By the time the fourth year of training is reached, the basic fundamentals for the general psychiatrist have been taught and incorporated. Some trainees choose to transition to child psychiatry training at this point. For the others who remain in their fourth year, opportunities are there to function as assistant medical director on the acute care inpatient unit at MCG. Completion of ECT training is encouraged if this has not already been accomplished. Multiple elective opportunities at MCG, the VA, and other psychiatric facilities are available depending upon the interests of the trainee.

Emphasis is also placed on the role of the senior psychiatric resident as educator. They are increasingly involved in medical student teaching and lecturing, supervision, and mentoring. The completion of research interests and the completion of a senior project are emphasized as well. This also provides an opportunity to further hone psychotherapy skills and to increase comfort with their utilization.

Core competencies continue to be monitored and evaluated, with specific objectives being tailored to the individual and the composition of their year.

Core Competencies:

A. Knowledge: Residents will continue to broaden their capacities to provide competent care and consultation to patients with a broad range of psychiatric disorders that are commonly encountered in clinical practice. Their patients will include people in all age groups and of both sexes. Some of their patients will be from various ethnic minority groups.

B. Skills: Residents will become more highly skilled at interviewing, history taking, mental status examination, differential diagnosis, treatment planning, diagnostic testing, and recording of findings. They may choose to have more in-depth clinical experience in psychotherapy and/or somatic treatments (such as ECT) provided in inpatient and outpatient settings. They may have roles as direct providers of care, as consultants, and as teachers of junior residents and medical students.

C. Attitudes: Residents will consolidate their identities as psychiatrists and will remain committed to the scientific and ethical values that underlie the doctor-patient relationship.

A. Knowledge: Residents will learn about the major theories and viewpoints in psychiatry, together with a thorough grounding in the generally accepted clinical facts. They will learn to diagnose and treat a wide range of psychiatric disorders. They will learn the etiologies, prevalence, diagnosis, treatment, and prevention of all major psychiatric disorders in the current standard diagnostic statistical manual, including the biological, psychological, sociocultural, and iatrogenic factors that affect long-term course and treatment of psychiatric illness. They may elect to learn more about research methods in psychiatry and to teach and function as leaders in the role of chief resident.

B. Skills: Residents will become more skilled at applying their knowledge of psychiatric illness to particular clinical problems, both as direct providers of care, as consultants, and as teachers. They will develop excellent working knowledge of numerous psychotherapies, and of somatic treatments (including psychopharmacologic interventions and ECT) that are provided in inpatient, acute care, and outpatient settings.

C. Attitudes: Residents will understand and appreciate the value and role of a strong knowledge base in the provision of comprehensive psychiatric care, consultation, and teaching.

A. Knowledge: Residents will become familiar with the fundamentals of clinical and academic psychiatry so that they can go on to engage effectively in life-long learning.

B. Skills: Residents will learn how to deal effectively with complex psychiatric illness through critical reading and expert consultation

C. Attitudes: Residents will develop an appreciation of the value of life-long learning for competent patient care.

A. Knowledge: Residents will learn clinical techniques to insure respectful and ethical interactions with patient and colleagues.

B. Skills: Residents will have the opportunity to develop their interpersonal and communication skills in didactic seminars, in supervision, and in their roles as teaches and administrative leaders within the residency program.

C. Attitudes: Residents will develop an appreciation of the value of interpersonal and communication skills for assurance of ethical and effective patient care.

A. Knowledge: Residents will study and receive mentorship in professionalism and ethical behavior in psychiatric practice.

B. Skills: Residents will develop their professional skills by interacting with the colleagues and supervisors, and learn to practice psychiatry in accordance with professional norms.

C. Attitudes: Residents will develop an appreciation of the value of professional and respectful treatment of patients and colleagues in all clinical settings.

A. Knowledge: Residents will learn about the importance of approaching patient care in a systems-oriented way, with particular attention to the challenges of promoting access of patients (regardless of socioeconomic status) to high-quality mental health care in both the public and private sectors.

B. Skills: Residents will develop their skills at working ethically in various psychiatric contexts by discussing and participating in clinical cases that raise issues related to health-care systems.

C. Attitudes: As they approach the transition to post-residency practice, residents will develop an appreciation of the value of thinking about various systems (such as private practice, managed care, and public-sector care) insofar as they relate to the provision of ethical patient care in psychiatry.