Program Requirements

KAWEAH DELTA HEALTH CARE DISTRICT GRADUATE MEDICAL EDUCATION  
Psychiatry Residency Program Minimum Program Requirements    

The following is a summary of minimum program requirements for the Psychiatry Residency Program at Kaweah Delta Health Care District.  Each resident must: 
 
A.           APPLICATION  
·         Follow all rules for the Kaweah application and interview process;
·         Sign and follow a confidentiality and non-disclosure agreement for the residency application Interview process;  
 ·         Understand that personal or family connections to the Central Valley of California and/or clear desire to practice in an underserved rural area are given some priority in applicant ranking;
·         Have sufficient proficiency in the English language to permit accurate and unimpeded communication (both verbal and written);  

B.           ORIENTATION  
·         Have a Basic Provider CPR certificate by the first day of KD employment. 
·         Complete and Advanced Cardiac Life Support (ACLS) class during Orientation;
·         Must complete pre-course prep work for ACLS prior to first day of KDHCD Orientation;
·         Complete the CPI Non-Violent Crisis Intervention Training Program during Orientation
·         Complete a detailed Orientation/Psychiatry Boot Camp during the first two-weeks of the PG-1 year;
·         During the PG-2 to PG-4 years, co-teach two seminars/year with a faculty member for the PGY-1 Orientation/Boot Camp; 
 
C.           PROFESSIONALISM  
·         Maintain good professional conduct including the absence of unethical behavior.  Follow ethical principles of the American Psychiatric Association and American Medical Association;
·         Apply and maintain membership in good standing with the Tulare County Medical Society (annual Resident dues paid by KDHCD);
·         Have no physical, emotional or substance abuse conditions that impair the ability to practice medicine; 

D.           SUPERVISION  
·         PGY-1 residents must be directly supervised by a Faculty member until passing the “Initial Faculty Assessment of Progressive Authority” which should occur within the first few months of the PGY-1. Criterion include:  ability and willingness to ask for help when indicated, ability to gather an appropriate history, ability to perform an emergent psychiatric assessment, and ability to present patient findings and data accurately to a supervisor who has not seen the patient;
·         Attend one hour of direct group supervision daily by the site director of each rotation;
·         Attend one hour of direct group supervision weekly during the didactic conference day;
·         Attend one hour of direct individual supervision weekly with the site director of each rotation;
·         Attend one hour of direct individual supervision weekly with an assigned faculty mentor (this may occur at KDHCD or require travel to the supervisor’s local private practice office);
·         Meet with the Program Director every six months for a formal evaluation;
·         Progressively require less direct supervision and steadily progress towards requiring primarily indirect supervision and oversight in the PGY-4;  

E.           TECHNOLOGY  
·         Have computer skills to utilize the sophisticated KDHCD Electronic Medical Records;
·         Have a Smartphone (e.g., iPhone, Android, etc.) with text/web access (at Resident’s own expense) and immediately notify the GME office of any changes in contact information;
·         Check their KDHCD email account whenever on duty and regularly each weekday except when on vacation. ·         Obtain/maintain an iPad (or similar table computer) during the entire residency.  One iPad is provided to each Resident free at Orientation.  If the Resident or KDHCD terminates the residency program before graduation, the iPad must be returned to KDHCD;
·         Each resident must maintain a free DocBookMD App on their SmartPhone for HIPAA-compliant text messaging.  

F.           ROTATIONS/SEMINARS  
·         Be aware of and meet specific ACGME competency-based objectives for each rotation and PG year;
·         Receive a passing evaluation by their Site Supervisor for each Rotation;
·         Be aware that five months of rotations during the 48 month residency are located in Fresno and Bakersfield and which require Resident travel (temporary housing provided in Bakersfield if desired);
·         Have/maintain a vehicle, valid U.S. driver’s license and auto insurance (at Resident’s own expense);
·         Have/retain housing within a 15 minute drive of the hospital (at Resident’s own expense);
·         Complete all required readings for rotations and seminars;
·         Attend a minimum of 75% of didactic seminars; 
 
G.          PSYCHOTHERAPY CASES  
·         During the PG-2 to PG-4 years, maintain weekly psychotherapy cases with weekly individual supervision and demonstrate progressive competence in supportive, psychodynamic, cognitive-behavioral, brief and family/maritial psychotherapies.  Resident must maintain a minimum of one weekly psychotherapy case in PG-2 year, two weekly psychotherapy cases in PG-3 year and three weekly psychotherapy cases in PG-4 year; 
 
H.           SCHOLARLY ACTIVITY  
·         Make at least two presentations to the Journal Club during the PGY-3;
·         Complete a scholarly activity (SA) project in psychiatry during the residency and formally present the results to the faculty at Grand Rounds in the PGY-4.  Regularly meet with a faculty advisor/mentor to assist in his/her scholarly activity project;  

I.             DOCUMENTATION  
·         Thoroughly complete all required medical record documentation in a timely manner;
·         Conduct peer chart audits and handoff/transition audits as assigned by the Program Director;
·         Complete timely and accurate handoff/signouts at transitions in care.
·         Submit a weekly patient log demonstrating variety of diagnoses, treatment, adequacy of supervision and duration of treatment;  

J.            POLICIES  
·         Be aware of and follow both hospital and GME policies;
·         Wear your Kaweah Delta Identification Badge at all times while on duty;
·         Be aware of ACGME duty-hour restrictions, closely monitor their duty hours and promptly report any violations.
·         Be aware of signs of Sleep Deprivation and intervention strategies including backup transportation plans; ·         Immediately notify their Attending for any of the following events involving one of their patients: Patient death, Patient transfer to higher level of care (ICU, etc.), Patient code or rapid response team, DNR orders, Suicide attempt or violence, Patient arrest or criminal charges, Unplanned patient discharge from hospital, Formal complaint filed involving patient care, Contact from law enforcement/attorney/court involving patient care or other high-risk or unusual incidents.  

K.           QUALITY IMPROVEMENT  
·         Complete the 16 online courses for the IHI Basic Certificate of Performance Improvement and Patient Safety online training during the first two weeks of PGY-1 Orientation at http://www.ihi.org/offerings/IHIOpenSchool/Pages/default.aspx.   Residents can enroll at any time so can begin/complete it prior to arrival to Visalia if desired;
·         Complete the two IHI online courses on Population Health and Quality Improvement Practicum by the end of the first week of the PG-2 year at http://www.ihi.org/offerings/IHIOpenSchool/Pages/default.aspx
·         Make two presentations at the Quality Improvement Conference during the PGY-2.  One QI project should be in collaboration with a CUSP (Comprehensive Unit Based Safety Team) and one in collaboration with a Faculty Member and the KDHCD Performance Improvement Division;
·         Attend 10 Quality Improvement/Patient Safety hospital committee meetings during each PG year from among Quality Council (3rd Wed each month 7 am to 8:30) – AWCR, Patient Safety Committee (3rd Wed each month 12 to 13:30 pm) – Blue Room, and Quality Improvement Committee (1st Tue each month 12 to 13:30 pm) – Blue Room;  

L.           ASSESSMENT/EXAMINATIONS  
·         Pass the annual PRITE (Psychiatry Resident-In-Training Examination) exam with a score > 50% the national percentile each year in September or October for objective assessment of his/her psychiatric knowledge;
·         Complete an annual Intensive PRITE Review course taught by Faculty during the summer of each PG year; ·         Pass the annual PPCT (Psychodynamic Psychotherapy Competency Test) exam each year held in March or April for objective assessment of his/her knowledge of psychodynamic psychotherapy.
·         Answer 1-2 daily Board Preparation questions each weekday sent to their KD email address (or using Smartphone App) by the Q-Stream spaced-learning system;
·         Complete Moodle On-Line Assessment Modules as assigned by the Program Director
·         Attempt a Clinical Skills Examination (one hour observed interview and case presentation) at the end of each psychiatric rotation;
·         Passed at least one Clinical Skills Assessment (at the performance level of a trainee) during each PG year; ·         Passed at least one Clinical Skills Verification (at the performance level of an independent practicing psychiatrist) by the onset of the PGY-3;
·         Passed at least two Clinical Skills Verification (at the performance level of an independent practicing psychiatrist) by the onset of the PGY-4;
·         Pass three Clinical Skills Verifications (at the performance level of an independent practicing psychiatrist) before graduation from the program;  

M.          LICENSING  
·         Obtain and maintain medical licensure in the State of California and a DEA registration by the end of the PG-2 year;
·         Residents with a PTAL (Postgraduate Training Authorization Letter) must update their applications annually by submitting Forms L1A-F to the California Medical Board. 
 
N.           PROGRAM EVALUATION  
·         Attend an annual Resident retreat and participate in program self-evaluation;
·         Elect a representative from each PGY class as representative to the monthly meetings of the Resident Education Committee;
·         Each April, constructively participate in formulation of an annual written report on program improvement for the Program Director.
·         To facilitate a systems approach to quality improvement, bring non-urgent concerns about program improvement through their representative to the Resident Education Committee; 
 
O.          MISCELLANEOUS  
·         Residents must care for patients in a teamwork environment that maximizes effective communication including consulting physicians, psychologists, psychiatric nurses, social workers, and other professional and paraprofessional mental health personnel involved in the evaluation and treatment of patients;
·         Competently participate in on-call duties and activate the back-up resident on-call system when duties become excessive;
·         During each PG year, attend one meeting of the local Tulare Alliance for the Mentally Ill;
·         Only moonlight in the PGY 3-4, only internally at KDHCD and only if approved by the Program Director;
·         Successfully complete at least six, but no more than 16 months of inpatient psychiatry rotations prior to graduation;
·         Limit child/adolescent patients to no more than 20% of patients treated while on required Adult Psychiatry rotations;
·         Successfully complete any remediation plans as assigned by the Program Director
·         Other miscellaneous duties as assigned by the Program Director.  


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