OHSU

Clinical Rotations

Rotation Descriptions

portland tram view
VA 5C Inpatient Psychiatry Unit (3 consecutive months in PGY1, 6 consecutive wks in PGY2):

 

Location/Focus: The VA psychiatric unit 5C is a relatively spacious location in the Portland VA Hospital and overlooks the Willamette River. It provides services for US military veterans with mental health concerns.The average census is about 20 patients with an average length of stay of 8 days, slightly longer than that of the OHSU inpatient unit. Patients have a variety of psychiatric diagnoses requiring complex neuropsychiatric, medical, substance abuse, and psychosocial assessments and interventions. Veterans needing inpatient care are most often admitted from the ED, although are admitted from other inpatient wards (after psychiatric C/L service consultation), as direct admits from VA outpatient psychiatry providers, or as transfers from regional VA or non-VA facilities as well. The patient census is divided among three treatment teams, each of which consists of a psychiatric resident (PGY1 or PGY2), an attending psychiatrist, social worker, nursing staff, and up to 3 medical students (mostly 3rd years, although frequently a subintern). Occupational therapists, recreation therapists and psychologists are also integrally involved in care on 5C. Residents actively participate in admission evaluations, development of treatment plans, individual therapeutic interactions, care coordination with consultants, documentation, and medical student education.

Supervision: On-site supervision with unit attending, as well as group supervision off the unit every other week in PGY1.

OHSU 1NW Inpatient Psychiatry Unit (3 consecutive months in PGY1, 6 consecutive wks in PGY2):

Location/Focus: The Psychiatric Inpatient Care Unit is a 20-bed acute psychiatric hospital ward, and is colloquially known as "One Northwest", due to its location on campus. The unit cares for patients who are admitted for a range of acute psychiatric conditions – from severe depression to psychosis to agitation due to dementia or traumatic-brain injury to severe conversion disorder and beyond. Most patients are referred and admitted from the Emergency Room or from OHSU Medical or Surgical Services (after psychiatric C/L service consultation), while some are direct admissions from OHSU psychiatry providers or transfers from other regional hospitals. The census is divided into 3 treatment teams, which includes attending, resident, medical students. Patient care on the unit involves a multidisciplinary approach to psychiatric and medical assessment, appropriate short-term psychopharmacotherapy, individual and family therapy, occupational therapy, social work, coordination with pre- and post-hospitalization psychiatric providers, coordination with county legal representatives (if necessary). Residents play a very active role in psychiatric care on the unit, participating in assessment, care planning, care coordination, documentation, prescribing, and medical student education, all with attending physician direction and supervision. There is some variation in resident responsibilities based on PGY1 v. PGY2 status.

Supervision: On-site supervision with unit attending, as well as group supervision off the unit every other week in PGY1.

VA Inpatient Internal Medicine Service (2, likely non-contiguous, 1-month rotations during PGY1):

Location/Focus: The VA Internal Medicine Service cares for a number of patients on multiple floors of the Portland VA hospital. During the 2 months of training on the Internal Medicine Service, you will learn a tremendous amount of basic inpatient Internal Medicine.  You will work on a team with a non-psychiatry intern and a senior resident.  There will also be 2 medical students on your team.  Your team can take care of up to 16 patients total so you will at most be responsible for 8 patients.  You will admit new patients nearly every day and will see a wide variety of interesting cases in addition to great 'bread and butter' Internal Medicine (COPD, CHF, Pneumonia).  You will be expected to work 6 days per week from 6:30am until 7:30pm.  At noon every day there is a teaching conference (either didactic or resident-led report) that enriches your Internal Medicine experience.  Conferences are mandatory for all of learners on the medicine services. Psychiatry residents have traditionally felt that they were treated as an equal team member, received good supervision and training from attending, and were given good experience with a wide range of acute medical illnesses.

Supervision: on-site with medicine attendings at daily rounds, as well as protected psychiatry group supervision off the unit every other week.

OHSU/VA Neurology Units (2, likely non-contiguous, 1-month rotations during PGY1):

Location/Focus: The VA and OHSU neurology services treat a wide range of patients requiring inpatient neurological care – from Guillain-Barre to Myasthenia Gravis to seizure disorders to Creutzfeldt-Jakob Disease and beyond. Most often, residents train on the VA service, although sometimes on the OHSU service as well. The services have some differences. The OHSU service is busier, the service sometimes covering up to 15 patients, and sees a wider variety of neurologic disease. The VA service is a little slower paced, having often around 8-10 patients, but also covers the VA epilepsy monitoring unit. On both services, teams consist of multiple neurology residents, often an internal medicine resident, multiple medical students, attending neurologist, all in addition to the psychiatry resident. Psychiatry residents function as equals to neurology residents, and are integrally involved in assessment and treatment planning of patients on the service. There is frequently ample opportunity for education whether through impromptu lecture or independent study.

Supervision: on-site with neurology attendings at daily rounds, as well as protected psychiatry group supervision off the unit every other week.

VA Emergency Medicine Department (one 1-month rotation during PGY1):

Location/Focus: The Portland VA ED is a small ED, with 8-10 acute beds, 8-10 subacute beds. It has a circumscribed population of veterans, it is not a trauma center, and therefore is less susceptible to ebbs and flows of community care. It does see a fair share of acute medical emergencies, with which rotating psychiatry residents may be involved. Like the VA medicine service, the VA ED provides training in "bread and butter" emergency medicine - ACS, strokes, COPD exacerbations, pneumonia, CHF, etc. Psychiatry residents work alongside internal medicine and emergency medicine residents as equals, report directly to attendings, and are discouraged from seeing patients with mental health complaints (to maximize non-psychiatric learning). Each psychiatry resident will be responsible for 18-20 shifts per month, which will be scheduled for the resident prior to their arrival. Shifts are often about 10 hours in length and may start as early as 6:30am and may end as late as midnight. Residents do not work overnight in the ED (as it is often very slow and holds few educational opportunities).

Supervision: on-site with ED attendings, as well as protected psychiatry group supervision off the unit every other week.

OHSU/VA Chronic Illness Management Clinic (one 1-month rotation during PGY1):

Location/Focus: This rotation involves a number of multidisciplinary chronic illness outpatient clinics both at the Portland VA Hospital and at the OHSU University Hospital. The goal of the rotation is to train residents to care for patients who are afflicted with a complex assortment of chronic medical illnesses, most frequently metabolic syndrome and diabetes mellitus. Frequently these patients are also burdened by psychosocial stressors or psychiatric comorbidities which influence their care. Care is provided by a multidisciplinary team of internal medicine physicians, residents, nurses, pharmacists, educators, and often includes motivational interviewing, patient education classes, patient/pharmacist interactions, in addition to the traditional patient/physician interactions. Psychiatry residents have found this rotation both valuable to learning management of chronic medical conditions (which often affect psychiatric patients) as well as a nice respite from the inpatient services, as it is the only rotation of PGY1 that does not take place in the inpatient setting.

Supervision: on-site with medicine attendings and allied providers at daily rounds and patient staffings, as well as protected psychiatry group supervision off the unit every other week.

OHSU Psychiatry Consult/Liaison Service (one 6-week segment in PGY2):

Location/Focus: The OHSU Consultation/Liaison (C/L) service provides direct assistance with psychiatric assessment and care of patients admitted to non-psychiatric adult inpatient services throughout the hospital. This includes service to patients on general medicine, family medicine, surgery, neurology, OB-Gyn, ICU services, among others. The C/L service is the conduit to admission to an inpatient psychiatric admission from these services. The C/L service also periodically assists primary teams with direction and instruction on complex care topics such as decision-making capacity, complex discharges, and coordination of Notice of Mental Illness (two-physician hold). As well, the C/L team is periodically involved in Complex Case Review Meetings (frequently with primary teams, palliative care, medical ethics, etc) on patients whose care situation is especially challenging or poses questions with unclear answers. Example patients seen by the C/L team might be: patient on trauma service to assess need for psychiatric hospitalization after suicide attempt, patient in SICU on ortho service with post-operative delirium after hip transplant, patient on OB service with post-partum psychosis, marginally stable schizophrenic patient admitted to medicine in need of cardiac stent, patient on neuro service with Parkinsons and agitation, patient in ED with AMS who recently stopped Clozapine. The OHSU C/L team consists of C/L attending, Psych PGY2 resident, 3rd year medical student, and periodically a Psychosomatic Fellow or 3rd year neurology resident. The psychiatric resident participates in patient assessment, care choices and planning, obtaining collateral info on patients, reporting recommendations to and addressing concerns of the primary team, documentation, and medical student education.

Supervision: on-site with C/L attending.

VA Psychiatry Consult/Liaison Service (one 6-week segment in PGY2):

Location/Focus: The VA Consultation/Liaison (C/L) service assists in evaluation and treatment of veterans who may have psychiatric needs, but who are inpatients on VA non-psychiatric wards, including internal medicine, surgery, and neurology. The VA C/L service sees a similar range of consultation cases as the OHSU C/L service, although more directly assists in decision-making capacity evaluations and complex care coordination meetings than the OHSU C/L service. The VA C/L team most often consists of a PGY2 psych resident, attending psychiatrist, a Nursing Care Coordinator, and a 3rd year medical student. Frequently a Psychosomatics Fellow, a Geriatic Psych Fellow, a Geriatric Medicine fellow, or a 2nd year neurology resident will also work with the team. The psychiatric resident participates in patient assessment, care choices and planning, obtaining collateral info on patients, reporting recommendations to and addressing concerns of the primary team, medical student education, and documentation.

Supervision: on-site daily, by C/L attending.

OSH/Forensic Psychiatry:

Location/Focus:  Oregon State Hospital in Salem, Oregon.  OSH cares for patients whom county mental health courts have assessed to require longer rehabilitative treatment for their psychiatric illnesses. Although the Oregon State Hospital System cares for many forensic psychiatric patients (who may have committed crimes but been found "guilty except for insanity"), residents primarily care for patients who do not require this forensic oversight. The goal for civily committed patients is recovery and return to the community. Patients usually transfer to OSH after some weeks of treatment at community hospitals, and often suffer from complex or refractory psychoses, including Schizophrenia, Bipolar DO, Psychosis secondary to TBI, and more. The average length of stay for patients at POSH is about 2 - 3 months. Two PGY2 residents at a time are assigned to OSH, work for 6 consecutive weeks alongside seasoned veteran psychiatrists, and carry a maximum caseload of about 10 patients, performing assessments and case formulations, participating in treatment planning and patient care meetings. Clinical focuses include advanced psychopharmacology (clozapine, multiple antipsychotics, detailed understanding of medication interactions), inpatient group psychotherapy, and familiarity with the complex dynamics of forced hospitalization.

Supervision: on-site daily supervision with ward attendings.

OHSU Acute Emergency Psychiatry (two 3- or 4-week segments during PGY2, alternating with NightFloat):

Location/Focus: The OHSU Acute Emergency Psychiatry rotation provides trainees with the opportunity to work directly in the Emergency Department with patients seen for psychiatric concerns. Patient interactions include psychiatric assessment, triage and admission recommendations to ED staff, suicide risk assessments, violence risk assessments, domestic violence assessments, rapid management of acute agitation or unstable psychiatric conditions. The resident works with ED physicians, social workers, nurses, and frequently coordinates care with the psychiatry consult/liaison team. Of note: as this service often has a moderate work load, this resident position also assists with care on 1NW acute psychiatry ward and C/L service (two high work load services) during periods when residents on those rotations are on vacation.

Supervision: on-site with Acute Psychiatry attending.

OHSU/VA Night Float (two 3- or 4-week segments during PGY2, alternating with Emergency Psychiatry):

Location/Focus: The night float rotation is a crucial part of the residency's primary call pool. The night float resident spends a total of 6-7 weeks, broken into two 3-4 week segments during which they are in-hospital from 8pm to 8am five nights a week, from Sunday through Thursday nights. The rotation is designed to train in the common community model of call – rapid triage and overnight care planning for patients admitted to the inpatient psychiatric ward by the ED physicians. The night float resident covers both OHSU and VA, accepts admissions (brief assessments + holding orders), manages acute overnight inpatient concerns, and performs the rare emergent nighttime consult on non-psychiatric wards or the ED. Both EDs have admission privileges and therefore the night float resident is not often involved in admission decisions. Strong emphasis is placed on care handoffs when coming on call and signing off, so as to insure continuity of patient care.

Supervision: attending supervision by telephone at hours and also every morning at 7:30 am with director of inpatient psychiatry to discuss patient care concerns.

OHSU Outpatient Psychiatry Clinic (½ day per week, all year long, during PGY2-3; two ½ days per week in PGY4):

Location/Focus: The OHSU outpatient psychiatry clinic is located on the hill, on the 6th floor of Sam Jackson Hall, a building just adjacent to the OHSU hospital. The space itself consists of about 20 small offices, and is the site of a variety of outpatient psychiatric clinics – general psychiatry to geriatric psychiatry to complex neuropsychiatry. Each resident has a dedicated office, which other residents may use on other days. During each ½ day in clinic residents see 3-4 patients, in 30-minute to one-hour visits. The outpatient clinic experience is designed to be an introduction and training in the general outpatient psychiatry setting, to common outpatient psychiatric concerns, and to a growing degree of independence and primacy in patient care. The resident is tasked with assessment, formulation, and treatment of patients with a wide variety of psychiatric concerns amenable to outpatient management. Psychotherapy is an encouraged focus of this clinic, and is bolstered by weekly didactic training in supportive, cognitive-behavioral, and psychodynamic therapies, including a four-session "psychotherapy boot camp" - a preparatory series on psychotherapies during the first month of the clinic, prior to building larger resident caseloads. Of note: during PGY4, one ½ day in the clinic includes the Outpatient Consultation Clinic, in which residents work closely with a clinic attending to perform one-visit consultations on complex patients whose PCPs or outside psychiatrists have requested additional perspective or recommendations.

Supervision: 1 hour weekly, with a dedicated outpatient supervisor (on campus for PGY2s, possibly off-campus for PGY3s-4s, some degree of selection) who may not be directly in clinic. Direct, in-clinic attending supervision for Consultation Clinic in PGY4.

OHSU/Doernbecher Child and Adolescent Psychiatry Clinic (1/2 day/wk clinic + ½ day didactics for full year, during PGY3):

Location/Focus: The core of the child and adolescent psychiatry experience is the evaluation and treatment of selected children and adolescents and their families in an outpatient setting at OHSU. The intent is to give the resident familiarity with clinical psychiatric syndromes in children and adolescents, provide tools and working knowledge to help him or her be a competent evaluator of children and adolescents, and enable the resident to develop competence in family assessment and therapy. An underlying goal is to teach a developmental, multi-factorial approach to understanding people that should be as helpful in the psychiatrist's work with adults as with children and families. The resident can broaden this basic experience by electing a child and family-oriented community psychiatry placement concurrent with the child psychiatry rotation, and by continuing selected treatment cases into PGY-4. Included in Child and Adolescent training is ½ day of didactics on Thursday mornings dedicated to detailed training on care for child and adolescent patients and their families.

Supervision: In-clinic supervision at the end of every clinic ½ day with on-site faculty, plus 1 hour dedicated Child Psych supervision with a community or university provider outside of clinic times.

Call: see general PGY3 call section above

OHSU Geriatric Psychiatry (6 weeks, during PGY2):

Location/Focus: The goals of the geriatric psychiatry rotation include resident exposure to a wide variety of work in caring for a geriatric population needing psychiatric care.  This experience may include general psychiatric evaluation and care for elderly patients with long-standing psychiatric disorders such as schizophrenia or depression. It has also included work with elderly patients with psychiatric sequelae of dementia, stroke, or other brain injury or degeneration. Some residents get exposure to care for elderly patients in residential nursing facilities or in-home settings. The rotation is unique among residency rotations, as it provides in-depth exposure to Electroconvulsive Therapy, during which residents perform initial ECT clinical evaluations and follow-up for a wide array of patients, and assist in the treatment itself.

Supervision: on-site daily supervision

VA General Medicine/Psychiatry Clinic (1day/wk for 6mo):

Location/Focus: The Portland VA General Medicine / Psychiatry (GM/Psych) clinic occurs in 2 different locations off the hill. Both locations are in VA regional clinics, in more suburban settings, such as Hillsboro and Vancouver, Washington, a short drive away. The clinic is essentially a small psychiatric clinic embedded in a primary care clinic. Its goals are to offer psychiatric evaluation and brief, episodic care to veterans whose mental health concerns may be moderate in severity and manageable in a few sessions in the less controlled, less service-intensive Primary Care setting. Residents serving on GM/Psych perform psychiatric evaluations, medication management, and brief psychotherapy for patients with such diagnoses as major depression, PTSD, generalized anxiety disorder, and ADHD. After brief courses of care for stabilization of their mental health concerns, patients return to their PCPs for ongoing care. Unique in this rotation is significant opportunity for collaboration with primary care physicians, as consultant and partner in care provision.

Supervision: on-site daily supervision

VA Substance Abuse Treatment Program (1 day/wk for 6mo):

Location/Focus: The Portland VA Substance Abuse Treatment Program (SATP) operates out of the Portland VA Medical Center and the Vancouver, Washington branch of the Portland VA. The Program cares for veterans with a variety of addictions, including nicotine, alcohol, opiate, and stimulant addictions. Residents serving on the VA SATP rotation perform evaluation and ongoing psychiatric care for patients enrolled in the larger overall treatment program (which includes individual therapy, group therapy, psychoeducation, dual diagnosis). Residents learn overall treatment philosophies of substance abuse treatment programs. They also learn prescribing and therapeutic practices for patients in this vulnerable population, including methadone maintenance and use of medications with less abuse potential. Some residents in this rotation also participate in the Complex Pain Consultation Clinic, which serves to assist primary care with patients whose pain syndromes may be complicated by addictions and other psychiatric concerns.

Supervision: on-site daily supervision.

Call: see general PGY3 call section above

Community Psychiatry Training Program (1 day/wk clinic + ½ day didactics for 6mo):

Location/Focus: The focus of the community rotation is on the care of under-served rural populations and/or the urban deinstitutionalized chronically mentally ill. Residents can select from more than 40 potential training sites in rural and urban mental health programs, forensic psychiatry, transcultural settings and community support programs. Friday mornings, all PGY3 residents on the community psych block participate in community psychiatry didactics, which provide a broad overview of community psychiatry history, services, issues, etc.

Supervision: both on site with clinic coordinators as well as 1h general community psych supervision with a community provider who may or may not be associated with your chosen clinics.

Call: see general PGY3 call section above

Elective Rotations (possibly during PGY3, definitely during PGY4):

There are multiple elective rotations in which residents have participated during PGY3 and PGY4. Detailed descriptions of them would be too voluminous to include on this page. A list of some common elective rotations is included below. (If you are interested in getting more information on any of the rotations listed below, please contact the training office, and they can direct you to a resident who may have participated in that rotation.)

Administrative Psychiatry/Chief Resident Elective

Research Elective (per resident interest/project)

OHSU Somatization Clinic

OHSU Intercultural Psychiatry Program

OHSU Women's Health Clinic

OHSU Child or Adult Sleep Disorders Clinic

Portland VA Women's Health Clinic

Portland VA Dialectical Behavioral Therapy groups

Portland VA Day Treatment for significantly mentally disabled veterans

Portland VA Couples and Family Therapy

Portland VA Geriatric Psychiatry Program

Oregon State Hospital Forensic Evaluation Services Team – Salem, OR

Multnomah County Early Assessment and Support Alliance (EASA) for Young Persons with Emerging Psychosis

Multnomah County School Based Health Initiative

Portland State University Student Health Therapy Clinic

Reed College Mental Health Clinic

Cascadia (public behavioral health organization)

Lifeworks (public behavioral health organization)

NARA (Native American health care organization)

Outside In (Care provider for the Homeless Youth Population)