PSYCHIATRY ROTATIONS

VA Inpatient Psychiatry (“5C”) - 3 consecutive months

You will work with patients that have a variety of psychiatric diagnoses requiring complex neuropsychiatric, medical, substance abuse, and psychosocial assessments and interventions. The patient census is divided among treatment teams, each of which consists of a psychiatric resident (PGY1 or PGY2), an attending psychiatrist, social worker, nursing staff, and medical students. 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.

Unity Inpatient Psychiatry - 3 consecutive months

Unity Center for Behavioral Health (UCBH) cares for individuals with a wide range of acute psychiatric conditions, including affective, psychotic, personality, and substance use disorders often complicated by complex psychosocial struggles. Most patients are referred and admitted through Unity’s Psychiatric Emergency Service (PES). Patient care involves a multidisciplinary, trauma-informed approach to psychiatric care and medical assessment with team members including physicians, medical students, nurses, mental health technicians, occupational therapists, mental health counselors, and social workers. Residents play an active role in the psychiatric care of patients on the units, participating in assessment, documentation, pharmacological management, individual and family therapy, and post-discharge care coordination. On this rotation, residents will split their rotation on 2 wards with different levels of acuity to diversify exposure to different levels of psychiatric care.

MEDICINE ROTATIONS (4 months required)

VA/OHSU Chronic Illness Management (CIM) - 1 month

This rotation involves a number of multidisciplinary chronic illness outpatient clinics both at the Portland VA Hospital and at OHSU, including a half day in the VA Primary Care Medication Assisted Treatment (PC-MAT) clinic where you will care for patients on buprenorphine, naloxone, and naltrexone. The goal of the rotation is to train residents to care for patients who are afflicted with a complex assortment of chronic medical illnesses. 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.

VA Emergency Medicine - 1 month

The Portland VA ED is a small ED, with 8-10 acute beds, 8-10 subacute beds. It is not a trauma center and therefore is less susceptible to ebbs and flows of community care but does see a fair share of acute medical emergencies. 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 and are discouraged from seeing patients with mental health complaints (to maximize non-psychiatric learning). Residents do not work overnight in the ED.

VA Internal Medicine - 1 month

During training on the Internal Medicine service, 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.  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). At noon every day there is a teaching conference (either didactic or resident-led report) that enriches your Internal Medicine experience.

Pediatrics ~OR~ Family Medicine ~OR~ Internal Medicine - 1 month on ONE of the following services

• VA Inpatient Internal Medicine Service
  • Details above as this would be a 2^nd month on this service
• OHSU Inpatient Pediatric Service
  • Spend time in the inpatient pediatric service at OHSU’s Doernbecher Children’s Hospital
• OHSU Outpatient Family Medicine Clinic
  • East Portland Community Health Center is an FQMC where residents will work with patients from all age groups. One half day a week will be at Project Nurture providing prenatal and postpartum care for women who struggle with addictions as well as pediatric care to their infants. You will also spend a half day doing Geriatric Medicine assessments.
• Legacy Inpatient Internal Medicine Service
  • Residents will be based either at Legacy’s Good Samaritan Medical Center (LGSMC) or Legacy Emanuel Medical Center (LEMC). LGSMC has a large population of geriatric, tertiary care, and chronically ill patients, and LEMC is a Level I trauma site that serves underserved inner city and rural populations. You will be teamed with a medicine resident and medical students.

NEUROLOGY ROTATIONS (2 months required)

OHSU Neurology - 1 month

Residents will spend the month on the OHSU Stroke Team, which is both a consult and primary service. You will join a team with an attending, stroke fellow, neurology resident, and medical students.

VA Neurology - 1 month

During your time on the VA  neurology service, you will cover the VA neuro wards and the VA epilepsy monitoring unit, as well as occasionally join the team on consults. You will join a team with an attending, jr and sr neurology residents, often an internal medicine resident, and medical students.

OHSU Outpatient Psychiatry Clinic - ½ per week for full year except on NF

Our residents begin their outpatient clinical training as a PGY2 with a half day per week in the OHSU Outpatient Clinic (OPC) all year except when on their Nigh Float rotation. The outpatient clinic experience is designed to be an introduction and training in the general outpatient psychiatry setting and common outpatient psychiatric concerns. It is also designed to teach longitudinal care over 3 years with 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. Residents continue this clinic in their PGY3 and PGY4 year with growing levels of independence over time

Unity Emergency Psychiatry - 1 month

The Psychiatric Emergency Service (PES) at Unity (UCBH) is a stand-alone psychiatric emergency room, serving as the initial point of contact for many patients with acute psychiatric conditions including affective, psychotic, personality, and substance use disorders. The PES is capable of serving over 40 patients per day in an open milieu, furnished with comfortable recliners for each patient. Residents are responsible for the initial assessment and triaging of patients and work closely with social workers, crisis intervention specialists, and nursing staff in establishing treatment plans which include pharmacologic management, safety planning, disposition planning, and coordination of community mental health resources. In addition, residents are responsible for subsequently admitting patients to the inpatient psychiatric units at UCBH.

OHSU Child Consultation Liaison - 1 month

The Child and Adolescent Consultation Liaison (CAP CL) service provides direct assistance with psychiatric assessment and care of patients in the pediatric emergency department or admitted to pediatric inpatient services. It is the conduit for admission to inpatient acute and subacute psychiatry units throughout the region. Your team includes a CAP attending, CAP fellow, social workers, and medical students. The resident participates in patient assessment, treatment planning and recommendations, planning, obtaining collateral information from family, communicating with and addressing concerns of the primary team, documentation, and medical student education.

OHSU Adult Consultation Liaison - 1 month

The CL service provides direct assistance with psychiatric assessment and care of patients admitted to non-psychiatric adult inpatient services throughout OHSU and is the conduit to admission to an inpatient psychiatric admission from these services. It also 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). The CL team is 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. The team consists of CL attending, resident, medical student, and CL Fellow. The 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.

VA Adult Consultation Liaison - 1 month

The VA CL service assists in evaluation and treatment of veterans who may have psychiatric needs as inpatients on VA non-psychiatric wards. The VA CL 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. The VA CL team consists of a psych resident, CL fellow, attending, a Nursing Care Coordinator, and a medical student. 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.

Oregon State Hospital Forensic Psychiatry - 1 month

The Oregon State Hospital (OSH)  cares for patients whom county mental health courts have determined require longer rehabilitation for their psychiatric illnesses. Patients often transfer to OSH for additional evaluation and treatment after several weeks of treatment at community hospitals. These patients may suffer from chronic, complex, or refractory mental disorders including schizophrenia, bipolar disorder, personality disorders, and psychosis secondary to TBI. Residents train alongside Forensic Psychiatrists, and typically work with multiple forensic patient populations such as those being evaluated for capacity to stand trial for accused crimes, and those who have been found Guilty Except for Insanity and are undergoing psychiatric treatment. Residents are exposed to the medicolegal aspects of psychiatric care, and have the opportunity to attend court hearings on involuntary medication, the Psychiatric Security Review Board, or civil commitment for their patients. 

VA Geriatric Psychiatry - 1 month

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 includes general psychiatric evaluation and care for elderly patients with long-standing psychiatric disorders such as schizophrenia or depression as well as work with elderly patients with psychiatric sequelae of dementia, stroke, or other brain injury or degeneration. 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.

Community Psychiatry - 1 month

This rotation is an introductory look at community psychiatric care where your week will be broken up with different sites each day of the week providing an overview exposure to multiple community clinics at Lifeworks NW and OHSU. At Lifeworks NW, you will spend time in the Hawthorn Walk-In Center, Adolescent Day Treatment Program, and Bridge Clinic. At OHSU you will spend time learning HIV Psychiatry in the Department of Internal Medicine and Psychiatric Collaborative Care housed in Department of Family Medicine clinics.

VA Inpatient Psychiatry (“5C”) - 4 weeks over an 8 week period (coordinated with the NF resident in a joint coverage schedule)

See full description above in PGY1 section.  You will return to 5C in a more senior role.

OHSU/VA Night Float - 4 weeks over an 8 week period (coordinated with the VA 5C resident in a joint coverage schedule)

The night float resident spends a total of 4-5 weeks, broken into 1-3 week segments during which they are in-hospital from 8pm to 8am five nights a week, 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. 

OHSU Outpatient Psychiatry Clinic - ½ per week for full year 

This clinic is a continuation of PGY2 year, where PGY3s will still spend a half day per week in the OHSU Outpatient Clinic (OPC) all year with more independence. Residents can start taking on therapy patients. See description above in PGY2 rotations for more details. Residents continue this clinic in their PGY4 year. 

OHSU Outpatient Child & Adolescent Psychiatry Clinic - ½ day per week of clinic and ½ day per week of CAP didactics all year

The core of the child and adolescent psychiatry (CAP) experience is the evaluation and treatment of 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 them 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 will also be helpful in the psychiatrist's work with adults. Included in CAP training is ½ day of didactics dedicated to detailed training on care for child and adolescent patients and their families.

VA Outpatient Psychiatry Clinic - Full day per week for full year

This VA Outpatient Clinic (OPC) is designed to provide residents a 2-year longitudinal clinical experience in providing psychiatric care as part of an outpatient, multidisciplinary, mental health care team in a large, integrated public health care system. Residents will be based at one of many VA based sites in the greater Portland area. Residents will be provided ample opportunity to advance skills in diagnostic assessment, treatment planning, multidisciplinary team-based care, and longitudinal management of individual cases and a patient panel as a whole. One resident per class will have the chance to have this clinic for a half day per week plus a half day in PPMC, where the resident plays a dual role as psychiatrist and Primary Care provider. Residents continue this clinic in their PGY4 year. 

VA Substance Abuse Treatment Program (SATP)  - 1 day per week for 6 months

The Substance Abuse Treatment Program (SATP) 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 addiction related prescribing and therapeutic practices, including methadone maintenance and use of medications with less abuse potential.

VA Collaborative Care Clinic - 1 day per week for 6 months

This clinic is an innovative model to address both the nationwide need to increase veteran access to psychiatric care by lowering barriers and increasing efficiency as well as the changing field of consultation medicine within Psychiatry. Each collaborative care team consists of one resident, an attending, and a nurse care manager. Part of the rotation involves being a consult to VA primary care physicians to address more complex psychiatric care needs of their patients. The resident determines if the consult is done with a one time in-person interview with the patient, telephone call or chart survey and e-consult. Another part of the rotation involves working closely with the VA nurse care managers to provide care for their 20-30 patient panel in the Translating Initiatives for Depression into Effective Solutions (TIDES) Project. The psychiatry residents meet weekly with the nurse care managers to address medication management or other issues that arise with their veterans.

Community Psychiatry - 1 day clinic and one ½ day didactics per week for 6months

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. 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. Residents can choose to be at 1 or 2 different sites depending on interest. Residents will get supervision on site with clinic coordinators as well as 1h general community psych supervision from our departments Director of Public Psychiatry. As a learning component for the Community Psychiatry rotation, residents will take part in multiple field trips. A majority of the field trips will be to community sites in and around Portland. In addition, residents will take a multiple day field trip to Vancouver, BC (comes with stipend) to learn about the community mental healthcare systems and resources available in Canada. Here is a sample list of some community psychiatry training site options

• Asian Health & Service Center
• Cascadia Behavioral Health - multiple specialty clinics
• Catholic Community Service
• Central City Concern - multiple specialty clinics
• Confederated Tribes of Grand Ronde
• Confederated Tribes of Warm Springs
• Deschutes County Behavioral Health
• Kartini Clinic for Children and Families (eating disorders)
• Lifeworks NW - multiple specialty clinics
• Multnomah County Department of Corrections
• Multnomah County Early Assessment and Support (EASA)
• Native American Rehabilitation Association
• New Narrative
• OHSU Avel Gordly Center
• OHSU Intercultural Psychiatric Program
• Oregon State Hospital Forensic Evaluation Service
• Outside In
• Portland State University Center for Health and Counseling
• Dont see something you are interested in? We can easily set up new options that meet your interests

OHSU Outpatient Psychiatry Clinic - ½ per week for full year 

This clinic is a continuation from resident' PGY2&PGY3  year, where PGY4s will still spend a half day per week in the OHSU Outpatient Clinic (OPC) all year with more independence. See description above in PGY2 rotations for more details.  

VA Outpatient Psychiatry Clinic - Full day per week for full year

This clinic is a continuation from resident' PGY3 year where they will spend a full day per week all year. See description above in PGY3 rotations for more details.   

Electives - Five ½ days per week with opportunity to switch throughout the year

Elective opportunities are available in the community, at OHSU, at the VA and other local hospitals. Here is a sample list of elective site options which includes the community psychiatry sites above:

• Administrative Psychiatry/Chief Resident Elective
• Asian Health & Service Center
• Cascadia Behavioral Health - multiple specialty clinics
• Catholic Community Service
• Central City Concern - multiple specialty clinics
• Collective Care Clinic
• Confederated Tribes of Grand Ronde
• Confederated Tribes of Warm Springs
• Deschutes County Behavioral Health
• Center for Geriatric Psychiatry at Hillsboro Medical Center
• Kaiser Permanente Interventional Psychiatry
• Kartini Clinic for Children and Families (eating disorders)
• Lifeworks NW - multiple specialty clinics
• Medical Education Elective
• Multnomah County Department of Corrections
• Multnomah County Early Assessment and Support (EASA)
• Native American Rehabilitation Association
• New Narrative
• NorthStar TMS and keteamine/esketamine
• OHSU Avel Gordly Center
• OHSU ECT
• OHSU Family Medicine Collaborative Care
• OHSU HIV Clinic
• OHSU Intercultural Psychiatric Program
• OHSU Palliative Care
• OHSU Womens Health Clinic
• Oregon State Hospital Forensic Evaluation Service
• Outside In
• Portland State University Center for Health and Counseling
• Reed College Mental Health Clinic
• Research Elective (per resident interest/project) including psychedelic medicine opportunities
• VA ECT
• VA Geriatric Psychiatry
• VA Intensive Community Mental Health Recovery (ICMHR)
• VA Primacy Care Mental Health Integration
• VA Psychotherapy Clinic
• VA Sleep Clinic
• VA TMS
• VA Women's Health Clinic
• Dont see something you are interested in? We can easily set up new options that meet your interests

Residents work together across the four years of our program to provide 24-hour coverage seven days a week for the psychiatric services at OHSU and the Portland VA. The time spent on call lessens with each year of training. The overarching theme of the call system is to "never worry alone." Residents are encouraged to contact the on call attending at any hour of the day or night whenever they have a question.  

Weekends: An assigned team of two PGY1s and one PGY3 or PGY4 cover both Saturday and Sunday from 8 am to 8 pm. One intern covers the VA inpatient unit and the other the OHSU CL service. If everyone gets caught up on work, one intern can go home early leaving the other intern and senior resident to provide coverage. There is always a senior resident available in-house to support interns during their call shifts.

Weekday evenings: PGY-2s cover the majority of call and are responsible for evening shifts from 4 pm to 8 pm on weekdays. For these shifts residents do not need to be in-house and can take call from home. This evening shift allows the daytime resident to leave between 4 to 5 pm most days.

Weekday nights:  This shift is covered by the PGY2 resident on their night float rotation from 8 pm to 8 am. 

Weekend nights and holidays: These are also covered by PGY-2s. Residents who work a major holiday (Thanksgiving, Christmas or New Years) are allowed an additional day of vacation called a "floating holiday" that they can use at a later date that academic year. 

When entering the 3^rd and 4^th years, the amount of call reduces significantly. Senior residents supervise interns on weekend call shifts and provide jeopardy coverage. The jeopardy resident is on backup call for a week at a time. These residents are on back up call in case the workload becomes unmanageable or an emergency/illness arises for the resident assigned to the primary call shift.  Our residents do not cover call at Unity Behavioral Health, which is the stand-alone psychiatric hospital associated with OHSU.