Inpatient Psychiatric Service, Units, UNITS 2, 3, 4, 5/ Desert Vista Behavioral Health Campus
This experience is required during the PGY-2 year for a 5-month period (1-3 month rotations) and for both PGY-1 and PGY-2 residents for the month of July.
Faculty includes full-time psychiatrists as well as one licensed psychologist who is available to perform psychological testing and to aid in constructing behavior plans.
Residents are trained in a multi-disciplinary environment. Residents provide services on the units for approximately 30 hours/week. They participate in multidisciplinary team staffings, individual patient evaluation and treatment sessions, and supervision. Teaching is provided by the faculty attending psychiatrists in informal didactic presentations based on case material. Residents provide both the psychiatric and some non-psychiatric medical care on the units and non-psychiatric medical consultations are readily available on site and from other MMC hospital-based services.
During the first month of each academic year, faculty and PGY-2 residents help to orient PGY-1 residents to the operations of the hospital and to the basic processes of evaluating and treating psychiatric inpatients. This orientation includes basics of the mental status exam, beginning interviewing techniques, completion of required documentation, legal issues, and management of emergencies. PGY-1 residents are paired with more senior residents during night call shifts through at least the first month of the residency.
PGY-2 residents are expected to have mastered basic skills related to treatment of inpatients, and the emphasis is therefore on developing the resident’s capacity to manage clinical situations more independently. The resident is expected to take the lead in staff meetings and meetings with outside providers and families with respect to his/her 6-8 assigned patients. Faculty psychiatrists provide a gradient of input dependent on the resident’s individual skill level and clinical maturation. Residents will address questions arising in the course of clinical practice by searching and appraising literature and producing at least one critically appraised topic per rotation (6 CATs total). Residents spend approximately 8 hours per week in classes and meetings.
Hospital units are locked and provide short-term inpatient evaluation and treatment services. Eight-five percent of the patients are between 18 and 55 years of age. Diagnostically, patients reflect almost all DSM-IV-TR classifications with primary diagnoses including 42% schizophrenia and other psychotic disorders, 48% affective disorders, and 10% a mix of substance-induced, organic, personality, adjustment, eating, and other disorders. Comorbid substance abuse and personality disorder are prominent. Approximately 90% of patients are under involuntary treatment status (for initial evaluation, awaiting court or post-court order). The majority of patients is eventually found eligible for publicly funded behavioral health services either due to impairment or lower economic status. These units treat a high percentage of involuntary patients, making the socio-economic variety significant, because Maricopa Medical Center/MIHS is the only court evaluation inpatient center in the county. Frequently utilized treatment modalities include use of antipsychotic medications (including clozapine and the atypical antipsychotics), mood stabilizers, and antidepressants. Medical detoxifications and rapid stabilization of psychiatric emergencies are frequent occurrences on these acute care units. Brief, supportive psychotherapy and psycho-educational services are provided to patients. Attention is paid to aftercare planning and involvement with the public mental health system is emphasized. As part of the forensic psychiatry experience, the resident is actively involved in the court-ordered evaluation and treatment process, including the preparation of two (PGY-1) to three (PGY-2) affidavits per week and periodic court appearances.
All residents have daily (Monday-Friday) supervision in rounds as well as individually as indicated. When taking in-house call at night and on weekends, residents can access clinical and administrative supervision by paging the clinical and/or administrative psychiatrist on call. On-call psychiatrists are expected to respond to a page within 15 minutes.
Back to 2nd Post-Grad Year