GERIATRIC PSYCHIATRY FELLOWSHIP TRAINING PROGRAM HANDBOOK

Transcription

1 GERIATRIC PSYCHIATRY FELLOWSHIP TRAINING PROGRAM HANDBOOK THE WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY GERIATRIC PSYCHIATRY FELLOWSHIP TRAINING PROGRAM

2 GERIATRIC PSYCHIATRY FELLOWSHIP HANDBOOK TABLE OF CONTENTS 1. Geriatric Psychiatry Fellwship Training Prgram Missin and Overview 2. ACGME Prgram Requirements f Residency Educatin in Geriatric Psychiatry 3. ACGME Accreditatin Letter 4. ABPN Geriatric Psychiatry Cre Cmpetencies 5. AAGP Geriatric Psychiatry Cre Cmpetencies 6. Geriatric Inpatient Psychiatry Rtatin Gals and Objectives 7. Geriatric Cnsult Liaisn Rtatin Psychiatry Gals and Objectives 8. Nursing Hme Psychiatry Rtatin Gals and Objectives 9. Geriatric Outpatient Psychiatry Gals and Objectives 10. Geriatric Medicine Ambulatry Care Rtatin Gals and Objectives 11. Geriatric Hmecare Psychiatry Rtatin Gals and Objectives 12. Memry Disrder Clinic Rtatin Gals and Objectives 13. Neurpathlgy Rtatin Gals and Objectives 14. Geriatric Neurpsychiatry Rtatin Gals and Objectives 15. Geriatric Neurradilgy Rtatin Gals and Objectives 16. Geriatric Substance Abuse Rtatin Gals and Objectives 17. Palliative Care Rtatin Gals and Objectives 18. Mvement Disrders Rtatin Gals and Objectives 19. Neurmdulatin Rtatin Gals and Objectives 20. Geriatric Assessment and Treatment Clinic Rtatin Gals and Objectives 21. Neurpsychlgy Rtatin Gals and Objectives 22. Geriatric Outpatient Psychiatry Clinic Overview 23. Geriatric Inpatient Psychiatry Overview 24. Sample Rtatin Schedule 25. Didactic Schedule Gals and Objectives 26. OSCE Gals and Objectives 27. HRSA Grant Overview 28. Prfessinal Licensure 29. American Medical Assciatin (AMA) Gifts t Physicians Guidelines 30. Geriatric Psychiatry Fellwship Training Prgram Salary 31. Geriatric Psychiatry Fellwship Training Prgram Agreement 32. Vacatin 33. Cverage Respnsibilities 34. Hliday, Sick and Bereavement Leave 35. Extended Leave Plicy 36. Academic Credit Guidelines 37. Cnference Time and Funding 38. Fellws Benefits & Expenses 39. Duty Hur Plicy 40. Guidelines fr Weekend Inpatient Cverage Respnsibilities 41. The Lttery 42. Mnlighting 43. Sexual, Racial and Ethnic Harassment Plicy 44. Risk Management 45. Medical Malpractice Insurance 46. Butler HIPAA Privacy Ntice 47. Fellws Patient Lg 48. Seminar Attendance Guidelines 49. Supervisin Guidelines 50. Brwn Psychiatry Residencies Plicy Regarding Resident Due Prcess 51. Evaluatin f the Geriatric Psychiatry Fellwship Training Prgram and Evaluatin f Residents 52. Research Training and Year Useful Web Sites

3 The Warren Alpert Medical Schl f Brwn University Geriatric Psychiatry Fellwship Training Prgram Missin and Overview The Brwn University Department f Psychiatry and Human Behavir in cnjunctin with Butler Hspital, The Miriam Hspital, Rhde Island Hspital, Prvidence Veterans Administratin Hspital, and the Brwn University Center fr Gerntlgy and Health Care Research ffer a ne r tw year clinical Fellwship in geriatric psychiatry. The Geriatric Psychiatry Fellwship Training Prgram is an intensive clinical experience designed t equip future practitiners with all the skills needed fr the practice f geriatric psychiatry, and t prvide a fundatin in research t train the future leaders in geriatric psychiatry. In the first year, the residents in the prgram will develp clinical cmpetence in handling the majr prblems encuntered in geriatric psychiatry including depressin, anxiety disrders, substance use disrders, late-life psychsis, delirium, dementia, persnality disrders, adjustment disrder, and family prblems. Residents will als develp specific technical skills including cnducting a neurlgical examinatin, perfrming a cgnitive assessment, chsing and mnitring psychtherapeutic drug therapy fr the frail medically ill patients, the adaptatin f psychtherapy, and the administratin f electr-cnvulsive therapy, as well as ther neurmdulatin prcedures. Residents will becme cmfrtable with a variety f general health-care settings, including the nursing hme, the acute psychiatric inpatient unit, hspice, the acute medical hspital, and the geriatric clinic. The Geriatric Psychiatry Fellwship Training Prgram is rganized with bth cntinuus experiences as well as rtatins. The cntinuus nging experience is thrugh the weekly utpatient geriatric psychiatry clinic. Residents are als expected t have at least a 3 mnth experience in inpatient geriatric psychiatry, at least 9 mnth experience in nursing hme psychiatry, 4 mnths f memry clinic, a 4 mnth experience in cnsult liaisn psychiatry, 4 mnths f hmecare and 4 mnth expsure t utpatient geriatric medicine clinic. In additin t these experiences, the resident will have a number f clinical rtatins t braden their knwledge and skills in palliative care, neurpathlgy, neurimaging, neurpsychiatry, and addictins. In additin, the resident can elect an experience in neurmdulatin. During the Geriatric Psychiatry Fellwship Training Prgram the resident will be given the pprtunity t participate in nging research activities within the Department in the first year. Upn cmpletin f the first year f training the resident shuld have the skills necessary t be recgnized as a specialist in geriatric psychiatry. In the secnd year the residents in the prgram will develp further cmpetence in dealing with clinical issues in geriatric psychiatry, but als develp a sund fundatin in research and hspital administratin related t geriatric psychiatry. The secnd year is specifically designed fr residents wh wish t becme future academicians. Residents will further develp their clinical skills by participating in utpatient treatment, as well as inpatient psychiatric care, and receive further expsure t lng-term care settings. During the year, the resident will have an pprtunity, under supervisin, t assume administrative respnsibilities fr geriatric psychiatry prgrams within either a general hspital setting r a psychiatric hspital. This experience shuld lead t the resident being cmfrtable with assuming a leadership rle within an academic institutin. Fifty percent f the time during the secnd year f the Fellwship will be devted t research. This will prvide the resident an pprtunity t gain a slid fundatin in all aspects f cnducting research by develping their wn prjects and participating in nging research seminars. Upn cmpletin f the secnd year f training, the resident shuld have develped skills sufficient enugh t cmmence an academic career in geriatric psychiatry. The secnd year f training is available t thse wh are USA permanent residents r citizens, as it is funded by a grant frm the Human Resurces and Service Administratin (HRSA). The Brwn University prgram is nly ne f ten such prgrams in the natin. Residents designated as HRSA fellws cmpleting the tw-year prgram als have the ptin t btain a Masters f Science r Public Health. The Brwn University Geriatric Psychiatry Fellwship Training Prgram has a wide range f pprtunities and experiences available t residents. Residents will have the pprtunity t gain expsure t the brad range f faculty and expertise ffered at the Warrant Alpert Schl f Medicine at Brwn University. The geriatric inpatient psychiatry rtatin is designed t expse the resident t the full spectrum f acute psychiatric disrders ranging frm the dementia's t md disrders and psychsis that can nt be managed in less intensive settings. In additin, the inpatient rtatin will ffer expsure t neurlgical and neurpsychiatric prblems, as well as t patients wh have cmplicated crmrbid medical cnditins that interact with their mental status. During this rtatin residents will becme prficient in individual psychtherapy, family interventin, milieu therapy, behaviral mdificatin techniques, pharmaclgical treatments, as well as ECT.

4 The geriatric medicine rtatin will prvide an pprtunity fr the resident t becme mre prficient in gaining an understanding between the rle f medical cnditins and their effect n mental state. Residents will be expsed t a full spectrum f medical cnditins. The geriatric medicine ambulatry care clinic will give the resident an pprtunity t wrk with their medicine clleagues and understand hw dementia and psychiatric disrders present in primary care, and the influence f medical cmrbidity n these illnesses. In additin, the resident will gain an appreciatin f hw the geriatric medicine specialist deals with cmmn medical issues in the elderly. The geriatric cnsult liaisn rtatin will prvide a different perspective t the resident as t the interactin between medicine and psychiatry in the aged individual. This rtatin will fcus n the management f psychiatric patients in the acutely medically ill. Residents will have an pprtunity t deal with acute psychiatric prblems that may be secndary t the medical cnditin r a management f nging psychiatric cnditins. This rtatin will als ffer an pprtunity fr the residents t gain an appreciatin fr the prblems encuntered by an elderly individual in an acute medical hspital. These experiences, management f psychiatric prblems requiring inpatient psychiatric hspitalizatin, the management f medical prblems in elderly patients, and the management f psychiatric cnditins in the acute medical setting will be supplemented by a lngitudinal utpatient experience. Mst geriatric patients d nt have their psychiatric disrders managed in inpatient settings. In rder t gain an appreciatin fr the brader spectrum f emtinal disrders encuntered in the geriatric ppulatin a year-lng lngitudinal utpatient geriatric psychiatric experience is required. The geriatric utpatient psychiatry clinic will ffer residents an pprtunity t d psychpharmaclgical and psychtherapeutic management f a brad spectrum f psychiatric disrders. Family interventin will als be emphasized alng with psychpharmaclgical treatments. As a sizable prprtin f the nursing hme ppulatin has psychiatric disabilities, as well being a majr fcus f geriatric psychiatry, 3 different nursing hme experiences will be ffered. The gal f the nursing hme experience is t prvide the resident an pprtunity t learn hw t manage patients utside f the traditinal hspital envirnment. Residents will be expsed t a brad range f psychiatric cnditins and their cnsequences including anxiety disrders, biplar disrders, schizphrenia, substance abuse, in additin t the dementias. The residents will gain expsure t pharmaclgical management, learn t liaisn with nursing staff, and prvide in-services. Further expsure geared specifically t the management and the diagnsis f the dementias will be gained in participatin in the varius memry disrder prgrams available in the Brwn University system. The gal f the memry disrders prgram is fr the resident t becme acquainted with the varius types f dementia's, hw t diagnse and wrk up dementia's, as well as t be intrduced t nvel and smetimes experimental treatments that are used in the management f dementing disrders. In additin, the resident will receive mre frmal expsure t neurpsychlgical testing, and n appreciatin fr bth the capabilities and limitatins f neurpsychlgical assessments. The memry disrder prgrams prvide frmalized experience in wrking with a multidisciplinary team. The neurlgical assessment and the neurlgical prblems and the bundaries between neurpsychiatry and geriatric psychiatry are nt well-defined in dealing with the elderly ppulatin. The training ffered during this Fellwship has, therefre, placed a special emphasis n btaining a firm fundatin in neurlgical assessment. Expsure t geriatric neurlgy in the neurpsychiatry rtatin will assist the resident in imprving their skills in cnducting a general neurlgical examinatin, as well as t intrduce the resident t the management f neurlgical prblems that are cmmnplace in lder ppulatins, such as strke. Mvement disrders are frequently encuntered in the elderly ppulatin. Upn cmpletin f this rtatin, the resident shuld be well versed in ding a neurlgical assessment. Neurimaging prcedures are frequently used in geriatric psychiatry and expsure t radilgical techniques and nuclear medicine techniques used in assessing patients, therefre, is necessary. The neurimaging rtatin is geared t prviding the resident with an understanding f when and why neurimaging studies shuld be rdered and fr which suspected diagnses. This rtatin will als serve as an intrductin in being able t read a CT scan r MRI scan. An understanding f the basis f pathlgical changes in the brain with age is necessary as new therapies are evlving fr dementias and ther cnditins assciated with aging. A rtatin in neurpathlgy will allw residents t begin t learn bth frm the macrscpic t the micrscpic level hw aging and aging assciated disrders alter the human brain. These skills, hwever, will be supplemented thrughut the training prgram t cmplete the resident's appreciatin fr the interface f neurlgy and geriatric psychiatry. Such an pprtunity will be ffered by the neurpsychiatry rtatin. Wrking with behaviral neurlgists, the resident will have an pprtunity t see hw geriatric patients wh are n the brderline f psychiatry and neurlgy are managed by behaviral neurlgists. This will give an pprtunity t the resident t gain a different perspective n hw patients wh may nt present t psychiatrists are managed, as well as serve as an intrductin t geriatric neurpsychiatry.

5 New treatment mdalities are evlving. Brwn University is at the frefrnt f develping these new treatments, including clinical trials in dementia. In additin, Brwn University is at the cutting edge f new smatic treatments invlving neurmdulatin such as Electrcnvulsive therapy (ECT), Transmagnetic Stimulatin (TMS), Vagal Nerve Stimulatin (VNS), and Deep Brain Stimulatin (DBS). Residents can elect t receive specialized training in these prcedures, where they will als gain an understanding f their rle in geriatric mental health treatment. As the Fellwship training prgram's primary gal is t train the future specialists in geriatric psychiatry, expsure t three emerging specialized treatment areas will be ffered within the prgram. Addictins are ften ignred amng the aged ppulatin. The use f alchl and ther substances, hwever, remain prevalent. Participatin in a geriatric addictins clinic will ffer the resident an pprtunity t gain expsure t the cmplicatins resulting in addictins that ccurs with age and the management f these cnditins in the elderly. Hme care is a grwing area in geriatric psychiatry and the huse call has becme a rare experience. The hme care rtatin is designed t expse the resident t the services received by patients within their hme, by visiting nurses and hme health wrkers, as well as t ffer the resident an pprtunity t experience a huse call and t appreciate the difference that seeing a patient in their wn envirnment may make. Palliative care and attentin t pain management, and caring fr thse wh are dying is t ften ignred in medicine. The palliative care rtatin prvides expsure t hspice care in a variety f settings, in the hme, in lng-term care and in the inpatient unit. The future leaders in geriatric psychiatry will be individuals wh develp an academic rientatin and are nt nly gd researchers, but als have administrative skills. A mdest research experience is ffered in the first year f training primarily t expse the resident t research and t help guide them in learning hw t understand the literature. Residents wh chse t g n t a secnd year, hwever, will be ffered the pprtunity t initiate an independent research prject and t develp a fundatin in research methdlgy. The administrative geriatric psychiatry experience is geared t prviding the resident with an pprtunity t gain administrative skills and t prepare the resident t assume a rle f leadership in geriatric psychiatry. The many pprtunities ffered by the Brwn University Schl f Medicine will allw individuals interested in becming specialists in geriatric psychiatry t be utstanding clinicians, administratrs, and researchers in the field. 06/24/10

6 ACGME Prgram Requirements fr Residency Educatin in Geriatric Psychiatry

7 ACGME Prgram Requirements fr Graduate Medical Educatin in Geriatric Psychiatry ACGME-apprved: February 4, 2013; Effective: July 1, 2013

8 ACGME Prgram Requirements fr Graduate Medical Educatin in Geriatric Psychiatry One-year Cmmn Prgram Requirements are in BOLD Intrductin Int.A. Residency and fellwship prgrams are essential dimensins f the transfrmatin f the medical student t the independent practitiner alng the cntinuum f medical educatin. They are physically, emtinally, and intellectually demanding, and require lngitudinally-cncentrated effrt n the part f the resident r fellw. The specialty educatin f physicians t practice independently is experiential, and necessarily ccurs within the cntext f the health care delivery system. Develping the skills, knwledge, and attitudes leading t prficiency in all the dmains f clinical cmpetency requires the resident and fellw physician t assume persnal respnsibility fr the care f individual patients. Fr the resident and fellw, the essential learning activity is interactin with patients under the guidance and supervisin f faculty members wh give value, cntext, and meaning t thse interactins. As residents and fellws gain experience and demnstrate grwth in their ability t care fr patients, they assume rles that permit them t exercise thse skills with greater independence. This cncept graded and prgressive respnsibility is ne f the cre tenets f American graduate medical educatin. Supervisin in the setting f graduate medical educatin has the gals f assuring the prvisin f safe and effective care t the individual patient; assuring each resident s and fellw s develpment f the skills, knwledge, and attitudes required t enter the unsupervised practice f medicine; and establishing a fundatin fr cntinued prfessinal grwth. Int.B. Int.C. Geriatric psychiatry fcuses n preventin, diagnsis, evaluatin, and treatment f mental disrders, and signs and symptms seen in lder adult patients. An educatinal prgram in geriatric psychiatry must be rganized t prvide prfessinal knwledge, skills, and pprtunities t develp cmpetency thrugh a well-supervised clinical experience. The educatinal prgram in geriatric psychiatry must be 12 mnths in length. I. Institutins I.A. Spnsring Institutin One spnsring institutin must assume ultimate respnsibility fr the prgram, as described in the Institutinal Requirements, and this respnsibility extends t fellw assignments at all participating sites. The spnsring institutin and the prgram must ensure that the prgram directr has sufficient prtected time and financial supprt fr his r her educatinal and administrative respnsibilities t the prgram. Geriatric Psychiatry 1

9 I.A.1. I.B. I.B.1. The spnsring institutin must als spnsr an Accreditatin Cuncil fr Graduate Medical Educatin (ACGME)-accredited prgram in psychiatry. Participating Sites There must be a prgram letter f agreement (PLA) between the prgram and each participating site prviding a required assignment. The PLA must be renewed at least every five years. The PLA shuld: I.B.1.a) I.B.1.b) I.B.1.c) I.B.1.d) I.B.2. I.B.3. I.B.4. identify the faculty wh will assume bth educatinal and supervisry respnsibilities fr fellws; specify their respnsibilities fr teaching, supervisin, and frmal evaluatin f fellws, as specified later in this dcument; specify the duratin and cntent f the educatinal experience; and, state the plicies and prcedures that will gvern fellw educatin during the assignment. The prgram directr must submit any additins r deletins f participating sites rutinely prviding an educatinal experience, required fr all fellws, f ne mnth full time equivalent (FTE) r mre thrugh the Accreditatin Cuncil fr Graduate Medical Educatin (ACGME) Accreditatin Data System (ADS). The number f and distance between participating sites must allw fr fellws full participatin in all rganized educatinal aspects f the prgram. Within at least ne f the participating sites there shuld be an ACGMEaccredited prgram in at least ne f the fllwing nn-psychiatric specialties: family medicine, geriatric medicine, internal medicine, neurlgy, r physical medicine and rehabilitatin. II. II.A. II.A.1. I.A.1.a) Prgram Persnnel and Resurces Prgram Directr There must be a single prgram directr with authrity and accuntability fr the peratin f the prgram. The spnsring institutin s GMEC must apprve a change in prgram directr. After apprval, the prgram directr must submit this change t the ACGME via the ADS. The prgram directr must devte n average (ver ne mnth) at Geriatric Psychiatry 2

10 least 10 hurs per week t the prgram with 1-2 fellws, r, 15 hurs per week, t the prgram with 3 r mre fellws. This must include activities related t administratin, didactic teaching and fellw supervisin utside f clinical activities, and time spent directly bserving fellws r being bserved in the clinical setting. II.A.2. II.A.2.a) II.A.2.b) II.A.2.b).(1) II.A.2.c) II.A.3. II.A.3.a) II.A.3.b) II.A.3.c) II.A.3.c).(1) II.A.3.c).(2) II.A.3.c).(3) II.A.3.c).(4) II.A.3.c).(5) II.A.3.c).(6) Qualificatins f the prgram directr must include: requisite specialty expertise and dcumented educatinal and administrative experience acceptable t the Review Cmmittee; current certificatin in the subspecialty by the American Bard f Psychiatry and Neurlgy (ABPN), r specialty qualificatins that are acceptable t the Review Cmmittee; and, The Review Cmmittee accepts nly ABPN certificatin in the subspecialty. current medical licensure and apprpriate medical staff appintment. The prgram directr must administer and maintain an educatinal envirnment cnducive t educating the fellws in each f the ACGME cmpetency areas. The prgram directr must: prepare and submit all infrmatin required and requested by the ACGME; be familiar with and versee cmpliance with ACGME and Review Cmmittee plicies and prcedures as utlined in the ACGME Manual f Plicies and Prcedures; btain review and apprval f the spnsring institutin s GMEC/DIO befre submitting t the ACGME infrmatin r requests fr the fllwing: all applicatins fr ACGME accreditatin f new prgrams; changes in fellw cmplement; majr changes in prgram structure r length f training; prgress reprts requested by the Review Cmmittee; respnses t all prpsed adverse actins; requests fr increases r any change t fellw duty Geriatric Psychiatry 3

11 hurs; II.A.3.c).(7) II.A.3.c).(8) II.A.3.c).(9) II.A.3.d) II.A.3.d).(1) II.A.3.d).(2) II.A.3.e) II.A.3.f) vluntary withdrawals f ACGME-accredited prgrams; requests fr appeal f an adverse actin; and, appeal presentatins t a Bard f Appeal r the ACGME. btain DIO review and c-signature n all prgram infrmatin frms, as well as any crrespndence r dcument submitted t the ACGME that addresses: prgram citatins, and/r request fr changes in the prgram that wuld have significant impact, including financial, n the prgram r institutin. develp and implement a supervisin plicy that specifies lines f respnsibility fr prgram faculty members and fellws that is cnsistent with the supervisin plicy in the general psychiatry prgram; and, participate in schlarly activities apprpriate t the subspecialty, including lcal, reginal, and natinal specialty scieties, research, presentatins, r publicatin. II.B. II.B.1. II.B.1.a) II.B.1.b) II.B.2. II.B.3. II.B.4. Faculty There must be a sufficient number f faculty with dcumented qualificatins t instruct and supervise all fellws. In additin t the prgram directr, there must be at least ne faculty member certified by the ABPN in the subspecialty. Each participating site must have a designated site directr wh is respnsible fr the day-t-day activities f the prgram at that site with verall crdinatin by the prgram directr. The faculty must devte sufficient time t the educatinal prgram t fulfill their supervisry and teaching respnsibilities and demnstrate a strng interest in the educatin f fellws. The physician faculty must have current certificatin in the subspecialty by the American Bard f Psychiatry and Neurlgy, r pssess qualificatins acceptable t the Review Cmmittee. The physician faculty must pssess current medical licensure and apprpriate medical staff appintment. Geriatric Psychiatry 4

12 II.B.5. II.B.6. II.C. Faculty members must participate in schlarly activities apprpriate t the subspecialty, including lcal, reginal, and natinal specialty scieties, research, presentatins, r publicatins. Faculty members must regularly participate in rganized clinical discussins, runds, jurnal clubs, and cnferences. Other Prgram Persnnel The institutin and the prgram must jintly ensure the availability f all necessary prfessinal, technical, and clerical persnnel fr the effective administratin f the prgram. II.C.1. II.C.1.a) II.C.1.b) II.C.2. II.C.3. II.D. Resurces Geriatric Care Team The geriatric care team shuld include representatives frm related clinical disciplines, including psychlgy, neurpsychlgy, scial wrk, psychiatric nursing, activity r ccupatinal therapy, physical therapy, pharmacy, and nutritin. Qualified clinicians frm disciplines within medicine, including ne r mre f the fllwing: family medicine, internal medicine (including geriatric medicine), hspice and palliative medicine, neurlgy, and physical medicine and rehabilitatin, shuld be available fr participatin n the geriatric care team fr cnsultatin. Fellws shuld have access t prfessinals representing allied disciplines, including ethics, law, and pastral care. There must be a designated prgram crdinatr. The institutin and the prgram must jintly ensure the availability f adequate resurces fr fellw educatin, as defined in the specialty prgram requirements. II.D.1. II.D.1.a) II.D.2. II.D.2.a) The psychiatry department f the spnsring institutin must be a part f r affiliated with at least ne acute care general hspital. The acute care hspital must have a full range f services, including bth medical and surgical services, intensive care units, an emergency department, a diagnstic labratry and imaging services, and a pathlgy department. There must be at least ne lng-term care facility. Such facilities shuld be either discrete institutins separate frm an acute care hspital r frmally designated units r services Geriatric Psychiatry 5

13 within an acute care hspital. II.D.3. II.D.4. II.D.5. II.E. There must be an ambulatry care service that prvides care in a multidisciplinary envirnment. Each participating site must prvide teaching facilities and ffice space. There must be patients available f each sex and spanning the spectrum f psychiatric diagnses in late life, and frm diverse sciecnmic, educatinal, and cultural backgrunds. Medical Infrmatin Access Fellws must have ready access t specialty-specific and ther apprpriate reference material in print r electrnic frmat. Electrnic medical literature databases with search capabilities shuld be available. III. III.A. Fellw Appintments Eligibility Criteria Each fellw must successfully cmplete an ACGME-accredited specialty prgram and/r meet ther eligibility criteria as specified by the Review Cmmittee. The prgram must dcument that each fellw has met the eligibility criteria. III.A.1. III.A.2. III.A.3. III.A.3.a) III.B. Prir t appintment in the prgram, fellws must have satisfactrily cmpleted either an ACGME-accredited general psychiatry prgram r a general psychiatry prgram in Canada accredited by the Ryal Cllege f Physicians and Surgens f Canada. Prir t appintment in the prgram, each fellw must be ntified in writing f the required length f educatin. Prir t appintment in the prgram, the prgram directr must receive dcumentatin frm each fellw s prir general psychiatry prgram verifying satisfactry cmpletin f all educatinal and ethical requirements fr graduatin. Number f Fellws Agreements with applicants made prir t the cmpletin f the general residency must be cntingent n this requirement. The prgram directr may nt appint mre fellws than apprved by the Review Cmmittee, unless therwise stated in the specialty-specific requirements. The prgram s educatinal resurces must be adequate t supprt the number f fellws appinted t the prgram. III.B.1. The presence f ther learners must nt interfere with the appinted fellws educatin. Geriatric Psychiatry 6

14 IV. IV.A. IV.A.1. IV.A.2. Educatinal Prgram The curriculum must cntain the fllwing educatinal cmpnents: Skills and cmpetencies the fellw will be able t demnstrate at the cnclusin f the prgram. The prgram must distribute these skills and cmpetencies t fellws and faculty annually, in either written r electrnic frm. These skills and cmpetencies shuld be reviewed by the fellw at the start f each rtatin; ACGME Cmpetencies The prgram must integrate the fllwing ACGME cmpetencies int the curriculum: IV.A.2.a) Patient Care Fellws must be able t prvide patient care that is cmpassinate, apprpriate, and effective fr the treatment f health prblems and the prmtin f health. Fellws: IV.A.2.a).(1) IV.A.2.a).(2) IV.A.2.a).(3) IV.A.2.a).(4) IV.A.2.a).(5) must demnstrate prficiency in diagnsis and treatment f all majr psychiatric disrders seen in elderly patients, including adjustment disrders, affective disrders, anxiety disrders, delirium, dementias, iatrgenesis, late-nset psychses, medical presentatins f psychiatric disrders, persnality disrders, sexual disrders, sleep disrders, substance-related disrders, and cntinuatin f psychiatric illnesses that began earlier in life; must demnstrate prficiency in perfrming the mental status examinatin that takes int accunt the special needs f elderly patients, including structured cgnitive assessment, cmmunity and envirnmental assessment, family and caregiver assessment, medical assessment, and functinal assessment; must demnstrate prficiency in shrt-term and lng-term diagnstic and treatment planning by using the apprpriate synthesis f clinical findings and histrical as well as current infrmatin acquired frm the patient and/r relevant thers, including family members, caregivers, and/r ther health care prfessinals; must demnstrate prficiency in the selectin and use f clinical labratry tests, radilgic and ther imaging prcedures, and plysmngraphic, electrphysilgic, and neurpsychlgic tests; must demnstrate prficiency in recgnizing and managing Geriatric Psychiatry 7

15 psychiatric c-mrbid disrders, including dementia and depressin, as well as agitatin, wandering, changes in sleep patterns, and aggressiveness; IV.A.2.a).(5).(a) IV.A.2.a).(6) IV.A.2.a).(7) IV.A.2.a).(8) IV.A.2.b) This must include cmpetence in the nging mnitring f changes in mental and physical health status and medical regimens. must demnstrate prficiency in recgnizing the stressful impact f psychiatric illness n caregivers, assessing their emtinal state and ability t functin, and prviding guidance and prtectin t caregivers; must demnstrate cmpetence in recgnizing and assessing elder abuse, and prviding apprpriate interventins; and, must demnstrate prficiency in managing the care f elderly patients with emtinal r behaviral disrders, using age-apprpriate mdificatins in techniques and gals in applying the varius psychtherapies (with individual, grup, and family fcuses) and behaviral strategies. Medical Knwledge Fellws must demnstrate knwledge f established and evlving bimedical, clinical, epidemilgical and scialbehaviral sciences, as well as the applicatin f this knwledge t patient care. Fellws: must demnstrate prficiency in their knwledge f the fllwing cntent and skills areas: IV.A.2.b).(1) IV.A.2.b).(2) IV.A.2.b).(2).(a) IV.A.2.b).(2).(b) bilgical and psychscial aspects f nrmal aging, psychiatric impact f acute and chrnic physical illnesses, and bilgical and psychscial aspects f the pathlgy f primary psychiatric disturbances beginning in r cntinuing int lder age; current scientific understanding f aging and lngevity, including theries f aging, epidemilgy and natural histry f aging, and diseases f elderly patients, t include: effects f bilgic aging n human physilgy with emphasis n altered pharmackinetics, pharmacdynamics, and sensry acuity in elderly patients; differences and gradatins between nrmal and Geriatric Psychiatry 8

16 abnrmal age-related changes with particular reference t memry and cgnitin, affective stability, persnality and behaviral patterns, sleep, and sexuality; and, IV.A.2.b).(2).(c) IV.A.2.b).(3) IV.A.2.b).(4) IV.A.2.b).(5) IV.A.2.b).(6) IV.A.2.b).(6).(a) IV.A.2.b).(6).(b) IV.A.2.b).(6).(c) IV.A.2.b).(7) IV.A.2.b).(8) IV.A.2.b).(9) successful and maladaptive respnses t stressrs frequently encuntered in elderly patients, including retirement, death f a spuse, rle changes, interpersnal and health status lsses, financial difficulties, envirnmental relcatins, and increased dependency. relevance f cultural and ethnic differences, and the special prblems f disadvantaged minrity grups, as these relate t mental illness in elderly patients; epidemilgy, diagnsis, and treatment f all majr psychiatric disrders seen in elderly patients; American culture and subcultures, including immigrant ppulatins, particularly thse fund in the patient cmmunity assciated with the educatinal prgram, with specific fcus n the cultural elements f the relatinship between the fellw and the patient including the dynamics f differences in cultural identity, values and preferences, and pwer; indicatins, side effects, and therapeutic limitatins f psychactive drugs and the pharmaclgic alteratins assciated with aging, including: changes in pharmackinetics, pharmacdynamics, and drug interactins; apprpriate medicatin management and strategies t recgnize and crrect medicatin nncmpliance; and, the psychiatric manifestatins f iatrgenic influences. applicatins and limitatins f behaviral therapeutic strategies, and physical restraints; apprpriate use and applicatin f electrcnvulsive therapy and ther nn-pharmaclgical smatic therapies in elderly patients; apprpriate use f psychdynamic understanding f develpmental prblems, cnflict, and adjustment difficulties in elderly patients which may cmplicate the Geriatric Psychiatry 9

17 clinical presentatin and influence the physician-patient relatinship r treatment planning; IV.A.2.b).(10) IV.A.2.b).(11) IV.A.2.b).(12) IV.A.2.b).(13) IV.A.2.b).(14) IV.A.2.b).(15) IV.A.2.c) apprpriate use f psychtherapies as applied t elderly patients, including individual, grup, and family therapies; psychscial impact f institutinalizatin; family dynamics in the cntext f aging, including intergeneratinal issues; ethical and legal issues especially pertinent t geriatric psychiatry, including cmpetence, capacity, guardianship, right t refuse treatment, wills, advance directives, infrmed cnsent, elder abuse, the withhlding f medical treatments, and federal legislative guidelines gverning psychtrpic drug prescriptin in nursing hmes and ther settings; current ecnmic aspects f supprting services and practice management, including Title III f the Older Americans Act, Medicare, Medicaid, and cst cntainment; and, research methdlgies related t geriatric psychiatry, including bistatistics, clinical epidemilgy, medical infrmatin sciences, decisin analysis, critical literature review, and research design (including crss-sectinal and lngitudinal methds). Practice-based Learning and Imprvement Fellws are expected t develp skills and habits t be able t meet the fllwing gals: IV.A.2.c).(1) IV.A.2.c).(2) IV.A.2.c).(3) IV.A.2.d) systematically analyze practice using quality imprvement methds, and implement changes with the gal f practice imprvement; lcate, appraise, and assimilate evidence frm scientific studies related t their patients health prblems; and, demnstrate administrative and teaching skills in the subspecialty. Interpersnal and Cmmunicatin Skills Fellws must demnstrate interpersnal and cmmunicatin skills that result in the effective exchange f infrmatin and cllabratin with patients, their families, and health Geriatric Psychiatry 10

18 prfessinals. IV.A.2.d).(1) IV.A.2.d).(2) IV.A.2.d).(3) IV.A.2.d).(4) IV.A.2.d).(5) IV.A.2.e) Fellws must demnstrate cmpetence in effective frmal and infrmal administrative leadership f the mental health care team. Fellws must demnstrate cmpetence in effectively cmmunicating treatment plans t the patient and the family. Fellws must demnstrate cmpetence in making apprpriate referrals t and btaining cnsultatins frm ther health care specialists. Fellws must demnstrate cmpetence in prviding cnsultatins. Fellws must demnstrate cmpetence in interviewing sciculturally-diverse patients and family in an effective manner which may include thse with limited English prficiency, health literacy, visin/sight, and hearing. Prfessinalism Fellws must demnstrate a cmmitment t carrying ut prfessinal respnsibilities and an adherence t ethical principles. IV.A.2.e).(1) IV.A.2.e).(2) IV.A.2.f) Fellws must demnstrate sensitivity and respnsiveness t diverse patients, including but nt limited t sex, age, culture, race, religin, disabilities, and sexual rientatin. Fellws must demnstrate cmpetence in recgnizing and apprpriately addressing biases in themselves, thers, and the health care delivery system. Systems-based Practice Fellws must demnstrate an awareness f and respnsiveness t the larger cntext and system f health care, as well as the ability t call effectively n ther resurces in the system t prvide ptimal health care. IV.A.2.f).(1) IV.A.2.f).(2) Fellws must demnstrate cmpetence in prviding cntinuing care thrugh rganizing recmmendatins frm the mental health care team and integrating recmmendatins and input frm primary care physicians, cnsulting medical specialists, and representatives f ther allied disciplines. Fellws must demnstrate cmpetence in the apprpriate Geriatric Psychiatry 11

19 use f cmmunity r hme health services, respite care, and institutinal lng-term care. IV.A.3. IV.A.3.a) IV.A.3.b) IV.A.3.b).(1) IV.A.3.c) IV.A.3.d) IV.A.3.d).(1) IV.A.3.e) IV.A.3.f) IV.A.3.f).(1) IV.A.3.f).(2) IV.A.3.g) IV.A.3.h) IV.A.3.i) Curriculum Organizatin and Fellw Experiences The 12-mnth prgram must be cmpleted within n mre than a tw-year perid. Cnferences in geriatric psychiatry, including grand runds, case cnferences, seminars, and jurnal club shuld be specifically designed t augment the clinical experiences. Fellws must attend at least 70% f all required didactic cmpnents f the prgram. Attendance by fellws and faculty members shuld be dcumented. The curriculum must include didactic instructin and clinical experiences t enable fellws t achieve all required cmpetencybased utcmes. As part f their lngitudinal care experience, fellws must be assigned t fllw and treat patients requiring cntinuing care. Fellws shuld have clinical experience in geriatric psychpharmaclgy, electrcnvulsive therapy (ECT), and using individual and grup psychtherapies. Fellws must have patient care experiences as part f an interdisciplinary geriatric care team. Fellws must have geriatric psychiatry cnsultatin experience. Cnsultatin experiences shuld be frmally available n the nn-psychiatric services f an acute care hspital. Experience shuld include cnsultatin t inpatient, utpatient, and emergency services, as well as cnsultative experience in chrnic care facilities. Fellws shuld have experiences that enable them t becme familiar with the rganizatinal and administrative aspects f hme health care services, utreach services, and crisis interventin services in bth cmmunity and hme settings. Each fellw must have a minimum f tw hurs f faculty preceptrship weekly, ne f which must be ne-t-ne preceptrship and ne f which may be grup preceptrship. Each fellw must maintain a patient lg dcumenting all clinical experiences. Geriatric Psychiatry 12

20 IV.B. IV.B.1. Fellws Schlarly Activities Fellws must participate in develping new knwledge r evaluating research findings. V. Evaluatin V.A. V.A.1. V.A.1.a) V.A.1.b) V.A.1.b).(1) V.A.1.b).(2) V.A.1.b).(3) Fellw Evaluatin Frmative Evaluatin The faculty must evaluate fellw perfrmance in a timely manner. The prgram must: prvide bjective assessments f cmpetence in patient care, medical knwledge, practice-based learning and imprvement, interpersnal and cmmunicatin skills, prfessinalism, and systemsbased practice; use multiple evaluatrs (e.g., faculty, peers, patients, self, and ther prfessinal staff); and, prvide each fellw with dcumented semiannual evaluatin f perfrmance with feedback. V.A.1.b).(3).(a) V.A.1.c) V.A.1.d) V.A.2. The evaluatin must include review and discussin with each fellw f his r her educatinal recrd dcumenting cmpletin f all required cmpnents at the time f the evaluatin f the prgram, evaluatins f clinical and didactic perfrmance by supervisrs and teachers, and patient lg dcumenting all clinical experiences. The evaluatins f fellw perfrmance must be accessible fr review by the fellw, in accrdance with institutinal plicy. Assessment shuld include quarterly written evaluatins f all fellws by all supervisrs and directrs f clinical cmpnents f the prgram. Summative Evaluatin The prgram directr must prvide a summative evaluatin fr each fellw upn cmpletin f the prgram. This evaluatin must becme part f the fellw s permanent recrd maintained by the institutin, and must be accessible fr review by the fellw in accrdance with institutinal plicy. This evaluatin must: Geriatric Psychiatry 13

21 V.A.2.a) V.A.2.b) V.A.3. V.B. V.B.1. V.B.2. V.C. V.C.1. V.C.1.a) V.C.1.b) V.C.1.c) V.C.1.c).(1) V.C.2. V.C.3. V.C.4. dcument the fellw s perfrmance during their educatin, and verify that the fellw has demnstrated sufficient cmpetence t enter practice withut direct supervisin. The final evaluatin f each fellw must dcument prficiency in all required cmpetency-based utcmes. Faculty Evaluatin At least annually, the prgram must evaluate faculty perfrmance as it relates t the educatinal prgram. These evaluatins shuld include a review f the faculty s clinical teaching abilities, cmmitment t the educatinal prgram, clinical knwledge, prfessinalism, and schlarly activities. Prgram Evaluatin and Imprvement The prgram must dcument frmal, systematic evaluatin f the curriculum at least annually. The prgram must mnitr and track each f the fllwing areas: fellw perfrmance, faculty develpment, and, prgram gals and bjectives as well as prgram effectiveness in achieving them. At least ne fellw representative and all faculty members shuld participate in these reviews. If deficiencies are fund, the prgram shuld prepare a written plan f actin t dcument initiatives t imprve perfrmance in the areas listed in sectin V.C.1. The actin plan shuld be reviewed and apprved by the teaching faculty and dcumented in meeting minutes. At least 80% f the eligible prgram s graduates frm the preceding six years shuld have taken the ABPN certifying examinatin in geriatric psychiatry. At least 80% f the prgram s graduates frm the preceding six years taking the ABPN certifying examinatin fr geriatric psychiatry fr the first time must pass. VI. VI.A. Fellw Duty Hurs in the Learning and Wrking Envirnment Prfessinalism, Persnal Respnsibility, and Patient Safety Geriatric Psychiatry 14

22 VI.A.1. VI.A.2. VI.A.3. VI.A.4. VI.A.4.a) VI.A.4.b) VI.A.5. VI.A.5.a) VI.A.5.b) VI.A.5.c) VI.A.5.d) VI.A.5.e) VI.A.5.f) VI.A.5.g) VI.A.5.h) VI.A.6. Prgrams and spnsring institutins must educate fellws and faculty members cncerning the prfessinal respnsibilities f physicians t appear fr duty apprpriately rested and fit t prvide the services required by their patients. The prgram must be cmmitted t and respnsible fr prmting patient safety and fellw well-being in a supprtive educatinal envirnment. The prgram directr must ensure that fellws are integrated and actively participate in interdisciplinary clinical quality imprvement and patient safety prgrams. The learning bjectives f the prgram must: be accmplished thrugh an apprpriate blend f supervised patient care respnsibilities, clinical teaching, and didactic educatinal events; and, nt be cmprmised by excessive reliance n fellws t fulfill nn-physician service bligatins. The prgram directr and spnsring institutin must ensure a culture f prfessinalism that supprts patient safety and persnal respnsibility. Fellws and faculty members must demnstrate an understanding and acceptance f their persnal rle in the fllwing: assurance f the safety and welfare f patients entrusted t their care; prvisin f patient- and family-centered care; assurance f their fitness fr duty; management f their time befre, during, and after clinical assignments; recgnitin f impairment, including illness and fatigue, in themselves and in their peers; attentin t lifelng learning; the mnitring f their patient care perfrmance imprvement indicatrs; and, hnest and accurate reprting f duty hurs, patient utcmes, and clinical experience data. All fellws and faculty members must demnstrate respnsiveness Geriatric Psychiatry 15

23 t patient needs that supersedes self-interest. Physicians must recgnize that under certain circumstances, the best interests f the patient may be served by transitining that patient s care t anther qualified and rested prvider. VI.B. VI.B.1. VI.B.2. VI.B.3. VI.B.4. VI.C. VI.C.1. VI.C.1.a) VI.C.1.b) VI.C.1.c) VI.C.2. VI.C.3. VI.D. VI.D.1. Transitins f Care Prgrams must design clinical assignments t minimize the number f transitins in patient care. Spnsring institutins and prgrams must ensure and mnitr effective, structured hand-ver prcesses t facilitate bth cntinuity f care and patient safety. Prgrams must ensure that fellws are cmpetent in cmmunicating with team members in the hand-ver prcess. The spnsring institutin must ensure the availability f schedules that infrm all members f the health care team f attending physicians and fellws currently respnsible fr each patient s care. Alertness Management/Fatigue Mitigatin The prgram must: educate all faculty members and fellws t recgnize the signs f fatigue and sleep deprivatin; educate all faculty members and fellws in alertness management and fatigue mitigatin prcesses; and, adpt fatigue mitigatin prcesses t manage the ptential negative effects f fatigue n patient care and learning, such as naps r back-up call schedules. Each prgram must have a prcess t ensure cntinuity f patient care in the event that a fellw may be unable t perfrm his/her patient care duties. The spnsring institutin must prvide adequate sleep facilities and/r safe transprtatin ptins fr fellws wh may be t fatigued t safely return hme. Supervisin f Fellws In the clinical learning envirnment, each patient must have an identifiable, apprpriately-credentialed and privileged attending physician (r licensed independent practitiner as apprved by each Review Cmmittee) wh is ultimately respnsible fr that patient s care. Geriatric Psychiatry 16

24 Only licensed independent practitiners as cnsistent with state regulatins and medical staff bylaws may have primary respnsibility fr a patient. VI.D.1.a) VI.D.1.b) VI.D.2. This infrmatin shuld be available t fellws, faculty members, and patients. Fellws and faculty members shuld infrm patients f their respective rles in each patient s care. The prgram must demnstrate that the apprpriate level f supervisin is in place fr all fellws wh care fr patients. Supervisin may be exercised thrugh a variety f methds. Sme activities require the physical presence f the supervising faculty member. Fr many aspects f patient care, the supervising physician may be a mre advanced fellw. Other prtins f care prvided by the fellw can be adequately supervised by the immediate availability f the supervising faculty member r fellw physician, either in the institutin, r by means f telephnic and/r electrnic mdalities. In sme circumstances, supervisin may include pst-hc review f fellw-delivered care with feedback as t the apprpriateness f that care. VI.D.3. Levels f Supervisin T ensure versight f fellw supervisin and graded authrity and respnsibility, the prgram must use the fllwing classificatin f supervisin: VI.D.3.a) VI.D.3.b) VI.D.3.b).(1) VI.D.3.b).(2) VI.D.3.c) Direct Supervisin the supervising physician is physically present with the fellw and patient. Indirect Supervisin: with direct supervisin immediately available the supervising physician is physically within the hspital r ther site f patient care, and is immediately available t prvide Direct Supervisin. with direct supervisin available the supervising physician is nt physically present within the hspital r ther site f patient care, but is immediately available by means f telephnic and/r electrnic mdalities, and is available t prvide Direct Supervisin. Oversight The supervising physician is available t prvide review f prcedures/encunters with feedback prvided after care is delivered. Geriatric Psychiatry 17

25 VI.D.4. VI.D.4.a) VI.D.4.b) VI.D.4.c) VI.D.5. VI.D.5.a) VI.D.6. VI.E. The privilege f prgressive authrity and respnsibility, cnditinal independence, and a supervisry rle in patient care delegated t each fellw must be assigned by the prgram directr and faculty members. The prgram directr must evaluate each fellw s abilities based n specific criteria. When available, evaluatin shuld be guided by specific natinal standards-based criteria. Faculty members functining as supervising physicians shuld delegate prtins f care t fellws, based n the needs f the patient and the skills f the fellws. Fellws shuld serve in a supervisry rle f residents r junir fellws in recgnitin f their prgress tward independence, based n the needs f each patient and the skills f the individual fellw. Prgrams must set guidelines fr circumstances and events in which fellws must cmmunicate with apprpriate supervising faculty members, such as the transfer f a patient t an intensive care unit, r end-f-life decisins. Each fellw must knw the limits f his/her scpe f authrity, and the circumstances under which he/she is permitted t act with cnditinal independence. Faculty supervisin assignments shuld be f sufficient duratin t assess the knwledge and skills f each fellw and delegate t him/her the apprpriate level f patient care authrity and respnsibility. Clinical Respnsibilities The clinical respnsibilities fr each fellw must be based n PGY-level, patient safety, fellw educatin, severity and cmplexity f patient illness/cnditin and available supprt services. VI.F. Teamwrk Fellws must care fr patients in an envirnment that maximizes effective cmmunicatin. This must include the pprtunity t wrk as a member f effective interprfessinal teams that are apprpriate t the delivery f care in the specialty. VI.F.1. VI.G. Cntributrs t effective interprfessinal teams include cnsulting physicians, psychlgists, psychiatric nurses, scial wrkers, and ther prfessinal and paraprfessinal mental health persnnel invlved in the evaluatin and treatment f patients. Fellw Duty Hurs Geriatric Psychiatry 18