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Medical College of Wisconsin has a fully accredited program in Psychiatry training that offers both four-year and three-year options. The three-year program is available to individuals who have chosen psychiatry later in their careers. The residency program is under the overall direction of the Medical College of Wisconsin Affiliated Hospitals, Inc (MCWAH). The program director is Mara Pheister, M.D. and overseen by the interim Chair Jon Lehrmann, M.D.[1]

Post-Graduate Year 1

According to ACGME requirements, the first year of training in a psychiatry residency requires "a minimum of four-months in a primary care clinical setting that provides comprehensive and continuous patient care in specialties such as internal medicine, family medicine, and/or pediatrics. Neurology rotations may not be used to fulfill this four-month requirement. One month of this requirement may be fulfilled by either an emergency medicine or intensive care rotation, provided the experience is predominantly with medical evaluation and treatment and not surgical procedures, and no more than 8 months in psychiatry." [2] At the Medical College of Wisconsin, these requirements are fulfilled through:

VA Inpatient Psychiatry

Duration: 3 consecutive months

Where: Clement J. Zablocki VA Medical Center, 5000 West National Avenue, Milwaukee, WI Unit 3C

Hours/Call: Morning report starts anywhere between 8:30 and 9:30 am depending on which team the resident is assigned to. He/she has the option to see patients prior to morning report, but it is neither required nor expected. Admits are taken until 4:30 pm. Therefore, most days will finish between 4:30 and 6:00 pm.

Call is every third weekend to be divided however the residents decided. Call consists of arriving between 8:00 and 9:00 am, meeting with the on-call staff briefly to divide patients, and then seeing only new overnight admits. Generally, residents are done anywhere between noon and 2PM. It is expected the resident to keep their pager on after leaving the VA to handle calls that nursing may have on new admissions, however pages are rare. There is no night call. Holidays are also handled like weekend days. Residents are encouraged to use a week vacation during this rotation.

Patient load/Patient Population: As a VA psychiatry resident, residents have the honor of serving the country’s veterans for their acute mental health needs. Residents generally carry between 4 and 8 patients (8 max) at any given time, depending on the team census. There are generally 1–2 admissions daily (2 max). At the VA, the resident will care for patients with substance abuse disorders, mood disorders, schizophrenia and variants, and personality disorders.

Supervision: There are 2 inpatient psychiatric wards at the Milwaukee VA. Most of the resident's time is spent on the acute ward. There are three teams served by 3 attending physicians and 2 residents. The resident will have the opportunity to work with each of the three attendings, changing from month to month. The attendings have the reputation of being very easy to work with, supportive, easy to approach, with an interest in teaching. Attendings will give residents the opportunity to manage patients at the resident's comfort level, always discussing diagnoses and treatment choices and offering appropriate guidance and oversight. They encourage residents to manage cases which are both interesting and educational.

Medication Management: In the VA system, the resident will become well versed in alcohol detox, as well as learning about narcotic detox. In addition, he/she become very familiar with SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Selective Norepinephrine Reuptake Inhibitors), and the mood stabilizers, especially lithium and valproic acid, along with a variety of antipsychotic medications. Lorazepam is used as part of the "SSA protocol (Selective Severity Assessment)" for patients with alcohol withdrawal or benzodiazepine withdrawal. In some cases of alcohol withdrawal the resident may also use a Librium taper. Quetiapine is used frequently in the VA system to help with sleep and anxiety.

Inpatient Psychiatry at MCBHD

Duration: 3 consecutive months

Where: Milwaukee County Behavioral Health Complex 9455 Watertown Plank Road, Milwaukee; Acute Adult Unit 43D

Hours/Call: Morning Report starts at 8:45. Attendings prefer residents not round on patients earlier. The typical ends anywhere between 2 pm and 5 pm. There is no call, although residents are expected to keep their pagers on until 5 pm if they leave before. Weekends and Holidays are always off. Residents are encouraged to use up a week vacation during this rotation.

Patient load/Patient Population: The resident is expected to carry a max of 8 patients, with a max of 2 new admissions per day. He/she will treat the most severe of the psychiatric pathologies (Schizophrenia, Schizoaffective bipolar type, Bipolar I presenting with mania, suicide attempts, psychosis NOS.) The resident will also see many Axis II diagnoses such as Anti-social Personality Disorders and Borderline PDs. The majority of patients admitted to the acute ward are involuntary and uninsured and often have suffered significant trauma in their past. Though patients may have a history of violence/aggression, all measures of precaution and education are taken to ensure safety for both staff and patients. The resident will also be well-versed in the legal aspect of Milwaukee's Mental Health care regulations and may have opportunities to be witnesses in court hearings held at MCBHD.

Supervision: There are two attendings assigned to a team. The resident spends six weeks on each team. Both attendings practiced internal medicine for many years before training in psychiatry and bring a wealth of knowledge and experience to treating the both the patient's physical and mental health needs. They encourage as much autonomy as the resident is comfortable with.

Medication Management: Mood Stabilizers (Depakote, Tegretol, Trileptal, Lithium); Antipsychotics (Haldol, Risperdal, Consta IM, Invega Sustenna IM, Zyprexa/Zydis, Abilify); Anticholinergics (Cogentin, Benadryl); Benzodiazepines/Benzo-like (Ativan, Clonazepam, Ambien). Because the patient population is so severe, residents will get experience treating with second-line drugs (i.e. Clozaril) and treating atypical presentations (i.e. Atypical Depression with MAOIs and suicidality with Lithium.

Emergency Psychiatry at MCBHD

Duration: 1 month

Where: Psychiatric Crisis Services (PCS)

Hours/Call: Resident is there Monday–Friday 8 am to typically 5 pm (On Fridays, the resident is often allowed to leave by noon). Weekends and Holidays are off. There is no call. Tuesdays/Thursdays/Fridays the resident is expected to arrive at 7:30 am for a morning report with the director of the PCS and the resident on-call overnight. It is an informal session to review interesting cases and go over questions.

Patient Load/Patient Population: PCS is run like a medical emergency room. Patients are seen by the nurse and triaged based on acuity (children take priority). PCS is a unique setting in comparison to other metropolitan cities in its exclusivity toward psychiatric patients. It is also the place where the most dangerous/high acuity patients are brought in for assessment exposing the resident to every type of psychiatric emergency known. PCS is made up of several modalities: PCS ER, Crisis Walk-in Clinic, Crisis Hotline, Mobile Urgent Treatment Team (MUTT), and the Observation Unit. During this month, the resident has access to participate in mostly in the PCS ER, MUTT and Crisis Walk-in Clinics

PCS ER: The attending/resident/medical student will sign up on the board to see a patient after the nursing assessment. Either the attending or resident will do a Medical Screening Exam based on the interview with the patient to determine any acute medical issues before proceeding. Once the resident has completed his/her assessment, they staff the patient with an attending to determine disposition.

Observation Unit: For patients that do not require formal inpatient hospitalization, but need further observation to resolve any acute crisis, they will stay 24–48 hours in this locked unit that is run as an inpatient unit. The patient has access to all members of a typical treatment team (nurses, social workers, clinicians and psychologists). The resident typically takes a less active role in this modality, but can practice interviewing or observe patient interviews.

Crisis Walk-in Clinic: For less acute crisis and medication check-ups, residents can participate in interviewing patients for intakes and following-up with med-checks.

MUTT: The mobile unit is often called into the community for crisis intervention for families or patients that may not need police intervention. The resident can participate in going out on this calls to observe how crises are managed.

Supervision: The resident is expected to present the patient to an attending with an assessment and plan. The attendings are known to be very encouraging and eager to teach making it an enjoyable learning experience.

Medication Management: Resident will become familiar with ordering medication to chemically restrain a patient. Benzodiazpenies/Narcotics are not typically given to patients given the high number of drug seeking that presents in the emergency setting. However, the resident will be encouraged to offer a patient antipsychotics or immediately administer them if requested by a patient given the low abuse potential of these particular class of drugs. And if it is deemed safe according to the individual patient.

VA Inpatient Medicine

Duration: 1 month

Where: Clement J. Zablocki VA Medical Center

Hours/Call: Resident can expect close to the 80 hours/week with call. He/she will take 3–4 overnight calls and 3–4 late calls (resident is expected to leave by 9pm and not return for 10 hours). Overnight and late call alternate every 4 days. The day typically begins at 7 am to sign out and then pre-rounding is done independently by the resident. He/she then presents the patients to update the medical team at 9 or 9:30. Team rounds are completed 1–2 hours before lunch. After lunch, the medical team may round on the patients again. Afternoon rounding times vary by attending. Most of them will try to do them in the mid-afternoon allowing the resident to finish and leave between 5 or 6PM.

Patient load/Patient Population: Resident carries a maximum of eight patients but will average closer to 4–5. The patient population is typically elderly with multiple medical problems: Chronic Heart Failure, Chronic Obstructive Pulmonary Disease, Pneumonia, Myocardial infarctions, Diabetes, and other common chronic illnesses.

Supervision: There are two attendings (one for the first two weeks, one for the last two). They rotate in from internal medicine and all the medical subspecialties.

Medication Management: Resident gains experience using all types of medications to manage common chronic illnesses

VA Outpatient Medicine

Duration: 1 month

Where: Various locations with the majority time spent at VAMC

Hours/Call: No call on this rotation. For the most part the hours are typically 8AM-5PM although individual days may start earlier or end later depending on the particular schedule of the clinic the resident is at that day. Some half days are allotted for "independent study."

The resident is given a choice to rank 31 out-patient clinics in all areas of medical/psychiatry specialties according to his/her interest. Generally there is a morning clinic in one specialty and an afternoon clinic in a different one. The majority of the clinics are located at the VA, but resident can expect to travel to different locations around the Milwaukee area. A detailed schedule is made for the resident at the beginning of the rotation month.

Attendings/Supervision: Most of the attendings expect the resident to see the patients alone and then staff the patient with them afterward. Given the variety of locations, there is not one particular attending the resident works closely with. Each attending will complete a small green card that is basically a "Mini evaluation" to evaluate the resident.

Emergency Medicine

Duration: 1 month

Where: FMLH Emergency Department 9200 W Wisconsin Avenue, Milwaukee, WI 53226

Hours/Call: This depends on the amount of interns rotating in the ED, but the resident could expect anywhere from 7-16 shifts on the month. The shifts are either day from 8AM-6PM, or night from 6 pm – 4 am. The resident will have plenty of days off. He/she can request days off or even a week at a time and schedule adjustments are made if requested far in advance. The resident typically arrives for the shift and checks in with a senior resident before signing in on the computer. He/she then finds a patient who hasn’t been seen yet, makes initial orders that are reasonable, presents the case to the senior resident, writes a note and moves on to the next while continuing to follow previous pts from earlier in the shift. The senior resident is responsible though for the disposition.

Patient load/Patient Population: The population is diverse. Froedtert is the only level one trauma center in Milwaukee. The typical load is 8-10 patients per shift.

Supervision: The resident interacts mostly with a senior resident. Attendings are present but most patients will be presented to the senior resident.

Medication Management: The resident becomes familiar with ordering standard fluids/pain medications such as 1L Normal Saline, Morphine 4 mg IV, Dilaudid 1 mg IV.

Family Medicine

Duration: 1 month

Where: Columbia St. Mary’s Hospital 2323 N. Lake Dr. Milwaukee, WI 53211

Hours/Call: Most days during the week are patterned the same, weekends are off unless the resident is scheduled to be on call. Morning report/review of overnight admits (led by the residents who were on call) begins at 7:30 am before seeing patients. At 10:30 they reconvene and discuss plans for the day/work to be done. Lectures are scheduled at 11:30 (the resident will split one lecture with another resident and give a 15 minute talk on the topic of his/her choice), 12:00 noon is Lunch/conference, after which leaves time for finishing work. The team takes admits up until 3:00, so if there are none, the resident is free to go home.

Call is overnight 5–7 times over the month. The nurses are known to be very generous in letting the resident sleep. Only two types of patients are admitted (family medicine clinic patients and emergency room backup patients). Call typically is not overwhelming as the senior resident can decide at any time to stop taking ER backup patients. While still required to admit clinic patients if need be, about 4 hours sleep at night is what is expected at a minimum. The patients admitted overnight are distributed amongst the team.

Patient load/Patient Population: FMTS interns need to average 5 patient exposures per day. Thus, the Family Medicine resident will inherit patients before the psychiatry intern who will typically carry 2-3 patients. The entire team (psychiatry intern, two FMTS interns, a second year FMTS resident, a senior FMTS resident, attending and a senior medical student) will typically carry 12–16 patients.

Supervision: Each week a new Family Medicine attending will rotate over from the clinic. There are about 15 attendings in the pool and all have the reputation of being easy to work with. At the end of the month, the resident is treated to lunch with the entire team and the 4+ attendings worked with over the course of the rotation.

Medication Management: The resident is exposed to a wide range of medications on this rotation. From antibiotics to antipsychotics, they are all here.

Neurology

Duration: 1 month

Where: FMLH 5NW

Hours/Call: 6:30 am to 5:30 pm. There are 4–7 overnight calls and the resident is post call until 12 noon the following day. The resident rounds on his/her patients in the morning before presenting to the attending at 9 am during rounds. Rounds finish about noon and the resident will work on discharge orders, progress notes and discharge summaries. Transfers from the NICU will then be handled along with transfers from the emergency department.

Patient Load/Patient Population: As part of the general neurology service, the resident carries 3–6 patients at one time. They treat common neurological diseases, including various types of neuro-oncology, traumatic brain injury, multiple sclerosis, and CIDP. Much of this management occurs after patients are seen by neurosurgery and transferred out of the neurology intensive care unit. In addition, in cross-coverage while on call, the resident handles neuro consults from the ER, covers the phone bank for the neurology private patients, and manages stroke patients on the floor or coming out of the ER, all of this with the senior neurology resident.

Supervision: The neurology team consists of 2–3 junior residents (off-service PGY 1's or neuro PGY 2's), one senior resident (neuro PGY 3's), and an attending staff physician. The entirety of the team remains the same throughout the rotation with the exception of the attending staff, who rotate weekly. The attending staff are respectful of off-service residents, understanding that neurology may not be their area of expertise. In addition, several members of the attending staff will make time to teach and to teach at a level appropriate to the various types of residents on staff. The senior residents' role is to manage the team and assist junior residents as needed. Overall, the senior residents are extremely helpful in transitioning the intern into the role of physician compared to the earlier role of medical student.

Medication Management: The resident will become familiar with such medications as Keppra, Depakote, Dilantin, become well versed in management of hypertension. Electrolyte management is also very important on this service.

Post-Graduate Year 2

Post-Graduate Year 3

Post-Graduate Year 4

References

External links

This article uses material from the Wikipedia article Medical College of Wisconsin Psychiatry, that was deleted or is being discussed for deletion, which is released under the Creative Commons Attribution-ShareAlike 3.0 Unported License.
Author(s): Maximusveritas Search for "Medical College of Wisconsin Psychiatry" on Google
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