Residents have a wide spectrum of clinical experiences in different settings and levels of care. These include multiple KP healthcare services: Intensive Outpatient Program, Wellness Club, Outpatient Adult Clinic, Addiction Medicine Recovery Service, and Child & Adolescent Clinics, and inpatient units at Heritage Psychiatric Health Facility and KP Fremont Medical Psychiatric Inpatient Unit. In addition, residents spend 2-months providing care for Alameda County’s underinsured population at John George Psychiatric Pavilion. Our residents receive training in the full spectrum of psychotherapies, medication management as well as psycho-educational and behavioral interventions. Residents are also advantaged by utilizing our robust electronic medical record (EMR) that incorporates Tele-Video capacity and our HIPPA compliant patient email system. In PGY4 residents assume a Clinical Service Chief Resident role on a service of their choice or the Chief Resident role for the program. In addition, PGY4 residents have the opportunity to elect training experiences in our innovative Eating Disorders Clinic and Transcranial Magnetic Stimulation (TMS) Program. Trainees are well versed in patient-centered and evidenced-based approaches to care. In outpatient settings residents gain experience in co-managing patients with other clinicians. In addition, they are provided a comprehensive didactic curriculum that is integrated with their clinical rotations and stage of training.
Download the schedule for detailed rotation block information.
Residents spend 4-months on the 26-bed acute psychiatric inpatient unit at Heritage Psychiatric Health Facility in Oakland. The facility cares for adult inpatients with a wide variety of mental health disorders including psychotic disorders, mood disorders, personality disorders, substance use disorders, anxiety disorders, and adjustment disorders.
Training includes: working as part of a multidisciplinary team, patient and family diagnostic interviewing, selection of evidence-based treatments, brief psychotherapy, medication management, patient and family education, discharge planning, appropriate documentation, and medico-legal issues that arise in the care of acute psychiatric inpatients.
Intensive Outpatient Program (IOP), Wellness Club, and Adult Outpatient Clinic
Residents spend 2-months on these services. In the IOP, residents work with a team of two attending psychiatrists, 4-5 psychotherapists and the Director of IOP to assess and treat subacute outpatients. The IOP operates on Mon/Wed/Fri mornings. The IOP cares for severely ill and suicidal outpatients, requiring residents to make frequent assessments whether patients require psychiatric hospitalization or are safe to return home. Residents also gain valuable experience in medication management of this patient population.
Residents spend Tues/Thurs mornings in Wellness Club, a drop-in program for our severe and persistently mentally ill (SPMI) patients. Residents work closely with the attending psychiatrist and case managers to provide pharmacologic management of patients afflicted with psychotic disorders and severe bipolar disorder.
Residents spend their afternoons performing initial evaluations and follow up care in the Adult Outpatient Clinic. Residents work closely with attending psychiatrists honing their interviewing, diagnostic, and clinical reasoning skills during this rotation. Residents monitor patient progress over time and communicate with patients through our HIPPA compliant email system.
Residents spend 3-months on the inpatient medicine wards at the 349-bed KP Oakland Medical Center that opened in 2014. They are a member of a clinical team consisting of one senior internal medicine resident (PGY2 or 3), two PGY1 internal medicine residents and an attending physician. Residents have primary responsibility for their assigned patients. Residents refine their medical interviewing and physical examination skills, develop acumen in selection of diagnostic tests, learn the management of a wide variety of medical conditions, and develop discharge care plans allowing for safe patient transitions to the outpatient setting. Ethical and psychosocial issues are highlighted when appropriate. Residents have the opportunity to consult with and learn from sub-specialists when managing patients with complex medical conditions.
Residents spend 2-weeks each rotating on the Cardiology and Infectious Disease consulting services. Residents perform initial evaluations and follow up care for medical and surgical inpatients.
Residents spend 2-months rotating on the neurology inpatient consultation service and the neurology outpatient service. On inpatient consultation, residents provide initial and follow-up consultations on medical and surgical inpatients and initial consultation for patients in the Emergency Department. During the outpatient experience residents provide initial evaluations and conduct follow-up visits. Particular attention is given to developing the following skills: obtaining and interpreting patient histories, performing physical and neurological exams, interpreting laboratory and neuroimaging results, developing a differential diagnosis; and implementing evidence-based treatments.
Residents spend 2-months on the KP Med-Psych unit (MPU) in Fremont, California. The unit has 18-beds with three attending psychiatrists. The resident cares for a maximum of six inpatients and works under the supervision of an attending psychiatrist and within a multidisciplinary team to provide high quality care for patients suffering from acute psychiatric illness and co-morbid complex medical conditions. The resident acquires high level of training in the diagnosis, treatment, and leadership needed to care for such a unique patient population. The treatment program philosophy is modeled on recovery principles and has a strong emphasis on patient participation and active engagement in their own care.
Residents spend 2-months on the community-based rotation at John George Psychiatric Emergency Service (PES). The PES serves the diverse patient population of Alameda County with the majority of patients having MediCal, Medicare or no medical insurance coverage.
Residents are exposed to the full range of psychopathology as they learn to interview and triage acutely ill patients in an efficient manner, manage agitated and highly distressed individuals, initiate pharmacologic treatment, and educate patients and families. Their training emphasizes crisis intervention, level of care decisions including placing patients on involuntary holds (5150), and system-based practice as a member of an interdisciplinary team providing care and disposition plans for the nearly 40 new vulnerable patients who are brought to the PES each day.
Residents have three full months and one half time month on the adult consultation-liaison service at the KP Oakland Medical Center. Residents evaluate and provide treatment recommendations for medical and surgical inpatients with cognitive, emotional, and behavioral disorders with an emphasis on potential interactions with medical conditions and non-psychotropic medications. In addition, residents have opportunities to assess patients’ capacity to consent to medical care.
Residents act in the liaison role to enhance communication and understanding of mental health issues with patients, families, and other health care providers. In addition, residents are involved in discharge planning of patients should they require further mental health care ranging from inpatient psychiatric hospitalization to outpatient psychiatric, addiction medicine services, and referrals to community resources.
Residents spend half time (i.e., 8:30am-12:30pm Monday-Friday) of a one-month rotation at the KP Post-Acute Care Center (KPPACC) located in San Leandro, that provides inpatient rehabilitation care to geriatric patients. Residents gain clinical experience in evaluating and managing elderly patients with comorbid psychiatric, neurodegenerative, and medical disorders. Residents learn to manage behavioral issues that occur in an unlocked facility that does not use restraints. They also gain experience with medication management of the elderly including side effects, drug – drug interactions, and contraindications for certain medical conditions. Residents perform basic cognitive testing (e.g., the Montreal Cognitive Assessment) to assess and monitor cognitive functioning in patients with neurodegenerative disorders. Moreover, they gain experience with end of life issues as well as the ethical and legal issues that often arise in the care of the elderly. Examples include capacity to consent for treatment and self-determination issues related to post-discharge living arrangements. By working with physical, occupational and speech therapists, residents gain a better understanding of the role these services provide in rehabilitating the elderly.
Child and Adolescent Psychiatry
Residents spend 2-months on the Child and Adolescent Psychiatry (CAP) outpatient clinic at the KP Richmond Medical Center. In addition, during PGY3 residents who intend to fast-track into CAP will be given the option of spending a half-day per week in the CAP outpatient clinic at our Oakland site.
During the PGY2 experience, residents join a multidisciplinary team that includes social workers, psychologists, and board-certified child and adolescent psychiatrists. Residents evaluate and provide evidenced-based treatments as part of the multidisciplinary team’s coordinated treatment plan. Resident’s focus their treatment on medication management either as the primary provider or in support of therapists, who are the patient’s primary provider. Residents provide CBT to a patient under the supervision of a licensed clinical psychologist. In addition, residents learn case management skills while caring for one teen with severe mental illness in the CAP Intensive Outpatient Program or Dialectical Behavioral Treatment (DBT) Program. Residents also participate as a co-facilitator in a time-limited therapy group. Their CAP experience emphasizes working with parents and at times with grandparents and includes participation in psycho-educational parenting workshops.
Residents complete a 2-month clinical rotation at the KP Addiction Medicine Recovery Service (AMRS) in Oakland, CA. Residents work with patients at all stages of recovery, including management of intoxication and withdrawal syndromes. Residents gain experience in treating alcohol, opioid, sedative-hypnotic, cannabinoid, stimulant, nicotine, as well as other substance use disorders. Residents conduct intake psychiatric assessments of patients with substance use disorders and participate in their care as a member of the multidisciplinary treatment team. They learn about the differential diagnosis of substance induced versus primary psychiatric disorders and appropriate treatment modalities. Residents also perform addiction medicine evaluations for organ transplant candidates, including learning about appropriate laboratory testing and diagnosis. They gain experience in caring for chronic pain patients, who are enrolled in chemical dependency treatment. Residents provide supervised group psychotherapy and have an opportunity to observe Mutual and Self-Help Programs, including both 12-step and non-12-step programs.
There are several unique aspects to the outpatient training experience in PGY3 & 4. First, residents do not receive patients transferred from other residents or clinicians at the beginning of PGY3. Rather they evaluate new patients and build their own patient panel over time. This allows residents to follow a cohort of new patients continuously over their last two years of training. Residents gain experience with medication management and individual psychodynamic psychotherapy, supportive psychotherapy, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), mindfulness based cognitive therapy, and group therapy (i.e., time limited CBT, DBT, and trauma/grounding skills).
Second, our system of care relies on the psychiatrist for evaluating patients and establishing a treatment plan. For many patients, especially those requiring medication management, the psychiatrist co-manages care with other KP clinicians, namely primary care providers, non-physician psychotherapists, and physician extenders. These physician extenders include clinical pharmacists, case managers, nurses and medical assistants. The KP system also offers patients a large array of diverse behavioral health educational classes. This unique system, with its many resources, creates a collaborative care system so that the psychiatrist is not the sole practitioner caring for most patients. The system also has many built in efficiencies that help the psychiatrist focus on patient care. These efficiencies include the KP state of the art EMR that enables psychiatrists to communicate with patients (via HIPPA secure email) and other clinicians to coordinate care (via staff messaging or forwarding encounter notes), order medications through KP pharmacies, and view laboratory/imaging results or other clinicians’ notes. In addition, psychiatrists frequently perform telephone or video follow-up appointments for those patients who prefer this option. In our experience these tele-video doctor – patient interactions are both effective and efficient.
In PGY3 residents have the opportunity to pursue a 1 day a week longitudinal elective experience. This longitudinal elective model also applies to residents in the Research Track (see Scholarship and Research Training section) and to clinical training in correctional psychiatry and geriatric outpatient psychiatry.
In PGY4 residents pursue an elective experience for 6 months of the year. This may involve a deeper immersion in one aspect of their prior training such as individual psychotherapy or working with the seriously and persistently mentally ill. Alternatively, they may elect to pursue a new experience with our innovative Eating Disorders Clinic or our Transcranial Magnetic Stimulation (TMS) clinic for patients with refractory depression. For certain residents, who are engaged in significant research investigations or scholarly activities, the elective time can be used to complete their projects.
Chief Resident Experience
In PGY4 two residents are selected as Chief Residents for the program. The Chief Residents develop their leadership skills while working closely with the program leadership to administer the program, recruit prospective applicants, teach junior residents and sub-interns in didactic sessions, and participate in program development as a member of the Program Evaluation Committee. A particular emphasis is placed on developing the Chief Residents’ medical educator skillset.
For those residents who are not in the Chief Resident roles, they are Clinical Service Chief Residents on a service of their choice for six months. This leadership role requires the Clinical Service Chief Residents to work closely with the faculty leadership on the service to ensure optimal clinical care is provided and to help oversee educational activities for the junior residents. Particular attention is paid to providing these Clinical Service Chief Residents with opportunities and mentorship to develop their administrative, clinical supervision, systems-based practice, interpersonal and communication skills.
Residents have a half-day per week of protected time for didactics for the entirety of their psychiatric training. During PGY1, while rotating on Medicine and Neurology, interns participate in that service’s didactics rather than Psychiatry didactics.
The curriculum is designed to provide residents with the requisite knowledge and skills to thrive in their everyday practice. It utilizes progressive pedagogies to enhance learning and retention of knowledge through the promotion of learner participation, timely feedback, life-long learning, and application of knowledge. A general overview of the curriculum for each year is noted below:
- Child & Adolescent Psychiatry
- Cultural Psychiatry
- Evidence-Based Medicine
- History of Psychiatry
- Intro to Cognitive Behavioral Therapy / Dialectical Behavioral Therapy / Interpersonal Therapy
- Intro to Pharmacology
- Intro to Psychiatric Interviewing
- Intro to Psychodynamic Psychotherapy
- Motivational Interviewing
- Psychiatric Disorders
- Substance Use Disorders
- Administrative Psychiatry
- Assertive Care Management
- Case Management with the SPMI Population
- Cognitive Behavioral Therapy Techniques
- Countertransference Seminar
- Cultural Psychiatry
- Eating Disorders
- Geriatric Psychiatry
- Interventional Psychiatry
- Landmark Studies
- LGBTQ Psychiatry
- Mindfulness Workshop
- Neuroscience of Psychiatry
- Personality Disorders
- Perspectives on Addiction Psychiatry
- Physician Wellness
- Psychiatric Disorders
- Psychodynamic Formulations Course
- Quality Improvement
- Residents as Educators
- Sleep Physiology
- Step-back Consultation
- Classic Psychoanalytic Papers Course
- Countertransference Seminar
- Forensic Psychiatry
- Geriatric Case Conference
- Group Psychotherapy
- Human Sexuality in Psychiatry
- Narrative Medicine
- Neuropsychologic testing
- Palliative Care
- Professionalism (Ethics)
- Psychodynamic perspectives of Psychopharmacologic Management
- Psychodynamic Psychotherapy
- Quality Improvement
- Residents as Educators
- Residents as Leaders Course
- Step-back Consultation
- Women’s / Reproductive Psychiatry
- To be released June 2022
Residents also have opportunities to learn from case conferences, journal club, and Grand Rounds.
To improve their medical educator knowledge and skills, residents receive instruction on educational principles and techniques as well as supervised educational experiences with UCSF medical students, visiting sub-interns, and more junior residents. For example, the formal Resident Medical Educator course begins in PGY2 and is coupled with early opportunities for residents to apply the lessons learned by teaching their peers in the classroom and supervising junior residents on weekend C-L call. The educator role is a key component of the Chief Residents’ experience during PGY4.
We train residents to be productive mental health scholars. Residents receive research methodology training and have time in all four years of training to perform quality improvement (QI) and scholarly activity. Our local Graduate Medical Education (GME) Research Director and GME Research Project Managers are available to facilitate resident QI and research projects at our East Bay locations. Residents have access to analysts to assist with their research projects.
Residents can collaborate on a research project with a member of the KP Division of Research (DOR). Located in Oakland, CA, the DOR is one of the largest non-university and non-government-based epidemiology research groups in the nation. The DOR has a rich history of producing landmark studies utilizing the KP Healthcare System’s clinical population (with over four million KP members in Northern California) and multigenerational databases. The DOR has a section devoted to mental health research with a core group of scientists, who can serve as research mentors.
Residents are expected to complete the following activities prior to graduation:
- Completion of all Internal Review Board (IRB) training,
- Grand Rounds presentation of at least 30 minutes duration, and,
- One of the following:
- Submission of a Case Report for publication
- Submission of a Book Chapter for publication
- Submission of a Manuscript for publication
- Presentation of a Poster at a regional or national conference
- An Oral Presentation at a regional or national conference
- Completion of a QI project, either in a group of up to 3 psychiatry residents or individually, and presentation of the results in any of the formats specified above
- Serving on a regional or national committee
Residents who are interested in pursuing a formal research project can apply to enter our Research Track that provides the following protected time:
- 0.5 day per week for the last 12 weeks of PGY2,
- 0.5 day per week for the entirety of PGY3,
- 40% protected time for the first 6-months of PGY4.
To enhance their leadership skills, PGY4 residents serve as a Chief Resident or a Clinical Service Chief Resident (see section on Chief Residents in the PGY3 and 4 curriculum). In addition, residents have a course on administrative psychiatry that addresses organizational and role-specific issues as well as current issues in mental health policy. Moreover, residents gain experience as change agents through quality improvement projects and in advocating for their patients. And finally, residents will have the opportunity to participate in resident recruitment and to serve on programmatic and local and regional GME committees.
PGY1: Approximately six weekends during the six months of psychiatry rotations and weekly “Long Call” until 7 pm while on the medicine wards. There is currently no call while rotating on Neurology.
PGY2: Six weekends (day only) on C-L service. In addition, weekly in-house day call and roughly two-weekend calls (which is a combination of in-house day and at-home night) during the 2-month KP Fremont Inpatient (MPU) rotation.
PGY3: 2-3 weekends on C-L service.
PGY4: There is currently no plan for residents to be on call during 4th year.
There is currently no night float. The call schedule is subject to change in years to come.
Moonlighting: Residents in good academic standing are eligible to moonlight with the program director’s approval starting in PGY3.
All call and moonlighting hours are included in the total weekly duty hours. And, all call duties comply with ACGME duty hours:
- Residents will average 1 day off a week over a 4-week period,
- Residents will have 8 hours off between routine shifts and 14 hours off following a 24-hour shift,
- Residents will average less than 80 hours of work a week over a 4-week period.
Starting in orientation each resident is paired with a faculty mentor, who coaches professional development and if needed assists the resident in accessing resources for emotional and physical wellbeing. The mentor is expected to meet with the resident once every two months for the duration of their training.
In addition, starting in orientation each resident is paired with a senior resident as part of our peer mentoring program.
Resident wellbeing is a high priority for our program. It is supported and monitored through a combination of training in a nurturing and healthy learning environment, education, programmatic resources for residents, mentorship, supervision, resident feedback, and timely access to care.
Starting in orientation residents are educated about self-care and the importance of healthy lifestyle choices and adequate sleep. They learn about sleep hygiene, dysfunction related to drugs or alcohol and the signs and symptoms of burnout. Residents are provided access to the Maslach Burnout Inventory, the gold standard self-rating burnout scale. Finally, residents are encouraged to seek assistance from the Program Director, their mentors, and faculty members if they are experiencing stress, demoralization, and any other symptoms of burnout.
Resident wellbeing is further cultivated through the program’s Wellness Committee. Residents have the opportunity to be a member of the Wellness Committee as it is composed of a resident representative from each class and two Assistant Program Directors. We view this committee as an example of the inclusive and collaborative approach we take to resident wellness (and program development as a whole). Residents are invited to the annual Winter holiday party and the resident retreat. Residents have a supplemental stipend to pay for a gym membership.
Resident wellbeing is enhanced through the many resources and activities available within KP East Bay. These include: health fairs, yoga, running clubs, social and community events, child-care, and the stress management program.
Residents who are identified as experiencing mental health, physical health, or substance use problems are provided timely access to confidential care with the appropriate clinician outside of our department. These services may include psychiatric care, medical care, or chemical dependency/rehabilitation through KP’s employee assistance program.