Residents will have a wide spectrum of clinical experiences in different settings and levels of care. These include multiple KP healthcare programs: Crisis Response Team, Consultation-Liaison Service, Intensive Outpatient Program, Wellness Club, Outpatient Adult and Child & Adolescent Clinics, and inpatient units at Heritage Psychiatric Health Facility and KP Fremont Medical Psychiatric Inpatient Unit. Our residents will receive training in a full spectrum of psychotherapies, medication management as well as psycho-educational and behavioral interventions. Residents will also be advantaged by utilizing our robust electronic medical record (EMR) that incorporates TeleVideo capacity and our HIPPA compliant patient email system. In PGY4 residents will assume the Chief Resident role on a clinical unit or within the residency education program and have the opportunity to elect training experiences in our innovative Eating Disorders Clinic and Transcranial Magnetic Stimulation (TMS) Program. Trainees will be well versed in patient-centered and evidenced-based approaches to care. In outpatient settings residents will gain experience in co-managing patients with other clinicians. In addition, they will be 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 will spend 4 months during PGY1 on the acute psychiatric inpatient unit at Heritage Psychiatric Facility. It has 26 beds and an average census of 21 patients. 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 will include: interviewing and diagnostic evaluation, selection of evidence-based treatments, brief psychotherapy, family therapy, 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 will spend 2-months on their IOP, Wellness Club and Adult Outpatient Clinic rotation which spans the entire spectrum of adult outpatient services. On IOP, residents will work with a team of two attending psychiatrists, 3-4 psychotherapists and the Director of IOP to assess and treat subacute outpatients. The IOP operates on Mon/Wed/Fri mornings. The IOP cares for a high number of severely ill and suicidal outpatients, and because of this residents will be required to make frequent assessments whether patients require psychiatric hospitalization or are safe to return home. Residents will gain valuable experience in medication management of this patient population.
Residents will spend two ½ days per week on Wellness Club, a drop-in program for our severe and persistently mentally ill (SPMI) patients that has an average active patient census of 40 patients. Residents will work closely with the attending psychiatrist and case management staff to provide pharmacologic management of patients afflicted with psychotic disorders and severe bipolar disorder.
Residents will spend their afternoons performing initial evaluations and follow up appointments in the Adult Outpatient Clinic. Residents will work closely with an attending psychiatrist honing their interview, diagnostic and clinical reasoning skills during this portion of the rotation. This includes tracking patient progress over time and communicating through our HIPPA compliant patient email system.
Residents will spend 4-months on the inpatient medicine units at the 349 bed KP Medical Center that opened in 2014. They will be 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 will have primary responsibility for their assigned patients. Residents will 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 will have the opportunity to consult with and learn from sub-specialists when managing patients with complex conditions.
Residents will spend 2-months rotating on the neurology inpatient consultation service and the neurology outpatient service. On inpatient consultation, residents will 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 will provide initial evaluations and conduct follow-up visits. Particular attention will be given to developing the residents’ skills in: 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 will spend 2-months on the Kaiser Permanente Med-Psych unit (MPU) in Fremont, California. The unit has 18 beds with three attending psychiatrists. The resident will carry up to six patients at a time and work 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 will be guided in acquiring the high level of skills in 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 will have a 2-month rotation in Emergency Psychiatry. Residents will work with our Crisis Response Team (CRT) consisting of an attending psychiatrist and two masters or doctoral level mental health clinicians. Residents will perform evaluations of acute psychiatric patients presenting to the Emergency Department and in our Walk-In Clinic. They will perform risk assessments for harm to self or others and the ability to care for self to determine the appropriate level of care including the need for involuntary psychiatric hospitalization. For those patients not requiring hospitalization, residents will make appropriate referrals to other care settings within the KP Healthcare System and to community resources. Residents will develop skills in crisis intervention including mobilization of family resources, non-pharmacologic de-escalation techniques, brief supportive psychotherapeutic interventions, motivational interviewing, and problem solving therapy.
Residents will have a 3-month rotation on the adult consultation-liaison service. Residents will 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 will have opportunities to perform assessments of patients’ capacity to consent to medical care.
Residents will 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 will be involved in discharge planning of patients to the next phase of clinical care ranging from inpatient psychiatric hospitalization to outpatient psychiatric and chemical dependency services and referrals to community resources.
Residents will complete a one-month clinical rotation at the KP Post-Acute Care Center (KPPACC) located in San Leandro, CA that provides inpatient rehabilitation care to geriatric patients. Residents will gain clinical experience in evaluating and managing elderly patients with comorbid medical, neurodegenerative, and psychiatric disorders. Residents will learn to manage behavioral issues that occur in an unlocked facility that does not use restraints. They will also learn about psychopharmacological treatment of the elderly including side effects, drug – drug interactions, and contraindications for certain medical conditions. Residents will perform basic cognitive testing (e.g., the Montreal Cognitive Assessment) to assess and monitor cognitive functioning in patients with neurodegenerative disorders. Moreover, they will 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 will gain a better understanding of the role these services provide in rehabilitating the elderly.
Child and Adolescent Psychiatry
We have deliberately designed our training program to give all residents, but especially those who have an interest in fast-tracking into CAP training, an early exposure to child and adolescent psychiatry (CAP) with a two-month outpatient experience in PGY2 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 will join a multidisciplinary team that includes social workers, psychologists, and board certified child and adolescent psychiatrists. Residents will evaluate and provide evidenced-based treatments as part of the multidisciplinary team’s coordinated treatment plan. Resident’s will focus their treatment on medication management either as the primary provider or in support of therapists, who are the patient’s primary provider. Residents will also develop their own patient panel by performing new evaluations weekly including seeing patients in the walk-in crisis clinic. In addition, residents will 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 will also participate as a co-facilitator in one time-limited therapy group. Their CAP experience will emphasize work with parents and at times with grandparents and will include participation in psycho-educational parenting workshops.
Residents will complete a 2-month clinical rotation at the newly renovated KP Addiction Medicine Recovery Service (AMRS) in Oakland, CA. Residents will work with patients at all stages of recovery, including management of intoxication and withdrawal syndromes. Residents will gain experience in treating alcohol, opioid, sedative-hypnotic, cannabinoid, stimulant, nicotine, as well as other substance use disorders. Residents will conduct intake psychiatric assessments of patients with substance use disorders and participate in their care as a member of the multidisciplinary treatment team. They will learn about the differential diagnosis of substance induced versus primary psychiatric disorders and appropriate treatment modalities. Residents will have the opportunity to perform addiction medicine consults for organ transplant candidates, including learning about appropriate laboratory testing and diagnosis. They will gain experience in caring for chronic pain patients, who are enrolled in chemical dependency treatment. Residents will also have the opportunity to provide supervised group psychotherapy and will 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 will not receive patients transferred from other residents or clinicians at the beginning of PGY3. Rather they will evaluate new patients and build their own patient panel over time. This will allow residents to follow a cohort of new patients continuously over their last two years of training. Residents will 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 including 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 telephonic doctor – patient interactions are both effective and efficient.
In PGY3 residents will have the opportunity to pursue ½ day a week longitudinal elective experiences. This longitudinal elective model will apply to child and adolescent outpatient psychiatry, La Clinica (an outpatient adult clinic for the Latinx and Spanish Speaking population), and geriatric outpatient psychiatry.
In PGY4 residents will 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 will be selected as chief residents. The Chief residents will 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 the program evaluation committee. For those residents who do not inhabit the chief resident roles, they will become chiefs of a clinical service of their choice for six months. This leadership role will require clinical service chiefs to work closely with the faculty leadership on service to ensure optimal clinical care is provided and to help oversee educational activities for the junior residents. Particular attention will be made to provide these clinical service chiefs with opportunities and mentorship to develop their administrative, clinical supervision, systems based practice, interpersonal and communication skills.
Residents will have a half-day per week of didactics for the entirety of their psychiatric training. The curriculum is designed to provide residents with the requisite knowledge and skills to thrive in their everyday practice. It will utilize progressive pedagogies to enhance learning and retention of knowledge through promotion of learner participation, timely feedback, life-long learning and application of knowledge. In addition, mini-didactic sessions will occur on site during the clinical rotations. Residents will also have opportunities to learn from case conferences, journal club, grand rounds, and self-reflection.
To improve their medical educator knowledge and skills, residents will receive instruction on educational principles and techniques as well as supervised educational experiences with UCSF medical students, sub-internship medical students who train in the KP Healthcare System, and more junior residents. The educator role will be a key component of the Chief Resident experience during PGY4. Moreover, one PGY4 resident each year will have the opportunity to work closely with the residency Program Director (PD) as Chief Resident of the residency educational program.
We will train residents to be productive mental health scholars. Residents will receive research methodology training and have time in PGY3 to perform quality improvement and scholarly activity. They are expected to deliver one Grand Rounds presentation in PGY4 and to complete one scholarly project. For residents who want to pursue a formal research project, the Research Track provides significant support and resources beginning in PGY2 and continuing through PGY3 & 4. Our local Graduate Medical Education (GME) Research Director and GME Research Project Managers are available to facilitate resident research at our East Bay locations. In addition, residents will have the opportunity to collaborate on a research project within the KP Division of Research (DOR) located in Oakland, CA, the largest non-university based epidemiology research group in the nation. The DOR has a rich history of producing landmark studies utilizing the KP Healthcare System clinical population (with over four million KP members in Northern California) and multigenerational databases. The DOR has a number of scientists, who can serve as research mentors.
Residents are expected to complete the following activities:
- Completion of the KP online research training courses,
- Grand Rounds presentation of at least 50 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
- Presenting a Poster at a regional or national conference
- Giving an Oral Presentation at a regional or national conference
- 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 a 0.5 day of weekly protected time in the last 12 weeks of PGY2 and continuing through PGY3 and 40% protected time for the first 6-months of PGY4.
To enhance their leadership skills, PGY4 residents will serve as a Chief Resident or a Chief of a Clinical Service (see section of Chief Residents). In addition, residents will have a course on administrative psychiatry that addresses organizational and role-specific issues as well as current issues in mental health policy. Moreover, residents will 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 the resident selection process and to serve on a number of service-based committees.
Residents will be on call approximately three to four weekends in the PGY1 and PGY3 years and 6-7 weekends in PGY2 year. There is currently no night float or overnight call. The call schedule is subject to changes in years to come.
The specifics of call are:
- Residents will perform call during PGY1, 2, and 3.
- There is no night float or overnight call during the residency at this time.
- There is weekend call during the inpatient psychiatry rotations at Heritage Psychiatric Health Facility, KP med-psych unit in fremont, and as a psychiatric consultant on the medical/surgical inpatient wards at the KP Oakland Medical Center.
- The internal medicine rotation has “Long Call” (i.e., weekdays until 7 pm) on the day the team is admitting patients.
- There is currently no call on the neurology rotation.
- Call hours are included in the total weekly duty hours.
- All on 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 shifts, and
Residents will average less than 80 hours of work a week over a 4-week period.
Starting in orientation each resident will be paired with a faculty mentor, who will guide professional development and if needed assist them in accessing resources for emotional and physical wellbeing. The mentor will be expected to meet with the resident once every two months for the duration of their training.
Resident well-being is a high priority for our program. It will be supported and monitored through a combination of education, KP East Bay wellness resources for residents, mentorship, supervision, resident feedback and timely access to care.
Starting in orientation residents will be educated about self-care and the importance of healthy lifestyle choices and adequate sleep. They will learn about sleep hygiene, dysfunction related to drugs or alcohol and the signs and symptoms of burnout. Finally, residents will be encouraged to seek assistance from the PD, their mentors, and faculty members if they are experiencing stress, demoralization and any other symptoms of burnout.
Resident wellbeing will be enhanced and cultivated 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 are also invited to many of the wellness events developed for KP attending physicians that occur several times a month; there is no cost for residents. These include cooking classes, nature walks, museum tours, and relaxation retreats to name a few. Residents will also be invited to the annual resident retreat and graduation. Residents have a supplemental stipend to pay for a gym membership.
Residents who are identified as experiencing mental health, physical health or substance use problems will be 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.