Psychiatry Oakland - Curriculum

KP Fremont Inpatient Psychiatry

Residents spend 2-months on the KP Med-Psych unit (MPU) in Fremont, California working alongside KP San Jose PGY-2 residents. 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. In addition, residents have the opportunity to teach and mentor Drexel University College of Medicine students who rotate on service for their third-year psychiatry clerkship.

Emergency Psychiatry

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.

Consultation-Liaison Psychiatry

Residents have a 2-month rotation 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.

John George Inpatient Psychiatry

Residents spend 2-months on the community-based inpatient unit at John George Psychiatric Pavilion. The inpatient facility consists of 3 Units with 23 patients on each unit, a courtyard, and access to outdoor space. Under the supervision of an attending psychiatrist, residents are exposed to the full range of acute psychopathology. Carrying an average of 6-7 patients at a time, residents provide initial evaluations and on-going pharmacologic management, brief supportive therapeutic techniques and, when relevant, DBT or CBT. They gain valuable experience in directing and facilitating care for highly depressed, manic, psychotic, distressed or agitated patients. They are routinely expected to collect collateral information and conduct family meetings. They are expected to attend treatment team meetings, legal hearings, and weekly didactics with the PGY4 on their Selective Leadership Experience.

Residents receive valuable training in systems-based practice as a member of an interdisciplinary team consisting of an attending psychiatrist, psychiatric nurse, social workers, mental health technicians, and occupational therapists. In addition, they interface with members of the Alameda County criminal justice system. Unit B has 4 beds designated for patients arriving for care from Santa Rita Jail. Residents play an active role in formulating and arranging safe and appropriate discharge plans for their patients. Finally, residents learn how to navigate the outpatient based public and private mental healthcare systems and how to creatively ensure the welfare of the most vulnerable patients, who lack consistent access to food, shelter, income and transportation.

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/or guardians and includes participation in psycho-educational parenting workshops.

Addiction Psychiatry

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 addiction medicine treatment.

Outpatient Psychiatry

There are several unique aspects to the outpatient training experience in PGY3 & 4. First, residents receive very few 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 (e.g., Peripartum Women’s Mood & Anxiety Support Group, ACT Group, etc.).

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 HIPAA 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 each resident spends two ½ days per week over 4-months on the Geriatric Outpatient Rotation in the resident outpatient clinic under the supervision of an attending who is board-certified in geriatric psychiatry. They perform psychiatric evaluations, medication management, cognitive testing, coordination of care, family and caretaker education, and behavioral interventions for the attending supervisor’s diverse panel of geriatric outpatients. These patients are not empaneled with the residents.

Elective Experience

In PGY3 residents have the opportunity to pursue a 1 day a week longitudinal elective experience in the Research Track (see Scholarship and Research Training section). 

In PGY4 residents can pursue electives throughout the entire 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 new experiences with ECT, Reproductive Psychiatry, Health Equity, and Crisis Services. 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 or Selective Leadership 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 gain Selective Leadership Experiences at 20% time on a service of their choice. This leadership role involves working 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 residents on their Selective Leadership Experience 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:

PGY1

• Child & Adolescent Psychiatry
• Cultural Psychiatry
• Evidence-Based Medicine
• History of Psychiatry
• Intro to Cognitive Behavioral Therapy
• Intro to Pharmacology
• Intro to Psychiatric Interviewing
• Intro to Psychodynamic Psychotherapy
• Motivational Interviewing
• Professionalism
• Psychiatric Disorders
• Substance Use Disorders

PGY2

• Administrative Psychiatry
• 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
• Narrative Medicine
• Neuroscience of Psychiatry
• Personality Disorders
• Perspectives on Addiction Psychiatry
• Physician Wellness
• Professionalism
• Advanced Psychiatric Disorders
• Psychodynamic Formulations Course
• Quality Improvement
• Residents as Educators
• Sleep Physiology
• Step-back Consultation

PGY3

• Classic Psychoanalytic Papers Course
• Forensic Psychiatry
• Geriatric Case Conference
• Group Psychotherapy
• Human Sexuality in Psychiatry
• 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

PGY4

• Leadership Training
• Gender Affirming Psychiatry
• HIV Psychiatry
• Bariatric Psychiatry
• Case Conference
• Countertransference Seminar
• CBT for Psychosis
• Exposure and Response Prevention Therapy for OCD
• CBT for PTSD
• ACT Workshop
• Business of Psychiatry
• COVID19/Psychosis
• Affect Regulation

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, Drexel medical students, visiting sub-interns, and more junior residents. For example, the 2-year 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,
• Completion of the Institute for Healthcare Improvement “Basic Certificate in Quality & Safety” by the end of PGY3
• Grand Rounds presentation of at least 30 minutes duration, and,
• One of the following:
  1. Submission of a Case Report for publication
  2. Submission of a Book Chapter for publication
  3. Submission of a Manuscript for publication
  4. Presentation of a Poster at a regional or national conference
  5. An Oral Presentation at a regional or national conference
  6. 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
  7. 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 entirety of PGY4.

KP Oakland Psychiatry Residency Program Scholarly Research

Residents will have the opportunity to participate in GME-facilitated leadership training starting as a PGY2.

Additionally, residents have the opportunity to directly participate in the recruitment process of new applicants to the program, including informal ambassador roles as well as formal interviewing roles.

To more specifically enhance their leadership skills, PGY4 residents serve as either a Chief Resident or on a Selective Leadership Experience. The former experience is overseen by the Program Director, whereas the latter is overseen by our Director of Leadership Development, and former Department Chair of Behavioral Health.

During the Selective Leadership Experience, the PGY4 will be fulfilling primarily non-clinical duties. However, while the expectation is that they would not regularly carry a clinical caseload, they may be asked to do so per needs of the service. Additionally the PGY4 fulfills these roles:

• Leadership role: role model and mentor for the PGY1 / PGY2 residents regarding professionalism, care ownership, timeliness of documentation completion, and residency culture. Seek for opportunities to provide constructive feedback to the junior resident and empower them to provide bidirectional feedback.
• Educational role: provide clinically appropriate pearls following patient encounters. Develop and deliver structured didactic sessions of high-yield topics to your rotation on a weekly basis. Demonstrate how to integrate current evidence-based medicine and journal articles into care delivery and personal development. Assess for the impact of systems-based factors on care delivery and discuss these impacts with the junior resident. Be an accessible source of accurate knowledge that the junior resident can rely upon.
• Liaison role: coordinate with the rotation lead Attending on a regular basis. Role model effective interdisciplinary care with non-physician care providers on service. Provide feedback to the Program Director as to any concerns on rotation, or significant opportunities for improvement with the junior resident.

Lastly, residents have a longitudinal Leadership Seminar throughout PGY4 wherein they develop their skillset as an informal / formal leader, their social-emotional learning acumen, and learn how to lead within an organizational system. This involves structured didactic sessions, as well as discussant participation from diverse leaders throughout the community.

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. One week of evening at-home call and one weekend of in-person day call on the John George Inpatient Psychiatry rotation. 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: Two – three weekends on C-L service.

PGY4: No call during this 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 first-year 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 month for the duration of their training.

In addition, starting in orientation each first-year resident is paired with a more 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.