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Policy on Supervision

Supervision is designed to help the resident learn the principles and practice of psychiatry, primarily through review and detailed discussions of their clinical cases with an experienced attending psychiatrist. The resident is supervised on every clinical rotation. Residents beginning their first year will have close, daily supervision. As the resident progresses through the program, he/she will still be supervised but generally less closely and frequently. He/she will be given increasing responsibility for patient care in a graduated manner appropriate to his/her level of training.  Residents will always have direct access to attending supervision. If the resident feels uncomfortable with any supervision relationship, for whatever reason, he/she should consult the Residency Program Director and/or one of the Chief Resident for help and advice.
For more details regarding resident supervision, please refer to the “ACGME Program Requirements for Graduate Medical Education in Psychiatry” (all residents have been provided with a copy of this).

Overview of Supervision by PGY Year

PGY-1 Year

  • Daily supervision with inpatient psychiatry, emergency psychiatry and inpatient detoxification attendings when on psychiatry rotations.
  • One hour a week of 1:1 supervision with an attending psychiatrist.
  • Direct and back up attending supervision when on call.

PGY-2 Year

  • Daily supervision with an attending psychiatrist in clinical rotations.
  • One hour a week on 1:1 supervision with an attending psychiatrist.
  • All residents’ clinical cases are supervised by onsite attendings and faculty members who are primarily responsible for patient care.
  • Direct and back up attending supervision when on call.

PGY-3 Year

  • Daily supervision with outpatient attending
  • One hour/week of 1:1 supervision with outpatient attending
  • All residents’ clinical cases are supervised by onsite attendings and faculty members who are primarily responsible for patient care.
  • At least one hour per week of psychotherapy supervision required.
  • Direct and back up attending supervision during clinic days and when on call.

PGY-4 Year

  • All residents’ clinical cases are supervised by onsite attendings and faculty members who are primarily responsible for patient care.
  • Direct and back up attending supervision during clinic days and when on call.

Expectation Regarding Supervision

The Psychiatry Residency Program consists of a series of rotations in a variety of clinical settings. The program is structured as a hierarchical system in which senior residents also supervise junior residents. However, all residents receive direct supervision from the attending faculty.

Interactions between residents and supervising attendings are governed by the following principles:
  • Interactions between residents and attendings are expected to be respectful, collegial and focused on the common goal of excellent patient care;

  • A resident should, at all times, have direct access  to a faculty attending;

  • When the attending is on vacation or otherwise unavailable, a specific covering attending will be designated;

  • A faculty attending on the clinical service in which patient care takes place is designated as the supervising attending and has the ultimate clinical and legal responsibility for the care provided, although the resident is encouraged (and may be required) to also consult with other clinical or regular faculty supervisors;

  • Residents will present new cases to the attending on daily rounds on the inpatient, emergency and consultation-liaison psychiatry services. On outpatient rotations, the resident will present new cases to the attending (caseload supervisor) as soon as possible, and definitely within two weeks and will provide regular (i.e., at least monthly) updates for ongoing cases.

  • Residents on Psychiatry services (i.e., not on Internal Medicine or Neurology) will have at least two hours of individual supervision per week (including individual supervision with the inpatient/consult l/ER attending, supervision, psychotherapy supervision, and/or outpatient caseload supervision.

  • As a teacher, the supervisor/attending is expected to provide the resident with information, guidance and choices in patient care. The attending/supervisor needs to keep abreast of clinical issues on the service or with the resident’s patient caseload, and supervision needs to be sufficiently close to allow him/her to identify problems.

  • The attending/supervisor needs to monitor the resident’s performance and give regular, constructive feedback. The attending/supervisor determines how closely the resident needs to be supervised and how much reporting he/she expects from a particular resident, depending on the resident’s level of training, experience, and skills. The resident is expected to be open to learning, willing to consult, and prepared to fully inform the attending/supervisor about all patient care issues. It is strongly expected that terms, and goals of the supervisory agreement be made explicit in a collegial discussion between the attending/supervisor and the resident.

  • The supervising attending needs to be informed by the resident:
a)  When the patient’s condition deteriorates unexpectedly;
b)  When additional information puts the working diagnosis in doubt, or questions the treatment plan;
c)  When information is obtained that raises concerns regarding the patient’s risk for self-harm or harm to others;
d)  When the patient or family members disagree with the treatment plan;
e)  When there are serious disagreements or conflicts within the treatment team or with other services or providers;
f)  When decisions need to be made that have major clinical or legal implications, such as decisions not to hospitalize suicidal or homicidal patients.
  • During on-call duty, the resident will notify the on-call attending when:
a)  The resident has questions or concerns about the patient or the care provided;
b)  When patients decide to leave AMA;
c)  When the resident intends not to hospitalize a patient seen in the ER who has expressed ideas of self-harm or harm to others;
d)  When the resident intends to turn down a request for admission;
e)  When the resident plans to send a patient home from the ER who has a rapidly deteriorating clinical course (e.g., recent onset of mania, anorexia with significant recent weight loss);  
f)  The resident will also call the on-call attending to review all consults.