Child Fellowship
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GOALS AND OBJECTIVES
Washington University School of Medicine
Child Psychiatry Education and Training Program
Anne Glowinski, M.D., M.P.E.
Director of Residency Education and Training in Child Psychiatry
Richard D. Todd, Ph.D., M.D.
Director, Division of Child Psychiatry
Arif Mirza, M.D.
Chief Resident 2007 – 2008
Brigitte Northrop
Fellowship Coordinator
Charles Zorumski, M.D.
Chairman, Department of Psychiatry
Department of Psychiatry
Washington University School of Medicine
OUTLINE:
A. General Objectives
B. Core competencies
C. Clinical and Educational Experiences
D. Block Diagram of Rotations during the 2 years of training
E. Curriculum
F. Miscellaneous
A. General Objectives
The overall goal of the Washington University School of Medicine Training Program in Child and Adolescent Psychiatry is to help each fellow develop the necessary knowledge, skills, and experience to enjoy a productive career as a child/adolescent psychiatrist in either a clinical or a research career. In order to obtain this goal, a fellow is active in a progressive series of clinical, educational, and research experiences designed to continuously enhance the fellow's abilities. The fellowship provides a combination of didactic and clinical work which is both broad enough to ensure knowledge of the wide variety of disorders of childhood and adolescence and yet intensive enough to ensure thorough diagnostic and treatment skills. All fellows are required to gain competence in clinical child psychiatry and to address mental disorders from infancy through adolescence in terms of the individual, their family and their social setting. Developmental considerations are at the core of the conceptual approach.
B. CORE COMPETENCIES:
We first outline the core competencies which each fellow is expected to have at the time of graduation from our program by knowledge, skill and attitude: Core competencies as defined by the ACGME are the necessary and measurable outcomes of medical residency and/or fellowship education and training. While the core competencies of patient care, medical knowledge, interpersonal and communication skills, practice based learning and improvement, professionalism, and systems based practice are in fact highly inter-correlated, it is useful to conceptualize separately the major characteristics of each set of core competencies (and how we endeavor to measure them in our program). These descriptions should be used as a roadmap for trainees and faculty of our program. As noted, the core competencies which are described in the pages that follow were adapted for our medical discipline of child and adolescent psychiatry using several sources including the American Board of Psychiatry and Neurology (ABPN) guidelines and the academic literature.
I: Core Competencies: Patient Care
In the practice of Child and Adolescent Psychiatry, good patient care can be summarized as the ability to accomplish a variety of evaluative and treatment planning tasks effectively. It is important to also underline strongly that the competent patient care which is expected of all our trainees upon graduation implicitly relies also on the achievement of competency in all other domains.
Knowledge:
1-Adequate understanding of development including child, adult, parental and family development
2-Psychotherapy principles including understanding and maintaining of clinical boundaries, principles of psychoanalytic, cognitive-behavioral and systems theories
3-Psychopharmacology principles, including differences between adult and pediatric drug delivery systems, safe medication management strategies using single or whenever appropriate multiple drugs, knowledge of dosages, side effects and drug interactions.
Skills
1-Performance and documentation of a developmentally appropriate and comprehensive history and examination of diverse patients and their families
2-Formulation of a sensible differential diagnosis including use of a DSM-IV formulation using skilled familiarity with developmental disorders and other psychiatric disorders with onset in childhood and adolescence
3-Formulation of effective management plans including as needed further inquiries and evaluations including appropriate laboratory, imaging, medical, and psychological examinations and the obtaining of additional information from pertinent sources (e.g., teachers) and a comprehensive treatment plan addressing biological, psychological, educational, family, and socio-cultural domains.
4. Comprehensive assessment and documentation of patient’s potential for self-harm or harm to others or potential environmental harm to patient, and appropriate therapeutic approach including an assessment of risk and formulation of a plan to minimize this risk
5. Ability to conduct a range of individual, group, and family therapies using standard, accepted models, including behavioral and cognitive-behavioral modalities, and to integrate these psychotherapies in multi-modal treatment, including biological, family, educational, and socio-cultural interventions.
7. To develop, document, and carry out, when indicated, an integrated psychopharmacological treatment plan while recognizing special considerations in childhood and adolescence
8. To appropriately monitor progress of the patient including the development of the patient and integrate new information and changes in clinical presentation into an updated differential diagnosis and treatment plan
Attitudes:
Motivation to learn patient care by (i) reviewing the literature, attending didactics and reading, (ii) practicing supervised patient care in multiple varied settings with multiple varied patients and their families, (iii) observation of faculty engaged in patient care, (iv) synthesis of multimodal learning through participation in supervision which includes openness to integration of supervisory feedback into enhanced learning of patient care.
ASSESSMENT:
1-Performance on mock oral boards
2-Evaluation of ability to think about patient care by individual supervisors
3-Observation of patient care by supervisors in multiple settings and with multiple patients and their families
4-Regular record review by supervisors including review of appropriate clinical record-keeping, documentation of appropriate formulations/diagnoses/treatment aspects.
5-Feedback of staff, patients and families to supervisors
II: Core Competencies: Medical Knowledge (Clinical Science)
Clinical science combines knowledge base about established, evolving and emerging facts from the basic and clinical sciences relevant to Child and Adolescent Psychiatry and the application of this knowledge to clinical care.
Upon graduation, the trainee will demonstrate competence in clinical science as detailed below:
Knowledge: Sufficient mastery of information integral to the clinical principles of child and adolescent psychiatry as presented in the educational and clinical curriculum and enhanced by self directed learning. Broad topics include:
1-Normative Development
2-Developmental Psychopathology
3-Dimensional and Categorical assessment of psychopathology and assessment procedures
4-Clinical and biological sciences
5-Epidemiology and Prevention
6-Treatment modalities
7-Principles of Consultation in clinical, academic, school and community settings
8-Research literacy
Skills: The trainee will demonstrate the ability to
1-Apply knowledge to the care of psychiatrically ill children, adolescents and their families
2-Integrate evidence into an analytical and investigative framework used to approach to clinical care
3-Learn and effectively teach medical knowledge about child and adolescent psychiatry
Attitudes: The trainee will demonstrate a strong commitment to the acquisition and practice of medical knowledge as evidenced by:
1-Attendance and participation in didactics including clinically based conferences
2-Presentations at divisional, departmental, institutional and possibly other conferences
3-An open and curious mind as indicated by literature searches and other investigative work including optimally research
ASSESSMENT:
1-Annual completion of PRITE and Child PRITE (Child Psychiatry Resident in Training Exam)
2-Record of attendance and participation at core didactics
3-Performance during mandatory teaching exercises in multiple settings
4-Supervisory evaluations from multiple supervisors
III: Core Competencies: Interpersonal and Communication Skills
Interpersonal and communication skills are developed to allow optimal communication between the child and adolescent psychiatrist, patients and their families, colleagues, staff and system. These skills require both the acquisition and practicing of certain techniques but also the fostering of underlying attitudes involving trainee’s personal beliefs, values, self understanding, opinions about self and others and understanding on his/her role in relationship to patients and their environments.
Upon graduation, the trainee will demonstrate competence in interpersonal and communication skills as outlined below:
Knowledge:
1-The effect of patient’s or family members’ emotional reactions and associations to their psychiatric provider (and vice versa) on evaluation and treatment
2-Cultural differences
3-Structure and function of multiple systems including multidisciplinary treatment teams
Skills: Effective interpersonal and communication skills in a wide range of settings including ability to:
1-Listen to, understand and communicate effectively with children, adolescents, adults and families
2-Forge and sustain a therapeutic alliance and an ethically sound relationship with patients and caregivers
3-Elicit and provide information using effective verbal, nonverbal, clarifying, interrogatory, interpretive, play and writing skills as appropriate
4-Negotiate an agreed upon treatment plan with patients and caregivers
5-Clearly educate children, families and if applicable other professionals about medical, psychological and behavioral issues in the life of children and families
6-Communicate effectively within multidisciplinary team structures as member, consultant or leader
Attitudes: Demonstration of attitudes which facilitate interpersonal and communication skills:
1-Respect for others including others with differing points of view or professional or cultural backgrounds
2-Willingness to gain understanding of another’s position and reasoning and to achieve mutual understanding
3-Belief in the intrinsic worth of other human beings
4-Willingness to share information in an open rather than dogmatic fashion
5-Desire to continuously self observe, self monitor and address one’s own biases and reactions
ASSESSMENT:
1-Direct observation by faculty and staff in multiple clinical and community settings
2-Direct observation by faculty in multiple supervisory settings including clinical case conference format
3-Evaluations from clinical rotations and supervisors
4-Mock Oral Boards
5-Evaluations of presentations at divisional core lectures and departmental Grand Round or Research Seminars
IV Core Competencies: Practice Based Learning and Improvement
This set of core competencies comprises both a process and the skills which allow this process to occur. The process of practice based learning and improvement is one whereby a child and adolescent psychiatrist continues to learn throughout his/her career in order to expand his/her knowledge and skill to ensure highly competent evaluation and treatment of patients and their families. Recognizing that a child and adolescent psychiatry fellowship is a relatively brief period of concentrated multimodal learning, we ask our fellows to practice during fellowship the skills which allow them after training to in essence self direct their own learning and improvement for the rest of their lives. Upon graduation, our trainees will have demonstrated competency in practice based learning and improvement.
I. Knowledge: Our trainees will be able to identify what is currently known and to critically evaluate how this knowledge was established. They will be able to identify gaps in our existing knowledge and at least conceptualize and understand research methods which will be appropriate to fill these gaps. Broad topics for critical evaluation and understanding of emerging and future research include:
1-Development and developmental psychopathology
2-Biological and clinical sciences
3-Genetic by environmental interplays (correlations and interactions)
4-Nosology
5-Assessment of dimensions and of categories related to psychopathology
6-Ethics, forensic and legal topics
7-Research literacy including design, basic statistical methods and results interpretations
Skills:
1-Ability to identify strengths and weaknesses in relationship to this set of competencies so that weaknesses can be addressed with faculty supervision during training
2-Ability to acquire and integrate information from a variety of sources, to organize the information thus acquired and to synthesize findings for self and others
3-To develop a critical mind set which questions the current “truths” of our discipline and understands the crucial place and function of research for the future of child and adolescent psychiatry
Attitudes: Demonstration of attitudes congruent with lifelong learning
1-Recognition of the necessity of lifelong learning
2-Demonstration of active learning
ASSESSMENT:
1-Evaluation of regular (at least twice monthly) critical review of the literature for problem based learning during weekly enhanced supervision
2-Attendance and participation at didactics
3-Evaluation of Scholarly presentations to division and department
4-Supervision evaluations in multiple settings
V Core Competencies: Professionalism and Ethical Behavior
This set of core competencies is traditionally of the utmost importance to physicians, recognizing that medical professional standards are in fact (as articulated for instance in the Hippocratic Oath) substantially different than the professional standards of other disciplines. Thus, professionalism and ethical behavior in our medical specialty of Child and Adolescent Psychiatry encompasses both the mundane (standards of professionalism which would be reasonable in most professions) and the special commitments which are made by physicians including responsiveness to the needs of patients and society that supersedes self interest. Professionalism is manifested in a variety of ways which will be monitored throughout training. We expect all our trainees to be highly professional and ethical at graduation.
Knowledge: Our trainees will demonstrate through their behavior an understanding of professional and ethical expectations in the practice of child and adolescent psychiatry including broadly:
1-Basic principles which apply to most professions: compliance with an honor code whereby behavior is honorable regardless of whether it is observed or not, honoring of commitments (including through arranging coverage by others), ownership of tasks to be accomplished, punctuality, timely communication of lateness or absence to clinical and other settings, appropriate and respectful dress, conduct and behavior at all times.
2-Cultural competence including understanding and respect of population diversity, compassionate understanding of health disparities including in our discipline, differences in child rearing, child development, and perceptions of physician and family roles.
3-Medical legal and ethical principles of confidentiality assent and consent to research and treatment, evaluation and treatment of minors including involuntary commitment.
Skills:
1-Ability to review, discuss and conform to institutional and governmental ethical guidelines (e.g., HIPAA)
2-Discuss and obtain consent from appropriate person
3-Accomplishments of tasks related to clinical care both by him/her and also within team contexts (e.g., peers or interdisciplinary teams)
Attitudes: consistent with high professional and ethical standards, such as
1-Adherence and commitment to ethical principles pertaining to provision or withholding of care, confidentiality of patient care and information
2-Recognition of conflicts of interest
3-Capacity to continually review/challenge care procedures for the patient’s benefit
4-A commitment to patients and their families which transcends trainee’s self interest
ASSESSMENT:
1-Evaluation by all supervisors in relation to ethical practice of child and adolescent psychiatry
2-Periodic review of clinical rotations for socio-demographic diversity (ethnic, social, economic, gender, age)
3-Faculty and staff our program understand need to rapidly relate concerns about any aspect of trainee’s professional behavior to the program director
VI: Core Competencies: Systems-based care
The competency to render systems-based care refers to the treatment of children and adolescents with psychiatric problems within the context of multiple complex systems. Upon graduation, our trainees will demonstrate competence in child psychiatric treatment and consultation across multiple systems involving multiple agencies.
Knowledge: Our trainees should demonstrate an adequate understanding and familiarity with multiple systems relevant to psychiatrically ill children and adolescents and their families, such as:
1-Educational system
-Public and private resources for management of learning, and/or emotional, and/or behavioral problems
-Legal aspects of education including the IDEA (Individuals with Disabilities Education Act)
-Concepts of school-based mental health
-Concept of IEP (Individual Education Plan) and the role of the child and adolescent psychiatrist for determining and negotiating the educational needs for particular patients
2-Social Services
-Role of child welfare and protective services
-Role of social services in the treatment system
-funding mechanisms for child-related social services
3-Primary and specialized medical care
-Role, structure and function of pediatric health care systems
-Partnering with pediatric health care systems
4-Mental health system
-Community resources
-understanding of levels of care and appropriateness of each for a given patient/family (e.g., hospitalization, day treatment, residential treatment, intensive case management)
5-Juvenile justice system
Skills
1-Interaction with multiple systems in a consultation or primary provision of care model
2-Effective use of community resources
3-Collaboration with other systems in the treatment of specific patients
Attitudes:
1-Understanding the concept of “least restrictive environment”
2-Motivation to enhance the environment/situation of a specific patient by collaborating with others as needed
3-A mindset which involves seeing oneself as a potential agent of positive change through advocacy across multiple systems
ASSESSMENT:
1-Observation by supervisors of performance of specific systems-based care related tasks (e.g., communication in writing or orally to school officials, reporting to Division of Family Services, management of consult/liaison service)
2-Performance on related subsections of mock oral boards, PRITE and Child PRITE
3-Performance and participation in related didactic activities (e.g., interdisciplinary lectures with pediatric neurology, problem-based learning enhanced supervision)
C. Clinical and Educational Experiences
Each fellow participates in a variety of clinical and educational activities, including supervised patient management, clinical conferences, departmental conferences, journal clubs, fellow-specific didactic courses, and advanced supervision formats. Fellows also learn from actively teaching Washington University medical students, general psychiatry residents rotating on child psychiatry, and pediatric neurology residents. Fellows progressively assume more clinical and educational responsibilities over the two-year training period.
The program provides an understanding of normal behavior as well as the related forms of developmental psychopathology. Biological, sociocultural, psychodynamic, behavioral, and familial aspects of childhood and adolescence are learned.
The variety of clinical experiences includes inpatient child and adolescent psychiatry at Hawthorn Hospital, intensive outpatient child psychiatry, St. Louis County Special School District evaluations, research opportunities and consultation-liaison and emergency room experience at St. Louis Children's Hospital. Infant/preschool psychiatry is mandated exposure in the second year of training. Elective time in the second year also allows a resident to study areas of research interest or clinical areas he/she feels require more experience.
In addition to the lectures, staffing conferences, and other courses specifically designed for the fellows in child psychiatry, the child psychiatry fellow can attend any of the courses given in the department of psychiatry: these courses include neurobiology, genetics-molecular biology, epidemiology, psychodynamics, personality, behavioral medicine, law and psychiatry, psychological testing, statistics, advanced psychopharmacology, and research methods. Attendance at weekly departmental seminars is strongly encouraged and adds to the fellow's learning experience: Psychiatric Grand Rounds, Research Seminar, Epidemiology Seminar, and Genetics Seminar.
Specific Objectives
First Year
Child and Adolescent Inpatient Services at Hawthorn Hospital: These inpatient services expose the fellow to a broad variety of developmental problems and youth psychopathology. A full range of treatment modalities used to treat inpatients includes pharmacotherapy, behavior modification, family therapy, group therapy, milieu therapy, and psychodynamic therapy.
The objectives of this rotation are for the resident to demonstrate competence in:
- age appropriate interview techniques, as well as comprehensive mental status examination on children and adolescents
- talking with and obtaining a history from patients, family members, and all others involved in the caretaking system of the patient (DFS social worker, teacher, etc.)
- observing and interpreting family relationships and their pertinence to the child's presenting problems
- appreciating the role of the family in the assessment and treatment regardless of the age of the patient
- presenting cases succinctly and accurately
- differential diagnosis and dynamic case formulation of psychiatric symptomatology and the importance of biologic, psychologic, and socio-cultural aspects of symptoms
- knowledge of strengths and limitations of the current DSM diagnostic criteria
- current knowledge concerning the pathogenesis and etiology of psychiatric disorders
- the appropriate use of laboratory testing
- the appropriate use of psychological testing
- the appropriate use of adjunct medical consultation
- building psychotherapeutic skills over the two year fellowship
- the use of psychopharmacologic agents in child and adolescent patients
- understanding behavior modification and level systems in treatment
- the ability to function as a cooperative member of a multi-disciplinary therapeutic team
- understanding the roles of other mental health professionals including psychologists, nursing staff, social workers, educational therapists, activity therapists, etc.
- interacting with social and legal agencies in the management of child/adolescent psychiatric disorders
- assessment of patients admitted from emergency room settings
- administrative experience in ward management
- historical, cultural, legal, and ethical aspects of child/adolescent psychiatry
Child and Adolescent Psychiatry SLCH Outpatient Clinics: The overall objective of this ongoing outpatient experience is to help the fellow to gain competence in managing children and adolescents with developmental and psychiatric symptomatology in an outpatient setting. It is expected that each resident will follow several patients long-term, preferably for over a one or two year period, including at least one psychotherapy patient.
Specific objectives of the outpatient rotation are to learn:
- how to evaluate and treat children and their families on an outpatient basis
- the importance of the interaction between the family and patient
- the importance of other mental health professionals and psychological testing in managing outpatients
- how to incorporate school information for evaluative purposes
- the appropriate use of outpatient laboratory tests and other clinical procedures
- the use of play in both evaluations and therapy
- the psychotherapeutic skills necessary to manage outpatients
- how to initiate and monitor medications, including the use of standardized rating scales completed by the patients, parents and/or teachers and the appropriate use of laboratory testing
- outpatient family therapy
- to communicate effectively with physicians in other fields of medicine
BJC Behavioral Health Outpatient Clinic: This setting provides a unique outpatient experience in the treatment of more seriously and chronically ill children as well as those from multi-problem families. The rotation also offers greater experience with a very ethnically diverse population.
Specific objectives are similar to those above with the addition of:
- learn how to manage children from multi-problem families on an outpatient basis.
- work effectively as a member of a multi-disciplinary treatment team.
Second Year
Child and Adolescent Psychiatry SLCH Outpatient Clinic: The outpatient clinic experience of the second year fellow emphasizes the management of ongoing treatment cases. Residents will follow a variety of patients throughout the year under supervision in multiple treatment modalities including pharmacotherapy, psychodynamic psychotherapy, family therapy, behavioral and cognitive approaches.
The objectives of this clinical experience are for fellows to develop.
- short and long-term psychopharmacologic management of child outpatients
- techniques of medium and long-term psychodynamic psychotherapy (including play and cognitive-behavioral approaches)
- techniques used in collateral parent counseling
- skills in more intensive family therapy
- the appropriate use of cognitive/behavioral interventions in a wide variety of clinical syndromes
- skills in dyadic play therapy
Infant/Preschool Clinic: The objective of this rotation is to teach fellows how to evaluate and treat psychiatric disorders of preschoolers and infants in a familial, social and developmental context. The experience emphasizes evaluation of parent-child interaction, making use of free-play and semi-structured videotaped assessment techniques.
During this rotation the fellow will gain experience in:
- evaluation of very young children
- the use of play and other nonverbal modalities in the assessment and treatment of infants and preschoolers and the clinical use of principles of developmental psychopathology
- the role of early parent-child relational disturbances in the etiology of some infant and preschool psychiatric disorders
- the identification of developmental delays and aberrations in very young children and the appropriate use of developmental testing in these cases as a part of a comprehensive psychiatric assessment
- techniques of dyadic play therapy (parent-child interactional) in certain infant and preschool disorders
- the appropriate use of pharmacotherapy in disorders arising in the infancy/preschool period
Consultation-Liaison at Children's Hospital: The overall objective of this rotation is to apply skills learned in the first year of the program to assist colleagues in other medical fields who suspect that their patients' illnesses are influenced by psychiatric causes, or may result in psychiatric symptomatology. Complicated decisions regarding diagnostic and management issues in physically ill patients require advanced knowledge of child/adolescent psychiatry coupled with common sense and excellent communication skills with our nonpsychiatric physician colleagues.
These specific skills require experience coupled with close supervision. The fellow is expected to learn how to:
- perform a consultation which addresses the specific questions posed by the referring physician
- convey information, both written and oral, as understandably as possible without the use of jargon
- work effectively with the several disciplines often involved in the care of a pediatric patient, as well as address liaison issues
- understand how chronic disease affects children/adolescents and their families
- understand how psychiatric symptomatology may be the result of physical illness
- understand laboratory values for various medical diseases and how these may reflect on psychiatric symptomatology
- help children/adolescents relax in the hospital environment
- help patients and their families accept/live with illness
- help a family cope with the death of a child, and /or a child cope with the death of a parent
Neurology Clinic: The fellow participates, under the direct supervision of a child neurologist, in the evaluation and treatment of children with a variety of common neurological problems. This clinic maintains a particular emphasis on neurodevelopmental and neurobehavioral disorders of children and thus the relevance of this experience to child psychiatrist in training is quite significant.
The goals of this rotation are:
- develop the necessary skills in obtaining a neurological history and performing a neurological exam
- understanding the interface between neurological, developmental, and behavioral disorders
- understanding the use of EEG, MRI, CT, etc. and laboratory testing in the identification of neurological disorders
- develop basic competence in the pharmacologic management of common child neurological disorders
St. Louis County Special School District: The objectives of this rotation are to provide the fellow with an understanding of the numerous factors, which impact the role of a psychiatric consultant in the school setting. During the rotation the fellow will learn:
- structural and organization aspects of the school or school systems
- models of school consultations
- the process of effectively providing consultation to administrators or teachers
- understanding the social context of the school
- understanding the learning process
- specific learning disabilities and their relationship to behavioral disorders
- the academic and social implications of ADHD, depression, and other psychiatric disorders
- special education laws
Elective Time: The objective of this time is to help fellows expand research interest or an area of training in which he/she wishes more experience. A faculty mentor should be identified to work closely with each resident to determine the most profitable use of this time, especially in consideration of his/her developing future career objectives. This elective can be used for one of three possibilities:
- allow a fellow who would like to do research to pursue a mentored research project
- allow a fellow to pursue more in-depth training in an area he/she desires
- provide selected additional outpatient clinical experience if another alternative is not developed
D. CLINICAL ROTATIONS DURING THE 2 YEARS OF TRAINING
YEAR I (this represents 2008-2009 Year I)
3 months Child Inpatient |
3 months Adolescent Inpatient |
6 months Child & Adolescent Community Outpatient |
12 months Child & Adolescent Outpatient |
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YEAR II (this represents 2009-2010 Year II)
3 months Child Neurology Community Outpatient-WUSM |
3 months St. Louis County Community
Outpatient-WUSM |
3 months Infant Preschool Clinic New Evaluations Community
Outpatient-WUSM |
3 months Pediatric C/L
Community Outpatient-WUSM |
12 months |
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E. CURRICULUM
COURSES
The principal didactics during both years are two weekly series: (1) Core Didactics and (2) Psychotherapy Seminar. Core didactic lectures are coordinated in consecutive hours and are coordinated into modules. There are shorter courses throughout the year which substitute for the Core Didactics and they include: Fellows presentations, Board preparation and Life After Residency.
Several weekly departmental seminars are available: Grand Rounds, Research Rounds, Advanced Resident Seminar, and conferences on genetics and epidemiology. Unique to the first year is a summer initial introductory series on key topics. Finally, throughout both years, most rotations have unique weekly conferences.
Several weekly departmental seminars are available: Grand Rounds, Research Rounds, Advanced Resident Seminar, and conferences on genetics and epidemiology.
SUPERVISION
In addition to supervision from the director of each rotation and their faculty attendings, each resident has at least two weekly hours of supervision during both years of training including one hour of enhanced supervision which emphasizes the use of Problem Based Learning and Improvement to enhance the benefit of case presentations to faculty supervisors.
F. MISCELLANEOUS
EVALUATIONS
Evaluations of a resident are completed by directors of rotations after each rotation and by supervisors yearly. The training director gathers this information and provides feedback to each resident twice a year. In addition, residents take the PRITE exam (adult & child) and mock oral boards each year.
VACATION
Fellows are entitled to a maximum of three weeks paid vacation annually or a proportionate fraction thereof if the appointment period is for less than one year.
READING WEEK/EDUCATIONAL WEEK:
Educational time off can be requested and obtained up to one week per year, to be used for a variety of purposes (e.g., taking or preparing an exam). For second year residents, the division will cover up to $1,000 of expenses –full payment of expenses for our chief fellow- to attend the annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP).
SICK LEAVE
When a duly appointed fellow is off duty because of illness, he/she must notify the full-time attending. If the time exceeds three consecutive days, the Training Director must be notified. The Director must approve sick leave extending beyond one week and medical verification is required. Pay will be continued for a cumulative total of one month for a 12-month appointment or a fraction thereof if the fellow does not return to service. Sick leave for appointments of less than a full year will be proportionally prorated. Sick leave pay in excess of one month during the appointment year will only be granted in exceptional instances, such as work connected disability, and only upon agreement by the Chief of Service and the Training Director, in consultation with the Hospital Administration.
DISABILITY LEAVE
If a duly appointed fellow has need to be off duty for health-related reasons, including pregnancy and childbirth, beyond the allotted vacation and sick leave, a disability leave of absence must be requested from the Training Director. Acceptable medical verification indicating the need for disability leave and the projected date of return from the leave is required at the time the request for leave is made. The Director, in consultation with the Department Chairman, shall have the authority and discretion to approve or deny a request for a disability leave of absence and to impose whatever conditions or restrictions on the leave that he/she deems appropriate under the circumstances. If leave extends beyond cumulative vacation and sick leave, time must be made up. Before a fellow on disability leave may return to duty, a physician's statement releasing the fellow to return to work will be required. The maximum disability leave, which a resident may be granted, including extensions, is six months.
A fellow's disability leave shall be with pay to the extent of the fellow's accrued sick leave and vacation time. Once accrued sick leave and vacation time have been exhausted, the remainder of the disability leave shall be without pay. All decisions of the Training Director and
Department Chairman, with respect to disability leave issues, shall be made in a fair and nondiscriminatory manner.
PERSONAL LEAVE
If a duly appointed fellow needs time off in excess of his/her accrued vacation time for personal (non-health) reasons which may include child-rearing responsibilities or family problems, a personal leave of absence must be requested from the Training Director. The Director, in consultation with the Department Chairman, shall have the authority and discretion to approve or deny a request for personal leave of absence based upon the individual circumstances of the fellow requesting the leave and the needs of the training program and to improve whatever conditions or restrictions. (For example, it will be necessary to extend a resident's training program to make up for time lost while on personal leave.) Any approval of personal leave shall be documented in writing which sets forth the period of the leave, the conditions with respect to the resident returning to full-time duty and any other relevant factors. The maximum personal leave, which a fellow may be granted, including extensions, is two months. A fellow's personal leave shall be without pay. All decisions of the Training Director and Department Chairman with respect to personal leave issues shall be made in a fair and nondiscriminatory manner.
FUNERAL LEAVE
In the event of the death of a first degree relative of a fellow or a fellow's spouse, up to three (3) days of paid funeral leave will be allowed. Requests for more extended funeral leave when needed should be submitted to the Training Director.