Psychiatry Residency

FIRST YEAR

• Inpatient Internal Medicine or Pediatrics (2 blocks)
  • Inpatient medicine takes place at the Tripler Army Medical Center or The Queen’s Medical Center, Inpatient Medicine Unit.  Residents are part of an internal medicine team and attend medicine didactics while on this rotation.  Psychiatry residents are given the same responsibilities as other internal medicine c residents, and both follow up on and admit new patients. Rotation usually 6 days/week.
  • Pediatric inpatient rotations take place at the Kapiolani Medical Center.  Residents share similar responsibilities to pediatric residents and are expected to both follow up on admitted patients and help in admitting new patients depending on the type of call day.  Residents attend pediatric didactics.  Rotation usually 6 days/week.

• Outpatient Internal Medicine or Pediatrics (2 blocks)
  • Outpatient medicine takes place at the Pali Momi Outpatient Center or The Queen’s Medical Center, Queen Emma Clinic.  Residents work with family medicine residents in seeing patients through their clinic. Residents also see patients in the medical school’s traveling clinic for patients who are homeless. Rotation M-F.
  • Outpatient pediatrics takes place at the Kapiolani Medical Center.  Residents see patients for well-child checks and other acute visits. Rotation M-F.

• Neurology (2 blocks)
  • Neurology rotation takes place at the Straub Medical Center.  Neurology training is mostly centered in a general neurology clinic where residents both shadow and examine patients presenting with a wide variety of neurological complaints. Residents also follow inpatient neurologists for certain days during the week to gain exposure to more acute neurologic pathologies. Residents occasionally observe pathologists for neuropathology rounds. Rotation M-F.

• Adult Inpatient Psychiatry (6 blocks)
  • Inpatient psychiatry training occurs at the Queen’s Medical Center, Kekela Unit.  Residents generally carry up to 8 patients.  As one of only 2 psychiatric units for non-military affiliated individuals in Hawaii, residents gain exposure to working with a diverse patient population of individuals from Hawaii and across the world.  Residents work directly with an attending psychiatrist supervisor.  Rotation M-F plus 2-3 days/month of Saturday OR Sunday weekend coverage.

• Geriatric psychiatry (1 block)
  • Residents work in a variety of settings including inpatient consultation liaison seeing geriatric patients and working with geriatric medicine physicians, nursing home settings, and outpatient clinics at the Queen’s Counseling Services. Residents receive training in pharmacologic and behavioral management of disorders ranging from delirium and major neurocognitive disorder with behavioral disturbance to geriatric depression. Rotation M-F.

• Forensic / Correctional Psychiatry (1 block)
  • This rotation takes place at the Oahu Community Correctional Center.  Residents provide psychopharmacologic management for patients seen in a correctional setting.  They also review concepts in forensic evaluation with our forensic psychiatry physicians.  Rotation M-F.

• Night Float (1 block per each PGY Level)
  • Night Float is completed at the Queen’s Medical Center for one block per PGY Level.  Two residents are assigned to complete Night Float together usually pairing an upper with a lower-level resident.  

SECOND YEAR

• Addiction Psychiatry (1 block)
  • Residents work in various settings including inpatient consultation at the Queen’s Medical Center, local buprenorphine and methadone clinics.  All residents must become certified in prescribing buprenorphine during this rotation.

• Child and Adolescent Psychiatry (2 block)
  • Residents work with board-certified child and adolescent psychiatrists in the Family Treatment Center at the Queen’s Medical Center.  Residents participate in both medication management and family therapy interventions.  Residents typically carry up to 4-5 patients and work with children ranging generally from early childhood to adolescence.  Residents work M-F with 2 weekends of the month “on call” for new admissions.

• Consult-Liaison Psychiatry (2-3 blocks)
  • Residents on the consultation liaison service respond to consultations from the medical and surgical teams at the Queen’s Medical Center.  Residents become familiar with a variety of psychiatric and other medical pathologies, refine skills in capacity and safety assessment and gain comfortability in liaising with nursing, social work and primary teams.  Residents typically are on duty M-F with 2 half-days of Saturday coverage, Sundays are off.

• Emergency Department Psychiatry (2-3 blocks)
  • One of our busier services, residents interview, examine and treat patients who come to the Queen’s Medical Center psychiatric emergency room.  We operate as a consult service and provide recommendations for workup, treatment, admission and disposition.  Residents refine their skills in triaging and performing emergent safety assessments. Rotation usually 3-4 days/week (2 shifts on 2 shifts off).  Shifts are usually 12 hours in duration 8am-8pm.

• Forensic Psychiatry (2 blocks)
  • This rotation takes place at the Oahu Community Correctional Center.  Residents provide psychopharmacologic management for patients seen in a correctional setting.  They also review concepts in forensic evaluation with our forensic psychiatry physicians.  Other rotation sites include potential away experiences doing forensic evaluations with Dr. Pablo Stewart and training at the Hawaii State Hospital, a forensic hospital in Hawaii.  Rotation M-F.

• Geriatric psychiatry (1 block)
  • Residents work in a variety of settings including inpatient consultation liaison seeing geriatric patients and working with geriatric medicine physicians, nursing home settings, and outpatient clinics at the Queen’s Counseling Services. Residents receive training in pharmacologic and behavioral management of disorders ranging from delirium and major neurocognitive disorder with behavioral disturbance to geriatric depression. Rotation M-F.

THIRD YEAR

• Outpatient Psychiatry
  • PGY-3 residents complete 13 blocks at one of two outpatient psychiatry sites described below that operate Monday-Friday.   A half-day per week is dedicated for residents to schedule mandatory psychotherapy supervision.  During the year PGY-3 residents will also complete one block of night float and occasional weekend call.
  • Queen’s Counseling Services (QCS): Residents see patients referred from the Queen’s Medical Center inpatient, emergency room or consultation liaison settings.  Residents at QCS also participate in medication and DBT groups.  Weekly didactics occur for training in CBT and IPT.  Residents are encouraged to carry at least 3-4 psychotherapy patients but may see more depending on their available schedule.  On Wednesdays and Fridays, residents participate in the geriatric psychiatry clinic.
  • Veteran’s Administration (VA): Residents at the VA see patients who are veterans or in the military.  In addition to seeing medication management and psychotherapy cases, residents also have an opportunity to join multiple groups at the VA.  Residents have increased independence on this rotation site and staff their cases once a week with an attending psychiatrist.

FOURTH YEAR 

• Schedules for fourth year residents are centered around electives, preparing for independent practice in the community and studying for national board examinations using board preparation courses purchased by the program. 
• Required rotations in fourth year include ER, CL or Forensics rotations to prepare for independent practice. 

• Residents submit requests in advance of their elective blocks that outline the location, schedule, goals / objectives, milestones, and site supervisor’s approval for review and approval by the Clinical Competency Committee.
• Past electives have included (but are not limited to):

• Addiction Psychiatry – Oahu Drug Court 
• Administrative Psychiatry (Chief Resident)
• Administrative Psychiatry 
• Cultural Psychiatry
• Child and Adolescent Psychiatry 
• Community Psychiatry
• Day Treatment
• Electroconvulsive therapy (ECT)
• Emergency Psychiatry
• Forensic Psychiatry
• Homeless – Institute for Human Services or Veteran’s Administration
• Geriatric Psychiatry – Nursing Home
• Integrative Medicine
• Integrative Psychiatry / Outpatient Addiction Treatment Program
• Junior Attending Kekela Inpatient
• Medical Student Curriculum Development and Teaching
• Psychopharmacology – Included as part of CL rotation
• Posttraumatic Stress Disorder Psychiatry
• Research
• Reproductive Psychiatry
• Telepsychiatry
• Transcranial magnetic stimulation (TMS)

Call Duties

Resident call duties are designed to offer psychiatric emergency room and overnight psychiatric emergency training experiences. While you will have supervision from an upper-level resident as a PGY-1 and from an attending psychiatrist in all training years, the goal is to build your skills in triaging patients, performing focused psychiatric examinations and safety assessments and your confidence in independent practice.

Call occurs on weekday and weekend evenings. Residents are on-call for no longer than 12 hours per shift (we have no 24-hour call shifts). Call is distributed through a night float system and scattered weekend calls. All call is in-house, with a call room provided.

PGY1

• Weekend calls: none
• Night float: 1 month
• Shifts: 430pm-430am Monday through Friday (with upper-level resident).

PGY2

• Weekend calls: ~6
• Night Float: 1 month
• Shifts: 8pm-8am.

PGY3

• Weekend calls: ~8
• Night Float: 1 month
• Shifts: 8pm-8am.

PGY4

• Weekend calls: 0-maximum of 5
• Night Float: may vary but usually no more than 1-3 weeks
• Shifts: 8pm-8am.

Note on upper resident calls (PGY 2-4): Night float Monday-Friday (with PGY 1 and another upper-level resident). Weekends are solo calls. Weekend calls are not planned for consecutive days (i.e. Saturday and Sunday of the same weekend) unless requested by a resident.

Duties during call:

• Your primary responsibility is treating patients in the psychiatric emergency room.
• Occasionally you may receive calls from the adult or child inpatient unit regarding orders or emergent assessments.
• Emergent consultations from medical floor.