Psychiatry

Second- and third-residents work with our faculty psychiatrist, Dr. David Wilkins, seeing patients at Creekside Clinic. Dr. Wilkins also practices in the mental health department at Park Nicollet. At Creekside, residents participate in initial psychiatric consultations and follow-up visits for counseling and medication management, often on their own continuity patients.

Psychiatry Rotation Teaching Module

Rotational Goal
Residents will gain an understanding of psychiatric and mental disorders that are frequently present in a general family medicine practice and may be further referred to a psychiatrist.

Rotational Objectives
By the end of the psychiatry rotation, residents will be able to demonstrate competence in the diagnosis and treatment of mood and thought disorders as follows: 

(A) Patient Care
Through patient care experience gained as part of the psychiatry rotation, when further presented with the patient with mental health concerns in the family practice clinic or inpatient setting, residents will be able to:

• Accurately demonstrate taking a mental health history to include assessment of affect, mood, cognition, pertinent medical, social and family history, chemical and medication use, current level of function, and presence or absence of suicidal thoughts.
• Formulate appropriate management plans for patients with mental health concerns, taking into account medication risks and benefits, cultural concerns, and financial resources
• Refer patients appropriately for psychiatric consultation and for psychotherapy and acute hospitalization
• Recognize, address and counsel regarding mental health issues in primary care patients which are affecting their health, such as chemical dependency, eating disorders, depression, ADHD, and dementia.

(B) Medical Knowledge
At the completion of the psychiatry rotation, residents will be able to demonstrate medical knowledge of common mental health issues and “best practice treatment plans” suitable for the family physician, to include being able to:

• List the elements of a general psychiatric evaluation.
• Describe the use of psychotropic medications, especially for depression and anxiety disorders, including benefits, risks, side effects, possible drug-drug interactions and cost
• List the DSM-IV criteria for major psychiatric disorders (including personality disorders) and describe the elements of Axis I-IV diagnoses. (A copy of DSM-IV is in the preceptor room)
• Describe the components of an eating disorder evaluation.
• Describe the implications of and treatment options for behavioral problems such as dementia in elderly outpatient and nursing home patients
• List indications for a psychotherapy referral.
• Discuss indications and monitoring for benzodiazepines and sedative-hypnotics.
• Discuss the use of lithium and antiepileptics in bipolar disorder, including monitoring requirements.

(C) Practice-based Learning and Improvement
At the completion of the psychiatry rotation, and subsequently in the family practice clinic and inpatient setting, when presented with the patient with mental health concerns, residents will be able to:

• Critically evaluate evidence basis for diagnosis and treatment of depression, dementia, and chemical dependency
• Interpret and apply treatment guidelines for patients with mental illness, such as the ICSI  guideline on “Major Depression in Adults in Primary Care”
• Modify patient treatment plans on an ongoing basis based on patient response to therapy.

(D) Interpersonal and Communication Skills
At the completion of the psychiatry rotation, and subsequently in the family practice clinic and inpatient setting, residents will be able to:

• Obtain a full mental health history using effective communication skills with patients and, when appropriate,  their families/care takers
• Provide appropriate patient education on diagnosis and treatment as part of a management plan, taking into account the cultural orientation and literacy level of patients and their families/care takers.
• Coordinate care with patient and other team members for other care programs as appropriate.

(E) Professionalism
During the psychiatry rotation, residents will exhibit characteristics of a professional health care provider by:

• Dressing appropriately based upon standards present for attending physicians in the clinic setting associated with the rotation.
• Demonstrate sensitivity and responsiveness to patients’ perception of illness, and include these perceptions and patient preferences in formulation of management plan.
• Substantively contributing to the learning community in the residency associated with the psychiatry rotation, by participating in educational presentations associated with the rotation.

(F) Systems-based Practice
At the completion of the psychiatry rotation, residents will be able to:

• When presented with a patient with mental health concerns, describe several ways in which the primary care provider, psychiatrist, and therapist can work as a healthcare team in providing effective treatment
• When presented with a patient with mental health concerns, describe formulary implications for medication selection based upon insurance coverage (or lack of coverage) for the allergy patient.
• Coordinate referral to mental health treatment based on patient’s insurance coverage