Year III of residencyspecific goals and objectives

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The goal of this year is to enhance the resident's acquired competencies in ambulatory care by supervised experience in more complex arenas of psychiatric service. A whole variety of new competencies are derived from this emphasis on mastering the problems of psychiatric assessment and treatment in unique domains within the health-care system. The resident continues to treat patients in an office-based practice, but, through a comprehensive outpatient service, also has closely supervised experience in the assessment and treatment of chronic schizophrenia and affective disorders, anxiety disorders, drug and alcohol disorders, and sexual disorders. Special treatment experiences—psychopharmacology for chronic disorders, couples therapy, family therapy—are provided under close supervision along with an extended series of psychodynamically oriented lecture demonstrations. A significant exposure to community-based psychiatry is provided, including rehabilitative and outreach services.

Emergency psychiatric consultation both in the emergency department and in ambulatory settings enhances the residents' confidence in methods of assessment and develops their capacity to provide crisis management and behavioural stabilization. Certain medical/psychiatric clinics—AIDS, neuropsychiatric, and chronic pain clinics—provide experience in ambulatory consultation to primary-care physicians. Such ambulatory experiences help residents learn how psychiatrists function in a large system of health care.

We expect that by the end of this year a resident will have acquired:

• mastery of skills of psychiatric assessments and treatments in complex ambulatory settings;

• diagnostic skills in recognizing the psychiatric disorders that complicate medical/surgical conditions and the capacity to provide this information in consultation to primary-care physicians in general hospital inpatient and outpatient services;

• a firm grasp of the theoretical underpinnings and the practice pitfalls of ambulatory psychotherapy both in the time-limited symptom-focused form and in long-term insight-oriented treatment;

• competence in the assessment and management of psychiatric issues seen most commonly in ambulatory settings—in particular, anxiety, family, marital, sexual, and addictive disorders;

• competence with sustaining psychopharmacology treatments for chronic schizophrenia and affective disorder;

• a knowledge of community psychiatry that rests on supervised experience in ambulatory community clinics with an outreach programme;

• a capacity to function as an effective member of a primary-care team in assessing and treating ambulatory medical patients.

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