Western State Hospital Psychiatric Medicine Faculty

ACUTE ADMISSIONS UNIT ROTATION

Along with the Extended Rehabilitation rotation, the Acute admissions rotation represents 50% of the final grades.  All students will be assigned to one of the four admissions wards in the Pettis Building (A-1, A-2, & B1, B-2).  These admissions units represent the "front lines" where all patients are admitted and managed until stabilized.  They afford the student the opportunity to see a wide variety of patients in the acute stage as well as in the intermediate stabilization stage.   Individual Attendings will supervise the students' integration into the ward routine and clarify the expectations for individual students.  In general, students are expected to be capable of presenting, interviewing, and possibly dictating one patient case per day (on average).  On some days students will have the opportunity to present and dictate more than one case and on other days there may be no admissions.  Ward secretaries will provide orientation to students concerning the format for dictations.  Your Attending (if allowing dictations) will proof read the dictations and provide feedback for you.  This process allows students to demonstrate their ability to integrate information in an organized fashion, demonstrate their ability to formulate cases, and develop a differential diagnosis.  Dictations should be done promptly, usually within a day of the admission, and must be in the chart within 3 working days (including all corrections and signatures).

Students are also expected to participate in weekly Progress Rounds and will write in the Physician's Progress Note Section (white pages).  Black ink should always be used and students should refrain from using other patient's names, humor, or nonprofessional comments in these legal documents.  Any notes or orders written by students must be co-signed by an M.D., and charts should be flagged when a student has written an order.  Please notify your Attending if you have written a note that needs to be signed.  Students can expect to see, interview, workup, and possibly dictate many cases over the course of their rotation.  With the help of their Attending, students should select a few of the patients they workup to follow more closely over the course of their hospitalization.  Most students find that carrying a caseload of approximately five patients at one time is optional.

EXTENDED REHABILITATION ROTATION

Students will also be assigned to an Attending on one of the Extended Rehabilitation units.

Drs. Bill, Christensen, Lee, Leslie, Miller, Nichols and Shannon.

Students should contact this Attending as soon as possible (page them or contact them on their ward)

 Program:          3 hours per week (minimum) on the Ext Rehab rotation 

 1.             1 hour:   Assigned to Mall  Groups
 2.             1 hour:   Combined lecture(interactive) related to Ext Rehab 
 Issues check master schedule for times

                           1.     Outpatient Psychiatry                     Dr J Lee

                           2.     Substance abuse   part 1                 Dr Miller

                           3.     Substance abuse   part 2                 Dr Miller  

                           4.    Psychosocial rehabilitation             Dr Shannon      
  
3.              1 hour:  1:1 supervision with Attending

Expectations for the Ext Rehab rotation will differ as the types of patients, milieu, and ward programs are very different. Students are expected to spend their three hours per week, in the afternoons accounting for approximately 12 hours over the course of their rotation.  Activities/Responsibilities may involve seeing and presenting patients, preparing presentations for the ward staff or for the Attending, following patients over the course of four weeks, or even learning specialized skills such as sign language.  Your Attending should clarify the expectations and the opportunities available on their ward for the course of your rotation. 

ON CALL DUTIES

Call is from 8:30am through 7:00am the following day.  You should always bring an overnight bag with you in case you need to stay.

Pick up the On Call beeper from the switchboard on your arrival, and drop it off whenever you leave.

If you get called from A/O between 8:30am and noon, first check with your Acute Ward Attending.  It is at the discretion of that attending to release the med student to the A/O or have them stay on the ward (for example: if there are new patients to staff).  If the student is asked to stay on the ward, the Attending is asked to call the O/D MD and speak directly to them to let them know they need the student on the unit.  O/D's realize that we consider acute ward work priority in the am
12 noon lectures, formal afternoon lectures and Grand Rounds take priority over A/O.

1pm-2pm weekly video seminars (Thursday) take priority over Call. From 1 pm onwards, students are expected to be available to the A/O.

The WSH OD has the discretion to release the student at 5 pm if there are no further admissions.  Also, the moonlighting OD has the discretion to release the student at 7 pm if there is no work.  Consequently, students may be released as early as 5 pm but this should not be the expectation.

OUTPATIENT ROTATION

The outpatient rotation is expected to encompass 6-8 hours over the course of four weeks.  Students are scheduled for two experiences;

                      1)   To accompany an Attending to Augusta Correctional Center for 8 hours.

                      2) Attend one of two clinics at Valley CSB.

Participation in this outpatient program allows the students to experience treatment of chronically mentally ill individuals as well as individuals without major mental illness who are seen on an outpatient basis by psychiatrists.

ECT & NEURO/AIMS CLINIC

Students are assigned a half day to observe ECT in Charlottesville and information and directions are included in this orientation packet. You are expected to arrive at WSH by late lunch time.  Students are also assigned one afternoon to attend Neuro/AIMS Clinic at WSH.  You will have further information in your orientation packet with respect to the specific day that you can attend the Neuro/AIMS Clinic.

INCLEMENT WEATHER

In the event of inclement weather, such as snow or icy roads, students should make their own assessment if it is safe enough to drive to the hospital.  If in doubt, you are welcome to call the Clerkship Coordinator, Dr. Schofield, Page # 540/851-7484.  If WSH is following an inclement weather policy, it is understood that students are not expected to make it to the hospital.  As noted above, students are not expected to be present for Call if a WSH inclement weather policy is in effect.

ILLNESS/ABSENCES

If students are out sick or unable to make it to work, they are expected to contact their ward Attending and the clerkship coordinator.  In the event that an absence is prescheduled, students should arrange to make up the time with their ward Attendings.  In general, it is expected that students will be present at the hospital, unless otherwise assigned, from 8:30am until 5:00pm on the weekdays of the rotation.

SECURITY/SAFETY

WSH is obviously on State property.  There are several strict laws, which apply to you while you are here.  Alcohol and firearms are never permitted on the grounds, not even in a locked car.  When driving on grounds, remember that the speed limit is 15 miles per hour and is strictly enforced.  Students who will be parking on grounds should see Security and obtain a parking sticker.  Cars must be pulled in to park and must be parked in designated spots in order to avoid ticketing.  Students should be aware of the fire plan on the ward.  In the event of a fire or a fire drill, the doors in the building will close automatically and students should follow the directions of ward staff.  It is important to the faculty and to WSH staff to always maintain a safe environment for patients and staff.  Especially with new admission, always speak with them in the dayroom and be cautious to stay within sight of psychiatric aides.  Remember that in all hospitals there exist the potential for assaultive behavior in medical, surgical, and psychiatric patients.  If you feel unsafe, move slowly and exit the situation.  When on call do not agree to see a new admission until the Attending is present with you.  Students should not see patient's (especially patient of the opposite sex) alone in their rooms or behind closed doors.  It is best to either be in an open area or in an area with a window that can be observed by other staff.

LECTURES

A lecture schedule is available to you on the first day of the rotation.  You are expected to attend lectures unless you are scheduled to be at Augusta Correctional Center or Valley CSB.  Presence at lectures takes priority over all other duties.

KEYS

Each student will be supplied with a #2 key on your orientation day.  This will allow you entry to the various wards, treatment rooms, and student offices here at WSH.  These keys must be returned on the last day of the rotation to Security in the Tunnel of the Pettis Building.  It is important to keep these keys secured during your rotation and you will need to turn in your key before your grade will be processed.  There is a $35.00 charge for a lost key.

DRESS

Dress comfortably but not provocatively.  Ties are not required for men.  Jeans are not allowed at the prison as this is regular uniform for inmates (also, jeans should not be worn at WSH).  When going to the prison, individuals must have a picture ID (student ID preferred). Students should dress conservatively, coats and ties for males, and females should dress professionally.  Do not take food, cell phones, beepers, sharp items into the prison (you will be frisked). 

PHONES

Please do not hesitate to use the phones for any University or patient related business.  State law mandates a tight policy on the use of state phones for personal use and every call is documented automatically on a computer. The use of State phones for personal use is forbidden.  If you need to make a long distance personal phone call from work, use your calling card or bill it to your home phone.  To dial numbers within WSH, call 2-XXXX, to call UVA you will need to dial 9-1-434-XXX-XXXX.  Local phone calls can be made by dialing 9-XXX-XXXX and long distance calls (work related) require 9-1-area code-number.  Do not make work related long distance phone calls from your home with the expectation that you can bill the hospital for such call.

TRANSPORTATION

Students provide their own transportation and will be reimbursed $204.75 after the rotation.  Carpooling is encouraged.

OTHER

Any questions or concerns about the rotation or problems that arise during the rotation should be directed to the Clerkship Director, Dr. Schofield at page # (540) 851-7484.

Revised 6/22/06

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