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Curriculum Highlights

Sacred Heart Medical Center

Inpatient Psychiatry

The residency team serves 6 beds on the inpatient service located at SHMC. Residents spend time in the inpatient setting throughout their four years in residency training. In PGY1, residents are paired with PGY2s for 2 weeks, and then takes over as the solo resident for the next 2 weeks. In PGY2, residents spend up to 3 months on the inpatient service. The inpatient unit has both an acute and open side which allows for capacity to care for individuals who require higher level of care including the need for involuntary medications for non-compliance with oral medications, and the use of seclusion and restraints when indicated. ECT is a common treatment modality used at SHMC, for both inpatient and ambulatory patient care, with residents getting significant exposure to indications, consent and legal processes important in administering ECT. During PGY4 residents can complete an ECT rotation where they will become certified to administer ECT at SHMC.

Consultation-Liaison Psychiatry (CL) and Emergency Psychiatry

With 644 beds, Providence Sacred Heart Medical Center (SHMC) is one of the largest hospitals in the Northwest and is the only level II trauma center between Seattle, WA and Missoula, MT. SHMC boasts a 26-bed medical/surgical ICU and a 32-bed cardiovascular ICU designated to support a high complexity cardiovascular program that includes cardiac transplant, LVAD, and ECHMO. SHMC also has a kidney and pancreas transplant program and Level 3 Epilepsy center that helps support a large catchment area that includes nearly 1.5 million people.

Residents gain experience with a wide variety of consultation questions, including safety evaluations (> 25%, of which > 10% were admitted s/p suicide attempt), management of agitation related to delirium or major neurocognitive disorder (>20%), alcohol/substance related issues (>15 %), management of bipolar disorder/psychosis (> 5%), depression/adjustment/demoralization (> 5%), anxiety disorders (5%), somatoform and functional neurological disorders (4%), and capacity consults. Residents also receive experience evaluating for catatonia, acute stress/PTSD, peripartum depression/psychosis, buprenorphine inductions, etc.

Addiction Rotation

Addiction training starts in PGY1/2, with Medication Assisted Treatment waiver training during PGY1 Boot Camp, and treatment of patients with addiction disorders on the consultation liaison and emergency psychiatry services at SHMC. Senior residents get extensive high quality Addictions training in Spokane. Residents get practice providing buprenorphine as well as other medication assisted treatment at the Spokane Teaching Health Clinic (STHC) during their third year. The STHC Addiction clinic is a low barrier, patient centered, harm reduction clinic. The clinic serves voluntary patients with any type of substance use disorder. Residents enjoy the support of nurses and medical assistants that facilitate the workflow to obtain urine drug screens, check physician prescribing databases and can provide free naloxone/OD prevention to patients. Starting in 2020, Contingency Management became available for PRS patients. Residents frequently cite the STHC Addiction clinic as their favorite rotation at the Spokane Teaching Health Clinic.

In addition to the clinical aspects of the rotation, residents have numerous patient interactions coded for fidelity to Motivational Interviewing. They participate in a weekly Addictions Learning collaborative. Residents also get brief exposure to a local Intensive Outpatient Program, a Sobering Unit and a Chemical Dependency Assessment done by a CDP.

In their fourth year, the residents spend half a day a week at the VA Substance Abuse Treatment program, honing their therapy skills for substance use disorders. At the VA they work alongside Psychology Interns and get supervision from staff Psychologists in evidence based psychotherapies for substance use disorders.

Sacred Heart Children's Hospital

SHMC Child and Adolescent Consult Liaison Psychiatry

With 177 pediatric beds, Sacred Heart Children's Hospital is the largest pediatric hospital in Eastern Washington. Over 120 specialists provide care to 28 pediatric medical and surgical sub-specialities, including the only pediatric ICU in Spokane, surgical specialties, cardiology, neonatology, endocrinology, gastroenterology, neurology, neurosurgery, psychiatry, nephrology, ophthalmology, orthopedic, psychology, pulmonology, urology, adolescent medicine, and developmental medicine. Residents and fellows gain experience with a wide variety of consultation questions including safety evaluation, management of agitation, management of primary psychiatric disorders and psychological factors impacting medical conditions, management of somatoform and functional neurological disorders, management of eating disorders, and providing psychological support to families and children with chronic medical conditions.

Eastern State Hospital

Inpatient Rotation

Eastern State Hospital (ESH) is a state psychiatric hospital located in Medical Lake, WA that serves patients in the eastern part of Washington. ESH has civil, forensic and geriatric units. The average length of stay is 181 days, and the civil side admits about 240 people a year.

On this rotation, a resident works with an attending physician who carries between 15-17 patients. Patient are seen, on average, between two to three times weekly. The resident / attending team can expect 2-3 admissions a week. ESH does not currently have an electronic medical health record, and relies on paper charts where residents learns to write orders, and document legibly, and efficiently.

At this facility, common treatment modalities include medication management (antipsychotics, antidepressants, mood stabilizers), in addition to delivery involuntary medications. Residents work closely with a treatment team including a psychologist, social worker, activity therapist, occupational therapist, and speech therapist.

Forensic Psychiatry

This is a new rotation for AY 20-21. Previously our forensic rotation was in PGY4, which limited resident exposure to a potential fellowship choice. This year we moved it to an inpatient setting, at Eastern State Hospital, with residents able to work on a variety of wards, including restoration of competency and NGRI (not guilty by reason of insanity). Resident work with experienced psychiatrists for a month long required rotation in PGY1/2. An embedded rotation forensic learning curriculum ensures that residents have exposure to key supreme court cases, and develop an understanding of civil and criminal law and its intersection with psychiatry.

Geriatric Psychiatry

One of our very own graduates, Brian Sweatt, has taken the lead attending supervisor role on this rotation. Residents rotate on the geriatric admissions ward at Eastern state Hospital, providing patient care daily, as well as developing medical knowledge through a formal geriatric psychiatry curriculum, facilitated by Dr Sweatt.

Spokane Teaching Health Clinic

Psychiatry Specialty Clinic

PGY2, PGY3 and PGY4 residents have psychiatric continuity clinics at the Spokane Teaching Health Clinic. Supervision gradually gives way to independence and autonomy as residents move through residency training. The clinic is noteworthy in several ways. Each of the rooms is equipped with safety alarms (although we haven’t had to use them yet), and audio/video equipment to allow observation by faculty to enable safety as well as clinical feedback. The clinic has MA support to assist residents with rooming patients, collecting vital signs, scales, review of systems and scheduling. Resident patient appointments start with 90 min for an intake for R2’s and then transitions to 60 min intakes and 30 min return visits for R3’s and R4’s. Patient appointment time is limited to 2.5 hours in a half day to maximize the educational experience for residents. In PGY4 residents can choose a junior attending experience rotation in which patient care time is increased to 3 hours per ½ day, to ensure that residents choosing ambulatory post residency positions, are ready for practice. Residents are trained in billing and coding requirements in the ambulatory setting. Notes are reviewed by an educational coding specialist to ensure coding understanding and requirements, to ensure that residents are competent in this important area of work life, post residency. The clinic has ample free parking and is biker/walker friendly with a pedestrian bridge leading towards the hospital and rail to trail for cyclists. There is an on-site small gym, and two showers at clinic for staff use.

Collaborative care primary care consultation

Primary care consultation in a high fidelity collaborative care training model is a unique feature of our program. We have a mature, longitudinal training in collaborative care psychiatry, staring in PGY2 and threading through PGY3 and PGY4. Our training includes curriculum content, developed by the AIMS center at the University of Washington (UW), and taught by psychiatry residency program faculty who are educators in the UW Community Based Fellowship. Clinical rotations embed all principles of collaborative care, including patent centered treatment, population focused training, training in evidence based treatment and therapy for the primary care setting, outcomes based treatment, with use of a population based registry for care and a paradigm that uses a stepped care model so that those who are the most ill, get the most access to care, accountability, and quality improvement. You will consult to a range of primary care clinics across Providence Spokane and Steven’s County, working with patients from teenage years to the very elderly.

Frontier Behavioral Health

Child and Family Services

Frontier Behavioral Health (FBH) Child and Family Services clinic is a community mental health organization that cares for individuals ages 3 to 18 who are on state insurance (Medicaid). Each patient at FBH is assigned to a clinician who provides case management and developmentally appropriate therapy. If indicated patients are referred in for psychiatric specialty treatment with PGY3 residents, who form an integral part of the treatment team at FBH.

During this rotation, residents are directly or indirectly supervised by board certified Child and Adolescent psychiatrists. Patients are scheduled for 90 minute intakes, and 30 minute follow ups.

BEST child partial hospitalization program (JPS)

Steven’s County


This rotation was developed pre-COVID, to address rural health disparities in Steven’s county, a region north of Spokane, stretching all the way up to the Canadian border. PGY3 residents each spend six months providing one half-day per week of telepsychiatry services to the Family Medicine clinic in Colville, WA. During this rotation the residents provide remote medication management services to a rural, underserved population in Stevens County. Colville is a community with historically limited access to mental health resources and a significant mental health burden among its population; the demand for specialty psychiatry service is high among Colville’s primary care providers. Residents typically see one intake and several follow-ups during any given half day. In addition to gaining experience in outpatient medication management and navigating the technological advantages and barriers of telepsychiatry, they also learn about the policy, billing and regulatory aspects of telehealth services.

Gonzaga University

Gonzaga University Psychotherapy and e/m clinic

Our primary site for outpatient psychotherapy is currently located at the Health and Counseling Services of Gonzaga University, a private, university located on 152 acres near downtown Spokane.

Residents begin working at Gonzaga University starting in PGY2, with supervision provided in group format by the lead counseling Psychologist.

On ½ day rotations, residents follow 3 therapy patients. On full day rotations resident treat 5 therapy patients. The emphasis at this site is on brief psychotherapies, suited for the college age population. Treatment modalities include supportive therapy, cognitive behavioral therapy, harm reduction strategies, problem solving techniques, acceptance and commitment therapy which mirror psychotherapy didactic sessions occurring throughout the resident training.

Quality Improvement and Patient Safety Curriculum

Quality Improvement

All residents and faculty participate in patient safety and quality improvement, with QIPS being a core component of our training program and one which we are nationally recognized for. If you like QI and continuous process improvement, this is the program for you. The QIPS curriculum includes IHI online modules, on site didactic sessions led by core faculty and a systems of medicine rotation in PGY2. Knowledge acquisitions is paired with real world application with QI project work through all 4 years of residency. Residents are given allotted QI time during PGY2 primary care psychiatry rotations. Resident projects have resulted in permanent changes in our system and have improved patient care (insert photos). PRS graduates are comfortable planning and implementing QI projects by the time they graduate.

Patient Safety

Patient safety projects form a longitudinal thread through the entirety of the residency experience, blending into quality improvement projects for more senior residents. An introduction to root cause analyses occurs during the PGY1 year, with a focus on identifying modifiable causes for adverse events that allows for the proposal of systematic changes. During PGY2 year, root cause analyses are reviewed in more detail during the Systems of Medicine rotation, and residents have dedicated time to initiate QI projects that may address identified systematic patient safety issues. PGY3’s apply patient safety to actual cases, demonstrating mastery of root cause analysis by presenting at one of our quarterly Morbidity and Mortality conferences (which everyone attends across all four years). PGY4 residents complete a performance in practice (PIP) module, preparing for maintenance of certification requirements.

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