Psychiatry

Program Director: Kedarnath Challakere, MD
Residency Coordinator: Kathleen Nicholson
Telephone: (909) 580-2186
Fax: (909) 580-3814
Address: Behavioral Health, 400 N Pepper Ave. Colton, CA 92324
E-Mail: nicholsonk@armc.sbcounty.gov

The Department of Psychiatry at Arrowhead Regional Medical Center (ARMC) developed a residency training program which began in July 2008 and is accredited by the American Colleges of Graduate Medical Education (ACGME). On May 5th 2017, the program received initial accreditation status by the Accreditation Council for Graduate Medical Education (ACGME) retroactive to July 1, 2016. The urgent demand for psychiatrists in California due to ever increasing mandates for services at the federal, state, and county level requires an expansion of training programs in California. We are proud to be part of this expansion.

ARMC operates one of the busiest psychiatric emergency rooms in the Inland Empire and one of the busiest in all of Southern California with approximately 20,000 visits per year. We are the provider of last resort to the underserved population of Riverside, San Bernardino and other counties in the region. Our diverse clientele consists of Hispanic (40%), Caucasian (33%), African American (16%), Asian, and Native American patients among others. Certified interpreters are available both on-site and via tele-translation services at all times.

ARMC’s affiliation agreements with the County of San Bernardino Department of Behavioral Health and other training sites assure that our residents have a very broad spectrum of training within a system of care that employs more than 100 psychiatrists in every specialty field of psychiatry including child & adolescent psychiatry, adult inpatient and outpatient care, consultation / liaison services, outpatient and residential substance abuse care, geriatrics, and experiences in ECT procedures and TMS/Neuromodulation.

The overall goal of the psychiatry residency training program at ARMC is tailored to training physicians who specialize in modifying the longitudinal course of psychiatric illness processes using a combination of biological, psychological, social and community based approaches.

Curriculum

PGY 1: The first year of residency training is spent rotating both in psychiatry and fulfilling AOA/ACGME required rotations in psychiatry, internal medicine and neurology.

PGY 1: 12 1-month blocks

4 IM blocks
2 Neurology Blocks
6 Psychiatry Blocks

Internal medicine blocks are spent on an inpatient general medical team. During these weeks, the resident is trained alongside other residents in the principles of hospital medicine.

Neurology blocks are spent in inpatient and outpatient clinical neurology. Residents are exposed to both inpatient consult neurology as well as outpatient neurology clinic.

Four of the six monthly psychiatry blocks are spent on the Behavioral Health Inpatient Units at ARMC. As part of primary management of acutely ill hospitalized psychiatric patients, residents obtain exposure by working with other staff members of interdisciplinary treatment teams including clinical therapists, social workers, as well as occupational and group therapists. In addition, residents spend two months on the emergency triage service during which they develop skills in stabilization of patients with acute psychiatric issues. They may also be called upon to provide psychiatric consultation to patients on acute medical / surgical services.

At the conclusion of this year of training, PGY-1 residents are required to have met all level 1 ACGME psychiatry milestones. Graduates of US medical schools who complete twelve months of PGY-1 training before November 30, 2019 are currently eligible to apply for medical licensure in the State of California. (Graduates of medical schools from outside of the United States must complete 24 months of training prior to eligibility for licensure). However, beginning January 1, 2020, all residents must complete 36 months of training in order to be eligible for a license to practice medicine in the State of California.

PGY 2: The second year of psychiatry training is spent entirely on stabilization of patients with acute psychiatric service prior to inpatient hospitalization. Four months of the second year are spent in the emergency room setting (Triage Service). Two of these six months are spent during regular daytime hours; and, in order to facilitate state dependent learning, two of these six months are spent on night float. Night float months are non-consecutive and require one full month of night duty during each episode. Residents have access to immediately available direct supervision at all times with attending psychiatrists on site 24 hours per day.

Two non-consecutive months of the second year are spent providing consultation and liaison services to medical / surgical services. The medical center generates approximately 2200 consults per year. Residents receive indirect supervision with direct supervision immediately available during this experience. Senior residents may also be available on the C/L service to provide intensive liaison activities to the primary services.

Two months are spent on the Crisis Stabilization Unit with the goal of connecting healthcare recipients to intensive services in the community which preempt the need for inpatient hospitalization. In contrast to the Triage service who goal is initial evaluation of patients with acute psychiatric emergencies, the emphasis during the CSU rotation consists of disposition of patients with acute psychiatric crises to treatment in setting less restrictive than inpatient hospitalization services. During this service, residents may be required to “ride-along” with crisis stabilization teams to stabilize patients in their native environment.

Residents also spend one month on addiction treatment services during which they learn to manage patients whose lives are affected by substance use disorders. Techniques learned during this rotation include acute detoxification (including the use fo Buprenorphine), stabilization and intermediate term management of patients with substance use disorders in both inpatient and outpatient settings. Residents will be encouraged to attend process groups involving patients suffering from these disorders.

In addition, residents spend one month on Geriatrics Psychiatry service at our affiliated Innovage Program. During this experience, residents learn management of psychiatric disorders affecting patients older than age 55 in an interdisciplinary outpatient setting in concert with primary care geriatricians, geriatric psychologists, social workers, case managers and legal consultants. Residents will also be required to follow their outpatients when these patients are admitted to inpatient services at ARMC in a consultative mode to inpatient primary care services. Faculty at ARMC with geriatric psychiatry qualifications will provide geriatric psychiatry supervision to residents on this service.

At the conclusion of this year of training, current PGY-2 residents are required to have met all level 2 ACGME psychiatry milestones and have obtained licensure to practice medicine by the State of California and have obtained certification to prescribe Schedule 2 and above categories of medications by the Drug Enforcement Administration. This will no longer be the case after January 1, 2020.

PGY 3: The third year of psychiatry training is spent entirely at outpatient psychiatric clinics in which residents learn to modify longitudinal course of psychiatric illnesses in outpatient clinics (Operated by San Bernardino County’s Department of Behavioral Health). Residents are expected with work with an interdisciplinary team of therapists and allied health professionals. While caring for patients in the adult clinics, residents receive indirect supervision with direct supervision available by scheduling with attending faculty. In addition to psychopharmacology, residents learn psychotherapeutic approaches and are encouraged to engage in long-term psychotherapy with selected patients for a period of up to two years. Up to 50% of the patients treated during the third year of training may be mandated by the court system to obtain psychiatric care to fulfill their legal diversion requirements.

During the third year of training, residents also obtain exposure to assessment and management of child & adolescent patients under direct supervision of child psychiatry faculty. This exposure is discrete from the adult outpatient experience and is delineated by days of the week.

At the conclusion of this year of training, PGY-3 residents are required to have met all level 3 ACGME psychiatry milestones, and, after January 1, 2020, apply for licensure in the State of California. By the end of their PGY-3 year of training, residents will have completed all required rotations required by the certifying agencies WITH THE EXCEPTION OF time under training, thus facilitating the transition to combined fellowship training in ABPN certified subspecialties.

PGY 4: The final year of psychiatric training is spent in a combination of supervisory inpatient psychiatry (up to 3 months), C/L Psychiatry with focus on liaison activities (up to 3 months), Administrative Psychiatry (1 month), Quality Improvement and Systems Based Practice (1 month), Supervisory Outpatient Psychiatry (1 month) and Elective time (up to 3 months) including time spent at a dedicated private research unit at a regional private hospital and exposure to electroconvulsive therapies / neuromodulation technologies. Senior residents are required to continue to spend 4 hours per week with long term psychotherapy patients with whom they began to work in their PGY-3 years.

PGY-4 residents are also expected to cover court hearings and testify on legal matters involving all inpatients at ARMC behavioral health and main hospital. Court hearing are held every Tuesday afternoon and Friday mornings, unless modified by holiday schedules as observed by the courts. Supervision for the court activities will consist of indirect supervision with immediately available direct supervision.

PGY – 4 residents will be expected to successfully complete three Clinical Skills Evaluations prior to the completion of their training (Some of these examinations may also be undertaken during the PGY-3 year). At the conclusion of this year of training, PGY-4 residents are required to have met a majority of level 4 ACGME psychiatry milestones and attain eligibility to challenge the written examination for board certification by the American Board of Psychiatry and Neurology.

Didactics

Lectures are typically held during one afternoon each week. During this time, residents are excused from psychiatric coverage to attend lectures. Topics include journal club, case presentations, psychopharmacology lectures, board review classes, mock board examinations, DSM review, and the role of psychiatry in society and research methodology. Residents are encouraged to present seminal journal articles as well as interesting cases they have found. In addition to above, residents meet with program director for one hour on a weekly basis to discuss current cases and topics.

Each resident is afforded four hours per week of dedicated research time. This research time is divided into two two-hour blocks which must be spent on campus engaged in active research. A publication / poster presentation grade research project or approved structured quality improvement project is required for graduation from the program.

Current Residents

PSYCHIATRY (ACGME)

Emergency Medical Services – ACGME Accredited

The ARMC EMS Fellowship is designed to provide emergency medicine physicians the opportunity to become board eligible for the sixth subspecialty in Emergency Medicine. Emergency Medical Services (EMS) is a medical subspecialty that involves prehospital emergency patient care, including initial patient stabilization, treatment, and transport to hospitals in specially equipped ambulances or helicopters.

For more information, please contact the fellowship coordinator, Kevin Lyons at 909-580-6153

Maternal-Fetal Medicine – ACGME Accredited

Fellows are trained in the clinical skills that are essential for prenatal diagnosis and for the care of higher risk obstetric patients and in research related to maternal-fetal medicine.

For more information, please contact the fellowship coordinator, Madeleine Collado at 909-580-3496.

Pulmonary Disease and Critical Care Medicine – ACGME Accredited

The Fellowship Program provides an intensive clinical exposure, an extensive didactic program, in which the Fellow is expected to actively participate, both as a student and a trainer, and an introduction to clinical research.

The program offers two positions per year and Fellows rotate through four teaching sites over the 36-month program

For more information, please contact the fellowship coordinator, Becky Rivera at (909) 580-6343.


Graduate Medical Education
GME Office Manager
Teresa Smith, MBA
909-580-6157

Designated Institutional Official
Niren Raval, DO
Director of Medical Education

ARMC participates in the National Resident Matching Program. The application for all programs can be accessed through the
Electronic Residency Application Service (ERAS).

Arrowhead Regional Medical Center ©