Psychiatry

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 Osteopathic Association (AOA). On August 4, 2016, the program received pre-accreditation status by the Accreditation Council for Graduate Medical Education (ACGME). 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.

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 and adolescent psychiatry, adult inpatient and outpatient care, consultation / liaison services, outpatient and residential substance abuse care and geriatrics.

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 and be eligible to apply for medical licensure 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. Six months of the second year are spent in the emergency room setting (Triage Service). Three of these six months are spent during regular daytime hours; and, in order to facilitate state dependent learning, three 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.

Three 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.

The final three months are spent on the diversion services with the goal of connecting healthcare recipients to intensive services in the community which preempt the need for inpatient hospitalization. During this service, residents may be required to “ride-along” with crisis stabilization teams to stabilize patients in their native environment. In addition, they will be exposed to stabilizing patients experiencing crises in the hospital’s Psychiatry Crisis Stabilization Unit.

At the conclusion of this year of training, 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.

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. Approximately 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 and 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.

PGY 4: The final year of psychiatric training is spent in a combination of supervisory inpatient psychiatry (3 months), C/L Psychiatry with focus on liaison activities (3 months), Administrative Psychiatry (1 month), Geriatrics (1 month), Quality Improvement and Systems Based Practice (1 month), Supervisory Outpatient Psychiatry (1 month) and Elective time (3 months).

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.

At the conclusion of this year of training, PGY-4 residents are required to have met most level 4 ACGME psychiatry milestones.

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 informative 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 also 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

Kansas City University of Medicine and Biosciences, Kansas City, Missouri
Sadiq Mirza, D.O.
Western University of Health Sciences, Pomona, California

Touro University College of Osteopathic Medicine, Vallejo, California
Keith Noonan, D.O.
Western University of Health Sciences, Pomona, California
Jyoti Rajpoot, D.O.
Touro University College of Osteopathic Medicine, New York, New York
Spini, D.O.
Western University of Health Sciences, Pomona, California

Lake Erie College of Osteopathic Medicine, Lake Erie, Michigan
David Ly, D.O.
Touro University College of Osteopathic Medicine, Henderson, Nevada
David Ngo, D.O.
Touro University College of Osteopathic Medicine, Henderson, Nevada
Jessica Randell, D.O.
Western University College of Osteopathic Medicine, Pomona, California

Touro University College of Osteopathic Medicine, Henderson, Nevada
Ngoc-Minh Pham, D.O.
Touro University College of Osteopathic Medicine, Henderson, Nevada
Osmond Waheed, D.O.
Touro University College of Osteopathic Medicine, Henderson, Nevada
Dain Zylstra, D.O.
Western University College of Osteopathic Medicine, Pomona, California