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Post-Pediatrics Portal Program

Director: Jamie Snyder, M.D.
E-mail:  mailto:jamiesnyder@creighton.edu  • Phone: (402) 552-6222• Fax: (402) 552-6247

Program Coordinator: Mary Monaghan

E-mail: memonaghan@unmc.edu • Phone: (402) 552-6222, Ext. 20• Fax: (402) 552-6247

Address: Creighton University Department of Psychiatry, 3528 Dodge St., Omaha, NE, 68131

Post-Pediatrics Portal Project (PPPP)

The Psychiatry and Child and Adolescent Psychiatry (CAP) Residencies are unique joint ventures between the Psychiatry Faculties at Creighton University and the University of Nebraska Medical Center who work together for remarkably comprehensive and collegial training programs that offers residents the best amenities of two major medical centers and a remarkable array of institutional affiliates.

This project was set up as a unique blend of our existing programs, taking into account the expertise already acquired through the candidates’ training in Pediatrics. We provide an abbreviated structured training program for pediatricians from ACGME-accredited training programs to become eligible for certification in Psychiatry and Child and Adolescent Psychiatry within a three-year time period. This training builds on a core set of skills from their pediatric training, expanding their expertise to integrate the core competencies in Psychiatry and Child and Adolescent Psychiatry.

This involves spending the equivalent of 18 months in Adult Psychiatry rotations and programming, as well as 18 months in CAP rotations and programming. For optimal continuity we begin an outpatient treatment component in the afternoons which continues over the full three years. The program initially consists of mostly adults and transitions to more CAP cases by the end of the second year. In the third year, primarily CAP cases are handled. The inpatient and community rotations take place in the mornings. The didactic schedule integrates the best of the adult lectures with the best of the CAP didactic schedule.

This project involves careful assessment and monitoring of the residents’ developing competencies. This occurs regularly within their program (following RRC requirements) as well as nationally by their participation in the PRITE (in-training exam) and ABPN exams. Progress of this project is closely supervised by ACGME, including annual meetings of these programs during AADPRT meetings, ACGME resident surveys, and RRC visits.

Affiliated Institutions

Creighton University Medical Center (CUMC), the sponsoring institution, is a 400-plus-bed acute care facility providing state of the art care while serving as a setting for education and research programs. There are over 10,000 admissions and approximately 27,000 emergency department visits each year. PPPP residents rotate through CUMC for outpatient and consultation-liaison services.

The University of Nebraska Medical Center (UNMC) is a 689-bed academic medical center that has an international reputation. PPPP residents rotate through UNMC for inpatient adult, outpatient, and consultation-liaison services. They also provide on-call emergency room consultations in the brand new Level 1 trauma center emergency department.

Alegent Health, Immanuel Medical Center is home to a 20-bed inpatient acute care unit for children and adolescents ages 4-19. Approximately 500-700 children and adolescents are admitted per year, approximately a third are admitted to Creighton faculty. The Immanuel Medical Center is also home to the psychiatric residential treatment center (RTC). PPPP residents rotate through Immanuel during their first and second year.

Children’s Hospital is a nonprofit regional pediatric specialty healthcare center. Patients are referred to the 100-bed hospital from a five state region. Eight-two percent of patients are from Nebraska and the other eighteen percent come primarily from neighboring states. Children’s is dedicated to providing quality healthcare services for children, infants through adolescents, while encouraging health care education and clinical research. Children’s contains an inpatient eating disorder program for adolescents that has approximately 6 inpatients and 4 partial hospital patients at a time. The CAP residents spend at least one month FTE on this service.

Faculty Members

PPPP residents work with both Adult and CAP faculty. To read more about each faculty member, please go to the Our Faculty & Staff page, where links exist for each faculty member.

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PPPP Goals/Objectives
  1. The training program will teach scientifically based principles of normal human development, including the limits of normal variability, as well as an integrated appreciation of how cognitive, emotional, and physical growth and development interact. Trainees acquire the knowledge and understanding of development, assessment, diagnosis in children, adolescents, and adults, and learn to formulate a comprehensive treatment plan attending to intra-psychic, interpersonal, family, social, educational, and medical needs.
  2. Trainees will acquire skill in short-term and long-term psychotherapy, an understanding of group dynamics, skills in family therapy, and the ability to utilize, clinically, the principles of behavior modification and use of psychopharmacology for common childhood, adolescent, and adult disorders.
  3. Trainees will develop skills in coordinating a multi-disciplinary team in consulting with other professionals and agencies in case-centered and program-centered consultation to develop skills to serve as an effective consultant to primary care physicians, community agencies, and institutions serving children, adolescents, and adults.
  4. The training program will promote a working knowledge of research design statistics and computers sufficient to evaluate current scientific literature in the interest of best patient care and develop some understanding of research methodology related to adult, child, and adolescent psychiatry. Trainees will have the opportunity to participate in clinical research.

PPPP residents who complete the three-year clinical rotations and didactic program will be able to demonstrate the following:

  1. Knowledge and understanding of normal development in infancy, toddler hood, and preschool children, elementary and school age children, adolescents, and adults.
  2. Knowledge of normal development will include the limits of normal variability as well as integrate appreciation of how cognitive, emotional, physical growth and development interact with each other. The resident will be able to demonstrate familiarity with various developmental concepts and identify factors promoting or interfacing with normal development.
  3. Knowledge and understanding of established psychiatric syndromes and diagnoses in children, adolescents, and adults. The resident will learn criteria for each diagnosis, including exclusionary criteria and a flow chart of differential diagnoses for various systems.
  4. A clear understanding of psychodynamics, including defense mechanisms and intra-psychic problems in each stage of development.
  5. The ability to formulate a comprehensive treatment plan, including attention to intra-psychic, interpersonal, family, social, education, economic, and medical needs. The resident must be able to explain the differences in treatment planning for outpatients versus inpatients, including the implications for the contributions of each member of a multidisciplinary team.
  6. Skill in psychotherapy including both short-term and long-term treatment.
  7. An understanding of group dynamics. In addition to theoretical knowledge, each resident will have acted as a therapist or group leader (with supervision) for at least one adolescent group, one pre-adolescent group, and one adult group.
  8. Skill in family therapy. This includes the ability to assess family dynamics and intervene appropriately, given the nature of the family’s problem.
  9. Clear understanding of and the ability to apply principles of behavior modification, with at least one case successfully treated.
  10. Skill in psychopharmacotherapy of common childhood, adolescent, and adult disorders for which this treatment modality is appropriate. The resident will have the ability to enumerate side effects of various drugs, indications and contraindications and differences between pediatric and adult psychopharmacology.
  11. Skill in coordinating a multidisciplinary team. This includes developing appropriate professional relations, an understanding of what each discipline can contribute and ability to identify the patient’s needs that can be met by the resources available.
  12. Skills in consulting with other professionals and agencies in both case-centered and program-centered consultation.
  13. Knowledge and appreciation of possibilities for prevention.
  14. Basic skills in planning and coordinating services for exceptional children, such as the physically handicapped, mentally retarded and developmentally disabled, autistic, seriously disturbed and multiply disordered.
  15. Knowledge of research design, statistics, and appreciation of the value of research in patient care.
  16. Overall competent clinical care in a variety of settings.
  17. Ability to demonstrate competence by passing the Adult and Child & Adolescent Psychiatry Board Exams.

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The following Core competencies are used to rate the residents’ performance and progress throughout the training program:

  1. Clinical Science
  2. Interpersonal Skills and Communication
  3. Patient Care
  4. Practice Based Learning and Improvement
  5. Professionalism and Ethical Behavior
  6. System-Based Care

Monitoring of feedback from supervisors occurs monthly, any concerns are discussed in the RTC, feedback is discussed with the resident, and protocol for any necessary remediation is followed.

Curriculum

Our adult and child and adolescent psychiatry programs are both organized with outpatient clinics every afternoon after the first year. Inpatient experiences and other training experiences are organized in the mornings. This allows for significant long-term continuity with outpatient treatment cases. They will gradually pick up outpatients in the afternoons so that they will be able to follow some long-term. We have arranged to divide these afternoon experiences between Creighton and UNMC clinical outpatient sites to optimize the breadth of their experience and the faculty that they receive supervision from. They then do inpatient at halftime in the mornings. The inpatient setting provides the most intensive patient contact and supervision for beginning trainees. By the end of their inpatient rotations they should have acquired a level of competence that would allow them to do well in the more diverse settings that follow.

Click here to download a sample Rotation Schedule (30 KB PDF). For more details on specific rotations, please see Child & Adolescent Psychiatry Fellowship.

Click here to download a sample Didactics Schedule (85 KB PDF).

In addition to the didactic schedule outlined in the link above, there will be various types of rotation-specific training. For instance, when residents take call on the adult service they will participate in Morning Report. This is a meeting with faculty each AM following the previous night of call to discuss issues that have arisen, including COBRA and HIPPA issues, patient disposition, and working effectively with other healthcare professionals. Emergency psychiatry experience will be obtained by taking call on a rotating basis, being careful to meet all of the duty hour rules.

Contact Information

Please contact our fellowship coordinator, Mary Monaghan, at memonaghan@unmc.edu or 402-552-6222 for any questions.  

Applications

Candidates will need to submit a formal application during the year preceding their projected entry into the program. Completion of a general pediatrics residency is mandatory, as is a current license to practice medicine or eligibility for receiving one in the state of Nebraska.

For more information:
Contact: Mary Monaghan, Program Coordinator, or Jamie Snyder, M.D., Program Director
Email: memonaghan@unmc.edujamie.snyder@creighton.edu
Phone: Mary - 402-552-6222  • Dr. Snyder — 402-280-3566

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