Sacred Heart Medical Center
on M, T, Th, F
Ph: (509) 474-4744
Fax: (509) 474-4746
Spokane Teaching Health Clinic
Ph: (509) 626-9963
Psychiatry Residency Spokane is a training program, growing in strength. Our residents are thriving, and we have a dynamic, incredible team of educators who, together have shaped the program into what we consider an excellent training environment. In the past year, we graduated our first class, one to an academic teaching setting in California, one to forensic fellowship at the University of Minnesota, and another to a local ambulatory psychiatry position at Kaiser.
We are really proud of the work we have done to develop our academic community program. Psychiatry Residency Spokane trains residents with an eye to the future of medicine: with an emphasis on leveraging expertise through consultation, a strong commitment to population based care, and a focus on our specific regional social and health related disparities; meeting them through innovative treatment paradigms such as Collaborative care and Telepsychiatry and medication assisted treatment for addiction disorders.
We have strong graduate medical education partnerships, with robust internal medicine and neurology training. New this academic year is an intern ambulatory medicine rotation, created to address the significant healthcare disparities in patients with psychiatric disorders, and to emphasize that competence in treatment of common medical conditions is critical in advocating for the health of our patients.
We continue to partner with a diverse set of established rotation sites. Providence Sacred Heart Medical Center, our sponsoring institution, provides the setting for inpatient, emergency and consultation-liaison psychiatry rotations. Eastern State Hospital is a unique state psychiatric hospital setting where residents do inpatient, geriatric and forensic psychiatry. The Veterans Administration Medical Center provides elective experiences in evidence based psychotherapies, including group therapy for addiction disorders. Gonzaga University provides a transitional age population for training in therapy and primary care psychiatry to both undergraduate and graduate students. We closely collaborate with Frontier Behavioral Health, a community mental health clinic for outpatient child and adolescent training and elective rotations. New for this current academic year are rotations at BEST (child day psychiatric treatment program at Sacred Heart), Juvenile Detention rotation with the Spokane County Juvenile Court system.
Our ambulatory training site is a unique educational opportunity. The Spokane Teaching Health Clinic is a state of the art, interprofessional clinic, fulfilling two main aims; a focus on excellence in clinical care, and true integration in primary care specialties embedded with pharmacy, legal aid, physical and occupational therapy, social work, and on site laboratory and imaging services. You will work alongside residents in Family Medicine, Internal Medicine, and Rural Family Medicine, as well as pharmacy, and social work students. We offer core ambulatory rotations in addiction psychiatry with an emphasis on medication assisted treatment, collaborative care consultation to primary care, Telepsychiatry to rural Washington, and psychiatry specialty clinic, including psychotherapy.
Frankly, we believe that we train excellent clinicians who have a well-rounded set of skills that enable them to transition into independent practice or to pursue a variety of fellowships. Our smaller city size and community focused training allows for a more personal feel, balances independence and maturing skills with support, allows for a responsive feedback model and changes nimbly to respond to a rapidly emerging healthcare delivery system.
Is Psychiatry Residency Spokane the right fit for you?
We know our core program values and we pivot towards these as we think about the training culture and content in this program.
Why choose this smaller, emerging community academic program? Well, firstly, because your priority is that of being a clinician, and even more, if you are interested in developing skills as a clinician educator. In this underserved area of the United States, we believe we have a responsibility to leverage our expertise as psychiatrists to educate patients, primary care providers, and the larger community. As such we have a significant focus on consultation liaison psychiatry, both in the hospital setting and in high fidelity primary care collaborative care psychiatry. Our residents get training what we believe to be models of the future in addressing access to mental health care for the majority of patients, especially those that are underserved. We require longitudinal collaborative care training as well as rural Telepsychiatry. We also require that our residents get trained in medication assisted treatment for addiction disorders, and motivational interviewing training that is coded to fidelity.
We recognize the dilemma of shortage of psychiatrists but firmly believe that moving psychiatrists to the role of “providers” practicing medication management is not the solution. Our program has a deep commitment to the importance psychotherapy has in patient care, and embeds this training across PGY years, starting in PGY1 with 3 step supportive therapy on hospital based services, and expanding developmentally beyond that to CBT, ACT, full supportive therapy seminar, MI, psychodynamic therapy training, group therapy, harm reduction therapy and more. We are known for training in intensive short term dynamic therapy, and have 2 master educators in this area. We provide therapy training that includes seminars, videotaped therapy supervision, personal psychotherapy requirements in residency, and the opportunity to watch psychotherapy experts in action doing therapy on real patient cases.
Our faculty are exceptional – it has been very important to us to hire a psychiatrists specifically invested in teaching, and lifelong learning, as well as commitment to improvement. This year we are examining the role of a peer to peer learning environment. We have faculty from a diverse set of training sites, bringing in a variety of perspectives, to enhance the content and viewpoints in our program.
We have a growth mindset. We believe that it is critical to know about our deficits, so that we can improve. We have sought and responded to feedback, and we track these outcomes yearly in our resident surveys. Our program aims for transparency; we believe that our residents are the people who can bring us the most valuable information about our program quality, and environment, and we will continue to work to create good interpersonal working relationships based on trust.
We are flexible and nimble in our ability to respond to feedback, and to changes in rotation availability. That’s the joy of working in a smaller community, with an institutional sponsor who allows us to grow and create new training paradigms without a lot of structural barriers.
We aim for creativity in our interactions, with each other, learners, and in our educational paradigms. We have been able to develop some imaginative training options because we embrace change and ideas that may seem outside the box – currently we are exploring digital therapy options for treatment, as well as low threshold, harm reduction approaches for addiction disorders.
We have worked to develop compassion in our program, in terms of the concern that we show for each other, in our working environment. We are well aware of the high levels of burnout in physicians, and over the past few years we have moved away for individual solutions for burnout and much more towards looking at system problems and solutions. We have changes our approach to problems such as work and educational hours, to pivot to a place of understanding, rather than individual responsibility, involving residents openly in this discussion, with reporting that is becoming more accurate and can help us address the real underlying issues that residents and faculty face.
We actually want work to be fun, cos it’s much more fun when it’s that way. We have a great group of residents who come to work, ready to pitch in and be part of the team, but speak up for themselves, and prioritize their families and outside adventures. Taking care of our health as physicians is important, and as such we hope that we have created a culture where residents and faculty are encouraged and can actually attend the medical appointments that keep us healthy. We want our staff, residents and faculty to have purpose and meaning in their work and believe that this is possible only when we are taking care of ourselves well.
Our program has an intentional focus on mastery – this is a small program and as a resident, you will not get lost in the group. The other side of this is that you will be held accountable for learning the skills attitudes and knowledge essential in becoming an excellent psychiatrist. Competence is important to us and we see it as a responsibility that we as educators have to both you as a resident, but also the patents who will be cared for you in the many years to come.
Tanya Keeble, MD
Psychiatry Residency Spokane
Psychiatry Residency Spokane’s core purpose is to train residents as clinician educators, with a deep commitment to the poor and vulnerable.
Psychiatry Residency Spokane is committed to meeting the specific needs of our local and regional communities, designed to address the social and healthcare disparities that exist in Eastern Washington and across the five state region of Washington, Wyoming, Alaska, Montana and Idaho (WWAMI).
Our training program rotation structure is intentional and developmentally focused. We utilize a wide variety of community clinical settings to prepare residents for success in whatever career they pursue, be that as a generalist or in fellowship training; a career in academics or in private practice; as a hospitalist or ambulatory psychiatrist, in institutional settings or in profit based models or care.
We are committed to quality and innovation. Quality improvement is at the heart of the work we do, both in program development, and in faculty and resident performance improvement.
We are committed to evidence based, balanced training – we believe that psychiatrists cannot perform at their full potential without being excellent at both psychotherapy, medication treatments, social interventions, and in established emerging interventional therapies including ECT and TMS.
We prepare residents to work in changing healthcare models – expertise areas include population based care in high fidelity collaborative care in urban and rural communities, rural Telepsychiatry, medication assisted substance use disorder treatment and digital therapies.
Psychiatry Residency Spokane and Providence Health are steadfast in serving all, especially those who are poor and vulnerable. Jointly, we share a commitment to excellence, treatment that holds to the highest standards of compassion, dignity and integrity, and work to foster a culture that promotes justice for all.
For Providence’s full mission statement, please visit: https://www.providence.org/about/mission.
Psychiatry Residency Spokane Program Goals
Commitment to the poor and vulnerable:
Graduate residents who consistently demonstrate advocacy for vulnerable populations at individual and group level
Demonstrate accountability to the profession in working to reduce social and healthcare disparities in our community.
Demonstrate resident and faculty participation in local or regional professional communities.
Focus on development as a clinician educator:
Graduate residents who pursue clinician focused jobs, with teaching components, to educate patients, other providers, and the broader community and who are committed to the pursuit of lifelong learning.
Graduate residents who recognize and assume the role of a teacher as inherent to the job of being a physician, whether that be in work with patients, or medical or interprofessional learners.
Graduate residents who educate the broader community by disseminating their knowledge, skills and attitudes at workshops, posters, publications, committee, and through legislative advocacy/work.
Graduate residents that take jobs in the settings in which they train, and develop new community based programs to address the specific needs of our populations.
Successfully match residents into fellowship training of their choosing.
Graduate residents who are competent in managing a diverse set of clinical populations.
Attention to the needs of our local and regional communities:
Graduate residents that ideally remain in our region, or go and work in other underserved settings.
Focus on population-based care:
Train residents in the rationale for, and practice of population based care, with an emphasis in collaborative care as a clinical practice that embodies this as one of its core principles.
Graduate residents who can disseminate this model of care to new practice sites.
Develop psychiatrists that consider formal practice based quality improvement critical to driving excellence in patient care, provider practice, and program optimization.
Develop psychiatrists who have an attitude of humility and accountability, actively monitoring their own quality though outcome based tools
Graduate residents who consider performance improvement as necessary to lifelong learning and accountability to patents and our communities.
Graduate residents who are able to work and develop collaborative care programs
Graduate residents who lead interprofessional, interdisciplinary consultation teams
Graduate residents committed to leveraging psychiatric specialty care in a population based approach to deliver care to the most people we can
Graduate residents who consider program development as vital to addressing the needs of local/regional services
Graduate residents that competently utilize evidence based care principles in patient care
Recruit residents and faculty who see psychotherapy as inherent to the job of being a psychiatrist, who can think outside the box in terms of what would most help the patient, and enjoy working in teams.
Graduate residents who provide treatment that includes robust psychotherapy, outcome based care, and social interventions and treatment.
Graduate residents competent at working in and leading teams, and see team based care as critical to stewardship of healthcare resources, and to good patient outcomes.
Preparation for emerging healthcare models
Train residents for practice models of the future
Graduate residents who pursue work in emerging healthcare paradigms.
Graduate residents who are good stewards of our healthcare resources, by practicing cost effective, high value clinical care and are able to grapple with the challenges in inherent in considering both the best interests of the patent as well as the actual availability of resources.