A Resident’s GuideTo SurvivingPsychiatric Training2nd EditionEdited by:Tonya Foreman, M.D.Leah J. Dickstein, M.D., M.A.Amir Garakani, M.D.American Psychiatric Association1000 Wilson Boulevard, Suite 1825Arlington, Virginia 22209www.psych.org
American Psychiatric Association1000 Wilson Boulevard, Suite 1825Arlington, VA 22209703-907-7300NOTE: Support for this project was provided by an unrestrictededucation grant to the American Psychiatric Foundation from AstraZeneca. The views and opinions presented here are those of theauthors and do not necessarily represent the policies and opinionsof the American Psychiatric Association and the funding agencies.Copies of this book are available through apa@psych.org. Forinformation about the American Psychiatric Association, visit theAPA homepage at www.psych.org.Copyright 2007. All rights reserved.Printed in the United States of America.A resident’s guide to surviving psychiatric training / [edited by]Tonya Foreman, Leah J. Dickstein, Amir Garakani. AmericanPsychiatric Association; 2nd edition (2007)
CONTENTSAcknowledgements . .1Preface to the second edition . . .2Part I: Learning Curves: How to Maximize Your EducationalExperiencePsychiatrists are “Real Doctors” Too: Finding YourPlace in the World of Medicine . .5How to Maintain Your Basic Medical Skills . .8A Resident’s Guide to Keeping up with the Literature . . .11List of Psychiatric and Related Journals . .14A Reading List and Reference Guide for Psychiatric Residents .19Sleepless in Psychiatry: How to Survive On Call .26How To Get The Most OutOf Your Psychotherapy Supervision .30Finding and Developing a Relationship with a Mentor .32Doing Research as a Resident .35Getting Published During Residency. . 38Residents and the Pharmaceutical Industry . 41Part II: Standing OUT in the Crowd: How to Become aPsychiatric LeaderYour Role as a Team Leader . .48See One, Do One, Teach One: Your Role as a Teacher . 51How to be a Chief Resident .53Getting Involved: Participating in Professional Organizations. .56Directory of Organizations. . . .58Being Assertive in Your Professional Roles . .63Awards and Fellowships for Psychiatric Residents . 65Part III : Taking Care of Yourself During Psychiatric ResidencyCharting Your Course: Balance In Your Personaland Professional Life . 75Benefits (and Pitfalls) of Getting Your Own Psychotherapy .78Parenthood and Residency: NegotiatingParental Leave . .82Spirituality and the Psychiatric Resident . 85Coming to America: International Physicians as PsychiatricResidents . .89Romance, Relationships, and Residency . 91Opening the Closet Door: Residency and Sexual Preference . 95i
Your Personal Mental Health: The Foundation of your Career .97Part IV: And Justice for All: Legal Issues in PsychiatricTrainingSexual Harassment: You Don’t Have to be a Victim! .99Gender Bias Issues . . 102When Attending Physicians Appear Impaired . 105Part V: Entrusted to Your Care: Special Issues in Caring forPatientsUnderstanding the Diverse Cultures of All Patients . 108Boundary Issues in Psychiatry . .112Looking the Part: Professional Attire . .116When It’s Time to Say Goodbye: Terminating WithPatients When You Leave .118When Disaster Strikes . . .122Advocating For Psychiatric Patients . 125Part VI: Personal Finances During and After ResidencyTrainingMoonlighting for Residents .128Debt Management: Avoidance Equals Interest Accrual . 131How to Make Your University Work for You . .134Coping with the Changes in Medicine thatAffect Residency Training .138Dealing with Managed Care in the Outpatient Setting .140Part VII: A Look Toward Your Future as a PsychiatristCouch Time: Psychoanalytic Training .144Subspecialty Training in Psychiatry .147Sample Resident Admission Note 153Sample Hospital Progress Note 164About the Authors .166ii
ACKNOWLEDGEMENTSThe American Psychiatric Association would like to acknowledge thefollowing organizations and individuals for their contribution to thedevelopment of A Resident’s Guide to Surviving Psychiatric Training:American Psychiatric FoundationThe Group for the Advancement of PsychiatryAPA Committee on WomenAPA Committee on Residents and FellowsNancy Delanoche, M.S.Deborah Hales, M.D.Marla MitnickCarol Nadelson, M.D.Donna Stewart, M.D.Mount Sinai School of Medicine Department of PsychiatryResidents, Graduates, and FacultyVery Special Thanks to:Astra ZenecaFor its support of this publicationDedicationTo our families For giving us minds hungry for knowledge and hearts eagerto share.Thank you for your love and support.andTo future psychiatry residents May you find as much satisfaction in your careers aspsychiatrists as we have found in ours.Tonya Foreman, M.D.Leah J. Dickstein, M.D., M.A.Amir Garakani, M.D.April 20071
PREFACE TO THE SECOND EDITIONTonya Foreman, M.D.In the spring of 1999, twenty-five psychiatry residents met inWhite Plains, New York, to begin a two-year term as Sol GinsburgFellows with the Group for the Advancement of Psychiatry (GAP).As Ginsburg Fellows, we were invited to attend biannual meetings ofthe GAP and serve on standing GAP committees with distinguishedpsychiatrists from around the United States. In addition, we wereasked to develop a Ginsburg Fellows’ project. We spent severalhours scratching our heads and wondering what we, as psychiatryresidents, could contribute to an organization filled with the nation’spsychiatric leaders. “We’re not experts at anything yet,” we told eachother. “We don’t have anything to contribute.” Then it dawned onus – we were experts at being psychiatric residents! We representedtraining programs from Hawaii to Kansas to Canada. Collectively,we formed a rich tapestry of experiences as psychiatric residents andas individuals. During the evolution of this project, members of ourgroup completed a variety of fellowships, discovered the challengesof parenthood, struggled through divorces, and graduated fromresidency to take "real jobs!” And yes, we are even paying back ourstudent loans.As this book progressed, we collaborated with members of theAmerican Psychiatric Association’s Committee on Women in orderto insure that our project addressed the needs of women andminorities. We are grateful for their assistance and for theirsensitivity to issues that affect many residents. In 2006, AmirGarakani, M.D., an APA/GlaxoSmithKline fellow, approached staffat the APA about producing a second edition of the book. Hebelieved strongly that in addition to using excellent on-line resources,psychiatric residents wanted a handbook that they could actually holdin their hands, drop in their pockets, and read at their leisure. Histireless pursuit of the project led to the publication of this, the secondedition of The Resident’s Guide to Surviving Psychiatric Training.Dr. Garakani’s thoughtful appraisal of the first edition prompted thecreation of several chapters that make this edition more timely andcomplete.The authors who contributed to this book realize from firsthandexperience that the vicissitudes of everyday life do not stop becauseyou are a struggling resident. Even though you are emotionally,intellectually, and physically exhausted by the demands of training,your dog will still have to go to the vet, your car will break down, andthe dirty laundry will inexplicably multiply in your hamper. As a2
resident, you will be asked to spend much of your time and energytending to the needs of others. As some of your own needs gounmet, you may become disillusioned or cynical. In order tocomplete residency and become the physician you envisioned whenyou filled out your medical school application, you will have todevelop skills and coping mechanisms that allow you to manage yourown life as you take care of others.This book was written by psychiatric residents for psychiatricresidents. We tried to pool our collective experiences to produce ahandbook that would help you with the day-to-day challenges ofpsychiatric residency. This is not a clinical handbook – manyexcellent clinical handbooks already exist. This book contains thekind of advice we’d give to you if we could sit together over a cup ofcoffee and a stale donut in the hospital cafeteria. We have traveledthe path you are now taking. We hope that we can provide someencouragement and advice to make your trip a bit easier.Tonya Foreman, M.D.April 20073
PART I:LEARNING CURVES: HOW TOMAXIMIZE YOUR EDUCATIONALEXPERIENCE Psychiatrists are “Real Doctors” Too: Finding YourPlace in the World of MedicineHow to Maintain Your Basic Medical SkillsA Resident’s Guide to Keeping up with the LiteratureList of Psychiatric and Related JournalsA Reading List and Reference Guide for PsychiatricResidentsSleepless in Psychiatry: How to Survive on CallHow to Get the Most Out of Your PsychotherapySupervisionFinding and Developing a Relationship with a MentorDoing Research as a ResidentGetting Published During ResidencyResidents and the Pharmaceutical Industry4
PSYCHIATRISTS ARE “REAL DOCTORS” TOO:FINDING YOUR PLACE IN THE WORLD OF MEDICINEMonica Radford Green, M.D.In all likelihood, each person who chooses to enter the field ofpsychiatry realizes immediately that there is a bias against mentalillness and its treatment in our society. Despite our hopes that fourto six weeks of exposure to psychiatry during the third year ofmedical school will underscore the importance of psychiatry, weoften find that medical professionals have no greater understandingof mental illness than society at large. We could spend endless hoursruminating over the reasons for this, including the defenses employedagainst the fears of self-revelation. We could spend even more hoursanalyzing the manner in which much of psychiatry has isolated itselffrom the rest of the medical community. Instead, more can begained from a practical discussion of improving relationships withother specialties in order to “find our place” in today’s medical world.The Physician InsideFirst and foremost, let us remember that we are physicians. Weinvested many years in studying medicine, worked just as hard asother students on third year rotations, and made a conscious decisionto enter the field of psychiatry. Entering psychiatric training, we areexpected to have at least four months of general medicine orpediatrics and two months of neurology. Many psychiatric residentsprefer to do these months of general medicine and neurology first, asthey believe their skills in these specialties are fresher immediatelyafter medical school. If you reflect on your days on the generalmedicine wards, you may remember feeling fairly confident aboutyour skills at that time. So what is the transition that occurs? Often,psychiatric training focuses on the mechanisms of the mind and brainso much that we stop using our basic medical skills, skills we spentmany years developing. (Although this is also true of many of thesubspecialties, it is frequently noted in psychiatry.) Some psychiatricunits encourage consultation for every general medical question thatarises. Reasons for this may vary from liability concerns to pureworkload consideration. In more analytically-oriented settings,concerns about transference and countertransference with regard tothe physical exam lead to excessive consultations. In all psychiatricsettings, of course, there are concerns about boundaries and how theviolation of these may lead to a disrupted therapeutic alliance,especially when psychotherapy is involved. As our skills as5
psychiatrists develop, our physical examination, diagnosis, andtreatment skills often atrophy. (See section entitled “How toMaintain Your Basic Medical Skills” for a more complete discussion).The Psychiatric IslandAnother factor that frequently contributes to the increasingisolation experienced by psychiatric residents is the physicalplacement of psychiatric units. Often, psychiatric training facilities arefreestanding facilities (such as state psychiatric hospitals). Whenincorporated as part of a university or general hospital, psychiatricwards are frequently located in a separate building. Even when apsychiatric unit is located in the main hospital, the units are usuallylocked and not in a main corridor, for obvious reasons of elopementrisk and the potential for dangerous or disruptive behavior.Your contact with other services might be limited to time spenton consultation-liaison services or self-initiated interaction, such asestablishing friendships or moonlighting in facilities where otherspecialties are present. Didactic courses, as with most specialties, aretaught to psychiatric residents only. In-services are provided betweenmany other disciplines in the hospital (such as social work sessionswith nursing), but less frequently does a collaborative exchange ofknowledge occur between specialties of medicine. “Curbsideconsults,” though friendly, are limited in their ability to cultivaterelationships between services.Building BridgesWorking on the consultation-liaison service may help youestablish your identity as a part of the hospital. Even in psychiatricprograms where white coats are not worn, consultation-liaisonpsychiatrists typically don the stereotypical attire of “doctors.” Morevisible to the remainder of the hospital through their work on otherunits, the CL psychiatrist comes to represent the psychiatric serviceto the other physicians. This is reinforced by the role that the consultclinician plays in facilitating transfers to inpatient units. However,the CL clinician can sometimes feel isolated, as he or she is neither amember of the psychiatric service nor the consulting services,existing somewhere in-between.“Real Doctors”So how can you maintain your identity as a “real doctor?” Manyof the suggestions that follow are more completely discussed in thesection entitled “How to Maintain Your Basic Medical Skills.”Specifically, we should all maintain the knowledge base that we spent6
four years developing. Performing physical exams, handling basicmedical problems, and reading about your patients’ medicalconditions can help you retain and expand your medical knowledgebase. Still, maintaining your skills in isolation from the rest of themedical community can only do a limited amount to establish youridentity as a “real doctor.”Don’t forget that psychiatry IS a biological science that isbecoming increasingly technical. We develop our psychotherapeuticskills not as a means of separating ourselves from the rest ofmedicine, but in order to provide comprehensive care for the patient.Although it is difficult to use double-blinded, placebo-controlledstudies to demonstrate the efficacy of some psychotherapeutictechniques, this does not mean that we must hide away in our littlecorner of the hospital. Instead, we should try to educate othermedical professionals about the unique treatments we have to offer.This means that we must work to develop our own specializedknowledge and skills set so we can be effective teachers. Forexample, the orthopedic surgeon does not propose to be bestequipped to treat an unusual skin rash, turning instead to thedermatologist for help. (The surgeon knows he or she will be able tocontribute something valuable when the dermatologist’s patientfractures her arm.) Likewise, when we have honed our ownpsychiatric skills, we will more readily establish relationships withother services and can find our place in the world of medicine.7
HOW TO MAINTAIN YOUR BASIC MEDICAL SKILLSMonica Radford Green, M.D.Maintaining our basic medical skills is becoming more and moreessential in today’s world, where psychiatrists may find themselves inthe role of primary care physician (for example, in many of thenation’s VA hospitals). But, even if we do not function as primarycare physicians, modern psychiatry demands that we integrate generalmedicine with mental health.Daily ExposureAs with all learning, you will maintain your medical skills mosteasily when exposure is consistent. In other words, “Use it or loseit.”The academic training facility provides many excellentopportunities to maintain the knowledge base that you acquired inmedical school. The medical center environment is one of teachingand learning, where just walking down the hall, you can overhear theattending physicians of other services teaching their own residents.Most medical schools publish schedules of grand rounds anddepartmental presentations. “Outsiders” from other services areusually welcome, and you should make it a point to attendpresentations that interest you.Participation on the psychiatric consultation-liaison service is agood way to update your medical knowledge. Making helpfulrecommendations to the consulting service requires an understandingof the mechanisms of the patient’s disease, the relationship betweenthe medical problem and mental illness, and drug-drug interactions.Each consult provides an opportunity to review general medicaltopics that you may not have considered recently, as well as to learnnew information. As we all know, a fact learned because of itsrelevance to a particular patient is more easily remembered thanwhen it is memorized in order to pass a test. Similarly, when yourequest consultation from another service, take time to talk to theconsultants and ask them questions. They are likely to be impressedand flattered when you show a genuine interest in their areas ofexpertise.This interaction can form the basis of collegialrelationships and sometimes, new friendships.ReadingHow do you find time to keep up with the literature? It seemsimpossible to keep up with assigned reading for didactic courses, notto mention all the journals that appear in our mailboxes each month.Be selective and remember that many of the “free” psychiatric8
journals are pharmaceutical-supported and may include studies thatare not peer-reviewed or are biased. However, as residents, we doreceive a few good “free” basic medical magazines that are worthlooking at (before they become part of that artsy magazine-stack endtable that has developed in your living room). One periodical,Resident and Staff Physician, often includes self-assessment andreview articles that are relevant to our daily practice. HospitalPhysician: Medical Practice for Staff and Residents has similararticles. Finally, as members of the AMA, we receive JAMA weekly.Each of these journals has a plethora of pharmaceuticaladvertisements. Although the ads are marketing vehicles whoseclaims must be viewed with a discerning eye, they at least provide anopportunity to learn about new drugs and their clinical interactionswith psychotropic medications.Another way to keep your knowledge sharp is to read reviewtexts, such as the Current series, published annually, that discuss themost up-to-date information regarding diagnosis and treatment.Although it is difficult to find time to read large sections of thesetexts, it is helpful to read about the specific medical disorders thatour patients have. This provides an opportunity to review diagnosisand treatment, with an eye towards drug-drug interactions andpotential psychiatric manifestations of illness. If the expense ofbuying additional books is too great during training, you can alwaysgo to the library or utilize previously purchased texts such as Cecil,Harrison, or the Washington Manual. But, don’t forget that withmedical advances and the explosion of knowledge, those expensivetexts you purchased during medical school might already be out ofdate!Finally, consider utilizing the CD-ROM based systemUpToDate. The information provided is updated on a regular basis(in terms of months, not years), and the information is obtainedquickly and easily. This is a tool that you can utilize in a matter ofminutes and feel that you have studied the disease process for hours!Practice!As with anything else, “practice makes perfect” (or, at least,prevents loss of skill and perhaps resulting incompetence).Unfortunately, many medical centers operate with a division of laborsuch that psychiatrists – even those in training – do not have toperform physical exams, do lumbar punctures, or draw blood.However, it is potentially of great benefit for you to volunteer to helpout with these tasks when you have time. Doing so will also increasethe sense of camaraderie within the hospital. (It also could be9
extremely rewarding when the staff asks you, a psychiatrist, to drawblood because you have earned a reputation as “a good stick.”)Another opportunity to utilize your basic general medical skills isby moonlighting.In moonlighting positions, the admittingpsychiatrist often performs the admission history and physicals, aswell as handles all general medical emergencies. Although generallynot required in psychiatric training, it is advisable to remainBLS/ACLS/PALS certified. Some psychiatry residents moonlight ina general emergency room in order to keep up their skills. Thoughchallenging, the work can provide an opportunity to earn extramoney while maintaining skills, add variety to the work week, andestablish relationships with other services. One caveat is worthmentioning: never try to handle a medical problem that is “out ofyour league.” If you feel uncomfortable diagnosing or managing aproblem, GET SOME HELP! Your desire to maintain your medicalskills should never place the patient in jeopardy.Finally, maintaining basic general medical skills of physicalexamination, diagnosis, and treatment will also lead to improvedrelationships with other services. As psychiatrists, we are aware thatself-confident individuals instill confidence in others and moresuccessfully establish equal relationships. When we have maintainedour basic skills, we convey to other specialties our competence andmore readily obtain for each patient the care that they deserve. Welikewise increase the probability that patients under the care of theseother services will be given a psychiatric consult should one beindicated. Finally, we give to ourselves the satisfaction of providinggood general medical care to patients who may be limited in theirabilities to seek out such care themselves.10
A RESIDENT’S GUIDE TO KEEPING UP WITH THE LITERATUREJason Wuttke, M.D., M.P.H.Amir Garakani, M.D.The scientific psychiatric literature is expanding at unprecedented rates. There is no possible way for anyone to read everythingthat is being published. As novices in the field, residents have anexceptionally difficult time distinguishing what is important fromwhat can be discarded. They start off optimistically inclusive, arequickly overwhelmed, and, as the joke goes, soon eschew readingentirely to eat dinner or sleep instead. Journals, texts, and newslettersare expensive, and the residents’ cash, like their available time, is quitelimited. However, reading and assimilating newly published scienceis the cornerstone of continuing medical education and is essentialfor all physicians. Residency is the best time to develop strategies forthis life-long task, since the habits we acquire now are those likely toremain with us. Developing an efficient approach to keeping up withthe literature is critical to avoid misguided attempts at studyingeverything, inevitably leading to paralyzing frustration. This chapteroffers suggestions on how to approach the four main aspects of thetask: access, selection, evaluation, and management.Accessing the LiteratureComputer bibliographic databases have made accessing theliterature less onerous. Residents should, at the very least, becomefamiliar with comprehensive methods for article searches on Medline.Academic center librarians are invaluable resources in this processand can also coordinate ongoing personalized search programs fornarrower areas of interest. Still, for many residents, routine trips tothe academic medical library are inconvenient. An alternative, albeitless thorough, way to access the majority of leading journals is tosubscribe and have them delivered right to your home. While this isan expensive proposition later in your career, as a resident, it isinexpensively accomplished by joining the APA or other professionalorganizations.Selecting the LiteratureGiven the limited time available, you should be highly selectivein what you choose to read thoroughly. The most useful selectionstrategy is routinely to peruse articles printed in reputable, peerreviewed journals. The importance and relevance of a medicaljournal is often judged by its impact factor, a number that ispublished yearly by Thomson Scientific. It is calculated over a three11
year period by counting the number of times articles from the journalwere cited, divided by the number of articles published during thattime. In 2005, the ten psychiatric journals with the highest impactfactor, in descending order, were: Archives of General Psychiatry,Molecular Psychiatry, American Journal of Psychiatry, BiologicalPsychiatry, Neuropsychopharmacology, Journal of ClinicalPsychopharmacology, Journal of Clinical Psychiatry, Psychotherapyand Psychosomatics, British Journal of Psychiatry, and Sleep. Toaccess the complete list, arranged by subject (e.g. Psychiatry,Neuroimaging, Neuroscience, Psychology, Geriatrics andGerontology, Substance Abuse), please go to Journal CitationReports (isiwebofknowledge.com). Keep in mind that impact factorsare not considered by all experts to be the best judge of a journal’simportance.Some publications that publish summaries of recent, relevantfindings include: Psychiatric News (pn.psychiatryonline.org), ClinicalPsychiatry News (www.eclinicalpsychiatrynews.com), and thePsychiatric Times (www.psychiatrictimes.com). The Carlat PsychiatryReport (www.thecarlatreport.com) is a monthly newsletter thatprovides reports on various areas of psychiatry. It is “unbiased” inthat it receives no money from the industry. There is also JournalWatch: Psychiatry (psychiatry.jwatch.org), a publication providing areview and commentary of articles in over 50 journals. Faculty of1000: Medicine (www.f1000medicine.com) is an online site providingbrief synopses and ratings of journal articles in all areas of psychiatry(Full disclosure: A. Garakani is a faculty member of the Faculty of 1000).Evaluating the LiteratureInstructions on critical appraisal of the scientific literature andteaching statistical analysis are beyond the scope of this short chapter,but suffice it to say, these are skills worth acquiring. The abilities toscrutinize validity and assess statistical methodology are of crucialimportance when evaluating conflicting results and applyingguidelines to clinical practice. Consider reviewing the JAMA series“Users’ Guides to the Medical Literature”, as well as “Basic Statisticsfor Clinicians”, published in the Canadian Medical AssociationJournal. Also see: “How to Read a Journal Article.” The CarlatPsychiatry Report, Volume 5, Number 2, February 2007.Literature ManagementNow that you have decided how and where to look efficientlyfor reading material, as well as how to appraise the relevance andvalidity of its content, you face the actual task of management. You12
should strive to develop a routine of reading peer-reviewed journalsfor some small bit of time each day or week. Carry a few articles withyou so that when you are waiting for a ride, or a patient cancels, youcan use the time constructively. Focus on those articles and abstractsthat have titles that interest you or seem pertinent to your education.From those, take at least two articles per journal issue to read indepth and practice your skills at critical appraisal. Involve yourselfregularly in journal clubs and give presentations when there is theopportunity, as these are excellent incentives for keeping up with theliterature.ConclusionThe task of keeping up with psychiatric literature may appeardaunting to the resident juggling service and educational demandswith physical and emotional needs. The quantity of availableinformation can be overwhelming, but continual renewal andupdating of the knowledge base is essential for professional growthand the sound practice of medicine. By maximizing yield andefficiency in your approach to the processes of access, selection,evaluation, and management of the literature, you can establish aroutine that will serve you well throughout your entire professionallife.13
LIST OF PSYCHIATRIC AND RELATED JOURNALSAmir Garakani, M.D.*Note: These journals’ titles, publishers and websites are subject to change. Theinformation below is accurate as of April 2007.NameWebsite AddressAcademic Psychiatryap.psychiatryonline.orgActa Psychiatrica Scandinavica ournal.orgAddiction ier.comAlcohol and Alcoholismalcalc.oxfordjournals.orgAlcoholism - Clinical andwww.blackwellpublishing.comExperimental ResearchAlzheimer Disease &www.alzheimerjournal.comAssociated DisordersAmerican Journal of Geriatricajgponline.orgPsychiatryAmerican Journal of Medicalwww.interscience.wiley.comGenetics. Part B,Neuropsychiatric GeneticsAmerican Journal ofajp.psychiatryonline.orgPsychiatryAmerican Journal ofwww.springerlink.comPsychoanalysisAnnals of Clinical Psychiatrywww.tandf.co.uk/journalsAnnals of Neurologywww.interscience.wiley.comAnnals of the New Yorkwww.annalsnyas.orgAcademy of SciencesArchives of General Psychiatry archpsyc.ama-assn.orgAutism: The Internationalaut.sagepub.comJournal of Research andPracticeBehavioral and Brain Sciences www.bbsonline.orgBeha
This book was written by psychiatric residents for psychiatric residents. We tried to pool our collective experiences to produce a handbook that would help you with the day-to-day challenges of psychiatric residency. This is not a clinical handbook – many excellent clini
year Resident Educator license or alternative Resident Educator license. Beginning teachers, known as Resident Educators, must complete all four years of the program and successfully pass the Resident Educator Summative Assessment (RESA) in order to advance their license to a five-year professional license. The Resident Educator Program and the
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work/products (Beading, Candles, Carving, Food Products, Soap, Weaving, etc.) ⃝I understand that if my work contains Indigenous visual representation that it is a reflection of the Indigenous culture of my native region. ⃝To the best of my knowledge, my work/products fall within Craft Council standards and expectations with respect to
resident/patient needs to demonstrate some weight-bearing ability or upper-body strength in order to pivot with the use of Sara/Sarita. Can be used to stand resident/patient in resident/patient room, toilet area, bathing area and common areas. The Sara/Sarita is an excellent aid in the dressing/undressing and toileting of the resident/patient.