Psychiatry Residency Rotations

PGY1 Rotations

The goals of the first year of residency training are to provide a foundation in internal medicine and neurology and an introduction to the essentials of psychiatric practice through the supervised assessment and treatment of a diverse population of patients with psychiatric disorders. These experiences are aligned with the six core competencies and resident progress is monitored by achievements on the milestones. Residents gain experience in adult inpatient psychiatry, emergency psychiatry, neurology, geriatric psychiatry, and internal medicine. They are supervised by attending physicians and senior residents on each rotation.

Inpatient Psychiatry

St. Elizabeth’s Medical Center has two inpatient general adult psychiatry units, a combined total of 47 beds. The inpatient units are staffed by a multidisciplinary team of psychiatrists, social workers, nurses, occupational therapists, and mental health workers. Residents are assigned to a team for periods of approximately one month and participate in rounds with the attending physician on a daily basis. Spending time on more than one team over the course of the PGY1 and PGY2 years ensures a diverse experience with exposure to a variety of diagnoses and treatment modalities. Residents supervise medical students and physician assistant students assigned to their team. The clinical population is very diverse with a wide variety of psychopathology including bipolar disorder, depressive disorders, schizophrenia and other psychotic disorders, anxiety disorders, organic mental disorders, substance use disorders, and personality disorders.

Internal Medicine

Residents spend four months rotating through internal medicine on the inpatient wards during the PGY1 year. Residents follow the call schedule of an internal medicine intern during this time. Supervision is provided by hospitalists and senior residents in internal medicine. The experience is similar to that of a medical intern and residents have the opportunity to perform procedures under the guidance of a senior physician.

Neurology

Residents spend two months rotating through neurology during the PGY1 year, providing neurological consultations for patients throughout the hospital. They attend didactic sessions in neurology including case conferences and neuroradiology seminars. Residents gain experience in working with patients with a variety of common neurological disorders. The department has faculty members with expertise in multiple sclerosis, stroke, and other common neurological disorders.

Night Float

PGY1 and PGY2 complete a total of eight weeks of night float divided into a two-week block during the academic year. PGY3 complete four weeks of night float divided in a two-week block. During the transition period in the month of July PGY4s complete up to one week of night float.

PGY2 Rotations

The goals of the second year are to build on the foundational capacities developed in the first year and to introduce more advance knowledge and modalities of treatment. The development of the six clinical competencies will be demonstrated by the completion of the goals and objectives of each clinical rotation. Residents will gain experience in adult inpatient psychiatry, emergency psychiatry, consultation/liaison psychiatry, child/adolescent psychiatry, and addiction.

Consult / Liaison Psychiatry

Residents provide consultations throughout the hospital and in the emergency department under the supervision of an attending physician. Residents provide services to all medical and surgical specialties within the hospital. They learn to fill the liaison role in their interactions with physicians and care managers and learn about providing psychiatric treatment to medically ill patients. Residents provide emergency assessments, crisis intervention, and the initial treatment of patients presenting in the emergency department. This experience fulfills the emergency psychiatry requirement.

Addiction Psychiatry

The St. Elizabeth’s Comprehensive Addiction Program (SECAP) provides inpatient detoxification, intensive outpatient services, and medication-assisted therapy (MAT) to patients seeking treatment for addiction. The program is run by addiction medicine specialists together with a team of nurses, social workers, and addiction counselors. Residents spend part of their time on the inpatient service and the remainder of the time in the outpatient setting.

PGY3 Rotations

The goal of this year is to introduce the residents to management of psychiatric disorders in the outpatient setting using both psychopharmacology and psychotherapy. These experiences are aligned with lectures introducing cognitive behavioral therapy and psychodynamic psychotherapy. As the residents progress through the year, they will move towards mastering the areas of psychiatric assessment, formulation and treatment. The development of the six clinical competencies will be demonstrated by the completion of the goals and objectives of each clinical rotation and progression with the milestones.

Outpatient Psychiatry

Residents spend their PGY3 year seeing patients in the outpatient clinic. They see a small panel of weekly psychotherapy patients, a larger panel of psychopharmacology patients, and perform intake assessments for new patients. Each PGY3 has a private office in the clinic. Residents have weekly individual supervision in psychopharmacology, psychodynamic psychotherapy, and cognitive behavioral therapy. Additionally, residents present and see cases with the supervising attending after each patient encounter.

PGY4 Rotations

The goals of this year are those of mastery and depth. The senior resident will continue to build on the skills acquired over the past three years to attain competency and practice as an independent psychiatrist in the community in whatever chosen career path. The PGY4 residents rotate for three months as a junior attending in the inpatient units. They spend 2 weeks in our outpatient pain clinic and have the option to retain psychotherapy patients. They also have the opportunity to advance their expertise in a psychiatric subspecialty of interest through freely chosen electives. By the end of this year they will have completed their chosen scholarly activity project.

Outpatient Psychiatry

Residents with an interest in psychotherapy are given the opportunity to retain or recruit therapy patients to see during their last year of residency. They are assigned an individual supervisor to discuss cases with.

Adult Partial Hospitalization

Residents have the option to rotate through the Partial Hospitalization Program under the guidance of an experienced social worker. Residents participate in groups and gain experience with cognitive behavioral therapy, psychoeducation, and other types of group therapy.

Electives

Elective options are developed based on the interests of individual residents to ensure adequate preparation for practice or subspecialty fellowships. Options include junior attending experiences on the inpatient, geriatric, and consult services. Elective experiences in the pain clinic and the sleep center prepare residents for subspecialty fellowships in these or psychosomatic medicine. Residents have the option to spend time observing ECT at Beth Israel Deaconess Medical Center, a nearby Harvard affiliate hospital. They can also participate in neuropsychiatric testing with our neuropsychologist in the outpatient clinic. Off-site electives may be approved by the Graduate Medical Education Committee for PGY4 residents when a similar experience is not available at St. Elizabeth’s Medical Center. Electives are typically arranged on a part-time longitudinal basis to provide continuity of care to clinic patients.