Post-Graduate Year

Post-Transitional Year

Medicine and Neurology

PGY 1 residents begin their four-year program in the third week of June. Psychiatry residents spend four months on the internal medicine service and two months on the neurology service. Pediatrics at CMH may be substituted for the medicine rotation. Residents who have completed a PGY 1 transitional year or more elsewhere may start with the psychiatric portion of their residency in January. Arrangements, if needed, may be made for these residents to have a complete two-month neurology rotation in November and December.

The educational experiences during the medical rotations reinforce and build upon the knowledge, skills, and attitudes learned in medical school. In addition, residents become more aware of their identity as physicians, responsibility for the total care of patients, and ability to master difficult, often life-threatening, situations. Residents become comfortable with making diagnoses, administering medical treatments, and working with other health care professionals. This biomedical experience is crucial to the development of broadly educated psychiatrists.

In the first year, residents have three adult inpatient rotations on three separate inpatient units each lasting three months. For the fourth three-month block, each resident spends six weeks on a geropsychiatry inpatient unit and six weeks working half-time in the chemical dependency program and half-time in the emergency psychiatry program.

Inpatient Units

The rotations in the first year include three months on the acute adult care unit at NMH, three months on the general psychiatric unit at EH, three months on a general psychiatric unit at CRMHC, six weeks on the older adult inpatient psychiatry program at NMH, and six weeks half-time each at EH's chemical dependency program and NMH's emergency psychiatry unit.

Emergency Psychiatry

In addition to the emergency psychiatry rotation, residents are assigned to on-call duty. Call consists of covering the inpatient psychiatry units, emergency room, and medical floors at NMH when on rotation at NMH; the inpatient unit, emergency room and medical floors at EH when on rotation at EH, and the emergency room at CMH when on rotation at CMH for child psychiatry. Call frequency varies by hospital assignment and postgraduate year. Faculty members are available for consultation and supervision for cases seen during call.

Chemical Dependence

Geriatric Psychiatry

Veterans Administration Psychiatry

On-call

Experience

Debriefing

Each weekday morning after call, residents review their experiences in a half-hour debriefing meeting with a faculty member or chief resident.

Outpatient Psychiatry

While the focus of the first year is inpatient treatment, the second year focuses on outpatient assessment and treatment. Training occurs in several settings: adult outpatient at the Outpatient Treatment Center (OTC) at NMH, community psychiatry at NMH or EH, and child and adolescent psychiatry at CMH or EH. Each resident spends approximately half the time in the OTC for the entire year and the other half in child psychiatry (six months) and community psychiatry (six months). If patients under the care of residents during these rotations are hospitalized or transferred to a different program in the institution, residents may continue to follow them.

Outpatient Adult Psychiatry

Residents are assigned six patient-hours per week. Their case loads are carefully assigned and monitored to enable them to treat adult outpatients who are diverse in age, sex, socioeconomic status, and severity of illness. Some patients may be seen intensively in twice-weekly psychotherapy. All patients are seen as long as necessary, and many may continue in longer-term treatment if indicated. During this year residents begin to gain experience in group psychotherapy and learn to manage the medications of outpatients who are being seen in psychotherapy by non-medical therapists. All residents attend a weekly Diagnostic Assessment Team meeting chaired by the director of the OTC.

Outpatient Community Psychiatry

This clinical experience includes the provision of specialized services for severe and persistently mentally ill patients. Residents perform diagnostic interviews, manage patients' medication, provide supportive psychotherapy, conduct medication-support groups, and participate in case management services. Multidisciplinary team meetings provide experience in the coordination of different modalities and disciplines in the treatment of the severely disturbed patient.

Outpatient Child Psychiatry

Residents gain knowledge of the fundamentals of child and adolescent psychiatry during this rotation. They learn how to evaluate children and adolescents, obtain services for children and their families, and effectively intervene in a crisis. Each resident spends approximately 20 hours per week for six months at CMH or EH. Concurrent on-site didactic seminars on child psychiatry and development also are held.

Supervision

Each resident is assigned three supervisors for his or her individual cases at OTC. A supervisor for group psychotherapy also is provided. Additionally, residents receive two hours per week of individual supervision in child and adolescent psychiatry and community psychiatry during those rotations. Supervisory techniques include the use of detailed process notes, videotapes, and/or audiotapes.

On-call

Experience

Debriefing

Each weekday morning after call, residents review their experiences in a half-hour debriefing meeting with a faculty member or chief resident.

Senior Resident Rotations

Outpatient, Consultation-Liaison, and Administrative Psychiatry; Cognitive-Behavioral Psychotherapy and Electives

During the final 18 months of the residency, each resident continues to spend half time in the OTC (for a total of 30 months over the entire residency). The other half time is spent in three- or six-month blocks that include consultation-liaison rotations at NMH and EH, the chief residency (six months each for two appointed residents), a cognitive-behavioral outpatient therapy rotation at EH, and electives (see below). Residents build on the skills learned in the first two years and gain confidence and identity as psychiatrists.

Adult Outpatient

Residents continue in the OTC with cases begun in earlier years (individuals, children, and/or families) and are assigned new cases as openings occur. As before, continuity of care is emphasized and residents are responsible for their cases regardless of movement within the Northwestern system. Residents conduct seven hours of individual psychiatric treatment each week and continue their psychotherapy group as well as their medication management "mini-clinic."

Consultation-Liaison Psychiatry

The interface between psychiatry and medicine is complex and extremely important. Residents learn how to provide informative consultations to their medical and surgical colleagues, understand the complex effects of illness and hospital milieu on behavior, and collaborate in the care of the medically ill. The rotation for residents is half time (two days per week) for six months, three months at NMH and three months at EH.

Cognitive-Behavioral Psychotherapy

Each resident spends three months half time at the Mood and Anxiety Disorders Center at EH. The rotation provides residents with supervised clinical experience in cognitive-behavioral therapy (CBT) assessments and treatments involving both individual and group therapy formats. A weekly didactic seminar, “Doing CBT” is included.

Electives

Each resident (except for the chiefs, see below) has eight months of half-time electives. Recent clinical electives have included inpatient psychiatry at any of the affiliated hospitals, consultation-liaison psychiatry, community psychiatry, the Warren Wright Adolescent Program, the Chemical Dependence Program, and the Eating Disorders Program. Other electives, including research, are available and may be arranged with the residency director.

Chief Resident

Chief residency is a six-month, half-time elective position. The training director appoints two chief residents each year, and their terms run sequentially. The chief resident works closely with the training director in educational planning, clinical administration, and teaching. Specific activities include participation in all educational planning meetings, leading both the weekly resident group meeting and the first-year residents' meeting, interviewing residency applicants, managing the on-call schedule, and trouble-shooting a number of other administrative issues.

Original Paper

During the last 18 months, each resident is required to write a data-based or clinical case-based paper on a topic of his or her choice. Faculty preceptors supervise residents. A faculty panel reviews all papers, and the outstanding paper is presented each year at the department's annual Scholars Day.