Year 1  |  Year 2   |   Year 3   |   Year 4 

     PGY 1 - Clinical Assignments

• Medicine (4 months: 2 inpatient, 1 outpatient, 1 ER). Interns serve as members of the medicine department's inpatient, outpatient and ER services at MUH and the VA. Avg hr/wk - 70 for inpatient, 60 for ER, and 40 for outpatient service. Intern caseload avg 8 inpatients. Night call avg q 5th day.
• Neurology (1 month: inpatient).  Interns serve as members of the neurology department's inpatient service at the MUH. Intern caseload avg 8 inpatients.
• IOP 3N General Psychiatry & ECT (2 months: inpatient).  IOP 3N is a 30-bed inpatient service with two treatment teams (Drs. Short and Pelic, attending). All patients are seen along with the attending in daily rounds. Intern caseload is 8 inpatients.  There are weekend rounds but no night call (see nightfloat rotation below). While on this rotation, residents are asked to participate in evaluation and treatment for any patients needing electroconvulsive therapy (ECT) under the supervision of Dr. Foust.
• IOP 1N Psychiatry (1 month: acute inpatient). IOP 1N is a 12-bed intensive care service with one treatment team (Dr. Weinstein, attending). Common dx's are major depression, bipolar illness, schizophrenia, schizoaffective disorder, and anxiety disorders. Usual caseload is around 8 inpatients. There are weekend rounds but no night call during this rotation (see nightfloat rotation below).
• VA General Psychiatry (2 months: inpatient). The VA mental health service has a 16-bed general psychiatry inpatient unit with an avg length of stay of 6 days. Prevalent dx's are major depression, schizophrenia, bipolar, schizoaffective, substance abuse, and anxiety disorders. Treatment modalities include individual and group psychotherapy and the range of state-of-the-art biological interventions. All inpatients are seen along with a supervising attending physician (Drs. Albanese, Huber or Haren) who is involved in all significant decisions. Intern caseload is 7 pts. Teaching rounds occur five days per week. There are weekend rounds but no night call during this rotation (see nightfloat rotation below).
•  IOP 2N Child/Adolescent Psychiatry (1 month: inpatient).  IOP 2N is an inpatient service for youth aged 3 to 18 years, that has two treatment teams (Attendings: Drs. Wagner and Koval). Common dx's are disruptive disorders - 70% (e.g., ADHD, conduct disorder), mood disorders - 20%, and thought disorders, pervasive developmental disorders, mental retardation, anxiety disorders and substance abuse - 10%.  Treatment modalities include medication management and individual and family therapy.  There are weekend rounds but no night call during this rotation (see nightfloat rotation below).
• Emergency Psychiatry (2 months: night float). This service is the core of an organized 24/7 program, which provides emergency psychiatry consultation for patients presenting to our ER (e.g., diagnostic evaluation, crisis management, admission or referral). On average, residents evaluate around four emergency patients per shift including youth, adult, and geriatric patients (childhood mental disorders 15%; substance use disorders 25%; psychoses or delirium 30%; agitation or mania 10%; trauma and victimization 5%; and other conditions presenting danger to self or others 15%). The night float team also cross-covers IOP and VA inpatients.  Team members consist of two 1st or 2nd year residents (Junior Attending Residents - JARs), medical students, a 3rd year resident (Senior Attending Resident - SAR), who serves as team leader and triage officer, and an attending who is available for back up supervision. All patients seen in the emergency department are presented to an attending psychiatrist (Dr. Hardesty) for supervision during morning check-out. To maximize continuity of care, CMHC staff attends the morning checkouts where they receive information about non-hospitalized patients and communicate the information to case managers or arrange timely outreach as indicated.  Weekday shifts are 5 p.m. to 8 a.m. (15 hours).  Weekend shifts are from 8 a.m. to 8 a.m. (24 hours).  In accordance with ACGME Duty Hours regulations, if a resident is assigned to two consecutive float shifts, that resident is permitted to arrive at the hospital at 6 PM on their second shift rather than at 5 PM. The resident is responsible for handling calls between 5 and 6, but is not required to perform in-house duties. Additionally, residents are not required to perform in-house duties (such as an afternoon continuity clinic) between consecutive shifts or following a 24-hour shift.

     PGY 1 - Lectures/Seminars

• Essentials of Psychiatry & Psychopharmacology Series.  Management of clinical scenarios likely to be encountered as psychiatric emergencies (e.g., identification of clinical syndromes, first line treatments, practical aspects of care such as involuntary commitment assessment and procedures).  Lecture topics include: "call pearls," using the ental Status Examination in making differential diagnoses, identification and management of acute psychosis, mania, delirium, suicidal risk, substance abuse emergencies, overdose and toxicities; crisis intervention techniques, and use of antipsychotics, antidepressants, mood stabilizers, and anxiolytics.
• Psychopathology 101/Clinical Case Studies.  This series provides an overview of major diagnostic categories in psychiatry, including epidemiology, diagnostic criteria, differential diagnosis, and treatment options for each illness category.  The goal of this series is to provide a framework for the understanding the evaluation, diagnostic criteria, and differential diagnosis of each of the major DSM Axis I and II illnesses/categories to prepare residents to identify each disorder and consider treatment options.  Individual seminar topics include: depression; bipolar disorder; anxiety disorders; personality disorders; schizophrenia and other psychotic disorders; alcohol abuse and dependence; cocaine abuse and dependence; opioid abuse and dependence; and other substances of abuse.
• Psychiatric Interviewing.  This series overviews selected concepts and techniques of psychiatric interviewing.  Over several sessions, residents view segments of "Life Passage in the Face of Death”, which focuses on psychological engagement of the physically ill patient.  Discussion of book chapters that are appropriate to the residents’ clinical experiences on rotations at the time (from Shawn Shea’s Psychiatric Interviewing: The Art of Understanding). Additional video tapes are used to augment the readings (i.e., Lionel Aldrich's experience with Schizophrenia).