Inpatient Psychiatry Service
The Mount Sinai Hospital has one of the oldest general hospital psychiatric inpatient services in the nation. Located in Mount Sinai's most modern buildings, specialty services address the full range of acute psychiatric issues. We have organized the 103 psychiatry inpatient beds (representing nearly 10 percent of the overall beds in the hospital) into five discrete locked units: General Adult (2), Dual Diagnosis, Geriatric, and Child/Adolescent. Each is self-contained, with its own staff, beds, and nursing, and each is staffed by attendings who have completed fellowship training in the designated clinical areas. This division of duties facilitates the provision and promotion of resident expertise within each of these subspecialties.
Serving a vastly diverse patient population, Mount Sinai psychiatry treats approximately 2,300 inpatients each year. Genders are approximately equal, and ethnic makeup is approximately 45 percent white, 30 percent Hispanic, 20 percent black, and 5 percent other. Ages range from 6-13 years old on the child unit, 13-18 on the adolescent unit, and over 18 on the adult units.
The hospital serves both the affluent Upper East Side of Manhattan and the socioeconomically challenged East Harlem community. In addition, many admissions are transferred directly from affiliate hospitals, nursing homes, community mental health agencies, and adult and child residence programs. Many patients are homeless and seriously disenfranchised. Others are severely and persistently mentally ill and in need of comprehensive psychiatric, medical, and social services.
Given Mount Sinai's international acclaim and expertise in geriatric medicine and psychiatry, many patients are well into their 80s and 90s. The diagnostic range of patient presentations is also extremely diverse. Residents gain experience in the evaluation and treatment of all the major psychotic, mood, anxiety, personality, cognitive, and substance-related syndromes.
Residents learn intensively through immersion in acute psychiatric care, crisis intervention, establishment of a therapeutic alliance, maintenance of safety, and rapid psychopharmacological stabilization. Experience with electroconvulsive therapy and with serious medical comorbidity is also part of the training. Residents occasionally treat patients participating in research studies, thereby becoming familiar with research methodology and protocols.
There are usually one to three teams on each unit, depending on the number of patients. A treatment team consists of an attending psychiatrist, one to two psychiatric residents (often of different PGY-levels), nurses, and a social worker. As the average length of stay on inpatient units is approximately 11 to12 days, residents have the opportunity to get to know their patients relatively well. Residents work from 8 am until 6 pm, and are expected to manage up to eight patients with whom they will meet for daily sessions.
PGY-1 and 2 residents provide essential patient care, participate in daily interdisciplinary team meetings, daily patient rounds, and receive ongoing direct one-on-one supervision by full-time inpatient attendings in an apprenticeship model. Emphasis is placed on psychiatric and medical evaluation, formulation, treatment intervention and acute psychiatric care of serious mental illness. Evidence-based psychopharmacological practices are stressed as is targeted supportive psychotherapy. Psychiatric interviewing and mental status examinations are routinely performed with the unit attending. Case formulation, differential diagnosis, and treatment planning are discussed daily.
Besides the daily presentations of their patients in morning rounds, residents present each patient's condition and care plan status at weekly interdisciplinary team rounds. Residents also provide medical student supervision and education, gaining invaluable experience as teachers themselves early in their training. Psychiatric interviewing skills and mental status examinations are further refined by this experience.
Residents also present selected inpatients at case conferences and clinical seminars held on the inpatient units.>
- Twice weekly overnight rounds, focusing on acute presentations and issues that occur while on overnight call, led by Ronal Rieder, MD, Director of Residency Training
- Weekly seminar “Psychoanalytic Perspectives of Inpatient Psychiatry”, led by Peter Dunn, MD, the Medical Director of the New York Psychoanalytic Society & Institute
- Weekly case conference, focusing on psychiatric case formulation, symptom-specific interviewing, and patients’ subjective experiences of symptoms, led by Asher Simon, MD, Associate Director of Residency Training
- Weekly case conference focusing on substance-related psychiatric illness, led by David McDowell, MD, Assistant Professor of Psychiatry and Addiction Psychiatrist
- Weekly case conference at the VA inpatient unit focusing on the difficult patient, led by Larry Siever, MD, Director of the Special Evaluation Program for Mood and Personality Disorders
- Weekly case conference on the child/adolescent inpatient unit led by John O’Brien, MD, Director of Training, Child and Adolescent Psychiatry Fellowship
Additional senior faculty members direct a variety of unit-specific case conferences on our various specialty units.
Each resident will have the opportunity to rotate on all or nearly all of Mount Sinai’s specialized inpatient units in his/her first year of training, allowing exposure to different patient populations. Then as PGY-2s, residents return to these inpatient units in a more supervisory capacity, teaching interns and medical students, running a greater share of patient rounds and having a greater ownership of the team. They also provide more in-depth and advanced psychotherapeutic interventions. As PGY-4s, some residents also return to the inpatient floors as part of the highly-regarded “Teaching Resident” program, teaching clinical skills such as interviewing and supportive psychotherapy.
Icahn School of Medicine
Department of Psychiatry
One Gustave L. Levy Place
New York, NY 10029