The Second Year: Solidifying Skills
We divide the PGY-2 year into several rotations on a number of different psychiatric services:
- Consultation liaison psychiatry
- Adult inpatient psychiatry
- Geriatric and/or substance abuse inpatient psychiatry
- Outpatient intake clinic
- Emergency psychiatry
- Electroconvulsive therapy (ECT)
Rotations this year also include clinical experience at the James J. Peters Veterans Affairs Medical Center, which is one of only 10 in the country designated by Congress as a Mental Illness Research, Education, and Clinical Center (MIRECC). This experience—two contiguous months on the inpatient service, one month at the out-patient intake clinic, and one month on the consultation liaison service—affords residents the opportunity to work with both combat and non-combat veterans and gain experience treating special populations (e.g., PTSD patients).
In returning to the inpatient units during this year, PGY-2 residents receive additional exposure to psychiatric specialties to develop further competence across the field. PGY-2s move beyond learning the basic skills of internship and begin to acquire more specific diagnostic, therapeutic, and leadership skills. They apply these skills while learning and practicing more advanced psychotherapy in scheduled sessions with patients. On the inpatient units, PGY-2s are also responsible for more intensive clinical teaching responsibilities at Mount Sinai, where they work with more autonomy, teach and lead PGY-1 residents, and supervise medical students.
All PGY-2 residents complete one to two months in the Psychiatric Emergency Service at Mount Sinai Health System, where they encounter a variety of acute presentations of psychiatric illnesses. Residents are supervised by an on-site attending in the psychiatric emergency room, and learn about triaging and treating acute psychiatric crises.
PGY-2’s also begin their out-patient experience by conducting intake evaluations at the Bronx VA outpatient department, where they hone their skills in diagnosis, triaging, and treatment planning of new patients. Residents are also encouraged to begin treating long-term psychotherapy patients under individualized supervision in the outpatient clinic during this year.
In keeping with the goal of developing an area of concentration for their studies, PGY-2 residents are assigned a senior faculty mentor/advisor to facilitate their developing careers and their navigating the national psychiatric landscape. Elective time in the PGY-2 year varies in length, and it allows individualized introduction to fields of interest not yet encountered or further growth in areas already experienced, whether clinical or research-based.
During this second year of residency, and after completing the more introductory PGY-2 didactic schedule, residents begin what will be the backbone of their classroom didactic experience in a six-hour block one day per week. Like for first-year residents, didactics represent protected time, away from clinical duties. The expanded curriculum includes classes overseen and taught by recognized experts in the field:
- Psychiatric Interviewing
- Social Psychiatry
- Evidence Based Medicine
- Research Design
- Specialized Topics
- Process Group
As in the PGY-1 year, augmenting the weekly classroom didactic curriculum is a series of case conferences and clinical seminars, oftentimes held on the inpatient units.
- Weekly seminar "Psychoanalytic Perspectives of Inpatient Psychiatry", taught 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, taught by Asher Simon, MD,, Associate Director of Residency Training
- Senior faculty members direct unit-specific case conferences on our various specialty units
Sample Weekly Schedule
This sample schedule does not include the didactics that are specific for each inpatient unit. Unaccounted for time is spent on the inpatient units, seeing patients, in rounds, in supervision, or teaching medical students.
PGY-2 residents take call at the VA Medical Center, on two 2-week night-float rotations, usually from 7:15 pm until 8:00 am. Those residents not on night float provide coverage during weekend hours. An attending psychiatrist, who is available by phone throughout the night, provides clinical support for all questions and concerns. This experience provides an opportunity for expanded responsibilities and professional growth, as residents cover the inpatient psychiatry service and provide consultation services to the ER and to the general medical/surgical floors. PGY-2 residents do not take call during their rotations in the Psychiatric Emergency Service.
The general schedules of night float and weekend call are as follows:
- Sunday – Thursday overnights
- Friday overnight
- Saturday overnight to Sunday morning
- Sunday morning to Sunday evening
When on the night-float rotation, the remaining two weeks of the month are given as vacation, elective, or psychiatric ER time.
Icahn School of Medicine
Department of Psychiatry
One Gustave L. Levy Place
New York, NY 10029