The Second Year: Solidifying Skills
We see the second year as a time when you solidify your knowledge of inpatient psychiatry, round out your clinical experiences by learning to treat patients in a multitude of psychiatric settings, and develop the necessary skills to enter into the more independent third year. Additionally, we hope to inspire you to begin thinking of an area of psychiatry in which you would like to focus more of your time in the latter two years.
We divide the PGY-2 year into several rotations on a number of different psychiatric services:
- Outpatient psychiatry: 6 months full-time
- Consultation liaison psychiatry: 1 month
- Adult inpatient psychiatry: 2 months
- Outpatient addiction psychiatry: 1 month
- Emergency psychiatry: 1-2 months
In our redesigned curriculum, we have reduced the number of total inpatient months from 13 to 7, in keeping with the changing practice of how psychiatric services are provided.
Summary of Changes in our Redesigned Curriculum
PGY-2 residents will now have a six-month-long, full-time outpatient experience in the JJP VAMC. An educationally rich teaching service, the VA outpatient clinic is a hospital-based and highly supervised setting in which residents will learn to evaluate and treat established and new patients. Each resident will begin with a modest individual caseload of patients and will perform two new intakes per week. The treatments provided will focus on both acute stabilization and longer term psychopharmacologic management. The VA is unique in that all supervisors are present on-site, making for a medical-model of treatment. This full-time immersive and continuous experience will expose 2nd year residents to a breadth and depth of psychopharmacological and acute management in the outpatient setting. Additionally, during this six-month PGY-2 outpatient experience, residents will participate in DBT groups, learning targeted techniques which will be useful and applied in many subsequent clinical training experiences. Residents’ experiences will also include four hours per week in the geriatric psychiatry outpatient clinic. Each of these experiences will prepare residents for their more independent 3rd year.
The JJP VAMC outpatient clinic treats veterans along a wide range of ages (18-90+), illnesses, and functional levels. Over the last 10 years, the average age has declined from the 40-50s to the 20-30s. Our VAMC houses one of 10 MIRECCs (Mental Illness Research, Education, and Clinical Center) in the country. Designated by congress, the MIRECC is a think-tank with a staff of physicians, psychologists, and neuroscientists tasked with addressing best practices and novel therapeutics in serious mental illness, particularly among veterans.
In returning to the inpatient adult teaching service and the psychiatry emergency service, PGY-2 residents move beyond learning the basic skills of internship and begin to acquire more specific diagnostic, therapeutic, leadership, and educational skills, which they bring to more advanced interactions with patients and colleagues. PGY-2s are also responsible for more intensive teaching responsibilities, where they work with more autonomy, teach and lead PGY-1 residents, and supervise medical students. Learning and participating in the provision of electroconvulsive therapy (ECT) also occurs during this inpatient time. All PGY-2 residents complete one to two months in the Psychiatric Emergency Service at The Mount Sinai Hospital, where they encounter a variety of acute presentations of psychiatric illnesses while being supervised by on-site attendings.
During the one-month Consultation-Liaison rotation at the JJP Bronx VAMC, residents are very closely supervised by an attending, while also working with a Psychosomatic Medicine fellow. Consults come from services as varied as those of acute inpatient medicine, spinal cord rehabilitation, the on-site nursing home, and other acute subspecialty areas.
For outpatient addiction psychiatry, residents rotate in the Substance Recovery Service (SRS) at the VA. Experiences include intake evaluations, group therapy, and individual treatment. Residents learn to use buprenorphine, naltrexone, and other specialized psychopharmacological interventions for substance dependence, as well as gaining significant experience in using motivational interviewing (an evidence-based psychotherapy).
In keeping with the goal of developing an area of concentration for their studies, PGY-2 residents are assigned a senior faculty mentor/advisor of their choice to facilitate their developing careers and their navigating the national psychiatric landscape.
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 curriculum in a six-hour block one day per week. As 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.
We have also augmented the weekly classroom didactic curriculum and the clinical-based education on the units with a series of case conferences and clinical seminars:
- Twice weekly morning report run by the Chief Residents with selected faculty during which residents discuss interesting cases and issues encountered during short call and night float at Mount Sinai
- Weekly case conference (July-Sept)—“CBT and DBT for Inpatients”—taught during the first 3 months of each academic year
- Weekly case conference (Sept-May)—“Psychodynamic Perspectives of Inpatient Psychiatry"—taught by Peter Dunn, MD, the Medical Director of the New York Psychoanalytic Society & Institute
- Weekly case conference (year-round) on psychiatric case formulation, symptom-specific interviewing, patients’ subjective experiences of symptoms, and how to think deeply and flexibly about patients, taught by Asher Simon, MD, Associate Director of Residency Training
- Weekly case conference (year-round) on the VA adult inpatient unit, with invited facuty leaders
Sample Weekly Schedule
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 VAMC, 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, available by phone throughout the night, provides clinical supervision. 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 Psychiatry 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
Icahn School of Medicine
Department of Psychiatry
One Gustave L. Levy Place
New York, NY 10029