The Third Year: Developing Independence and Subspecialty Interests
All residents will have substantial outpatient training at both The Mount Sinai Hospital (PGY-3&4) and VAMC (PGY-2), allowing for diversity of experience in population, illness, treatment modality, evaluation style, system-based practices, supervision, mentorship, clinical/research, etc.
The PGY-3 experience continues residents’ immersion into outpatient psychiatry, where formal training and supervision in the overall management and long-term care of outpatients is combined with additional experiences in multiple specialty clinics, collaborative care models, and elective time.
- Outpatient cases, with new evaluations throughout the year
- Psychotherapy cases
- Day Treatment Program
- Geriatric psychiatry clinic
- Child and adolescent psychiatry evaluation clinic and ongoing cases
- Collaborative Care Clinics
- Elective time
- Approximately 30% elective time to define and pursue individual concentrated focus (i.e., your “major”)
- Sub-specialty clinics
In the third year, foundational skills in both the psychotherapies and the pharmacotherapies are emphasized, as residents treat cases in a longitudinal fashion throughout the year. All PGY-3 residents are based in the outpatient department at The Mount Sinai Hospital, where they are supervised by expert psychiatrists trained in the relevant disciplines/modalities of care. In addition to treating adult patients, residents also attend weekly geriatric and child/adolescent psychiatry clinics and participate in co-leading groups in the Day Treatment Program.
Several hours each week, residents will attend one of The Mount Sinai Hospital’s Collaborative Care Clinics. Reflects the newest form of the changing practice of psychiatry, the clinics foster an integration of services such that patients attending non-psychiatric clinics (internal medicine, HIV, Ob-Gyn, oncology, etc.) may be treated or receive consultation by a psychiatrist who interacts closely with the primary physician. Attending psychiatrists are present to supervise residents in these novel roles.
Experience in various psychotherapies is a core element of PGY-3, including work with both adult and child/adolescent patients and access to dedicated and experienced supervisors. All residents receive essential training (e.g., technique, supervision, patient care) in treating multiple cases with CBT, psychodynamic psychotherapy, and supportive psychotherapy. CBT supervisors are drawn from faculty in our specialty clinics, faculty psychotherapy researchers, and voluntary faculty. The Icahn School of Medicine at Mount Sinai's formal affiliation with The New York Psychoanalytic Society & Institute has united our faculties and resources and given residents access to leaders in the field and individualized supervision by senior psychotherapists.
Beyond this core training in the psychotherapies, residents can elect to learn, practice, and receive supervision in the following modalities:
- CBT for specific conditions (eating disorders, anxiety disorders, mood disorders, psychotic disorders)
- Dialectical Behavioral Therapy
- Exposure-Response Prevention
- Transference-Focused Psychotherapy
- Schema Therapy
- Brief Psychotherapy
- Prolonged Exposure Therapy
- Cognitive Processing Therapy
- Interpersonal Therapy
- Motivational Interviewing
- Family/Couples Therapy
- Group Psychotherapy
A significant component of the PGY-3 curriculum is the 30% elective time afforded each resident. We expect that residents will work with their advisors, mentors, and training directors to determine an optimal distribution of experiences to focus their learning and skills, in keeping with the idea of having a “major.” These electives may be based in clinical, teaching, administrative, or research settings and most often will include experiences in our subspecialty clinics working with experts in defined areas. Our goal is for residents to develop advanced skills in the diagnostics and therapeutics germane to their areas of interest, as well as the ability to translate novel research findings into practice.
In addition to choosing electives in specialty clinics with an opportunity to focus one’s learning and skills, residents may also elect to spend additional time in any one of the established PGY-3 outpatient rotations described above.
During this year (or PGY-4), each resident also presents one of her/his more challenging cases at a Clinical Grand Rounds. The care of the patient and the various teaching points therein are then discussed by an expert faculty member invited by the resident.
As in the prior two years of training, PGY-3 residents are given protected time for their classroom didactic curriculum, representing six-hours one-day per week. The PGY-3 didactic curriculum continues to build on the longitudinal courses begun in the PGY-2 year, and prioritizes an in-depth focus on the different psychotherapies and outpatient psychopharmacology.
Continuous case conferences allow residents to follows the treatment of a single case over time.
PGY-3 residents take call in The Mount Sinai Hospital’s dedicated Psychiatry Emergency Service, which is staffed by a supervisory attending psychiatrist 24/7. As in other years, the call schedule works on a night-float system to minimize disruption to one's daytime clinical experience. In the PGY-3 year, the night-float blocks are one-week at a time, in keeping with the needs of an outpatient psychiatrist (rather than two-week blocks as in the other years). Shifts are 12 hours (8:30pm – 8:30am), except on weekends when daytime shifts (8:30-8:30pm) are taken by non-night-float residents. Vacation during PGY-3 is scheduled and taken as desired by the individual resident, provided that it is cleared by the training office.
Icahn School of Medicine
Department of Psychiatry
One Gustave L. Levy Place
New York, NY 10029