The Third Year: Office Practice

The PGY-3 year affords the residents immersion into the world of outpatient psychiatry, and they begin to develop an identity as a practicing psychiatrist. Each resident chooses to establish her/his base at either the Mount Sinai Medical Center or the James J. Peters VA Medical Center for general clinic experience. Additionally, the resident will choose outpatient electives that can be based at either site.

The core of this third year is formal training and supervision in the overall management and long-term care of psychiatric outpatients. Foundational skills in both the psychotherapies and the pharmacotherapies are emphasized, as the resident carries her/his caseload throughout the year. Residents also experience treating patients in various specialty clinics, where they are supervised by expert psychiatrists trained in the relevant disciplines. Some of these clinics specialize in geriatric psychiatry, child/adolescent psychiatry, the severely and persistently mentally ill, schizophrenia, PTSD, substance abuse, and borderline personality disorder.

Likewise, residents have access to dedicated and experienced supervisors in many forms of psychotherapy:

• Long-term Psychodynamic Psychotherapy
• Cognitive Behavioral Therapy
• Supportive Psychotherapy
• Dialectical Behavioral Therapy
• Interpersonal Therapy
• Family/Couples Therapy
• Group Psychotherapy
• Prolonged Exposure Therapy
• Others

Mount Sinai's affiliation with The New York Psychoanalytic Society & Institute – a formalized affiliation that has united our faculties and resources – gives residents access to leaders in the field and individualized supervision by such senior psychotherapists.

In addition to their outpatient caseload and psychotherapy patients, PGY-3 residents experience longitudinal training in the treatment of the severely and persistently mentally ill patients in Mount Sinai's Continuing Day Treatment Program.

Dedicated weekly elective time allows residents the opportunity to develop proficiency in specialized diagnostic and therapeutic modalities. Electives include the following (a partial list):

• Extra experience in any of the psychotherapies:
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  • Psychodynamic Psychotherapy
  • Cognitive Behavioral Therapy
  • Supportive Psychotherapy
  • Dialectical Behavioral Therapy
  • Interpersonal Therapy
  • Family/Couples Therapy
  • Group Psychotherapy
  • Prolonged Exposure Therapy
  • Cognitive Processing Therapy

• PTSD Treatment
• Substance Abuse Treatment
• Additional Geriatrics
• Additional Day Treatment
• Additional Schizophrenia and Bipolar Outpatient Treatment
• Research

During this year, each resident also presents one of her/his more difficult 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.

Didactics

As in the prior two years of training, PGY-3 residents are given protected time for their classroom didactic experience, 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. New to this year are continuous case conferences in which the treatment of a single case is followed over time.

Sample Weekly Schedule

In this sample schedule, only the various clinics in which all residents participate are listed (i.e., elective clinics are not represented). The table is only a partial list of sample supervisions. Time apart from this is used to see outpatients, including all individual psychotherapy cases, family therapy cases, child and adolescent cases, and medication management cases.

Call

PGY-3 residents take call in Mount Sinai's dedicated Psychiatric Emergency Service, which is also staffed by a supervisory attending psychiatrist 24-hours per day, seven days per week. As in other years, the call schedule works on a night-float system to minimize disruption to one's clinical experience, one's experience of continuity, and one's patients. In the PGY-3 year, the night-float blocks are one-week at a time, in keeping with the needs of outpatients and the outpatient psychiatrist (rather than two-week blocks as in the other years). Shifts are 12 hours, from 8:30 pm until 8:30 am, except on weekends when daytime shifts are also to be had but are staffed by non-night-float residents.

During this third year, vacation is scheduled and taken as desired by the individual resident, provided that it is cleared by the training office.