The Fourth Year: Expertise and Specialization

The PGY-4 rotations focus on specialty training and cultivating residents' developing expertise and readiness for independent psychiatric practice.

  • Electives
  • "Teaching Resident"
  • Chief Residents
  • Consultation-Liaison Psychiatry
  • Outpatient practice

Eight months of elective time in specialized settings provide residents with mentorship and resources to develop clinical, research, and/or administrative expertise. Please follow the link to the Electives page to peruse some of the various options.

We at Mount Sinai believe that In addition to pursuit of their individual career interests, the development of teaching skills is essential for our residents to become future leaders in psychiatry. To cultivate these skills, we have established the Teaching Resident rotation, in which each PGY-4 resident spends two months taking responsibility for educating both junior residents and medical students in programmatic, supervisory, and didactic modalities.

As part of her/his role and while closely supervised by the residency training director, the Teaching Resident provides additional supervision of junior residents on the inpatient units, gives some lectures in the PGY-1 didactic curriculum, and teaches interviewing skills to both junior residents and rotating medical students. Residents have found this rotation to be an invaluable experience, both helping them consolidate their knowledge base as well as develop the necessary skills they will employ in future attending and faculty positions.

Continuing their immersion in the practice of outpatient psychiatry, residents maintain a more circumscribed caseload of patients of their choosing which allows for both an ongoing longitudinal outpatient experience as well as more time to pursue additional clinical and research interests. Together with this condensed outpatient caseload, residents continue with their long-term psychodynamic psychotherapy cases and associated supervisions. The many months of elective time as well as the flexibility of the fourth year make it possible for interested residents to begin formal psychoanalytic training as candidates at the New York Psychoanalytic Society & Institute, formally affiliated with Mount Sinai.

Three residents per year are chosen by the faculty to be the Chief Residents; they each perform in this role for four months and alternate this with other experiences. In addition, one resident from the Physician-Scientist Research Track is selected to be the Research Chief, focusing on facilitating the experiences of residents interested in pursuing basic science or clinical research. The Chief Residents attend weekly operations meetings of the Office of Psychiatric Education, and they are responsible – under the supervision of Vice Chair of Education Ronald Rieder, MD, and Associate Director of Residency Education Asher Simon, MD – for guiding much of the day-to-day operations of the residency. They hone their leadership and administrative skills through intimate involvement in the interview season, orientation, inviting speakers for Grand Rounds, teaching junior residents, organizing events for the residents (e.g., the Retreat, Chairman's Journal Club, get-togethers, etc.), and providing office hours for junior residents to discuss issues in a meaningful and confidential forum.

The fourth year also includes two months of training in Psychosomatic Medicine (Consultation/Liaison Psychiatry). As one of the preeminent academic medical centers in the United States, Mount Sinai Hospital has expertise in a multitude of disciplines, including geriatrics, gastroenterology, cardiology and cardiac surgery, neurology and neurosurgery otolaryngology, endocrinology, rehabilitation medicine, gynecology, renal medicine, pulmonology, and cancer. In addition to evaluating and treating general medical and surgical patients who require psychiatric care, residents also work with subspecialty-trained faculty who pursue clinical and research interests in transplant psychiatry, movement disorders, HIV psychiatry, the psychiatric aspects of multiple sclerosis, and post-partum and women's mental health.


As in every other year in residency, PGY-4 residents are given protected time for their classroom didactic experience, representing seven hours, one day per week. Building on courses begun in prior years, the PGY-4 year includes courses in advanced psychopharmacology and psychotherapy as well as covering special clinical and practical topics important for practicing psychiatrists.

  • Women's mental health
  • Sexuality, sexual history-taking, and treatment of sexual dysfunctions
  • Psychodynamic continuous case conference (adult)
  • Psychodynamic continuous case conference (adolescent)
  • Current Controversies in Psychoanalysis
  • Psycho-oncology
  • Ethics
  • Careers in psychiatry
  • Developing a practice
  • Process group


There is no call in the fourth year.

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

Contact Us

Tel: 212-659-8734

Icahn School of Medicine
Department of Psychiatry
Box 1230
One Gustave L. Levy Place
New York, NY 10029