Didactics

We base our didactic curriculum for residents on the concept of a matrix of areas of knowledge. For clinical work, one needs to have at one's disposal a broad knowledge base regarding phenomenology, diagnosis, and treatment. This is in addition to such skills as interviewing, clinical reasoning, and psychotherapeutic management. Of course, it is not possible to have a deep knowledge of all these areas straight away, especially in the first year of training, when a resident is practicing internal medicine as well as neurology and psychiatry. This concept focuses on acquiring general principles in many areas of clinical knowledge and skills. Residents then apply this material more specifically to their clinical work and discuss it with their teachers and supervisors. Throughout the years of training, each subsequent pass over the material increases in complexity, filling in the original matrix, until residents reach a textured proficiency.

Our residents’ didactic curriculum spans all four years. Rather than relegating the intern year to that of "workhorse," and assigning the residents' sole learning to their clinical rotations, we believe that classroom education and multiple conferences during this formative time can be an invaluable experience, especially because interns are hungry to learn. The introductory curriculum then progressively broadens and deepens across subsequent years, covering and delving into the many related topics that comprise the psychiatric landscape.

The curriculum is organized as multiple courses which run in parallel time slots within a given residency year. Several courses last a few months while others (e.g., psychopharmacology, psychotherapy) span two to three years. Our training directors oversee the entire curriculum.

All classroom didactics are considered protected time, allowing residents to be excused from their clinical duties.

Our yearlong PGY-1 didactic curriculum is meant to augment residents’ in vivo clinical-based education. Classes are attended not only by our residents rotating on psychiatric services but also by the majority of those on medicine and neurology. We believe this helps foster a sense of continuity, coherence, and class cohesion for first-year residents whose time spreads across different services.

The overall aims of the course are to provide 1) the knowledge, clinical skills, and attitudes that are useful for the types of psychiatric care that beginning residents are providing on inpatient services; 2) an introduction to research literacy and learn approaches to the accessing salient psychiatric literature; and 3) an opportunity for residents to practice self-assessment and reflect on their experiences and the challenges of being a new physician with primary responsibilities for extremely ill patients being treated in a busy academic urban hospital.

We have also augmented the classroom curriculum with on-unit clinical case conferences immediately following didactics twice per week. 

Explore a sample PGY-1 didactic schedule.

Commencing what will form the backbone of their classroom didactics, PGY-2 residents are excused from clinical responsibilities for 7 hours each Wednesday to attend five parallel courses divided thematically into Phenomenology & Clinical Neuroscience, Psychotherapy, Clinical Psychopharmacology, Social & Psychiatry Services, and Process Group. Additionally, the training directors hold a weekly meeting with PGY-2 residents at the start of each week’s class day.

In Phenomenology & Clinical Neuroscience, residents learn the meticulous understanding of and ability to describe symptoms of mental illness, including the multiple ways of conceptualizing patients’ presentations, from both subjective and objective frames of reference. With our goal to provide a translational means for residents to understand and talk to their patients as well as a literacy in approaching new research findings, we teach the underlying neuroscience of the various symptoms and syndromes, including intermediate phenotypes and a much more in-depth look at emotion, cognition, learning, and behavior, from socially observable phenomena down to genetics and epigenetics. In the latter third of the course, residents are taught using an experience-heavy pedagogical approach, departing from a basic lecture format in many instances and highlighting the approachability and clinical relevance of the material. 

With a primary goal of our psychotherapy curriculum being to foster knowledge and skills—techniques, theories, efficacy, application—in the established and emerging evidence-based treatments, the curriculum grows in its breadth and depth, such that the 1 hour per week PGY-2 psychotherapy course morphs into a more substantial 2-3 hours per week experience in PGY-3 and 4. (This reflects classroom time and does not include other psychotherapy-focused learning experiences for residents, like weekly case conferences, supervision, etc.). Early on, residents are taught how to attend to patients’ moment-to-moment cognitions, emotions, and behaviors, how these may be acknowledged and therapeutically addressed, and core listening and responding skills common to a variety of different therapeutic orientations. Questions such as, What is the patient trying to tell me? and What do I say next?͟—as well as the How, When, and Why of it—form the core conceptual and pragmatic scaffolding on which this series is built. Following this pragmatic and practice-heavy introductory series, residents attend an 8-month weekly series on various Models of the Mind, with each theory-heavy component followed by learning techniques fundamental to a specific psychotherapy practice. The technique component often includes learning from the process of the instructor’s actual ongoing treatment of patients. 

Psychopharmacology didactics begin with a brief overview of the nuts and bolts of the field, including pharmacodynamic and pharmacokinetic principles, the concept of target symptoms, and assessment of efficacy. The course goes on to examine, in nuanced fashion, each major class of psychiatric medications. Goals of the curriculum include mastery of psychopharmacology related to acute care psychiatry and how to adjust psychopharmacological treatments in the transition of patients from inpatient settings to alternative levels of care.

In keeping with the pedagogical philosophy behind our didactic curriculum, Social & Psychiatry Services is a comprehensive, multi-year course consisting of several discrete modules. Residents learn about the practice of psychiatry in systems, including the principles of publicly-funded mental health services, emergency psychiatry, and consultation-liaison psychiatry, including clinical, social, ethical, legal, administrative, and safety-based elements. Residents are introduced to increasingly complex issues in forensic psychiatry, including attending mock trials. This course also includes an introduction to mental health ethics, taught by Jacob Appel, MD, JD, (PhD in process), a graduate of our program and a highly-regarded former university professor of bioethics.

Process Group offers PGY-2, 3, and 4 residents a unique training experience in which residents come to learn about themselves and their peers and to process and examine their experiences in real time. Process Group is an in vivo training in how groups function and the effects of an individual within and  upon  the  group.  (As  a  resident,  you  work  not  only in  tight-knit  groups with  your peers but also in larger  groups  within  the  medical  system, where issues of  leadership,  professionalism,  communication, responsibility, and  individuality are  ever-present.) In Process Group, residents are invited to share their thoughts, feelings, etc. and simultaneously be part of and observe a group experience, fostering growth and development. While not explicitly therapy, Process Group also  fosters crucial self-reflection/assessment, resident cohesion, and an opportunity to discuss, in a confidential and  supportive environment,  the  pressing  emotional,  social, and  interpersonal  issues  involved in  being  a  resident in psychiatry. The process which unfolds from week to week often helps with the pressures and stresses of residency.  A fundamental agreement between members of the group and the leader(s) is  that all said within the group is confidential. Each PGY class has its own weekly group, with leaders who remain the same through all 3 years. The leaders are chosen from experienced members of the voluntary faculty who have no supervisory or evaluative functions in the residency.

Explore a sample PGY-2 didactic schedule.

The PGY-3 didactic curriculum advances residents’ classroom experience commensurate with their growing clinical knowledge base, practice, and independence, and prioritizes an in-depth focus on the different psychotherapies, outpatient psychopharmacology, and systems of care. PGY-3 residents have 6-7 hours of classroom didactics each Thursday throughout the year. 

Neuropsychopharmacology for the PGY-3s revisits many previously-encountered topics at an increasing level of sophistication and is organized by symptom, syndrome, disease, and population, rather than by medication-class as in the PGY-2 course. Additionally, the focus is more geared toward the psychopharmacological treatment of outpatients. These seminars also include a necessary focus on the neuroscientific bases of such treatments. 

The didactic component of PGY-3 psychotherapy training contains 2-3 hours per week, in addition to the hours spent in clinical supervision and in working with dedicated educational consultants. A wide range of therapies is taught, sequentially and in parallel, including psychodynamic, CBT, DBT, schema, group, transference-focused, family, couples, emotion-focused, and positive psychology. Longitudinal case conferences as well as comparative psychotherapy case discussions round out the didactic experience. Reflecting the high value placed on learning psychotherapy, the department has formed a formal affiliation with The New York Psychoanalytic Society & Institute, representing the first such arrangement the Institute has ever undertaken. Established in 1911, NYPSI is the oldest and among the most esteemed psychoanalytic organizations in the United States. Essential components of our collaboration include supervision of long-term psychotherapy cases, leadership and instruction in the core didactic curriculum, and specific financial and time-saving provisions for residents who elect professional paths involving forms of psychodynamic training. 

The PGY-3 Social & Psychiatry Services course augments residents’ experiences of treating outpatients in the community. Important elements in community mental health take center stage, including recovery, rehabilitation, and social service provisions. 

Begun during PGY-2 didactics, Process Group continues throughout PGY-3 and 4. 

Explore a sample PGY-3 didactic schedule.

As in the other years of training, PGY-4 residents have an uninterrupted and protected block of classes, for 7 hours on Tuesdays, including Grand Rounds. The senior curriculum focuses on advanced topics in psychiatry, assuming a previously well-integrated background of knowledge learned in the first 3 years. In our focus on "picking a major" and developing specific expertise, we have allowed for 10 months of true elective time in the fourth year. In this vein, we've extended this thinking to our  didactic  curriculum,  allowing  each upcoming  PGY-4  group of  residents to  have  a  significant  say in their didactic content. As such, these advanced courses are often geared to the needs and interests of each year's group of PGY-4 residents, though the presence of a core set of classes provides information generally required for all clinical interests, such as the year-long psychopharmacology course.

Professional development is another significant feature of PGY-4 didactics. Such classes include discussions of fellowships, jobs, office practice (legal, financial, etc.), financial considerations (personal finances, investing, etc.), board review, health care reform, and how to supervise and give feedback. 

Advanced clinical topics have included sexuality and treatment of sexual dysfunction, women’s mental health, psychology of love/marriage/divorce, flipped-classroom neuroscience seminars, and numerous psychotherapies (CBT and psychodynamic continuing case conferences, mentalization-based therapy, brief psychotherapy). 

Begun during PGY-2 didactics, Process Group continues throughout PGY-3 and 4. 

Explore a sample PGY-4 didactic schedule.