Clinical Rotation Sites

Adult Inpatient Service

First and second year residents spend between seven and eight months on the Inpatient Service at NYC Health + Hospitals/Elmhurst and NYC Health + Hospitals/Queens. They serve as physician-members of multidisciplinary treatment teams, which also include attending psychiatrists, psychologists, nurses, social workers, and activity therapists. Residents present new cases to the treatment team and discuss ongoing management issues in daily morning rounds and in treatment conferences.

The faculty places a great deal of emphasis on phenomenology at this stage of training, teaching residents to identify psychiatric signs and symptoms through meticulous observation and active listening.  Residents learn to conduct psychiatric evaluations, assess families, and to interpret an extensive assortment laboratory tests and other ancillary diagnostic procedures. An academically oriented clinical psychology division provides consultation and testing on appropriate cases. Supervision on medical issues is provided by an internist who is a member of the psychiatry department. Consultants from other medical specialties assist with diagnosis and treatment.

The resident gains experience with a wide variety of treatment modalities. Milieu therapy is ubiquitous on the Inpatient Service but is modified to accommodate the specific cultural environments and language needs of different units. Pharmacological management is often complex due to treatment resistance and comorbid conditions and caseloads often include patients undergoing electroconvulsive therapy.  Residents also begin their development as psychotherapists during these rotations learning to provide psychologically informed supportive interventions in individual and group settings.

PGY4 residents rotate on these inpatient units as part of their teaching assignments.

Comprehensive Psychiatric Emergency Program

The Comprehensive Psychiatric Emergency Program (CPEP) serves adults and children and consists of separate adult and children’s emergency rooms and extended observation units (EOU) as well as a mobile crisis unit (MCU). PGY-1 residents see patients in the ER and EOU under the supervision of emergency psychiatrists during a four-week day rotation. The EOU allows the resident to observe the evolution of a psychiatric crisis for up to three days and is particularly useful for training purposes.

PGY-2 residents have between two and four two-week night duty assignments to the CPEP. They are supervised by an attending psychiatrist who is stationed in the hospital.

Forensic Unit

This 14-bed unit is the sole provider of acute inpatient psychiatric care to the female forensic population of the City of New York. Second year residents have a one-month rotation on this unit during which they are trained in the evaluation and management of forensic patients. Supervision is provided by a subspecialist in forensic psychiatry and a forensic psychologist.

Child and Adolescent Inpatient Units

The Child and Adolescent Service is the site of an Accreditation Council for Graduate Medical Education accredited fellowship-training program. PGY-2 residents have a two-month assignment to Adolescent Psychiatric Unit, training alongside CAP fellows and receive supervision by faculty from the fellowship-training program. They are taught to evaluate patients and families and receive supervision on the use of a variety of therapeutic modalities, including individual and group psychotherapy, crisis intervention, psychoeducation, play therapy and medication treatment. Teaching rounds are held daily and treatment-planning meetings are held twice weekly.  Residents participate in community meetings and other aspects of the therapeutic milieu. They also are exposed to psychological and educational assessment procedures routinely conducted on the children, as well as to the on-site school facilities.

The Mount Sinai Hospital Geriatric Unit

A one-month rotation in geriatric psychiatry takes place during the PGY-2 year on a geropsychiatry inpatient unit at The Mount Sinai Hospital. Residents experience a unique inpatient setting that is dedicated to geriatric patients with multiple medical comorbidities in addition to their psychiatric illness. Their training focuses on co-managing medical and psychiatric treatment with emphasis on safe pharmacologic regimens and being astute physicians when monitoring for potential adverse effects in a vulnerable population.

Consultation/Liaison Service

The Consultation/Liaison Service provides psychiatric consultation on hospitalized patients treated in other clinical departments. The faculty consists of a Director and an attending psychiatrist. Residents have a two-month assignment during the second year and a three-month assignment in the fourth year. A typical case-mix consists of capacity evaluations (30 percent), suicide assessments (15 percent) and diagnosis and management consultations for ongoing psychiatric disorders, delirium and dementia, and disorders due to medical conditions. Approximately 55 percent have primary psychiatric disorders and 40% have substance use disorders. Each case is presented to faculty on a daily basis for detailed discussion and review. Residents also evaluate patients with faculty on teaching rounds.

Chemical Dependency Service

Comprised of an outpatient clinic, the Methadone Clinic and outpatient rehabilitation programs, the Chemical Dependency Service provides a one month rotation during the PGY-2 year. Residents receive training in evaluation, treatment and detoxification of substance use disorders from a subspecialist in addictions psychiatry as well as from other experts.

Ambulatory Behavioral Care Service

The diversity encountered in the outpatient services probably surpasses any of the resident’s previous training experiences. Case-mix is extremely broad in terms of both diagnosis and level of instrumental functioning. Residents see a wide range of disorders rarely encountered in inpatient settings while also providing aftercare to patients with chronic mental illness who have been discharged from the hospital. The approach to therapeutics is similarly varied and is supervised by faculty with expertise in specific areas of clinical concentration. Psychotherapy training encompasses a broad spectrum of modalities including psychodynamic psychotherapy, CBT, group therapy and family therapy. Medication is used in the management of a variety of acute disorders as well as in maintenance treatment and is routinely combined with psychotherapy. Residents also train in our partial hospital and may provide consultation to other clinical departments.

This is a 12-month rotation for third year residents. PGY-4 residents spend one day each week in the clinic continuing with long-term psychotherapy patients and a selection of medication management cases.

Clinical Electives

Four months of elective time is scheduled during the PGY-4 year during which experience is obtained in a clinical area of interest within the hospital or at other institutions. Popular electives have included, Addiction Psychiatry, the CPEP including the Mobile Crisis Unit, Forensic Psychiatry, Neurology Clinic at NYC Health + Hospitals/Queens, international electives through the Global Health Program, and Consultation-Liaison and Electroconvulsive Therapy at Mount Sinai Hospital. 

As previously mentioned, residents may elect to use this time for research.