First Year

The first year of the Child and Adolescent Psychiatry Fellowship at The Mount Sinai Hospital is designed to develop your skills in the acute care settings while offering valuable exposure in outpatient clinics.

Sample Schedule:

Inpatient Unit Rotation

Our inpatient unit has 17 beds. It consists of a child side (ages 5-12) and an adolescent side (ages 13-17). We serve patients from different areas of New York City and New York State.

During your rotation on the inpatient unit, you will work in a multidisciplinary team that includes psychologists, social workers, medical students, nurses, and art/occupational therapists. There is also a school program operating on the unit, run by Department of Education teachers.

Fellows carry their own caseload (with attending supervision), round on their patients daily, manage their medications and coordinate with other team members, participate in treatment planning and family meetings, and facilitate groups. Inpatient rotations are structured, yet flexible, and expose you to a variety of clinical presentations.

You will also participate in our case conferences, where faculty members with special expertise discuss specific cases. This gives you the opportunity to watch master clinicians interview, and then discuss the formulation of the case and psychotherapeutic interventions.

CARES Rotation

The Comprehensive Adolescent Rehabilitation and Education Service (CARES) at Mount Sinai Morningside offers a wide range of services to address issues interfering with optimal functioning for teens and young adults. The CARES team is multidisciplinary and includes psychiatrists, a nurse practitioner, psychologists, social workers, and trainees in these disciplines. The CARES team members collaborate with educational staff on site. Our clinicians provide a full range of targeted and integrated mental health and substance abuse services, using dialectical behavior therapy and motivational interviewing techniques to help adolescents attain their goals. Treatment services include individual and family therapy, brief interventions/milieu treatment, group therapy, psychopharmacology, and psychological testing. Restart Academy is the name of the high school that provides educational services through the Department of Education. The CARES program is unusual, in addressing both mental health and substance abuse issues in a school setting.

Fellows engage in many activities at CARES. You will provide medication management to your own caseload, co-facilitate groups, perform comprehensive intakes, and provide milieu therapy. Educational activities are abundant on the CARES rotation and include daily rounds, weekly team meetings, weekly group supervision, intake supervision, multidisciplinary systems supervision with the director, and journal clubs.

Consultation-Liaison Rotation

All fellows rotate through both The Mount Sinai Hospital and Mount Sinai Morningside. During your consultation-liaison rotation you will work in a team with an attending, a general psychiatry resident, and often a medical student. Consults come from the inpatient pediatric floors and emergency rooms. Our pediatric floors include long-term hematology/oncology patients, offering you the opportunity to work with the same family and sustain deep meaningful clinical relationships with them during your rotation. You will learn about phenomenology, etiology, and treatment of emotional, psychological, and behavioral problems associated with acute and chronic medical illnesses in children of all ages.

Our consultation-liaison services also incorporate ongoing learning and holds a specific journal club for the entire service team.

Development and Scholarly Block

This rotation is designed to build your knowledge base and clinical experience with normal and pathological development. As the weekly schedule below indicates, there are several components:

• Intakes: Early opportunity to observe and (if desired) lead intake evaluations in the outpatient clinic. Here you will see how different diagnoses present at different ages and learn how to assess appropriately. You will learn developmentally appropriate ways to assess and deliver clinical information
• Clinic: Protected time for your ongoing outpatient caseload.
• Nursery: You will participate in our Early Childhood Program, working with families and young children. This experience helps you learn normal and atypical development, how to interact with very young patients and their families, how to perform dyadic and triadic therapy, and assessing evidence behind treatments for this age group. There is also a didactic component that will discuss pivotal readings.
• Developmental Disabilities Clinic: In this clinic, you will learn to assess and treat patients with significant developmental disabilities.
• Pediatric Neurology: You will spend one morning a week working in the pediatric neurology clinic. This is an outpatient clinic with supervision from neurology attendings and residents.
• Development: You will learn about a specific developmental age (e.g., newborn to 2) or theorist and develop a presentation that you will give to all fellows at the end of the rotation.
• Seaver: Our Seaver Autism Center for Research and Treatment is internationally recognized. All our fellows get the opportunity to work with Division Chair Alexander Kolevzon, MD. You will learn about clinical research and see patients directly with him.
• Ethics: You will research an ethical dilemma and guide a relevant discussion about it with the fellows at the end of the rotation.

Sample schedule:

Outpatient Clinic

Throughout the entire year, one afternoon per week is blocked to be in the general outpatient clinic. First-year fellows receive one or two therapy cases and several medication management patients to begin to hone their outpatient skills.

Call

Our fellows are on call on average one evening a week and one weekend every five weeks. You will discuss each case with an attending. There is no overnight call.

Didactics

At Mount Sinai, we believe fellows can learn both in the clinic and in the classroom. We offer our fellows a variety of didactic opportunities.

• Summer crash course where we teach interviewing fundamentals, family assessments, assessing risk, working with schools, and introductory basics to common presentations such as attention deficit hyperactivity disorder, anxiety, and diversity-related issues.
• After Labor Day, classes are protected time on Wednesdays with the following curricula:
  • Psychopathology: Deeper understanding of presentation, epidemiology, genetics, neuroscience, and phenomenology over the child and adolescent years.
  • Psychopharmacology: Expert-level education on differences between children, teens, and adults and evidence-based treatment for the symptoms for which our patients most commonly seek care.
  • Psychotherapy: Therapy in children versus teens versus adults, how and when to include the family/school/agencies, play therapy, understanding individual education plans, parent-management training, and other topics.
• Grand Rounds: Internationally renowned speakers during weekly protected time at all locations.
• Journal Club: Reading and discussion of landmark readings and studies that every child psychiatrist must know.
• Fellows Meeting: A weekly session on Fridays at 12 noon when all trainees meet with the training team to discuss active topics and teaching materials. This is protected time and can include the following topics:
  • Regular check-ins
  • Board preparation
  • Developmental milestones
  • Ethical issues