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.

Explore a sample PGY-1 didactic schedule

PGY-2 residents are excused from clinical responsibilities for 7 hours each Wednesday for classroom activities. Topics are divided thematically into the following areas: Clinical Supervision; Phenomenology, Neuroscience, & Psychopharmacology; Psychotherapy; Social & Psychiatry Services; and Process Group.

Each week begins with a Group Clinical Supervision led by the training directors.

The year-long Phenomenology, Neuroscience, and Psychopharmacology course is divided into illness-specific modules. 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. Relevant psychopharmacology for each area is included in the module. Each module ends with a presentation by a faculty expert about the relevant state of the art research being conducted at Mount Sinai.

A primary goal of our psychotherapy curriculum is to foster knowledge and skills in the established and emerging evidence-based treatments, highlighting techniques, theories, efficacy, and application. Early on, residents are taught how to attend to patients’ moment-to-moment emotions, cognitions, and behaviors, how these may be acknowledged and therapeutically addressed, and how to begin to incorporate core supportive psychotherapy techniques into daily practice, regardless of therapeutic orientation. Questions such as, What is the patient trying to tell me? and What do I say next?═čas well as the How, When, and Why of it—form the conceptual and pragmatic scaffolding on which this series is built. Following this pragmatic and practice-heavy introductory series, residents attend a 6-month weekly series on various Models of the Mind, with theory-based components followed by learning techniques fundamental to specific psychotherapy practices. The technique component often includes learning from the process of the instructor’s actual ongoing treatment of patients. 

In Social & Psychiatry Services, residents learn about the practice of psychiatry in systems, including the principles of publicly-funded mental health services, emergency psychiatry, consultation-liaison psychiatry, and forensic psychiatry, including attending mock trial.

Process Group offers PGY-2, 3, and 4 residents a unique 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 8 hours of classroom experience each Thursday throughout the year. 

Each Thursday begins with 2 hours of Group Clinical and Administrative Supervision run by the Director of the Residents’ Treatment Clinic.

For 2020-21, we have begun a new longitudinal course in “Expert Supervision and Case Consultation,” which is divided into “Psychopharmacology with Joe Goldberg,”“Consultation-Liaison Formulation Rounds with Carrie Ernst,” and “Diversity Case Conferences with Shilpa Taufique.”

The year-long Advanced Outpatient Psychopharmacology class for the PGY-3s revisits many previously-encountered topics at an increasing level of sophistication and is organized by medication-class.

The didactic component of PGY-3 psychotherapy training includes 2 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, group, family, couples, emotion-focused, positive psychology, and eclectic approaches, as well as the psychology of psychopharmacology. Reflecting the high value placed on learning psychotherapy, the department has 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, instruction in the core didactic curriculum, and specific financial and time-saving provisions for residents who elect professional paths involving forms of psychodynamic training. Residents have also opted to undertake additional psychodynamic training in fellowships at NYPSI and at the William Alanson White Institute.

The PGY-3 Public Psychiatry 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 4-5 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 a majority 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 role in developing 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 courses in Women’s Mental Health, Sexuality and Treatment of Sexual Dysfunctions, Giving Effective Feedback, and Diversity. Professional development is another significant feature of PGY-4 didactics, including discussions of fellowships, jobs, office practice (legal, financial, etc.), financial considerations (personal finances, investing, etc.), and board review. This year also includes a more nuanced course in mental health ethics, taught by Jacob Appel, MD, JD, a graduate of our program and a highly-regarded former university professor of bioethics.

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

Explore a sample PGY-4 didactic schedule.