Our curriculum provides residents with the skills and knowledge to develop deep competence and confidence in their capacity to care for patients and contribute to the field. We follow several threads of learning throughout our didactics in the 4 years, including patient care and interviewing, psychopathology, psychotherapy, psychopharmacology, the neuroscience of psychiatry, child development and child psychiatry, professional development and wellbeing, and patient safety and quality improvement. Our clinical rotations provide residents with diverse patients and learning experiences, ranging from inpatient and emergency care to outpatient and addiction settings, from child to geriatric patients, from schizophrenia to severe personality disorders, and more.
The emphasis in the first year of training is in helping the new resident make the transition from student to physician. We recognize this is no easy task and plenty of mentoring and supervision makes the process as smooth as it can possibly be.
The first year includes rotations in Inpatient and Emergency Psychiatry, Internal Medicine, and Neurology. The six-month psychiatry rotation consists of a broad introduction to Inpatient and Emergency Psychiatry. All PGY1s spend four months on inpatient units that are designed to meet the training needs of beginning residents, and one month in the emergency room with full-time attending supervision. During inpatient psychiatry, sites include Mount Sinai Morningside and Mount Sinai West. The emphasis during these months is on clinical assessment, interviewing skills, treatment planning, and working in a treatment-team approach.
The Emergency Psychiatry experience is a one-month rotation during which attending physicians onsite closely supervise residents. In this way, the beginning trainee learns acute care psychiatry and differential diagnosis skills, working side-by-side with an experienced clinician until he or she feels secure in assessing patients independently.
The six month rotation in Internal Medicine and Neurology takes place within Mount Sinai Morningside and West. Close coordination between our department and the departments of neurology and medicine ensure a comprehensive exposure to diagnosis and treatment of major medical conditions and a full immersion into the intern experience.
While on medicine rotations, residents have in-house call every fourth day until 8:30PM, at which time a night-float resident takes over care of patients. While on psychiatry, residents have in-house call until 8PM on a rotating basis, either in the Mount Sinai Morningside or West CPEP. There is no 24 hour call for residents. During their psychiatry rotations, PGY1 residents do two weeks of night float in psychiatry. This ensures that residents work no longer than 14 hour shifts, with the night off to return home and sleep. During the first 6 weeks, calls are taken with senior residents who help to teach and support early trainees. At all times and throughout the residency, there is an in-house attending available for teaching, supervision and consultation.
Residents have protected lecture time while they are on psychiatry. While on medicine, they attend medicine noontime conferences that provide education on a wide variety of medical topics.
Prior to starting their rotations, residents attend a weeklong orientation that consists of a general welcome and orientation from GME and the psychiatry residency, an overview of residency training, a crash course in acute care psychiatry, safety training, and a social gathering to get to know fellow residents.
Introduction to Interviewing and Biopsychosocial Formulation: This case-based course, taught by the program director, introduces residents to principles and techniques of interviewing and an integrative biopsychosocial model for understanding and designing interventions for their patients. It includes discussion of DSM diagnoses, neuroscience, psychological aspects, and social determinants of mental health, as well as a range of treatment options including medications, psychotherapy, psychosocial interventions, and more.
Other classes in the PGY1 year build on this foundation to provide further skills and knowledge related to specific diagnoses, teach professionalism, provide an overview of the history of psychiatry, and more.
Wellness Group: On a monthly basis, the psychiatry residents on psychiatry join together to engage in an activity that helps them develop their skills of listening and attention, maintain their wellness, process their experiences, and think creatively. The series includes sessions on narrative medicine, mindfulness and positive psychology.
Journal Club: Each of the units has a regular journal club where residents read and present a current paper to the other residents on service with a senior resident or attending leading the discussion. Emphasis is on the critical evaluation of the study design and conduct of the research.
The PGY 2 year enriches and broadens the skills acquired in the first year as trainees further develop their identity as psychiatrists. The year is divided into 3 months of inpatient psychiatry, 2 months of Emergency psychiatry, 1 month on an addictions detox and rehab unit, 1 month in Psychosomatic Medicine, 1 month of night float, 1 month on the Child and Adolescent inpatient service, 1 month on an inpatient geriatric service, and 2 months in an outpatient Personality Disorders Program.
The inpatient and emergency psychiatry experience during the PGY2 year allow residents to strengthen their skills in these domains. Residents also spend 1 month on a substance abuse rotation which allows them to actively learn to diagnose and treat drug dependency with proven treatments. Residents learn to conduct comprehensive psychosocial evaluations, inpatient and outpatient detoxifications, and individual and group treatments incorporating motivational and self-help concepts.
The second year also provides an introduction to psychiatric care in the outpatient setting. At the Center for Intensive Treatment of Personality Disorders (CITPD), residents begin to treat individuals with borderline and other personality disorders with several different modalities including individual, group, and specialized treatments (e.g. dialectical behavioral treatment, or DBT). This program is an intensive outpatient program that serves as an alternative to hospitalization for patients who need significant support, but not 24-hour care. Here, residents learn to achieve rapid stabilization of symptoms, rehabilitation and resocialization for their patients. Residents learn the principals of DBT and co-lead a group with a skilled leader of DBT. Residents also become skilled in the pharmacological treatment of personality disorders.
PGY2 residents spend one half day a week in the Psychiatric Recovery Center (PRC), a continuity clinic that introduces them to the outpatient treatment of schizophrenia and other serious mental illnesses. Each week starts with an hour of clinical supervision and discussion of relevant readings, followed by sessions with their patients. The residents follow some of their discharged patients from the inpatient unit and are able to continue to treat their patients for up to three years, until graduation. This allows residents to build meaningful relationships with these patients, help prevent relapse and support them in achieving their recovery goals.
Didactics in the second year cover most core areas in psychiatry and include:
Consultation-Liaison Psychiatry: This course is a review of topics in consultation-liaison psychiatry, including delirium and dementia, pain, the psychological effects of medical illnesses, and the role of psychiatric liaison.
Introduction to Research: This course is a basic and clinically oriented introduction to research. Methodological topics reviewed include study design, ethics of research with human subjects, basic statistics and an overview of the IRB approval process.
Major Syndromes: The pathology, phenomenology, life course and neurobiology of the major diseases are taught by a variety of experts in the field.
Psychotherapy: There are two courses on psychotherapy, a supportive therapy course that introduces concepts and strategies for this important modality, followed later by a psychodynamic therapy introduction. Topics include understanding defenses, interventions, assessment and case formulation, goal setting, therapeutic relationship maintenance, crisis intervention, and special populations. These provide useful tools for the PGY2 work and prepare the resident for starting long-term dynamic treatment in the third year.
Personality Disorders: This course provides an overview of the different character styles ranging from the neurotic to the psychotic.
Community Psychiatry: Residents learn about the history of psychiatry with a focus on the care of individuals with serious mental illness in the public sector. Topics include the financing and regulation of mental health care, homelessness and housing as it affects those with mental illness, assertive community treatment and mandatory outpatient treatment laws, the care of forensic populations, models of substance use disorder treatment in the community, and the concept of recovery and recovery-oriented care.
Other lecture series include addiction psychiatry, geriatrics, interview skills, and child development.
Starting in the PGY2 year and continuing until graduation, there is a weekly confidential process group led by a voluntary faculty member who helps facilitate meaningful discussion about the residents' professional and personal development. While it is not a therapy group, the experience does help residents gain insight into group process.
In the third year, residents gain the necessary skills and theoretical base to practice psychiatry in an outpatient setting. Through their clinical experience and academic work, residents begin to master the pharmacological and therapeutic management of patients and the theoretical underpinnings of psychiatry. Residents master psychotherapy in this year, including supportive, dynamic, cognitive behavioral, dialectic behavioral, group, and couples and family work.
The experience in the Adult Outpatient Psychiatry Clinic (OPC) and Psychiatric Recovery Center (PRC) builds on the PGY2 year. Residents continue with their PRC cases and take on new cases in the OPC, which offer greater challenges and learning experiences. The OPC treats individuals with mood, anxiety, trauma-related, and personality disorders. PGY3s also co-lead a CBT, DBT, dual diagnosis, or early psychosis group under the supervision of an experienced group leader, adapting treatments to a group of patients.
Community Psychiatry Track: One or two residents each year with a particular interest in community psychiatry enter the community psychiatry track. It allows for mentoring, directed reading and time spent in a variety of community psychiatry settings outside the department, starting in the 3rd year and continuing into the 4th, often with a view to entering a career in public psychiatry.
PGY3 residents also receive training in child and adolescent psychiatry by treating a group of patients and their families for the course of the year. Residents learn to evaluate, diagnose and treat a wide range of psychiatric diagnoses in youths, and receive two hours of weekly supervision in pharmacology and psychotherapy from Child Psychiatry faculty.
Residents are highly supervised in their work during the third year, and the case load is kept to a moderate number of patients with a wide range of psychopathology. Residents receive five to seven hours of supervision in various psychotherapies as well as psychopharmacology and intake assessments. Additional supervision in DBT, couples and family is available for interested residents.
Neuroscience and Psychopharmacology: This course presents in depth the neurobiology of psychiatric disorders and mechanisms of action behind their pharmacological treatment. Topics include neuroanatomy, receptors and neurotransmitters, brain pathways, and novel treatments. Practical psychopharmacology is also discussed. Residents may present outpatient psychopharmacological cases in which there is poor response to previous medication trials, medication intolerance, complicating medical problems, or diagnostic questions. Basic and more advanced treatment algorithms are used to guide residents through treatment trials.
Psychodynamic Theory and Practice: This course is a more advanced presentation of the techniques and concepts of psychodynamic psychotherapy. The first hour is a lively discussion of some of the seminal and classical papers in psychodynamic theory and practice. Theories covered include Freudian and ego psychology, interpersonal, Kleinian, object relations, self-psychology, and more contemporary theories. In the second hour, residents present their own cases using video recording. Topics include patient selection, therapeutic interventions, transference,
Integrated Treatments: Psychotherapy and Pharmacology: The treatment model of “split treatments” is discussed with directed readings, and an integrated case conference series helps bridge the psychopharmacology and psychodynamic therapy courses. The transference and countertransference aspects of medication are discussed as well as adherence, splitting, and informed consent.
Cognitive-Behavioral Psychotherapy: This 12-week course is an introduction to the theory and techniques of cognitive-behavioral psychotherapy, including a section on dialectical behavior therapy. The treatments of depression, anxiety, eating disorders, sleep disorders, and borderline personality disorder are reviewed. The course has several clinical correlation classes where videotapes are used as teaching aides.
Suicide and Self Injury: This course reviews the assessment and treatment of suicidal patients and those patients who self-injure. Topics include assessment, treatment planning, chronic suicidality, and care of survivors.
Outpatient Case Conferences occur monthly in the OPC and PRC, with a guest consultant. Residents write up and present cases of ongoing treatments to the entire clinic.
During the fourth year, the training is focused on fostering confidence to be ready for independent practice, building supervisory and teaching skills, and integrating the various clinical skills acquired over the first three years. In addition, the fourth year of residency training allows the senior resident considerable flexibility to pursue specific areas of interest in depth. Residents have several months of elective time to do so, and the option to pursue one of several specialized tracks. and d Didactics mirror the objectives of this year, by including sessions on advanced clinical skills, career paths (including finding a job and setting up an office), leadership and teaching skills.
All PGY4 residents complete a Junior Attending rotation on an inpatient or outpatient psychiatry unit that lasts four to six months. Some may work at the Student Counseling center at Fordham University, functioning as the consultant psychiatrist. During this block, residents learn to lead teams, supervise junior residents and medical students, and manage the administrative aspects of leadership, as well as dispensing treatment with progressively less supervision.
Residents can apply for a specialized PGY4 track or may participate in one of many electives. Residents interested in pursuing research can work closely with a faculty mentors from throughout the Mount Sinai Health System during extensive dedicated time. An educator track allows interested residents to focus on classroom teaching, curriculum development, and clinical supervision skills development. Residents selected for the global mental health track have the opportunity to travel abroad to one of many sites where the program has developed long-standing relationships with local partners. Finally, a community psychiatry track engages residents in deeper discussion around topics in this field and provides several options to work in community psychiatry settings (such as joining an ACT team or work in a shelter).
Elective time may also be used to focus on specialized populations or the development of a particular clinical skills such as performing ECT or learning about novel neurointervention procedures (ketamine, TMS, DBS), providing specialized CBT for OCD, evaluating and treating of sleep disorders, caring for women in a high risk OB clinic, providing outpatient addiction care, learning couples and family therapy, or and working in the specialized CARES high school program or a specialized autism center, and more.
PGY4s return to the Consultation Liaison service for one month to consolidate their knowledge and skills in C/L. Residents perform consultations on medical and surgical patients and work closely with the doctors, nurses and social workers on the inpatient medical floors to provide treatment and management recommendations. Management of delirium, capacity issues, treatment adherence, drug and alcohol detoxification, preexisting mental illness, and characterological pathology are frequent treatment concerns. The clinical C/L experience is supplemented by a comprehensive curriculum and case conferences at which residents present cases and discuss management principles.
All residents also continue with a small caseload of patients at the Outpatient Psychiatry Clinic from their PGY3, including their psychodynamic therapy cases. PGY4 residents also take part in a course on Short Term Dynamic Psychotherapy. Each resident conducts treatment with a patient using this model while he/she receives weekly supervision using videotaped sessions.
Short-Term Dynamic Psychotherapy: In this course, residents learn the principles of short term dynamic psychotherapy. Each resident treats a patient under supervision and presents the work in videotape form to the class.
Leadership in Psychiatry: This course taught by the chair provides an introduction to leadership and administrative psychiatry. Topics include leadership of interdisciplinary teams, hospital administration, and larger trends in healthcare that impact systems of psychiatric care. Residents select a leadership topic, prepare a presentation in teams, and lead a class discussion.
Teaching and Supervising: This course reviews the principles of teaching medical students and residents and concepts of supervision. Residents prepare a class and teach the class to PGY1s and receive feedback on their teaching.
Psychiatric Career Series: This course brings in guest speakers to discuss their career paths and provide models for residents to consider. One portion of this course on private practice provides basics in setting up an office and the different styles of practices. Basics such as malpractice, managed care panels, and HIPAA regulations are covered. Other speakers discuss their careers in research, child psychiatry, public psychiatry, global mental health, hospital and administrative psychiatry, education, and more.
Neurology for Psychiatrists: This course reviews neurological issues which are relevant to the practice of psychiatry. Topics include headaches, movement disorders, neoplasms, Parkinson’s disease, stroke, amnesia, traumatic brain injury, and multiple sclerosis.
Human Sexuality: This course introduces residents to the diagnosis and treatment of sexual dysfunctions and the paraphilias, as well as techniques in sexual history taking. Residents conduct and present a sexual history of a patient to the group and present on the paraphilias.
Expert Clinican Series: This monthly class brings in expert clinicians to discuss more complicated cases and advanced treatment strategies. Residents present their own cases for discussion and consultation.