Psychiatry Residency Program – Training Curriculum

Rotations:

The PGY-1 year consists of six months on various psychiatry services, four months of internal medicine, and two months of neurology.

While on medicine rotations, the PGY-1 resident will do two months of inpatient wards, one month on a consult service and one month of emergency medicine. During their time on the medical side of the emergency room,  residents gain experience in treating patients with various chief complaints in a busy, level four trauma emergency room, in addition to learning the processes for appropriately consulting other services. During their time on inpatient wards, residents are assigned to a treatment team with one to two PGY-1 internal medicine residents, an upper level internal medicine resident and an attending. PGY-1 residents have "long call" every fourth day, when they remain in hospital for admissions until 8:00pm. There are frequent medicine lunchtime didactics which provide a broad educational experience during this rotation.

While on the medicine consult service, the resident works directly with a PGY-3 internal medicine resident and attending; consulting on patients on the surgical, psychiatric, neurology or other specialty services that request medicine consultations. There is no call  requirement during this month.

During their two months of neurology at Tufts Medical Center, the PGY-1 resident works on the neurology consultation service alongside neurology residents and attendings, providing robust exposure to a variety of neurological topics. This experience is fundamental to practicing as a psychiatrist, as many cases have concurrent psychiatric and neurological issues, and neurological issues are often considered in differential diagnoses on psychiatric services. There are frequent conferences and opportunities to expand ones knowledge of neurology.

For their time on the psychiatry services, the PGY-1 will complete one month of emergency psychiatry consultation at Tufts Medical Center working alongside a senior resident and directly staffing consults from the emergency room with the consultation/liaison attending. This is a busy service that allows the resident to become familiar with psychiatric triage, safety evaluations, legal requirements for involuntary admissions, and disposition planning including inpatient placement in a  locked psychiatric unit at either Tufts Medical Center or another location, stepdown services such as partial hospitalizations, and referral to outpatient resources.

PGY-1 residents will also spend a combined four months on the adult inpatient psychiatric unit at Tufts Medical Center and the consultation/liaison psychiatry service at Tufts Medical Center. During these months, the resident works on an interdisciplinary team consisting of other psychiatry residents, rotating neurology residents (for the consultation/liaison service), medical students, social workers, case managers, occupational therapists and the inpatient and consultation/liaison attendings. During the inpatient psychiatry month, the PGY-1 resident works with one other resident on one of two inpatient  teams,caring for 5-6 patients per day on a 20-bed unit.

PGY1 residents will also spend one month on the Addiction Consult service to gain experience with a broad spectrum of addiction psychiatry topics including medication assisted treatment for substance use disorders (e.g. buprenorphine, methadone), managing withdrawal, and managing pain control in the setting of active opioid use. An important part of this experience is exposure to working with patients with active substance use disorders in providing psychoeducation, motivational interviewing, and advocating for their appropriate and unbiased care. 
 

Didactics:

PGY-1 residents attend weekly psychiatry didactics on Wednesday afternoons.

"Long Day":

During neurology and psychiatry rotations, the PGY-1 has about 30 "long days"  per year, where they stay from 5-8pm on weekdays to assist with admissions. They also have about 14 weekend calls from 8am-8pm on one weekend day, with direct supervision from the senior on-call resident. The PGY-1 residents see psychiatric consults in the emergency room and on the medical floors with the senior resident, then staff them with an attending.

While on the internal medicine rotation at Tufts Medical Center, the PGY-1 resident does not take psychiatric call, but rather has a similar "long day" schedule until 8pm on weekdays or weekends, roughly every four days.

Rotations:

The PGY-2 year consists of one-month rotation blocks that include:

Four to six months of adult inpatient psychiatry at Tufts Medical Center. During this month, the PGY-2 resident works on a team with one other resident, several medical and PA students, a social worker, a case manager, an occupational therapist, nursing staff, mental health workers, and an inpatient attendings.  This unit encompasses a great variety of psychopathology; including severe mood, psychotic, and personality disorders, catatonia, and often complex medical comorbidities. This unit consists of patients from diverse cultural and socio-economic backgrounds, most with public sector insurance.

Three to four months of consultation/liaison psychiatry at Tufts Medical Center. During these months, the PGY-2 resident works on a team consisting of medical students, other PGY-1 and/or PGY-2 psychiatry residents, and the consultation/liaison attending. The consultation/liaison experience varies, but is generally busy and with a broad range of consultation questions and psychiatric pathology including mood, anxiety, and psychotic disorders, delirium, catatonia, behavioral dysregulation, capacity assessments, and more.

One month of inpatient child psychiatry at North Shore Hospital in Salem, MA. Residents rotate on a 20 bed locked unit and participate in all aspects of inpatient care, including initial assessments of children and adolescents, pharmacotherapy, and multidisciplinary team treatment. There is also exposure to the child/adolescent outpatient clinic in the PGY-3 year.

One month of inpatient geriatric psychiatry at Lawrence Memorial Hospital in Medford, MA. During this rotation, the PGY-2 resident works with patients on both an unlocked voluntary 18-bed unit and a locked involuntary 16-bed unit. This allows for exposure to older adults with a variety of psychiatric and neuropsychiatric disorders, frequently in the setting of significant medical co-morbidity.

One month of the Addiction Service, as described above under the PGY-1 year.

One to two months on the Tewksbury Hospital Addictions Service. PGY-2 residents rotate on one or more of the four, 32 bed inpatient units at Tewksbury Hospital, gaining an invaluable broad exposure to the issues of public sector psychiatry. Under the supervision of a senior psychiatrist and the many other disciplines at the hospital, residents gain experience in the diagnosis and treatment of the severely impaired psychiatric patient. This often includes an in-depth analysis of functional disability and rehabilitation potential.

Outpatient experience:

PGY-2 residents are expected to fulfill 10 "outpatient hours" per month, seeing their own psychotherapy and psychopharmacology patients. Each  resident has two supervisors: one “in-house” supervisor and one "out-of-house" supervisor, with whom they meet weekly to discuss patient diagnoses, treatment, therapy modalities and techniques, and any relevant topics to outpatient psychiatric care.

Didactics:

PGY-2 residents attend weekly psychiatry didactics on Wednesday afternoons throughout the year. PGY-2 residents also rotate with other residents in leading case presentations about their outpatients alongside experienced psychotherapists, several with training in psychoanalysis.

Call:

24-hourcall begins in the PGY-2 year and averages to about three calls per month. The average call per year is about 34 calls: 12 weekend calls from 8am-8am and 24 weekday calls from 5pm-8am.  The resident is post-call and free from clinical responsibilities the day after these overnight calls.

The PGY-3 year is dedicated to outpatient care, consisting of several six-to-eight week rotation blocks:

Adult clinics:

Mood and anxiety disorders intake clinic at Tufts Medical Center with Dr. David Adler. This clinic serves adults with major depression, bipolar disorder, chronic refractory mood disorders, panic disorder, PTSD, anxiety disorders, and phobias.  The clinic also serves as a referral for medical and surgical patients within the institution who require evaluation and treatment for psychiatric disorders that coexist with, or are associated with, medical illness.

General intake clinic at Tufts Medical Center with Dr. Paul Plasky. PGY-3 residents see patients together with Paul Plasky, MD, PhD, and perform comprehensive biopsychosocial psychiatric assessments. This is a weekly clinic for initial assessment of patients referred from within Tufts Medical Center or from outside sources.  After assessment, patients are referred to individual care by a PGY-3 resident.

Mood Disorders Consultation Clinic at Tufts Medical Center with Dr. Nassir Ghaemi. PGY-3 residents work with an internationally recognized expert in psychotherapy to perform comprehensive evaluations and consultations for complex psychiatric patients referred by other psychiatrists, non-psychiatric physicians, and mental health professionals.

The forensic psychiatry rotation with Dr. Ingrid Li at the Dr. Solomon Carter Fuller Mental Health Center inpatient unit. The hospital is in Boston’s South End, about one mile from Tufts Medical Center. Residents will gain experience in forensic psychiatry topics such as competency to stand trial, evaluation of criminal responsibility, assessment of persons on probation, risk assessment, and Massachusetts and federal mental health laws. There is an optional opportunity to observe an audit of a segregated unit in a state correctional institution and court testimony. Residents will observe forensic evaluations and have the opportunity to write a forensic report.

Community Psychiatry with Dr. Robert Diener. Residents gain valuable public psychiatry experience through work with Dr. Diener in outpatient and residential settings. PGY-3 residents also rotate with PACT (program for assertive community treatment) teams, providing outreach and support to patients with severe and long term mental disorders in a multidisciplinary treatment team setting.

Eating Disorders Program with Dr. James Greenblatt. PGY-3 residents rotate at an Inpatient facility in Dedham, MA associated with Walden Behavioral Care. This program is part of the Walden Behavioral Care organization, which offers outpatient, intensive outpatient, and inpatient treatment for eating disorders to patients of all ages  at 13 clinical locations. Our residents participate in treatment of patients with eating disorders through initial evaluations, pharmacotherapy, and multidisciplinary group treatments.

Child/Adolescent Clinics:

ADHD clinic with Dr. Judith Robinson (child and adolescent trained psychiatrist) and Dr. Hope Schreiber (PhD psychologist) provides exposure to ADHD diagnosis, pharmacologic treatment, and behavioral techniques for those with ADHD. Dr. Robinson is an expert in childhood and adult ADHD, particularly ADHD over the lifetime, and Dr. Schreiber is an expert in ADHD as well, including neuropsychiatric testing.

Child and adolescent family therapy clinic with Dr. John Sargent and Ted Green, PhD. This clinic allows residents to see child and adolescent patients with their caretakers in an interdisciplinary team environment including a Child and Adolescent Psychiatry attending and psychologist with expertise in family therapy, Child and Adolescent Psychiatry fellows, social work and psychology interns, and medical students. This clinic covers various family therapy topics and techniques with a mix of discussion-based didactic sessions and clinical experience.

Child anxiety disorders clinic with Dr. Sandra Lucio. This clinic serves both children and adolescents with a broad spectrum of mood and anxiety disorders, including depression, bipolar disorder, obsessive-compulsive disorder, general anxiety, social anxiety, separation anxiety and panic attacks. This clinic is also attended by medical students and social worker interns as it is focused on teaching and interdisciplinary care.

Trauma clinic with Dr. Krinsky and Alice Connors-Kellgren, PhD. This clinic provides consultations for child and adolescent patients with various forms of developmental trauma. Residents receive exposure to the complexities of developmental trauma and its sequelae through discussion-based didactics and direct patient evaluation and management in a consultation setting. This clinic has an interdisciplinary team with robust experience and expertise in these topics.

Didactics:

PGY-3 residents attend full-day didactics each Wednesday.

Call:

Overnight call during the PGY-3 year averages to about one to two calls per month with a total of 17 weekday calls and 5 weekend calls per year.

Rotations:

The PGY-4 year is dedicated to providing opportunities for residents to explore their particular areas of interest, and to prepare for the transition to independent practice. In addition to outpatient continuity clinic and 2 months of emergency psychiatry, this year consists of a flexible schedule to allow for elective rotations and research. Each resident will fulfill a specific chief responsibility during this year - a valuable experience in leadership and administrative skills.

Didactics:

PGY-4 residents attend full-day didactics each Wednesday.