ADULT INPATIENT PSYCHIATRY
While on this service, the resident functions as an integral member of the treatment team. Clinical responsibilities include psychiatric intake, evaluation, management and disposition planning of specifically assigned patients under the close supervision of an attending psychiatrist and psychiatry residents. The resident gains skills in psychiatric examination and evaluation, interviewing techniques, psychopharmacology and is offered some beginning experience in psychotherapeutic techniques.
During the inpatient rotation, PGY-1 residents will also receive weekly off-unit supervision from the Program Director and/or members of the voluntary faculty.
We take training residents as educators very seriously. PGY-1 residents supervise and instruct medical students, and receive guidance and support from senior resident staff. We work to provide useful assessment and feedback to guide residents’ professional development, and to create a learning environment that is constructive, exciting, and physically and emotionally safe.
Most inpatient rotations occur at Westchester Medical Center. We are planning to expand our residency training at Mid-Hudson Regional Hospital.
There are many learning opportunities for residents including lectures and weekly Grand Rounds (September - May). In addition, residents have opportunities to be involved with teaching, including supervising third year medical students, giving lectures, and participating in the education for psychiatry residents and medical students.
PSYCHIATRIC EMERGENCY ROOM
The resident will participate in the initial evaluation at the emergency room and be a part of the decision of psychiatric admission including mental status examination, physical examination and review of laboratory data. Residents will learn about legal documents pertaining to voluntary vs. involuntary admission and will also learn how to place the initial orders when a patient is admitted to the floor. This includes psychopharmacology and the level of monitoring (constant observation vs. Q15 minute checks). Residents will also learn about detoxification protocols in the treatment of substance withdrawal.
The resident will also become familiar with clinical steps that are necessary when patients are not admitted and are referred back to the community; this involves, besides the psychiatric evaluation of the patient, contact with the families and friends to gather collateral information and make proper referral for the outpatient follow-up.
ADULT PSYCHIATRIC OUTPATIENT SERVICE
Behavioral Health Center at Westchester Medical Center
Our outpatient service offers a full range of psychiatric treatment options. The adult OPD averages about 11,000-12,000 visits per year, and is staffed by social workers, psychologists, mental health workers, a nurse practitioner, psychiatry attendings, residents and other trainees. Residents may spend three to four hours per week evaluating new patients. Once they have seen the patient, they present the case to a supervisor who then joins the resident in seeing the patient. Interviewing technique, differential diagnosis and treatment planning are discussed. Residents treat adult patients in individual, group and family modalities. Treatment approaches utilized include: supportive psychotherapy, crisis intervention, brief and long-term psychodynamic therapies, combined psychotherapy and medication, cognitive behavioral therapy, group and family therapy, and psychopharmacological treatment. Each resident sees individual patients, co-leads one or two weekly groups, and does one or two weekly intake evaluations. Residents participate in a weekly meeting of all OPD staff to discuss patient evaluations and treatment planning.
The OPD has a broad ethnic mix, reflecting the surrounding community. The predominant patient populations are middle-class, working class, and poor socio-economic groups. Patients have the full-spectrum of psychiatric diagnoses, including adjustment disorders, major depression, anxiety disorders, personality disorders, and some cases of dementia. The OPD also treat patients with severe and chronic mental illness including patients with schizophrenia, and bipolar disorder. Many of the patients have co-morbid medical problems including hepatitis C, multiple sclerosis, chronic pain, and HIV. There are specific programs that residents participate in for specific patient populations, ITOP for fragile, chronically mentally ill patients, Gateway for gay, lesbian, bisexual and transgender patients, and Step-Up for patients with severe personality disorders. Residents have the option of seeing an adolescent patient, and there are a significant number of geriatric patients as well.
As of July 2016, 8 out of 9 – 10 residents in the PGY-II year rotate in addiction psychiatry at the Montrose VA Hospital, while the remaining 1 – 2 residents per year rotate at our sister campus at the MidHudson Regional Hospital in Poughkeepsie NY. Residents at both sites engage the complex psychological, psychosocial, and biologic forces behind the pathology and treatment of addiction.
The resident is responsible for responding to psychiatric consultations from medical, surgical, critical care, and other services. Duties include psychiatric examination and evaluation of patients, consultation with staff of various medical services and attendance at conferences and rounds. Residents will have the opportunity to work one on one with a board certified consultation/liaison psychiatrist.
Residents will have the opportunity to observe psychiatric manifestations of illness in an acute medical setting. Residents will gain knowledge of basic principles of psychosomatic medicine and learn to integrate psychiatric and medical care. Residents will be exposed to a wide variety of cases and will gain clinical reasoning skills in assessing and treating psychiatric components of medical illnesses.
The Adult Residency training program benefits from our unusual strengths in Child Psychiatry, including training on a dedicated child psychiatry inpatient unit, adolescent inpatient unit, Child and Adolescent OPD, and a dynamic Child C/L program at the WMC Maria Ferrari Children’s Hospital
The resident functions as an integral member of a treatment team responsible for specifically assigned children under the close supervision of an attending psychiatrist on a number of child psychiatric services including in- and outpatient facilities. Clinical responsibilities include psychiatric intake and evaluation of children, family studies, medical management, disposition planning and consultation. In order to effectively work with children and their families, the resident will develop an ability to work in teams with other professional staff including teachers, social workers, nurses, psychologists and recreational therapists. The resident gains skills in psychiatric examination and evaluation, interviewing techniques, psychopharmacology and is offered some beginning experience in psychotherapeutic techniques specific to child and adolescent psychiatry.
Residents will experience firsthand the daily role of inpatient and outpatient child psychiatrists. Through patient interactions, residents will have exposure to a wide variety of psychiatric illnesses. Residents will have the opportunity to observe the longitudinal course of chronic psychiatric illnesses and participate in patient treatment from acute management to long term care.
During the elective, residents will have the opportunity to interact with the Director of Child Psychiatry. There are many learning opportunities for students including lectures and weekly Grand Rounds (September-May). Residents have the opportunity to be involved in teaching as well.
As of July 2016, 8 out of 9 – 10 residents in the PGY-II year rotate in geriatric psychiatry at the Montrose VA Hospital, while the remaining 1 – 2 residents per year rotate at the med-psych geriatrics service at Westchester Medical Center. Residents at both sites engage the complex biological aspects of psychiatric illness and aging.
SCHOLARLY PROJECT REQUIREMENT
A scholarly project is required of all residents. The resident may begin a project during the PGY 2 year and must complete this requirement in order to graduate from our program. The scholarly product may be an original clinical research report, a case report, a comprehensive literature review, or a research project. Under the supervision of an attending psychiatrist or research psychologist, residents can participate in either clinical or basic science research in the department, medical school, or pursue their own original research. A research psychologist is available to match residents with projects and assist in data analysis. The scholarly project must be written up, and be of sufficient quality to be either submitted for publication or presented. If not submitted for publication, the project must be presented in Grand Rounds or another appropriate format. All residents present their projects at a Resident Research Forum in June.
Discussions are underway to provide research electives for residents at the Nathan Kline Institute, one of two psychiatry research institutes in New York State. NKI is located on the grounds of Rockland Psychiatric Center and is staffed by world-renowned researchers. This should afford an opportunity for residents with an interest in research to gain more experience and have additional mentors. Residents also have the opportunity to work with faculty from other departments including internal medicine and neuroradiology on research projects.
There is flexibility about the sequence in which the rotations are taken in the 2nd through 4th years. The rotations are adjusted for those doing a child fellowship after the 3rd year. Each block consists of 4 weeks; there are 13 blocks each year.
Medicine or Medicine/Pediatrics: 4 blocks (WMC or LHH)
Inpatient Psychiatry: 8 blocks (WMC or LHH)
Night Float: 1 block (WMC)
Inpatient Psychiatry: 2 – 3 blocks (WMC or LHH)
Emergency Psychiatry: 2 blocks (WMC)
Neurology: 2 blocks (WMC)
Substance Abuse: 1 ½ blocks (VA or MHRH)
Geriatric Psychiatry: 1 ½ block (VA or MHRH)
Consultation/Liaison: 2 – 4 blocks (WMC)
Child Psychiatry: 1 – 2 blocks (WMC)
Outpatient Department: 13 blocks
2 – 6 outpatient psychotherapy patients
Senior electives and scholarly project: 6 – 8 blocks
Child and Adolescent Psychiatry: 2 blocks
Junior administrative attending: 2 – 3 blocks
OPD Continuous Cases optional
Requirements not met in previous years