ADULT INPATIENT PSYCHIATRY
While on this service, the student 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 student gains skills in psychiatric examination and evaluation, interviewing techniques, psychopharmacology and is offered some beginning experience in psychotherapeutic techniques. Students will experience firsthand the daily role of an inpatient psychiatrist. Through patient interactions, students will have exposure to a wide variety of psychiatric illnesses. Students 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.
There are many learning opportunities for students including lectures and weekly Grand Rounds (September-May). In addition, students have opportunities to be involved with teaching, including supervising third year students, giving lectures, and participating in the education for psychiatry residents and medical students.
AVAILABLE AT: Westchester Medical Center; St. Vincent's Hospital, Harrison.
PSYCHIATRIC EMERGENCY ROOM
The student 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. Students 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). Students will also learn about detoxification protocols in the treatment of substance withdrawal.
The student 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.
AVAILABLE AT: Westchester Medical Center.
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.
50% of the residents’ time is spent on the outpatient day treatment substance abuse service and 50% on the inpatient detoxification unit at St. Vincent’s Hospital in Harrison, NY. Working closely with the faculty, residents learn to perform comprehensive substance abuse assessments and refine their interviewing techniques. There are extensive daily rounds with the attending psychiatrist. The resident learns inpatient and outpatient detoxification protocols, sees individual patients as well as some families of patients who have substance abuse problems. The resident does 3 comprehensive substance abuse evaluations per week and is also assigned 5 patients who are each seen individually 1 to 3 times per week. The resident attends 3 to 5 outpatient substance treatment groups per week and 3 outpatient team meeting per week, and does 1 inpatient unit presentation per rotation.
CONSULTATION LIAISON PSYCHIATRY
The student 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. Students will have the opportunity to work one on one with a board certified consultation/liaison psychiatrist.
Students will have the opportunity to observe psychiatric manifestations of illness in an acute medical setting. Students will gain knowledge of basic principles of psychosomatic medicine and learn to integrate psychiatric and medical care. Students will be exposed to a wide variety of cases and will gain clinical reasoning skills in assessing and treating psychiatric components of medical illnesses.
AVAILABLE AT: Westchester Medical Center.
The student 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 student will develop an ability to work in teams with other professional staff including teachers, social workers, nurses, psychologists and recreational therapists. The student 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.
Students will experience firsthand the daily role of inpatient and outpatient child psychiatrists. Through patient interactions, students will have exposure to a wide variety of psychiatric illnesses. Students 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, students 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). Students have the opportunity to be involved in teaching as well.
AVAILABLE AT: Westchester Medical Center
We offer evaluation and treatment of geriatric patients in an inpatient medical setting. Residents usually rotate on the med-psych unit at WMC and gain experience in the treatment of elderly patients, with and without co-morbid medical illnesses. They may also rotate on the geriatric inpatient unit at St. Vincent’s Hospital in Westchester for experience with ECT.
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.
THE PSYCHOANALYTIC INSTITUTE
The Psychoanalytic Institute of the Department of Psychiatry at New York Medical College offers comprehensive instruction in psychodynamic psychotherapy. The faculty of the Psychoanalytic Institute provides senior teachers and supervisors to the psychiatric residency training program. Residents can take a two-year course starting in their third year of residency, which leads to Certification in Psychodynamic Psychotherapy. Credit for the first year of training in the Psychoanalytic Institute can be given to residents who complete this course. In addition, an elective in psychodynamic psychotherapy is offered to residents as part of the curriculum.
DAY TREATMENT PROGRAM
Students have the opportunity to participate in a day program with a choice of several tracks including dual diagnosis, DBT and cognitive impairment. Students will work closely with the attending responsible for the program and see patients both individually and in group psychotherapy sessions. Students will be responsible for both evaluation and treatment of patients in conjunction with the attending. During this elective, students will observe the intensive non-hospital based treatment that is able to keep many patients from an inpatient hospitalization.
AVAILABLE AT: St. Vincent's Hospital, Harrison