PGY V Addiction Residency

PGY V Addiction Residency.

The Boston University Medical Center / Boston VA Healthcare System Addiction Psychiatry Residency is a one year (PGY V) fellowship program that was accredited by the ACGME in 1997.  Under the leadership of two nationally recognized addiction psychiatrists, Dr. John Renner and Dr. Grace Chang, the fellowship provides psychiatric physicians with advanced training in the recognition, diagnosis, and treatment of substance use disorders.  The program is funded for four PGY V fellows.  The primary site for training is the VA Outpatient Clinic (OPC) at Causeway Street in Boston, where the fellows will gain extensive experience working with patients on methadone and buprenorphine, and treat a full range of patients with other substance use disorders and co-occurring psychiatric disorders. A well-rounded and comprehensive series of didactic presentations as well as training at renowned Boston area tertiary care facilities ensures that graduates are clinically competent and knowledgeable in all aspects of addiction treatment. The development of broad expertise and an informed perspective on the addictions encompassing knowledge of the history of substance use disorders, sociological aspects of addictions and public policy, and the role of mutual-support groups and spirituality in the treatment of the addictions is an integral part of the fellowship.  To complement outpatient training experiences at the Causeway Street VA Clinic, residents also rotate through the Consultation Liaison Service at the Boston VA/West Roxbury Campus, Boston University Medical Center (emergency department, addiction medicine consultation, adolescent services), the Bedford VA (intensive outpatient treatment and geriatric services), Brigham and Women’s Hospital (addiction consultation services, services for pregnant women, and management of complex inpatient detoxification), and the Boston Public Health Commission (addiction services for men and women). Opportunities to participate in research and quality improvement projects are available at all of the primary rotation sites. A significant amount of time is dedicated to treatment of addictions in the public sector. Fellows are also provided with substantial elective time and are encouraged to pursue scholarly interests, for which a wide variety of mentors are available.

 

GOALS AND OBJECTIVES

The Addiction Psychiatry Residency and the Interprofessional Advanced Fellowship in Addiction Treatment provide training for psychiatrists and other clinicians interested in pursuing a career in addiction treatment. The PGY V program is designed as a comprehensive training experience that will meet the requirements for eligibility for the American Board of Medical Specialties certification examination for Addiction Psychiatry.  Through a series of clinical, didactic, and research experiences, residents will develop competence in the following four areas:

  1. The clinical management of patients with substance use disorders utilizing all standard treatment modalities including psychological therapies, social interventions, peer/mutual support, and medication-assisted treatment: Under close supervision, residents will be exposed to the full range of interventions from prevention to long-term treatment for chronic populations.  Emphasis will be placed on treatment interventions designed to address the needs of special populations such as the elderly, women including pregnant women, adolescents, minority groups, veterans and other trauma victims.  There will be a special emphasis on individuals with co-occurring psychiatric disorders.  Residents will have the opportunity to follow selected patients at the Causeway St. VA Clinic and at the Boston Public Health Commission for the duration of their year of training.  Experience will be gained utilizing APA and VA/DOD recommended treatment guidelines, and trainees will gain competence in the long-term management of the substance use disorders.
  2. The conceptual foundations of addiction psychiatry: Based on a rigorous program of reading, review of research articles, didactic seminars, self-directed learning opportunities, and participation in post-graduate courses, the trainee will gain familiarity with the scientific and clinical literature that supports modern addiction psychiatry practice.
  3. Research skills in addiction psychiatry: Residents will be taught how to critically review the scientific literature, how to utilize basic research assessment instruments and will assist in the implementation of research protocols.  Advanced Interprofessional Fellows will select a mentor who will guide their career development and assist them in the implementation of a specialized clinical, management, educational or research project that can be completed during the two year course of their training.  Under the guidance of senior addiction faculty, they will be expected to prepare scholarly reviews, and develop and implement a research protocol, including data analysis and manuscript preparation.  These experiences will serve as the foundation for a leadership career in the addictions field.
  4. Teaching skills in addiction psychiatry: Under the supervision of program faculty, trainees will participate in the training and supervision of medical students, junior residents, physician assistants, and other professionals.  Trainees will be expected to prepare and conduct academic seminars and journal club meetings, including the preparation of bibliographies and scientific presentations.

 

TRAINING SITES

Trainees are exposed to a broad range of experiences through rotations at several Boston area facilities.

BOSTON UNIVERSITY MEDICAL CENTER:

Boston University Medical Center (BUMC), one of the major clinical, research and teaching institutions in New England, is located 3 miles from the primary training site at the Boston VA Outpatient Clinic.  It was formed in 1996 by the merger of Boston City Hospital and University Hospital.  As the primary teaching institution of Boston University School of Medicine, it has extensive experience treating minority and disadvantaged populations, many of whom have substance use disorders. Seventy percent of BUMC patients are low-income families, elders, people with disabilities, minorities, and immigrants, 150,000 patients have Medicaid, subsidized insurance, or no insurance, 30% do not speak English as a first language, and 65% are Boston residents, concentrated in neighborhoods with the greatest level of health disparities. BUMC has 496 active beds.  BUMC is the primary medical backup for an affiliated group of 10 neighborhood Health Centers that service the community.  Several Health Centers operate outpatient substance use disorder counseling programs on site.  At BUMC, fellows will rotate through a range of services, under the supervision of Dr. Tae Woo (Ted) )Park,  a graduate of the psychiatry residency and addiction psychiatry fellowship at the University of Pittsburgh and the Boston VA Interprofessional Advanced Fellowship in Addiction Treatment. Primarily, fellows will rotate through the following programs: 1) Inpatient Addiction Medicine Consult Service provides addiction consultation services to all inpatient medical and surgical units at BUMC,  2) CATALYST clinic provides addiction outpatient services for adolescents and young adults, and 3) Faster Paths program rapidly links patients from the ED to inpatient and outpatient treatment services, detoxification, and follow-up care. Additionally, addiction journal club and addiction case conferences are held on a monthly basis with addiction medicine trainees and faculty at BUMC.

VA BOSTON HEALTHCARE SYSTEM:

The VA Boston Healthcare System is the primary tertiary care referral center for five New England states, as well as a large primary care system that serves eastern Massachusetts. VA Boston comprises three main campuses, Jamaica Plain, West Roxbury and Brockton plus six community-based outpatient clinics (CBOC), including the Causeway Street Clinic.  The 438 bed West Roxbury Campus is the site for the acute inpatient Medical, Surgical, Neurological and Rehabilitation Services.  Acute Psychiatry, a Spinal Cord Injury Rehabilitation Program, an inpatient hospice program, a transitional care unit, nursing home unit and specialized substance abuse programs reside within the 375 bed inpatient beds and outpatient facilities at the Brockton Campus.  Training programs are overseen by a Dean’s Committee co-chaired by the deans of Harvard Medical School and BUSM.  VA Boston is one of the primary training affiliates of the BUSM Department of Psychiatry and is the sponsor for the Harvard South Shore Psychiatry Residency Training Program.

 

CAUSEWAY STREET COMMUNITY-BASED OUTPATIENT CLINIC

Affiliated with the VA Boston Healthcare System is the Causeway Street CBOC, a freestanding facility located in downtown Boston, approximately 6 miles from the Jamaica Plain Campus.  The CBOC provides primary care services along with psychiatric and subspecialty care for patients with substance use disorders. The Causeway Psychiatry Clinic is one of the largest in the VA system and includes a Substance Abuse Treatment Program (SATP) with over 25,000 visits per year and over 1,600 patients seen in treatment each year.  John Renner, M.D., Director of the BU Addiction Psychiatry Residency Training Program is based at this site.   Dr. Renner is Professor of Psychiatry at Boston University,  Associate Chief of Psychiatry at the VA Boston Healthcare System, and Director of Mental Health Services/Chief of the Substance Abuse Treatment Program at the Causeway Street CBOC.  He has a national reputation in addiction psychiatry, was former chair (and is currently vice-chair) of the Council on Addiction Psychiatry of the American Psychiatric Association and is President of the American Academy of Addiction Psychiatry.  The Causeway Street SATP includes two major units, the Dual Diagnosis Clinic which primarily treats patients with a wide range of substance use disorders and co-occurring psychiatric disorders and the Drug Dependence Treatment Center, which provides methadone treatment services for 160 veterans with opiate use disorder.  Methadone treatment patients range in age from 27 to 76; over 50% are positive for Hepatitis C, but less than 3% are HIV positive. The SATP also provides office-based buprenorphine treatment for approximately 130 veterans, and an intensive dual diagnosis long-term rehabilitation program that follows approximately 150 patients.  The SATP is the primary addiction psychiatry training site for PGY III general psychiatry residents from the Boston University Medical Center Program.  In addition, the SATP serves as an elective addiction rotation site for the Harvard South Shore General Psychiatry Residency Training Program.  It is also the site for the Addiction Medicine elective clerkship for BUSM students.  Other trainees involved in the SATP are physician assistant trainees from the Massachusetts College of Pharmacy and Health Sciences.  Diagnostic groups treated at the OPC include substance abuse (40%), psychosis (40%), anxiety disorders (30%), depression (20%), and organic brain disorders (5%).  Patients are 95% male, 80% white, 15% black, and 5% Hispanic.  Treatment approaches utilized in the SATP include individual and group psychotherapy, motivational enhancement therapy, cognitive behavioral therapy (primarily relapse prevention approaches and the “seeking safety” protocol), and medication-assisted addiction treatment, including office-based buprenorphine treatment, methadone maintenance, extended-release naltrexone treatment and disulfiram, and pharmacotherapy for co-occurring psychiatric disorders.  Faculty include 2 full-time and 2 part-time board certified psychiatrists with subspecialty certification in addiction psychiatry, 1 other part-time board certified psychiatrist, 2 psychologists, 5 social workers and 4 nurse clinicians. Addiction residents receive 1 to 2 hours per week individual supervision, and 1 to 2 hours seminars and case conferences per week.  All addiction psychiatry residents spend 8 weeks full-time at the SATP and then continue 8 hours per week for the duration of their residency in order to follow patients for long-term outpatient care.

WEST ROXBURY CAMPUS

Under the direction of Grace Chang, MD, the Associate Director of our Addiction Psychiatry Residency, the fellows rotate through the Psychiatry Consultation-Liaison (C/L) Service and the emergency department which are located at the West Roxbury Campus.  Dr. Chang is Professor of Psychiatry at Harvard Medical School and an internationally renowned expert on the treatment of pregnant women with substance use disorders.  Patients seen in the VA Boston Healthcare System have a full range of medical, surgical, psychiatric and substance use disorders.  The population is 85% male and ranges in age from 18 to 90.  The average age for all patients is 58.4 years.  Patients requiring complicated medical management are admitted to the medical service for detoxification.

AFFILIATED SITES:

BRIGHAM AND WOMEN’S HOSPITAL

Each fellow will spend approximated 20 hours per week for 12 weeks on the Consultation-Liaison Service for Brigham and Woman’s Hospital (BWH), Division of Medical Psychiatry in the Department of Psychiatry.  BWH is an internationally known teaching hospital, an affiliate of the Partners Health Care System and a core teaching institution of Harvard Medical School.  Trainees work under the supervision of Joji Suzuki MD, a graduate of our addiction psychiatry residency and the Director of the BWH Division of Addiction Psychiatry. Claudia Rodriguez MD, another graduate of our addiction psychiatry residency, also provides supervision. The Division of Medical Psychiatry provides addiction consultation services to all inpatient medical units including the emergency room, ICUs, burn-trauma, orthopedics, obstetrics, and a variety of outpatient clinics including primary care, and acts as the primary addiction education service for BWH staff.  BWH treats a mixed patient population, including 55% minorities and 40% women.  The Division of Medical Psychiatry consults on 800-900 addiction patients per year. Residents gain experience in managing acute medical illnesses complicated by substance use disorders. In particular, residents gain considerable experience managing acute pain, and buprenorphine inductions in hospitalized patients. Residents also obtain a supervised experience learning motivational interviewing from Dr. Suzuki, a member of the Motivational Interviewing Network of Trainers. Supervision is provided by two psychiatrist board certified in addiction psychiatry and board-certified psychosomatic medicine attendings on the C/L Service. Residents are formally assigned to supervise PGY1 residents from the BWH Psychiatry Program, HMS 3rd year psychiatry clerks, and HMS 4th year students in their addiction elective.

 

EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL, BEDFORD, MA

BOSTON PUBLIC HEALTH COMMISSION (BPHC)

Fellows will spend 4 hours a week at the Behavioral Health Services (BHS) Division’s outpatient psychiatry clinic at BPHC throughout the full year of the fellowship as a continuity outpatient experience. The mission of the BHS is to improve and sustain the quality of life for people of the City of Boston with co-occurring mental health and substance use disorders. The BHS provides high quality, evidence based, best practice treatment to meet the needs of these individuals who come to us with a myriad of mental, emotional, social, physical, family, legal, housing and financial challenges. To meet this mission, BHS has built a continuum of treatment services upon a philosophy that recovery from mental health and substance use disorders requires a biologic and social multi-dimensional approach. These services are designed with sensitivity and use specific expertise to meet the cultural, racial, ethnic and linguistic minorities’ needs of women, pregnant women, homeless and lesbian, gay, bisexual and trans-gendered people (LGBT). All services are available to Boston residents, regardless of ability to pay. Specifically, fellows will be providing psychopharmacology services for BHS patients, the majority of whom are receiving methadone maintenance treatment at one of the local methadone clinics. Currently, there are 90 patients being managed primarily by fellows and supervised by Dr. Tae Woo Park, MD (qualifications above under BUMC).

SCHOLARLY ACTIVITY

This is a major priority of the Addiction Psychiatry Residency and the Interprofessional Advanced Fellowship Program.  Trainees who elect the 2 year advanced fellowship program may elect to spend a majority of their time doing research.  They may elect either a basic science, quality improvement or a clinical research experience.  All fellows are encouraged to review the literature and research topics of interest.  They are expected to conduct training seminars for junior residents several times a year.  Selected residents may also elect a combined Addiction Psychiatry Residency – Master’s Degree program at the Boston University School of Public Health.  One tuition reimbursed position is available annually in the BU School of Public Health for the Boston University Medical Center Psychiatry Residency Training Program.  Trainees are also eligible to attend courses sponsored by the Division on Addictions at Harvard Medical School and educational meetings organized by the Interest Group on Alcoholism and the Addictions of the Massachusetts Psychiatric Society.  The VA also provides up to $850 dollars per year for educational tuition and travel reimbursement for Addiction Psychiatry Residents.  For further information on fellowship benefits please consult the BMC website www.bmc.org/gme/housestaff/benefits.htm . VA funding is also available to support research activities for PGY VI residents or fellows who elect the 2 year program.

NIGHT CALL

There is no required night call for Addiction Residents or Interprofessional Advanced Fellows.  Residents and fellows will be paid for elective night call at BMC during their addiction training.  These night call options are subject to the RRC mandated 80-hour work week limit, and must be approved by the training program director.  Trainees are also allowed to moonlight at other sites with approval of the training program director.

For more information about the Addiction Psychiatry Residency please contact:

John A. Renner, MD
Director, Addiction Psychiatry Fellowship Program
VA-Outpatient Clinic
251 Causeway Street
Boston, MA 02114

Telephone:  617-248-1022
FAX:          617-248-1121
e-mail:        john.renner@va.gov

 

Daisy Perez, MPH
Program Coordinator, Addiction Psychiatry Fellowship Program
Boston Medical Center
Department of Psychiatry
720 Harrison Avenue, 9th Floor
Boston, MA 02118

Telephone:  617-414-1985
FAX:          617-638-8535
e-mail:        daisy.perez@bmc.org