Boston University Medical Campus
Psychiatry

Second Postgraduate Year

Outpatient Clinic-Boston Medical Center

Second year residents begin their 3 year training in the treatment of outpatient patients at Boston Medical Center Outpatient Clinic.  This training experience is a 1/2 day clinic where residents provide long-term care for patients using both psychotherapy and psychopharmacological treatments.   Patients may transferred from senior residents as well as referred through the clinic referral system or may come resident cases on other services such as Emergency Psychiatry or Consultation-Liaison. Residents receive a weekly clinic group  supervision (2-3 residents) for psychopharmacology and case management and a weekly  educational psychotherapy supervisor. A twice monthly team multidisciplinary team meeting provides additional oversight and ensures a diverse an active caseload for residents to begin the learning of two important and integrated components of psychiatric treatment and professional identity.  The major strength of starting outpatient psychiatric clinic the second year of residency is that it allows excellent continuity of patient care with a highly diverse patient population.

Consultation-Liaison Psychiatry Boston Medical Center | VA Boston Healthcare System
Second year residents will spend 4 months (including night float rotations) learning psychosomatic medicine while rotating on the Psychiatry Consultation and Liaison Service at Boston Medical Center and at the West Roxbury VA.,campus of VA Boston Healthcare System. This rotation explores the connection between psychiatric and medical illnesses, as well as, emphasizing the integration between the Consultation and Liaison team and other medical services. Residents learn to assist other medical providers in helping patients with acute issues such as delirium, agitation,  psychosis, detoxification, and withdrawal syndromes. In addition, residents learn approaches to complex patients and  help manage patients with new medical diagnoses and adjustment disorders, as well as, chronic disorders like dementia, depression, chronic pain, and end of life care. During this rotation, residents work closely with attending psychiatrists, psychosomatic medicine fellows, medical students, and, at times, neurology residents.  A lecture series and participating in case conferences add to the training experience. The psychosomatic rotation also provides residents with an opportunity to teach medical students with a focus on developing both interview and diagnostic skills.

Adolescent Psychiatry Bournewood Hospital
One and a half months are spent working on the adolescent inpatient service and day hospital. The in-patient unit has a census of 14 with the day hospital census varying.  The patient population comprises adolescents with a range of psychopathology including psychotic disorders, mood disorders, and anxiety disorders.  While most patients live in the community with their families, some live in residential programs, foster care, or are in state custody.  The resident caseload is typically 3-5 patients.  The clinical work of the resident, supervised by an attending child psychiatrist, includes diagnostic evaluation, pharmacotherapy, psychotherapy, behavioral recommendations, family interventions, and systems meetings. The multidisciplinary team, which meets daily during rounds, includes staff from nursing, social work, and occupational therapy. Residents work with adolescent in inpatient setting and in the day hospital program, having the opportunity to work in systems of care.

Adult Inpatient Psychiatry-The Edith Nourse Rogers Memorial Hospital (Bedford VA)

Residents have a 1.5-month rotation to expand their knowledge and skills additional learning of inpatient psychiatry. Residents have greater leadership in multidisciplinary team approaches and work with first year residents taking on the role of supervising the weekly conference series for the service. Residents are responsible for clinical assessment and treatment veterans with serious mental illness, PTSD, TBI, personality disorders, and dual diagnosis disorders.  Supervision is provided daily and an educational core is devoted to geriatric psychiatry and inpatient psychopharmacology.  An educational curriculum includes a lecture series in geriatric psychiatry and inpatient psychopharmacology, journal club, psychiatric interviewing, and case based teaching in addition to daily bedside supervision.

Geriatric Psychiatry-The Edith Nourse Rogers Memorial Hospital (Bedford VA)

Residents have a 1.5-month rotation working in a variety of settings to learn geriatric psychiatry. Residents evaluate and treatment geriatric veterans as part of a multidisciplinary team on medical units and in the extensive nursing home system located on the medical center campus. Residents have a once a week training experience on the Geriatric Research and Education Clinical Center (GRECC) to learn about the treatment approaches for moderate to severe dementia. Other disorders common in this patient population include delirium, major depression, anxiety disorders, PTSD, bipolar disorder and psychotic disorders. Supervision is provided daily and an educational core is devoted to geriatric psychiatry and inpatient psychopharmacology. Second-year residents work with first year residents supervising the weekly conference series for the service. This rotation develops knowledge and skills to the geriatric patient and provides exposure to network models of care and systems issues that are increasingly regarded as critical to medical training and clinical competence in geriatric care. An educational curriculum includes a lecture series in geriatric psychiatry and inpatient psychopharmacology, journal club, psychiatric interviewing, and case based teaching in addition to daily bedside supervision.

Forensic and Community Psychiatry--Dr. Solomon Carter Fuller Mental Health Center Dr. Solomon Carter Fuller

Dr. Solomon Carter Fuller Mental Health Center located on the Boston University Medical Center campus and has 3 units with a focus on treatment of the severely mentally ill and on providing forensic services for the Commonwealth of Massachusetts. It is one of the core rotations for the second year residents providing both educational and clinical experiences in forensic psychiatry and care of the seriously mentally ill. This 1.5 month rotation offers frequent opportunities to observe court proceedings and formal competency evaluations, and to participate in commitment and guardianship filings.  Because of the long stays of many patients, the site also offers an unusual chance to observe the long-term response of schizophrenic and other illnesses to gradual introduction and consistent maintenance of medication, as well as to the secure social structure and material safety that has often been lacking for many patients before their arrival.  Treatment is based on a team approach, with practitioners in several disciplines participating actively in ward activities and regular rounds. Exposure to these broadly collaborative teams, to many of the complex areas in which psychiatry overlaps with the law, and to the challenges and possibilities of long-term psychiatric treatment and community management make the second-year rotation at the Dr. Solomon Carter Fuller Mental Health Center a valuable introduction to the field of forensic psychiatry.

BEST Emergency Psychiatry Boston Medical Center
The Boston Emergency Service Team (BEST) is a fully staffed 24 hour emergency psychiatry team that serves Boston and areas in Greater Boston. The Psychiatric Emergency Service at Boston Medical Center is the center of BEST where the residents in consultation with experienced emergency psychiatrists evaluate and make treatment decisions for patients at times of crisis. This  2 month rotation that includes 2 weeks of night float, teaches residents how to make clinical and triage decisions that determine the level of care most suitable for a patients.  Decisions about the appropriate level of care, interacting with patients and their families, and advocating for patients with insurance companies and patient care settings are invaluable training experiences that prepare residents for the full practice of psychiatry in today’s complex system of psychiatric care in the community.

Night Float Boston Medical Center | VA Boston Healthcare System
Night float is a new rotation implemented in July, 2011 to meet new duty hour regulations without disrupting the education and training experiences of the traditional PGY-2 rotations. Night float is a 2-week training experience that occurs 3 times during the year. One night float is embedded in the core Consultation-Liaison rotation at West Roxbury VA and the other in the Emergency Psychiatry rotation at Boston Medical Center.  The remaining 2-week block is less closely linked to the Consultation-Liaison rotation with often a 1 or 2 day follow-up period on the day service. This design allows residents begin and end on the day service and are able to continue have continuity of care for some patients that are seen while on night float. The other service covered on night float are the emergency services at both training sites. Night float occurs on weekdays (M, T, W, Th) from 6 PM to 8 AM and Saturday and Sundays from 8 PM to 8 AM. Night float residents have all day Friday and Saturday day off. A day float for 3 weekends (S, S) as well as 1 or 2 holidays a year balances the coverage from 8 AM to 8 PM. Residents on day float round on Monday to receive teaching and follow-up care to patients seen on the consult service but have Tuesday off to refresh.