Rotations PGY 2
|Dr. Solomon Carter Fuller ||
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 transfer from senior residents, through the clinic referral system, or may come from resident cases on other services such as Emergency Psychiatry or Consultation-Liaison. Residents receive weekly clinical supervision for psychopharmacology and case management and a weekly educational psychotherapy supervision. Twice monthly multidisciplinary team meetings provide additional oversight and ensures a diverse and 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.
Second year residents spend 12 weeks 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. In addition, residents have a 2 week night float experience as part of the West Roxbury rotation. These two rotations explore 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.
Two rotations, each 4 weeks in duration, are designed to prepare residents for new systems of care proposed in national healthcare and currently in design in Massachusetts, a leader in healthcare innovation. One rotation is located at West Roxbury VA campus and one at Bedford VA. Both rotations build upon an existing clinic with an established embedded psychiatrist as part of the primary care team to deliver immediate psychiatric intervention and follow-up to meet the full spectrum of clinical care. Residents are a member of the team working closely with the integrated psychiatrist to conduct consultations, psychiatric assessment, and treatment with planned follow-up as indicated.
Interprofessional Team Psychiatry–The Edith Nourse Rogers Memorial Hospital (Bedford VA) | This 4-week outpatient and outreach rotation is located at Bedford VA, a national leader in Telepsychiatry, an advanced tool used to expand clinical services to veterans away from the medical center, including 4 community colleges. Residents become certified in telepyschiatry and treat patients with this new technology. Residents also see new patients in walk-in clinic to establish care and see Geriatric outpatients. Residents participate in educational conferences, journal club case conference and interviewing seminars.
Residents have a 6 week rotation working in a variety of settings to learn geriatric psychiatry. Residents evaluate and treat 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, case conference, and case based teaching in addition to daily bedside supervision.
Adolescent Psychiatry Bournewood Hospital
Six weeks are spent working on the adolescent inpatient service and day hospital at Bournewood Hospital. The inpatient 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 attending child psychiatrists, includes diagnostic evaluation, psychotherapy, behavioral recommendations, pharmacotherapy, 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 across systems of care.
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 6 week 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 6 week rotation that includes 2 weeks of night float builds upon the first year rotation to further develop residents’ skills and knowledge in emergency psychiatry assessment, clinical management, 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, collaborating with the emergency medicine team and the patients other medical/psychiatric care providers, 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 was successfully 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 a 1 or 2 day follow-up period on 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.