Rotations PGY 3
Third Postgraduate Year
Outpatient Adult Psychiatry Boston Medical Center
Residents continue the second year outpatient clinic and expand the rotation to include evaluation of new patients and the addition of more patients for year-long (or more) treatment. Some residents have a supervised group therapy experience at BMC while others will have this experience at Boston VA Outpatient Clinic. This training experience is a 12 month clinic where residents provide long-term care for patients using both psychotherapy (individual and group) and psychopharmacological treatments. Residents meet weekly for clinic supervision for psychopharmacology and case management and as part of their core education receive 1-2 hours of weekly educational psychotherapy supervision. A weekly multidisciplinary team meeting provides additional experience in being a psychiatrist member of the team, provides additional attending 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 expanded outpatient psychiatric clinic residency allows excellent continuity of patient care with a highly diverse patient population. Residents continue with patients from the second year clinic and a cohort from this expanded third year training clinic will be treated by residents through the fourth year of training, providing long-term patient care for patients with psychiatric disorders with or without co-occurring substance use disorders.
Outpatient Clinic (Addiction and Dual Diagnosis Psychiatry Clinic, Schizophrenia Clinic, and Cognitive-Behavioral Therapy Clinic)- VA Boston Healthcare System
The rotations at the VA Boston Healthcare include year-long Outpatient training experience at the Boston VA Outpatient clinic in the historic North End, renowned for its culinary experiences and a 6 month CBT rotation on the Jamaica Plain campus.
In the Outpatient Clinic residents rotate for 2-2.5 days with core curriculum seminars in Addiction and Dual Diagnosis Psychiatry, and specialized treatments including Motivation Interviewing Therapy for people who suffer from addiction and Seeking Safety for patient with PTSD and substance use disorders, and relapse prevention. All seminars are in the morning to ensure residents capacity to attend while meeting all duty hour requirements. Residents learn Addiction Psychiatry from John Renner MD, a national leader in Addiction Psychiatry and the Program Director of the Boston University Medical Center Addiction Psychiatry Fellowship. Residents evaluate and treat veterans with psychiatric illness who suffer from substance abuse or dependence and a psychiatric disorder. Treatment approaches for this population are psychopharmacological management including buprenorphine with FDA approved training for all residents by Dr. Renner. Residents with a full license to practice medicine and the required state and federal drug licenses are able to treat patients with opioid addictions with Suboxone. Residents on a training license co-treat patients on Suboxone with their attending psychiatrist. Residents learn Motivation Interviewing/Motivational Enhancement Therapy for patients with substance use disorders and Seeking Safety for patients with PTSD and substance use disorders. These specialized evidence based treatments enhance residents’ skills for current treatment of complex patients. Residents continue to practice long-term treatments including supportive and dynamic therapies. All psychotherapy modalities are typically integrated with psychopharmacology to meet the patients’ full psychiatric needs. In addition, residents work with the Schizophrenia team learning the full spectrum of care including psychopharmacology and community care. Supervision includes a weekly one hour individual therapy as well as a case conference. Residents will continue to treat a selected cohort of clinic patients through the fourth year of training to provide a 2 year long-term treatment.
The Jamaica Plain CBT rotation is a 6 months that includes weekly morning didactics in a variety of CBT and DBT protocols with every afternoon in direct clinical care practicing CBT and DBT in individual and group therapy settings. Supervision is provided by psychiatrists and psychologists under the leadership of Barbara Kamholz, PhD, a national leader in CBT.
Outpatient Child Psychiatry- Boston Medical Center
This 6 month half-day/week rotation in Child Psychiatry complements the second year training in Adolescent Psychiatry. The focus in on children under 12 years of age and their families. The rotation begins each week with a didactic series on Child Psychiatry to educate residents in development, psychopathology, treatments, and family systems. Residents evaluate and treat children and families. Child and Adolescent Psychiatrists supervises this training experience and provided a didactic series in child development, psychopathology, and treatment of children and their families. Residents with an interest in Child and Adolescent Psychiatry have the opportunity to continue to treat a small number of children long-term, over 1 or 2 years depending on the time of entry into a Child and Adolescent Fellowship.
Call is a training experience where residents develop more independence while receiving indirect supervision for an experienced attending psychiatrist. Residents on call cover consultation-liaison and emergency services at Boston Medical Center or Boston VA Healthcare. Third year residents have on average call 36 times a year, 12 weekend days, and 24 weekdays or minor holidays. Weekend calls are a 24 hour shift, beginning at 8 AM. Weekday calls begin at 6 PM and end at 8 AM. Residents at this level are permitted to attend morning educational activities when post-call but not to conduct patient care. In total residents have 72 total shifts (night float or call) over the course of the 2nd and 3rd year with no call in the first or last year of training.