PGY-1 Rotations

FIRST POSTGRADUATE YEAR

The psychiatry residents at Boston University Medical Center actively participate in intern orientation each year. Each new intern is assigned a resident “buddy” that becomes the point person for questions focused on the resident experience.

Orientation is focused on welcoming new psychiatry residents to Boston Medical Center and preparing them for the transition to residency. Boston Medical Center organizes a day long program for all incoming residents. Our program has a day of orientation for new residents to meet with the Program Director, Associate Program Director, Residency Administrator and staff, Chief Residents, and residents. Senior psychiatry residents coordinate various activities for new residents including information, facility tour, and social events.

Buddies: A current first year resident is assigned following the match as a buddy to the incoming residents. Contact information is shared prior to the official start date so that “buddies” can provide information about moving to Boston, recommended reading materials, and information regarding the internship year.

Rotation Sites: Boston Medical Center | Bedford VA | VA Boston Healthcare System | Bournewood Hospital

PSYCHIATRY ROTATIONS

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

First-year residents have two 4-week clinical experiences in inpatient psychiatry at the VA hospital in Bedford, MA. On the acute psychiatry ward, residents are responsible for clinical work and clinically-related presentations. Residents treat a variety of veterans with serious mental illness, PTSD, TBI, personality disorders, and treat many patients with co-occurring substance use disorders and psychiatric disorders. Supervision is provided daily and there are several educational sessions built into this rotation to ensure breadth and depth of exposure to topics in psychiatry. One of the unusual strengths of the Bedford VA is its strong and widespread network including inpatient and outpatient hospital services, community-based programs, groups, and various supported and structured housing options. It is a national leader in milieu therapy that serves as a core principal of inpatient clinical care. The clinical staff responsible for resident training takes an active interest in maintaining inpatient and a range of systems of care and the professional and personal interactions necessary to allow these facilities and resources to continue to adjust to a changing and growing population of veterans. This rotation provides an introduction not only to individual care in inpatient psychiatry and milieu therapy, but also exposure to network models of care and systems issues that are increasingly regarded as critical to medical training and clinical competence. An educational curriculum includes a lecture series in geriatric psychiatry and inpatient psychopharmacology, weekly journal club, ongoing supervised psychiatric interviewing, and case-based teaching in addition to daily bedside supervision.

Adult Inpatient Psychiatry-Bournewood Hospital

This rotation is one of the four inpatient psychiatry rotations offered during the first year that teaches residents to evaluate, diagnose, and treat complex psychiatrically ill patients. First year residents have one 4 week inpatient psychiatry rotation at this private psychiatric hospital located in Brookline (about 5 miles from the Boston University Medical Campus). As a private hospital with a varied patient population, both diagnostically and socioeconomically, residents experience the business side of psychiatry and prepare for learning how to negotiate the complex world of insurance. Advocacy skills to ensure the best care for patients are part of learning to negotiate with managed care companies. In addition, residents learn psychopharmacology for many psychiatric disorders including psychotic and mood disorders, as well as, the management of patients with dual diagnoses, substance use disorders, and personality disorders. Residents have the opportunity to be involved in court commitments for their patients, which is incredibly valuable. Educational seminars include a Chief Resident lecture series and daily supervision with attending psychiatrists.

Adult Inpatient Psychiatry – VA Boston, Brockton Brockton VA Hospital

First-year residents have four different clinical rotations in inpatient psychiatry. On the acute psychiatry ward at the VA in Brockton, MA, residents are responsible for clinical work and clinically-related presentations. Residents treat a variety of veterans with serious mental illness including psychotic disorders, mood disorders, PTSD, TBI, personality disorders, and co-occurring psychiatric and substance use disorders. Supervision is provided daily and an educational core is devoted to inpatient assessment, psychopharmacology, and psychotherapy working as members of a multi-disciplinary team. Brockton VA has a strong and widespread network including inpatient and outpatient hospital services, community-based programs, groups, and various supported and structured housing options. An interdisciplinary approach ensures an active interest in maintaining the systems and the professional and personal interactions that are necessary to adjust to a changing and growing population of veterans. The rotation provides education and training, not only to individual care in inpatient psychiatry, but exposure to network models of care and systems issues that are increasingly regarded as critical to medical training and clinical competence.

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 4 week rotation introduces first year residents to making triage decisions that determine the level of care most suitable for 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. Occasionally, first year residents will be working with second year residents and senior residents as well for additional supervision. This experience increases residents’ familiarity with disposition options that are available to our patients, the broad spectrum of services offered to patients at BMC, and opportunities for collaboration with social workers who are instrumental to the functioning of the emergency services out of the emergency department. Resident responsibilities include helping attending psychiatrists to manage the 8-bed, unlocked, dedicated psychiatric pod in the Emergency Department as well as conducting consults from the medical ED.

Swing/Night Float

This is a rotation where first-year residents get exposure to swing and overnight shifts at BMC Main Campus. Each first year is paired with a second or third year for two weeks of “swing shift” 1-10pm and then overnight shifts in the ED. During these shifts, first-year residents get exposure to managing the 8-bed psychiatry pod of the emergency department while triaging consults from inpatient units and answering pages to the on-call psychiatrist from the community. It is a busy one-month rotation, and the goal is to expose the interns to this level of independence and responsibility while still having a senior resident in order to prepare them for when they are alone in their second and third years.

BMC Brockton Inpatient Psychiatry-Boston Medical Center – BMC Brockton Behavioral Health Center

First-year residents have four different clinical rotations in inpatient psychiatry. On the acute psychiatry ward, residents are responsible for clinical work and clinically-related presentations. BMC Brockton Behavioral Health Center provides innovative care to people with substance use disorders and mental illness. The Center provides specialized, culturally competent care to patients in two acute inpatient psychiatric units and one clinical stabilization service, delivered by an expert team reflecting the makeup of the communities we serve. Patients in the Center are primarily referred from other providers, including Emergency Departments. Our psychiatric units serve patients aged 16 and up who pose an imminent risk to themselves or others. In addition, they can address co-occurring substance use disorder needs. The clinical stabilization service provides an important step-down role from detox or inpatient care, with extensive 24-hour care.

MEDICINE AND NEUROLOGY ROTATIONS

Internal Medicine-Boston Medical Center

First year residents rotate with Internal Medicine residents for two 4 week rotations. Psychiatry residents on medicine function as an Internal Medicine intern as part of a medical team composed of a fellow intern, senior resident, and attending to evaluate, diagnose, and treat patients with serious medical illnesses. This rotation provides residents learning opportunities to strengthen their skills in internal medicine serving as one of two interns on a typical medicine team. Learning experiences include new patient admission and evaluation, acute and chronic illness management, and patient disposition planning. While this is one of the more rigorous rotations of the first year, all would agree that it is extremely valuable in teaching you how to operate efficiently within large hospitals and helps residents to develop knowledge and skills in evaluation and treatment of complex medical illnesses. Additionally, this rotation is very useful in honing medical skills that are essential for all psychiatrists so that we can ensure timely intervention of our patients if acute medical intervention is needed.

Of note, residents on medicine have duty shifts of no longer than 16 hours.

Urgent care, Internal Medicine-VA Boston Healthcare System

Urgent care clinic is a busy internal medicine clinic that serves veterans who have urgent medical needs. Residents rotate for 4 weeks in Urgent care and are exposed to a variety of patient presentations of varying levels of acuity. Residents work closely with attendings, PAs, and NPs to evaluate, diagnose, and triage patients. They will also work to initiate treatment for a variety of medical illnesses that may range from serious illnesses, such as chest pain of cardiac origin, to less acute community illnesses such as influenza.

Neurology-Boston Medical Center

Residents have two 4 week rotations as part of the neurology team that includes second, third and fourth year neurology residents and the team attending. The neurology team consults with all services in the hospital – most commonly medicine, surgery, and the emergency department – and also provides treatment to admitted neurology patients. Residents see a wide range of neurological disorders including disorders of the central and peripheral nervous system and provide state of the art treatment. Psychiatry residents learn through rounds with bedside teaching and in a weekly formal lecture series and Neurology Grand Rounds. This rotation is essential to a strong neurology foundation, which is invaluable to psychiatrists.

PSYCHIATRY BUDDY CALL

First year residents have no overnight call. They take buddy calls, in which they are assigned to work with a senior resident who is on-call and learn about the responsibilities of being on-call before they start to take independent call shifts in their second year. Under direct supervision and guidance of upper class residents, first year residents see patients, learn about the range of treatment options, and implement the best treatment for the patient in the Emergency Department or on the Consultation-Liaison service. These buddy call shifts usually take place in the last few months of the intern year.