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, 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. 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.
Second year residents spend 8 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. 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.
Addictions Psychiatry–The Edith Nourse Rogers Memorial Hospital (Bedford VA) | VA Boston Healthcare System
Residents spend 4 weeks rotating at the Veterans Mental Health and Addictions Program. The program is a multi-level dual diagnosis drug and alcohol addiction treatment program that offers a combination of evidence-based medication management and psychotherapies including motivational interviewing, trauma counseling, cognitive behavioral therapy, and 12-step treatment. Our residents typically rotate in the more intensive outpatient and partial hospitalization levels of care.
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 areas 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.
Geriatric Psychiatry and Neuromodulation-Brockton VA
Residents have a 4 week rotation working as part of a geriatric team to conduct assessments and treatment on an inpatient psychiatric unit and in residential care. The goals of the rotation are to obtain advanced educational experiences in assessment, diagnosis, and treatment of geriatric patients with acute and chronic psychiatric disorders across multiple setting. The resident will also spent time as part of the neuromodulation team to learn about the appropriate indications for ECT, Ketamine, and Esketamine and somatic treatments.
Adolescent Psychiatry Bournewood Hospital
Four 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.
For six weeks, residents spend 3 days weekly at the Cambridge Court and one day weekly on the forensic unit at the state hospital in Worcester. Residents will conduct both inpatient and outpatient court-ordered forensic psychiatric evaluations to understand the intersections between the legal system, mental illness, and psychiatric care. Residents will participate in the preparation of reports and affidavits, attend court, witness testimony when appropriate. The state hospital inpatient unit is a unique opportunity to observe long-term response to severe and chronic mental illness due to frequent long stays.
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 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. Second year residents in the emergency department take additional responsibility in managing the service and covering the consultation service in the early evening. Once weekly, second year residents have the opportunity to ride along to community crisis evaluations and with our mental health collaboration with local law enforcement
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 two at Boston Medical Center. Night float constitutes the bulk of the PGY2 “call” requirement. Residents on night float have the support of masters level clinicians to assess patients in the emergency room setting and staff cases that arise on the consultation liaison service and in the emergency room with a supervising attending by telephone. Residents receive robust training through buddy calls and a bootcamp in the latter half of their first year of residency to ensure that they feel comfortable entering nightfloat and call in their second year. BMC evening nightfloat is scheduled for 6 days a week with one day off.
The non-nightfloat “call” is comprised of Saturday and Sunday (and some holiday) days covering BMC psych emergency room and consultation service OR the West Roxbury VA consult service. These shifts are 8 AM – 8 PM.