Department of Psychiatry Residency Program - Year One

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It is a universal challenge in medical education that residents are first exposed to patients with the most complex problems and greatest needs when they themselves are the least experienced in terms of their own professional development. Realizing this, we have structured our two-year program to provide a graded learning experience for our residents that is built upon direct, readily available supervision and role modeling.  The program is designed to provide timely, relevant instruction and supervision around the fundamentals of child psychiatry that are responsive to the residents’ growth as developing professionals, and acknowledges the challenges of entering a new field. 

The organization and structure of our clinical rotations and our experiential approach to clinical supervision lend themselves to a flexible approach across our training sites.  This allows us to provide intense, hands-on supervision when and where it is needed, taking full advantage of critical teaching moments, as well as flexing to allow increasing autonomy as each resident demonstrates their emerging competencies.  In addition, upon entry to our program, each new resident is assigned a faculty mentor who remains with that resident for the full two-years of training. The primary responsibility of mentors is to guide residents in the process of professional self-awareness and self-discovery as they are exposed over time to the training experiences we offer in our program. 

The first year of training is designed to provide our residents with the core clinical skills of assessment and intervention that are crucial to all clinical settings from the psychiatric inpatient unit and medical consultation service, to the outpatient clinic and emergency department.  In each context, developing proficiency in case formulation and treatment planning are the core skills that inform all their work. The clinical rotations are integrated with didactic and supervisory experiences to ensure that relevant medical knowledge is imparted in a timely fashion. 

The first year is divided into three 4-month rotation blocks:  inpatient, outpatient and consultation psychiatry. In conjunction with these rotations, residents also participate in a 12-month continuity clinic, and in year-long didactic seminars.

Year I Outline  
4 months Psychiatry Inpatient Service
4 months Psychiatry Consultation Service
4 months Outpatient Specialty Clinics and School Consultation
12 months Outpatient Psychiatry Services (one afternoon)
Psychosocial Treatment Clinic - 3 hours/week
Psychopharmacology Clinic - 2 hours/week
12 months Core seminars
  • Psychiatry Inpatient Service (Bader 5): In this setting, our residents function as the primary clinician for two patients, and provide medication management for two additional patients. During this four-month rotation residents receive supervision from their team attendings and staff social workers, as well as from the medical director.  In keeping with our experiential model of training, attending staff, social work staff and residents routinely see patients and families jointly. Residents are expected to sign out their pagers to their attending when they are in clinic or in seminars, so they may pursue these protected activities without interruptions. A dedicated resource specialist is available to assist in planning for mental health care following discharge from the inpatient psychiatric service.
     
  • Psychiatry Consultation Service:  Working on the interface between psychiatry and pediatrics challenges the resident to refine his/her differential diagnostic skills and systems management skills, and to develop and implement comprehensive treatment plans in a non-psychiatric milieu.  During this four-month rotation the resident works closely with the consultation attending to evaluate and follow patients during their medical hospitalization. Here again, residents are expected to sign out their pagers to their attending when they are in clinic or in seminars, so they may pursue these activities without interruptions. A dedicated resource specialist is available to assist in planning for mental health care following discharge from the medical service. 
     
  • Throughout the course of the first year, residents maintain a continuity clinic in the Outpatient Psychiatry Services one afternoon each week.  This clinic is devoted to assessment, and ongoing psychotherapy and psycho-pharmacotherapy.  The clinic is supervised by onsite precepting attendings, who see patients jointly with residents and who review each day’s work with the resident. In addition each resident is assigned a therapy advisor and a psychopharmacology supervisor who review ongoing treatment cases individually with the resident as part of the educational experience, in a more traditional supervisory format.
     
  • In addition to this 12-month continuity clinic, for four months during the first year residents perform their primary clinical duties and training in a variety of outpatient settings. These include one afternoon each week in (child) Neurology clinic, one morning each week in the Developmental Medicine Center, and 2 half-days each week in the Adolescent Substance Abuse Program.
     
  • During this rotation, residents also frequent a local Head Start center and a Boston Public School one afternoon each week. The Head Start experience is intended to help residents become more familiar with typically-developing pre-school aged children, to become comfortable interacting with them, and to see how children function in a normative, community setting with educators and their peers. The public school experience combines these same normative observation experiences across a wider age range of typically developing children from kindergarten through middle school, with the added opportunity to provide clinical consultations in the school setting. 
     
  • Throughout both years of training,  fellows take emergency call on average every 10th night/weekend day, providing acute care for patients presenting with psychiatric emergencies in multiple hospital contexts, including the emergency department, the inpatient psychiatry unit, and the general medical floors. Emergency evaluations and treatment are core skills for the child and adolescent psychiatrist. We provide a progressive, structured and supervised set of experiences to ensure the development of these critical abilities. Beginning with a gradual phase-in involving shadow calls and seminars during the summer of the first year of training, and continuing with ongoing case teaching, our fellows have the support and structure needed to master the challenges they face when providing emergency psychiatric care. All call is taken from home, except for morning CL rounds on the medical floors on weekends and holidays. On-call attending staff cover rounds on the inpatient psychiatry unit and review all new and follow up cases seen by the fellows. Attendings are available to jointly see cases when indicated and to directly assist fellows when the volume of calls is high. A resource specialist works the busiest 20 hours of the Saturday and Sunday call, in order to assist the fellows with any disposition work. 

Residency Program - Year Two

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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