Child and Adolescent Psychiatry Residency Training Program

Introduction

It is a common challenge for 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, highly-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 yet 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 those critical teaching moments, as well as flexing to allow increasing autonomy as each resident demonstrates their emerging competencies.

Mentors

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.

Core skills

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 form the psychiatric inpatient unit and medical consultation service, to the outpatient clinic and emergency department.

In each context, developing excellence in case formulation and treatment planning are the core concepts that inform all their work. The clinical rotations are integrated with the didactic and supervisory experiences to ensure that relevant medical knowledge is imparted in a timely fashion.

Rotations

The first year is divided into three four-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.

In this setting our residents function as the primary clinician for two patients, and provide medication management for two additional cases. 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.

Pediatric 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-of- the-day to evaluate and then 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 Service one afternoon each week. This clinic is devoted to assessment, and ongoing psychotherapy and psychopharmacology. The clinic is supervised by an onsite attending-of-the-day, who jointly sees patients with residents and reviews each day's work with the resident.

Each resident is also assigned a therapy advisor who reviews ongoing cases individually with the resident as part of the educational experience, but in a more traditional supervisory format.

Outpatient settings

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 an expanded clinic with an additional afternoon each week in Outpatient Psychiatry, one afternoon each week in (child) Neurology clinic, one morning each week in the Developmental Medicine Center, and two half-days each week in the Adolescent Substance Abuse Program.

During this rotation, residents also frequent a local Head Start center one afternoon each week. This experience does not involve the provision of clinical services. Instead it is intended to help residents become more familiar with a range of typically developing children, to become comfortable interacting with them, and to see how children function in a normative, community setting with educators and their peers.

Emergency calls

Throughout both years of training residents take emergency calls, providing acute care for patients presenting with psychiatric emergencies in multiple hospital contexts, including the emergency department, the inpatient psychiatry unit and the general hospital.

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 clinical phase-in involving shadow calls and seminars during the summer of the first year of training, and continuing with ongoing case teaching, the residents have the support and structure needed to master the challenges they face when providing emergency psychiatric care.