Introduction

With the transition to the second year of training comes the expectation that our residents will begin to express their developing skills and competencies more independently, not only in more traditional hospital-based settings, but in community-based settings such as health centers and schools.

We continue to provide an experiential teaching model where senior staff are present on-site at all times and are available to jointly see patients and families with our residents. But residents also progress to spending more time seeing their patients and families independently.

The second year of residency training is designed to build in breadth and depth upon the core skills and competencies that our residents began developing during their first year of training and to allow them to pursue specific areas of their own personal interest.

Our seminars, supervision and clinical rotations are all structured and integrated to accomplish these goals - by the end of the second year our residents feel prepared to enter the field of child and adolescent psychiatry in the particular areas of their choosing.

The mentorship that we provide from the very beginning of the two-year residency plays a critical role all along in facilitating each resident's continued professional development and their transition to practice and other career choices.

Rotations

The core clinical experiences of the second year are a twelve-month hospital-based outpatient psychiatry experience, a six-month community-based experience and a three-month family court forensic experience.

In the Outpatient Psychiatry Service, residents increase their clinical time from one to three half-day clinics per week. The second year outpatient experience builds upon their developing skills of assessment, psychotherapy and pharmacotherapy, refining these skills through the experience of working with a wider range of outpatients. The resident can select to have one of these clinics be in an outpatient specialty area such as Medical Coping, Mood Disorders, Latino or other.

The supervisory structure for this expanded outpatient experience is the same as that for the first year, with the distinction that more than one attending of the day and more than one outside therapy advisor will be involved in the teaching and supervision of each resident.

During the course of the second year, each resident will also participate in at least one 15-week group therapy as a co-facilitator with a senior staff social worker. Residents may also elect to do more that one group therapy experience at their own discretion.

Children's Hospital Neighborhood Partnerships (CHNP)

In addition to the hospital-based general outpatient psychiatry experience, all second-year residents will have a six-month rotation working in Children's Hospital Neighborhood Partnerships (CHNP) as part of a community child psychiatry experience.

Again the same type of on-site supervision that follows the precepting attending of the day model is provided, so that residents can see and discuss patients jointly with the on-site clinic attending. Since we have a number of community-based settings to offer as training sites in CHNP, residents may choose a site based on their interests and inclinations to work with a particular population.

Cambridge Family Court

The Cambridge Family Court affords our residents the opportunity to learn under supervision the skills needed to function as a consultant to the legal system around matters related to the mental health needs and best interests of children who find themselves in the midst of domestic disputes such as custody and visitation battles.

Elective time

During the entire course of the second year of training, residents will have between eight to 12 hours/week of elective time to pursue any particular areas of clinical, research or administrative interest that they may have. Any of the clinical training programs and sites previously described may serve as a venue for residents to pursue their interests.

In addition, an updated list of other clinical programs within and outside the Department of Psychiatry, as well as research projects in the Center for Behavioral Science, is provided to and discussed with residents so that they are aware of the range of opportunities open to them.

In the spring of each year we also set aside time in our weekly residents' meetings so that our second year residents can give feedback to their first year colleagues concerning what they have been doing with their elective time and what their experiences have been in this regard.

Throughout both years of training, residents take emergency calls, providing acute care for patients presenting with psychiatric emergencies in multiple hospital contexts.