Rotations

Clinical Rotations

The goals of the first year of residency training are to provide a foundation in internal medicine and neurology and an introduction to the essentials of psychiatric practice through the supervised assessment and treatment of a diverse population of patients with psychiatric disorders. These experiences are aligned with the six core competencies and resident progress is monitored by the achievements on the milestones. Residents will gain experience in adult inpatient psychiatry, emergency psychiatry, neurology, addiction, geriatric psychiatry, and internal medicine. They will be supervised by attending physicians and senior residents on each rotation.

Inpatient Psychiatry
St. Elizabeth’s Medical Center has a 32 bed adult inpatient unit that is staffed by a multidisciplinary team of psychiatrists, social workers, nurses, occupational therapists, and mental health workers. The inpatient unit has three teams, each led by a supervising attending physician. Residents are assigned to a team for periods of approximately one month and participate in rounds with the attending on a daily basis. Spending time on more than one team over the course of the PGY1 and PGY2 years ensures a diverse experience. Residents supervise medical students and physician assistant students assigned to their team. The clinical population is very diverse with a wide variety of psychopathology including mania, depression, schizophrenia, anxiety, organic mental disorders, substance abuse and withdrawal states, suicidal or homicidal ideation, and personality disorders.

Geriatric Psychiatry
Residents are involved in evaluation and follow-up of patients as well as interacting with physicians from other departments. Residents have an opportunity to treat patients with dementia and learn to adjust treatment approaches to the needs of older patients. Residents are supervised by a geriatric psychiatrist.

Addiction
The St. Elizabeth’s Comprehensive Addiction Program (SECAP) provides inpatient detoxification, intensive outpatient services, medication assisted treatment, and other outpatient services to patients seeking treatment for addiction. The program is run by an addiction medicine specialist together with a team of nurses, social workers, and addiction counselors.  

Internal Medicine
Residents spend four months rotating through Internal Medicine during the PGY1 year. Residents follow the call schedule of an internal medicine intern during this time. One of the four months is devoted to emergency medicine and the other three months are spent on one of the wards. Supervision is provided by hospitalists and senior residents in Internal Medicine. The experience is similar to that of a medical intern and residents have the opportunity to perform procedures under the guidance of a senior physician.

Neurology
Residents spend two months rotating through Neurology during the PGY1 year. Residents provide neurological consultations for patients throughout the hospital. They attend didactic sessions in neurology including case conferences and neuroradiology seminars. Residents gain experience in working with patients with a variety of common neurological disorders. Residents are supervised by attending physicians as well as senior neurology residents from the Tufts neurology residency program. The department has faculty members with expertise in multiple sclerosis, stroke, and other common neurological disorders.

Night Float
The night float experience allows interns to work together with a senior resident to manage patients who present to the emergency department as well as new admissions to the inpatient units. The night float intern works from Sunday night through Thursday night with Friday and Saturday off (with some Sundays off as well). Online educational modules and opportunities to present patients to an attending physician ensure that there is an educational value to the experience.

 

PGY2

The goals of the second year are to build on the foundational capacities developed in the first year and to introduce more advance knowledge and modalities of treatment. The development of the six clinical competencies will be demonstrated by the completion of the goals and objectives of each clinical rotation. Residents will gain experience in adult inpatient psychiatry, emergency psychiatry, consultation/liaison psychiatry, and child/adolescent psychiatry.

Consult / Liaison Psychiatry
Residents provide consultations throughout the hospital and in the emergency department under the supervision of an attending physician. Residents provide services to all medical and surgical specialties within the hospital. They learn to fill the liaison role in their interactions with physicians and care managers and also learn about providing psychiatric treatment to medically ill patients. St. Elizabeth’s opened a new state of the art emergency department in June 2009. Residents provide emergency assessments, crisis intervention, and the initial treatment of patients presenting in the emergency department. This experience fulfills the emergency psychiatry requirement.

Child and Adolescent Psychiatry
Residents spend two months on the adolescent unit at Carney Hospital, a member of the Steward Hospital system located in the Dorchester neighborhood of Boston. Residents are involved in clinical interactions with patients and families. Residents are supervised by the medical director of the adolescent unit at Carney.

 

PGY3

The goal of this year is to introduce the residents to management of psychiatric disorders in the outpatient setting and managing these disorders through supervision with their advisors.  These experiences are aligned with lectures introducing the various schools of psychotherapeutic thought and subsequent treatment modalities and an advanced psychopharmacologic curriculum. As the residents progress through the year, they will move towards mastering the areas of psychiatric assessment, formulation and treatment.  Special treatment experiences such as group therapy, forensic psychiatry and a child and adolescent continuity clinic are included to broaden the resident’s experience. The development of the six clinical competencies will be demonstrated by the completion of the goals and objectives of each clinical rotation and progression with the milestones.

Outpatient Psychiatry
Residents spend their PGY3 year seeing patients in the outpatient clinic. They see a small panel of weekly psychotherapy patients, a larger panel of psychopharmacology patients, and perform intakes for new patients. Each PGY3 and PGY4 resident has a private office in the clinic. PGY3 residents have weekly individual supervision in psychodynamic psychotherapy and cognitive behavioral therapy. Psychopharmacology supervision is provided at the end of each patient visit.

 

PGY4

The goals of this year are those of mastery and depth. The senior resident will continue to build on the skills acquired over the past 3 years to attain competency and practice as an independent psychiatrist in the community in whatever chosen career path. The PGY-IV residents have the opportunity to advance their expertise in a psychiatric subspecialty of interest through a freely chosen elective. By the end of this year they will have completed their chosen scholarly activity project.

Outpatient Psychiatry
Residents continue to see patients in the outpatient clinic throughout the entire PGY4 year. At the same time, they gain experience in forensic psychiatry, community psychiatry, ECT, and the partial hospital program. Residents may also pursue a junior attending experience on the inpatient unit or consult service. PGY4 residents are encouraged to pursue carefully selected elective experiences based on their career interests.

Electroconvulsive Therapy (ECT)
Residents rotate through the ECT service for 2 months during the PGY4 year. They evaluate patients and learn to perform ECT under the guidance of an attending physician. During this period residents spend 2-3 hours in the morning in the ECT service and then spend the remainder of the day in the outpatient clinic. Residents have the opportunity to be certified in ECT.

Community Psychiatry
The Home for Little Wanderers operates a Community Collaborative program a few minutes away from the hospital. Children and adolescents who are clients of the Department of Mental Health may stay in one of the two residential programs or receive services on an outpatient basis. The program allows residents to learn about wraparound care and community services available to children and their families. Residents are supervised by the program psychiatrist but also work with social workers and case managers.

Adult Partial Hospitalization
Residents rotate through the Partial Hospitalization Program under the guidance of a social worker. They run groups and gain experience with cognitive behavioral therapy, psychoeducation, and other types of group therapy.

Administration
Chief residents have administrative responsibilities and provide support to the program director and program coordinator. Senior residents have the opportunity to assume a leadership role in overseeing one of the clinical services or teaching medical students. Leadership experiences are tailored to the interests of the individual residents. Rising chief residents have an opportunity to attend a leadership training session at Tufts University School of Medicine.

Electives
Elective options are developed based on the interests of individual residents to ensure adequate preparation for practice or subspecialty fellowships. Options include junior attending experiences on the inpatient and consult services or advanced experience in addiction. Two new elective experiences have been developed in the pain clinic and the sleep center to prepare residents for subspecialty fellowships in these or related areas. Additional opportunities in women’s mental health and psychosocial oncology are in the planning stages. Off-site electives may be approved by the Graduate Medical Education Committee for PGY4 residents when a similar experience is not available at St. Elizabeth’s Medical Center. Electives are typically arranged on a part-time longitudinal basis in order to provide continuity of care to clinic patients.

 

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PGY1

Internal Medicine - Wards

Medicine Emergency

Neurology

Geriatric Psychiatry

Inpatient Psychiatry

Night Float

Addiction

 

 

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PGY2

Inpatient Psychiatry

Consult / Liaison and Emergency Psychiatry

Inpatient Psychiatry

Consult / Liaison and Emergency Psychiatry

Child and Adolescent Psychiatry

 

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PGY3

 

Outpatient Psychiatry

 

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PGY4

Outpatient Psychiatry (80%)

 

Partial Hospital

Community Psychiatry

Forensic

Outpatient

ECT

Electives















 

** Inpatient psychiatry, consult/liaison psychiatry, internal medicine, and night float rotations are not necessarily consecutive.

 

 

 

 


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