The curriculum is based on the seven areas of core competency (as described in the AOA Basic Standards for Postdoctoral Training) and the six areas of core competency in the ACGME basic standards. Our program will successfully prepare residents to achieve certification in general psychiatry from the American Osteopathic Board of Neurology and Psychiatry (AOBNP).
It is our intention that upon graduation from the psychiatry training program, physicians will be fully prepared to serve their patients and be a great asset to the profession, as well as their community. Our residents have broad-based clinical training in multiple settings. As a Psychiatry Resident, you can expect to your training to take place in a variety of different settings to capitalize your learn experience, including:
- In the emergency room
- General medical
- Pediatric settings
Residents treat geriatric and adult patients, as well as adolescents and children. Evidence-based clinical work encompasses diagnosis, psychiatric management, psychopharmacology, somatic and psychotherapeutic treatment modalities.
The primary care training experience for psychiatry residents will occur during four months of the PGY-1 training year. Residents will train side-by-side with osteopathic family medicine residents during their Internal Medicine Rotation. We will have a fully accredited osteopathic family medicine and osteopathic manipulative treatment (OMT) training program with dedicated primary care osteopathic physician’s members serving as faculty members. Teaching methods include bedside clinical teaching on daily rounds, lectures, seminars, clinical conferences and grand rounds. Residents attend one afternoon (five hours) of didactic seminars each week.
The psychiatry residents will learn how the principles of OMT apply to primary care medicine through both didactic and clinical experience. As part of their clinical assessment of patients, residents will be required to complete a relevant musculoskeletal examination and employ manipulative techniques for a variety of disease states where applicable. The library will have available educational materials to support the psychiatric residents. Specifically, the textbook, Somatic Dysfunction and Osteopathic Family Medicine (Nelson, K, Glonet, T., ACOPF, 2007) will be available in addition to other educational, video and internet resources. Furthermore, visiting faculty from Touro College of Osteopathic Medicine (TouroCOM) will be invited to participate in the delivery of the didactic curriculum to all residents.
It is anticipated that the psychiatry residents will be embedded within care teams, with other learners, on the inpatient medicine teaching service (MTS). For example additional PGY-1 residents, one or more supervising residents (PGY-2 or PGY-3) and full-time faculty attending supervisors. The primary care experience will ensure a breadth of experience working with adults and geriatric patients (approximately 40% of patients are over age 60), with a full range of diagnoses on the IPS at Garnet Health Medical Center. The MTS at Garnet Health Medical Center reflects patients from diverse backgrounds (ethnic and racial) and from all socioeconomic statuses. Similarly, the psychiatry residents will have opportunity to treat a full range of disorders in pediatric populations (i.e., children and adolescents) on both the inpatient pediatric service as well as in outpatient clinics.
Caseloads vary with services but are comparable with those carried by interns in the specialty area.
- Supervision occurs at the bedside, on rounds, in scheduled seminars and in departmental conference
- Lectures, conferences and grand rounds are offered on a weekly basis in the family medicine department.
- Attending faculty are always available in person or by pager for supervision.
- Evaluations will be completed for each resident and returned to the psychiatry residency program director (PD).
The duration of neurology training for PGY-1 residents is two separate block rotations. One of the two blocks will typically consist of an inpatient neurology experience, while the other block will be spent on the neurology consult service. The neurology department consists of full-time, board- certified neurologists who have robust ambulatory practices in addition to serving as faculty attendees on the inpatient unit and consult service. Neurology faculty members work with psychiatry residents as well as family medicine residents on these services.
The patient population that residents will care for during this experience is approximately 75% Caucasian and 25% other races (majority African-American) with a male/female distribution of 40%/60% respectively. The diagnostic mix for the neurology services is roughly 50% cerebrovascular disease, 20% seizure disorders, and the remainder is comprised of a variety of other neurologic illnesses. Specifically on the stroke services approximately 60% of patients are over the age of 60.
Teaching methods include bedside clinical teaching on daily rounds, lectures, seminars, SIM training, clinical conferences, and grand rounds. Supervision of residents will occur at the bedside, on rounds and in peer review. Evaluations will be completed for each resident and returned to the psychiatry residency program director (PD).
Inpatient psychiatry will be a major component of psychiatry resident training during the PGY-1, PGY-2, and PGY-4 years of training. Inpatient training will begin with six months of block rotations in PGY-1. Garnet Health Medical Center provides inpatient psychiatry services for the Greater Hudson Valley Region in its 30-bed inpatient psychiatric unit. Psychiatry residents will serve as integral members of the care team on the inpatient psychiatry service (IPS). Each care team will consist of psychiatry attending faculty members who are board-certified/eligible psychiatrists many of whom maintain full-time inpatient loads as well as some who provide additional outpatient or consultation liaison (CL) services; there is an attending assigned to each of the inpatient care teams.
Only adult patients are treated on the IPS and approximately 25% of psychiatry inpatients are over the age of 60. The diagnostic mix on the IPS can be characterized as follows: 40% mood and anxiety disorders, 30% psychotic disorders, 10% cognitive disorders, 10% personality disorders, and 10% other psychiatric conditions.
Resident teams will typically care for an average daily caseload of five to six patients on this service. A significant portion of residents’ training and experience with Geriatric, Addiction and Forensic Psychiatry occurs during this rotation. Residents will be exposed to the various community mental health centers and other community based care organizations through discharge planning on the inpatient unit.
It is envisioned once fully operational, the PGY-4 residents will supervise the functioning of the IPS including activities of the PGY-1 and PGY-2 residents and medical students with oversight and counsel from the IPS attending. The PGY-2 resident also has opportunities for supervision of the IPS team in the absence of the PGY-4 resident. The PGY-1 is provided an opportunity to learn supervisory skills and utilize them when they assist in the supervision of medical students under the guidance of the PGY-2 and PGY-4 residents. Additionally, residents can be expected to assist in the instruction of medical students assigned to their service.
Teaching methods include bedside clinical teaching on daily rounds, working as part of an interdisciplinary team, lectures, seminars, inpatient clinical conferences, assigned readings with discussion and didactics. In addition residents attend five hours per week of formal didactics. Inpatient clinical conferences consist of weekly didactics on clinical interviewing, addiction psychiatry, CL/emergency room (ER) psychiatry and general psychiatry topics by different faculty attendees.
Supervision occurs at the bedside, on rounds and in peer review. The attending psychiatrist assigned to each inpatient team is also available throughout the day by phone. Evaluations are completed on each resident and are returned to the PD for review. In addition residents are expected to attend individual supervision for one hour per week for OGME-1 residents and two hours per week for OGME-3 residents.
Consultation Liaison (CL)
Two month rotation that occurs during the PGY-2 training year. The CL educational experience during these block rotations is taught by full-time, board-certified/eligible psychiatrists who are specifically assigned to each of the CL psychiatry teaching services.
Teaching methods include bedside clinical teaching on daily rounds, working as part of an interdisciplinary team, lectures, seminars, inpatient clinical conferences, assigned readings with discussion and didactics. In addition residents attend five hours per week of formal didactics. Inpatient clinical conferences consist of weekly didactics on clinical interviewing, addiction psychiatry, CL psychiatry and general psychiatry topics by different faculty attendings.
Supervision occurs at the bedside, on rounds and in peer review. The attending psychiatrist assigned to each CL service is also available throughout the day by phone. Evaluations are completed on each resident and are returned to the PD for review. In addition residents are expected to attend individual supervision for 1-2 hour per week.
Emergency (EM) Psychiatry
This rotation is three one-month block rotations during the PGY-2 training year which may include one or more months of night float. A full-time, board certified psychiatrist serves as the faculty attending for this rotation. During the daytime a psychiatry faculty member is assigned to each of the ER psychiatry services and during the night-time ER psychiatry rotation the attending psychiatrist on-call is immediately available by telephone to provide supervision. Furthermore, the psychiatry residents will work closely with the emergency medicine attendees who are consistently available to all residents who are assigned to ER rotations. An average daily caseload of five to ten patients is carried by residents during this rotation; during the night-time ER psychiatry service residents get a nightly average of five to ten consults.
Teaching methods include bedside clinical teaching on daily rounds, working as part of an interdisciplinary team, lectures, seminars, inpatient clinical conferences, assigned readings with discussion and didactics. In addition residents attend five hours per week of formal didactics.
Supervision occurs at the bedside, on rounds and in peer review. Faculty is also available 24/7 for consultation by telephone. Evaluations are completed on each resident and are returned to the PD for review. In addition residents are expected to attend individual supervision for one hour per week.
Outpatient psychiatry consists of twelve months of block rotations during the PGY-3 training year as well as approximately 40% of the residents’ educational experiences during the PGY-4 training year. The outpatient psychiatry experience includes both experiences in a suburban office-based setting as well as experiences in community health settings.
The outpatient psychiatry clinic where residents will have regular clinics and maintain a panel of continuity patients is fully staffed with full-time psychiatrists, full-time clinical psychologists, as well as full-time social workers. There is always an attending psychiatrist available to supervise residents on each day there is a resident-run clinic. The clinic population consists of lower, middle and upper socioeconomic classes and is about 50% female and male respectively; 70% Caucasian, 15% Hispanic, and 15% other races. Patients range in age from young adult through geriatric with the majority between the ages of 20 and 55. Primary clinical diagnoses for the ambulatory clinic include: approximately 60% depressed and/or anxious, 20% psychotic, 10% personality disorders, and 10% substance abuse with many patients experiencing one or more comorbidities. Residents will spend the majority of their time engaging in combined medication management and brief supportive psychotherapy. They also maintain a panel of at least six long-term psychodynamic psychotherapy and cognitive behavior therapy patients. Additional experiences are available for group psychotherapy.
An average daily outpatient caseload would consist of 7-10 patients scheduled for combined medication management and brief supportive psychotherapy, one to two patients per week for individual psychotherapy; a weekly group psychotherapy session may also be present.
In addition to the office-based clinic described above, residents will also hold clinic sessions at the Outpatient Child & Adolescent Psychiatry Clinic where patients are between the ages of 12 and 17 and approximately 65% of the patients seen are female and 35% are male. The diagnostic complexion of the patient panel at this clinic is as follows: 40% mood and anxiety disorders, 20% ADHD and related disorders, 10% learning disorders, 10% psychotic disorders and 20% other psychiatric conditions. Educational experiences in this clinic will typically consist of one or more medication clinics wherein patients are also seen for brief psychotherapy. Residents work closely with parents, families or guardians of patients.
Residents will hold clinic sessions at the Family Program for Alcohol and Substance Abuse. Patients are mostly adults. Approximately 58% of the patients are male and 42% are female; Caucasian 87%, African American 7%, other 6%. Patients with alcohol as primary substance 37%, drugs as primary substance (including prescription/over the counter meds) 63%; (42% of 267 total patients report no secondary substances); Co-existing psychiatric disorder reported 61%. Age range of patient served: 13yrs through early 70s. Education experiences in this clinic will typically consists of group therapy sessions and individual treatments. Residents will work in collaboration with CASAC workers and with the oversight of the psychiatric attendee.
All residents have required individual supervision twice weekly and additional supervision for group therapy. Residents are also supervised by the assigned attending psychiatrist for the clinic that day before the patient leaves the clinic. Additional supervision is available on an as-needed basis.
A significant portion of residents’ training and experience with geriatric, child and adolescent, addiction, and forensic psychiatry occurs during this rotation and may include clinics held at other area ambulatory clinics.
Residents spend, on average, five hours weekly in seminars and didactics; faculty are always available for consultations; caseloads are carefully monitored by the PD and controlled for both breadth and variety of experience.
During PGY-2 residents will spend one- 4 week will rotation at the Mid-Hudson Forensic Psychiatric Center (MHFPC). While at MHFPC residents will work with Geriatric patients and perform psychiatric evaluations in nursing homes affiliated with Garnet Health Medical Center. Residents will provide consultation liaison services at Middletown Park Manor Rehabilitation and Health Care Center and Highland Rehabilitation and Nursing Center. Duties will comprise of: psychiatric evaluations on behaviorally disturbed long term care patients, psychopharmacological management of these patients, consultation and liaison to physical rehabilitation, Hospice patients in the nursing home; follow up in the hospital should hospitalization be necessary, cross consultation and case discussion with primary care.
Forensic & Addiction Psychiatry
During PGY-2- residents will spend one- 4 week rotation each in Forensic and Addiction at the Mid-Hudson Forensic Psychiatric Center (MHFPC). At MHFPC residents will work with forensic and addiction patients admitted with psychiatric diagnosis and treat them for acute adjustment reaction & psychosocial dysfunction, depressive neuroses, neuroses except depressive, disorders of personality & impulse control, organic disturbances & mental retardation, psychoses, behavioral & developmental disorders, other mental disorder diagnoses, Alcohol/drug abuse or dependence, left AMA, Alcohol/drug abuse or dependence w rehabilitation therapy, Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC, Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC.