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 achievements on the milestones. Residents gain experience in adult inpatient psychiatry, emergency psychiatry, neurology, geriatric psychiatry, and internal medicine. They are supervised by attending physicians and senior residents on each rotation.
St. Elizabeth’s Medical Center has a combined total of 48 adult psychiatry beds. These are divided into a 16 bed psychosis unit, a 12 bed affective disorders unit and a 20 bed general psychiatry unit. The inpatient units are staffed by a multidisciplinary team of psychiatrists, social workers, nurses, occupational therapists, and mental health workers. Residents are assigned to a team for periods of approximately one month and participate in rounds with the attending physician on a daily basis. Spending time on more than one team over the course of the PGY1 and PGY2 years ensures a diverse experience with exposure to a variety of diagnoses and treatment modalities. 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.
Residents spend three months rotating through Internal Medicine on the inpatient wards during the PGY1 year. Residents follow the call schedule of an internal medicine intern during this time. 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.
The fourth month of medicine takes place in the Emergency Department under the supervision of the emergency department attending physicians. Residents work with residents from other departments and other local hospitals.
Residents spend two months rotating through Neurology during the PGY1 year, providing 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. They are supervised by neurohospitalists 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.
The St. Elizabeth’s Comprehensive Addiction Program (SECAP) provides inpatient detoxification, intensive outpatient services, and medication assisted therapy (MAT) to patients seeking treatment for addiction. The program is run by addiction medicine specialists together with a team of nurses, social workers, and addiction counselors. Residents spend part of their time on the inpatient service and the remainder of the time in the outpatient setting.
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 typically works five consecutive nights with two days off for two periods of one month each.
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, child/adolescent psychiatry, and addiction.
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. Residents are involved in clinical interactions with patients and families. Residents are supervised by the medical director of the adolescent unit at Carney.
The geriatric psychiatry satellite unit opened in December of 2014. This unique unit, designed specifically for geriatric patients, is run by St. Elizabeth’s Medical Center but physically located on the campus of Carney Hospital in the Dorchester neighborhood of Boston. Residents are supervised by a geriatric psychiatrist, where they have an opportunity to treat patients with dementia and learn to adjust treatment approaches to the needs of older patients.
The goal of this year is to introduce the residents to management of psychiatric disorders in the outpatient setting using both psychopharmacology and psychotherapy. These experiences are aligned with lectures introducing cognitive behavioral therapy and psychodynamic psychotherapy. As the residents progress through the year, they will move towards mastering the areas of psychiatric assessment, formulation and treatment. 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.
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 intake assessments for new patients. Each PGY3 and PGY4 resident has a private office in the clinic. Residents have weekly individual supervision in psychodynamic psychotherapy and cognitive behavioral therapy. Psychopharmacology supervision is provided at the end of each patient visit.
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 three years to attain competency and practice as an independent psychiatrist in the community in whatever chosen career path. The PGY4 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.
Residents continue to see patients in the outpatient clinic once a week throughout the entire PGY4 year. The continued outpatient experience allows residents to develop a continuing therapeutic alliance with patients. At the same time, they gain experience in forensic psychiatry and community psychiatry.
Adult Partial Hospitalization
Residents have the option to rotate through the Partial Hospitalization Program under the guidance of an experienced social worker. Residents participate in groups and gain experience with cognitive behavioral therapy, psychoeducation, and other types of group therapy.
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, geriatric, and consult services. Elective experiences in the pain clinic and the sleep center prepare residents for subspecialty fellowships in these or psychosomatic medicine. Residents have the option to spend time observing ECT at Beth Israel Deaconess Medical Center, a nearby Harvard affiliate hospital. 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.