The Psychiatry Residency Program
Gary Swanson, M.D., Program Director
Length of program: 4 years
Number of position(s): 16
The educational mission of the four-year Psychiatry Residency Program has two main components:
- To train residents to accurately and efficiently diagnose and treat patients with psychiatric and behavioral disorders using a biopsychosocial approach
- To foster critical thinking and leadership skills
Mastery of these skills enhances the residents' chances of success in whatever type of position they may choose after graduation, whether it be private practice, research, academics and/or administrative work. Most graduates go on to become clinical psychiatrists who practice in a variety of settings.
The content of the clinical and didactic work in the training program is intentionally eclectic. When residents graduate, they have had the requisite training to be proficient in the following areas with any patient:
- Accurate diagnosis
- Biopsychosocial formulation that identifies possible etilogies of symptoms
- Formulation of a treatment plan that includes any necessary medical evaluation, appropriate psychotherapies, and community, family and social interventions.
- Psychopharmacologic treatments
- A variety of psychotherapeutic interventions, including supportive, cognitive, behavioral, psychodynamic and group treatments
PGY-1 comprises a minimum of four months in General Internal Medicine and two months in Neurology. PGY-1 residents may request Family Practice, Pediatrics or Emergency Medicine rotations in place of some or all of the months in Internal Medicine. They may request more time in General Internal Medicine or Neurology and can use elective time for this purpose. These rotations occur on inpatient wards and psychiatry interns are expected to function on a par with medicine and neurology interns.
The remaining six months of the year are spent in Psychiatry rotations. Four months are spent on the General Adult inpatient units at Allegheny General Hospital and two months are spent on the Consultation-Liaison/Emergency Psychiatry Service.
During PGY-2, residents finish their inpatient experience at Allegheny General Hospital rotating two months on the General Adult Inpatient Unit and three months in the Intensive Partial Hospital Program. Residents also rotate through the VA Pittsburgh Healthcare System (Highland Drive) on either the Schizophrenia Research Unit, Mood Disorder Unit or the Neurobehavioral Unit for two months. They spend an additional two months on the Allegheny General Psychiatry Consultation-Liaison/Emergency Service and two months on the Child Inpatient Unit. They will spend one month at The Western Pennsylvania Hospital-Forbes Regional Campus for Geriatric Psychiatry.
The major focus of PGY-3 training is Adult Outpatient Psychiatry. This program provides outpatient evaluation and treatment for patients with a wide range of emotional and behavioral problems, including those that arise in the context of medical illnesses. The multidisciplinary staff provides pharmacological management, interpersonal therapy, cognitive-behavioral therapies, psychodynamic therapies, family therapy and group therapy. Residents are responsible for a caseload of 40 to 50 patients, providing psychotherapy and medication management. Residents also rotate one day a week at the VA Pittsburgh Healthcare System, providing outpatient treatment on the PTSD, Schizophrenia and/or Mood Disorder Services.
PGY-4 residents are required to function as senior residents on either the C/L Service or any of the inpatient units. This gives them additional experience in the administrative aspects of running a service or ward. They will also spend one month at Gateway Rehabilitation Center for Substance Abuse. There are nine months of elective time scheduled into the training program. Most residents who wish to use their time for clinical work plan electives during the fourth year, but residents are free to use their elective time at any point in their training after the first year.
In addition to the clinical rotations, residents have protected time to attend weekly conferences, Journal Club and Grand Rounds.
Seminars and Conferences
PGY-1 Seminars
- Introduction to Psychotherapeutic Techniques
- Introduction to Somatic Therapies
- Emergency Psychiatry
- History of Psychiatry
- Supportive Psychotherapy
- Ethical and Legal Foundations of Psychiatry
- Basics of Neurology
- Psychiatric Interviewing
- Assessment and Intervention Practicum
PGY-2 Seminars
- Introduction to Psychotherapies (CBT, IPT, Dynamic)
- Psychopathology and Psychiatric Diagnosis
- Assessment and Intervention Practicum
- Child and Adolescent Psychiatry
- Group Therapy
- Doing Psychotherapy
PGY-3 Seminars
- Psychological Assessment
- Research Methods and Issues
- Couples and Family Group Therapies
- Community and Social Psychiatry
- Human Sexual Dysfunction
- Advanced Topics in Psychotherapy
- Psychotherapy Practicum and Case Conference
- Forensic and Ethical Issues in Psychiatry
- Cultural Psychiatry
- Substance Abuse
PGY-4 Seminars
- Administrative Psychiatry
- Advanced Somatic Therapies and Topics in Behavioral Medicine
- Board Review
- Transition to Practice
Conferences (all levels of training)
- Psychiatry Grand Rounds
- Resident Journal Club
- Clinical Case Conference
- PRITE Review
Clinical Rotations
Inpatient General Psychiatry
These rotations includes clinical experience with geriatric as well as general adult psychiatric inpatients. During the inpatient psychiatry rotation, PGY-1 and 2 residents work under the supervision of faculty psychiatrists in caring for patients with psychoses, affective disorders and severe anxiety, personality and adjustment disorders. Residents are involved in supervising and teaching junior- and senior-level medical students. PGY1 and PGY2 residents carry an average caseload of seven patients and participate in daily attending teaching rounds and individual clinical supervision with faculty attendings and PGY-4 residents. In addition to weekly teaching case conferences, required core readings, didactic seminars and Journal Club, the educational curriculum includes consultative access to staff psychologists and neuropsychologists as well as the availability of selected literature relevant to specific cases. Residents will rotate off site at The Western Pennsylvania Hospital-Forbes Regional Campus for Geriatric Psychiatry, and at the VA Schizophrenia Unit. PGY-4 residents may choose to complete their two-month selective on one of the inpatient units or the C/L Service assuming greater responsibilities and supervising junior residents and medical students.
Consultation-Liaison Service
During the four-month Consultation-Liaison/Emergency Service rotation, residents evaluate new patients each day and provide follow-up care for those they have previously evaluated. All residents are involved in teaching medical students. PGY-4 residents may spend 2 months on the service for their selective. During this rotation, they supervise and teach PGY-1 and PGY-2 residents as well as medical students. Clinical teaching by faculty is an important aspect of daily attending rounds, individual clinical super-vision and weekly case-review conferences. Problem-based seminars and Journal Club are conducted weekly and cover the fundamentals of psychiatric diagnosis and treatment in the consultation setting, psychosomatic medicine, biopsychosocial case formulation and crisis intervention.
Outpatient Psychiatry
Although residents are encouraged to begin building an outpatient caseload starting in PGY-2, this aspect of residents' training is emphasized in PGY-3, with additional blocks of elective time available in PGY-4. This educational experience provides residents with firsthand clinical experience in providing longer-term psychodynamic psychotherapy, time-limited psychotherapy, cognitive-behavioral therapy and long-term supportive therapy and medical psychiatric follow-up of patients with chronic mental illnesses. They will spend one morning a week for three months on the ECT Service (which provides treatment for both inpatient and outpatients). Residents spend one day a week at the VA Pittsburgh Healthcare System, providing outpatient treatment for patients with STSD, Schizophrenia and/or mood disorders. Residents also gain practical clinical experience with group, family and couples therapies during this year. They will also provide longer-term dynamic therapy, under supervision of a psychoanalyst, through the low-fee dynamic therapy clinic. There is also opportunity to provide brief psychodynamic therapy at a local college outpatient service. While rotating through the Outpatient Psychiatry Program, residents participate in all ongoing educational and academic activities while providing clinical care under close faculty supervision.
Child and Adolescent Psychiatry
PGY-2 residents learn Child and Adolescent Psychiatry on a two-month inpatient rotation under the supervision of a Child and Adolescent psychiatrist. Patients have a variety of emotional, behavioral and social problems, that are addressed using an interdisciplinary team model. Residents have the opportunity to develop their skills in family assessment and intervention. They may use their elective time for additional training in this area. The hospital has a strong Division of Child and Adolescent psychiatry, which also offers the opportunity for additional fellowship training after three years of General Psychiatry.
Intensive Partial Hospital Psychiatry
During this rotation, PGY-2 residents work on a three-month rotation under the supervision of both a faculty psychiatrist and psychologist in caring for patients with affective disorders and severe anxiety, personality and adjustment disorders. They have the opportunity to develop group psychotherapy skills and follow acutely distressed patients for a longer period of time than in a typical inpatient setting. They may use elective time for additional training in this area.
Electives
The use of elective time is quite flexible, and, with the training director's approval, residents may create electives to suit their educational needs. Some of the electives already established are as follows:
- Outpatient Psychiatry (both general and/or targeted at a specific patient population such as trauma, pain management, women, bariatric surgery, cancer, etc.
- ECT (leading to certification)
- College Student Outpatient Service (at a local university)
- Forensic Psychiatry (at the county jail)
- Administrative Psychiatry (focused on helping residents gain a better understanding of managed care and involving interaction with medical directors of several local organizations)
- PTSD Outpatient Clinic at VA
- Adult Partial Hospital Program
- Geriatric Psychiatry
- Child Summer Partial Treatment
- Community Psychiatry
- Child and Adolescent Psychiatry
- Outpatient Psychiatry
- Research (with selected faculty)
- Sleep Disorders
- Toxicology
- Substance Abuse (both inpatient and intensive outpatient)
- Psychological Testing
