Clinical work during the PGY-II year focuses on evaluation, diagnosis and treatment of psychiatric patients in acute care settings.
PGY-II residents rotate through the Personality Disorders Inpatient Service at the Westchester Division, the General Psychiatry Inpatient Service Greenberg 11N (in Manhattan) and the Partial Hospital Program at Payne Whitney Manhattan. In both of these sites, the resident’s learning is experiential, as they care for patients during high-acuity illness episodes, supervised by expert faculty. The experiential learning is supplemented by case conferences and site-based didactics. During these rotations, residents deepen their understanding of hospital psychiatry including the multi-disciplinary approach to patient care, management of the milieu, psychopharmacology, and individual, family and group psychotherapy. While working on the Personality Disorders Unit, residents spend one afternoon per week in their community psychiatry rotation, at sites throughout the 5-boroughs, in partnership with Janian Medical Care. Residents gain expertise in addiction psychiatry during the Consultation-Liaison rotation, with additional didactics and a dedicated addiction psychiatry rotation.
PGY-II residents also rotate through the New York-Presbyterian Hospital Psychiatric Emergency Service and the New York-Presbyterian Hospital Consultation/Liaison Psychiatry Service. In the Emergency Department, residents work with patients requiring acute medical and psychiatric evaluation and treatment. On the Consultation-Liaison Service, residents learn evaluation and management of psychiatric aspects of medical illness while providing liaison and consultation to medical services in the hospital. A portion of the Consultation-Liaison time is spent at Memorial Sloan Kettering Cancer Center with a focus in psycho-oncology.
Every rotation in the PGY-II year includes a site-based curriculum, including academic and clinical rounds, resident and medical student teaching rounds in which trainees deliver scholarly presentations on the psychiatric literature, team meetings, and specialty rounds. A highlight of PGY-II site-based didactics is Professor’s Rounds, a weekly case conference seminar by nationally- and internationally-renowned expert psychiatrists. PGY-II residents teach PGY-I residents, medical students and sub-interns rotating through psychiatry services, and attend didactics related to their development as teachers.
A unique aspect of our PGY-II experience is to have one month of elective time during the year when residents pursue a clinical, research, or other scholarly project of special interest. Many residents pursue electives overseas. Mentorship is provided for all electives.
Examples of recent elective projects:
|Child and Adolescent Psychiatry||- Adapted use of Dialectical Behavior Therapy (DBT) in pre-adolescent children with Disruptive Mood Dysregulation Disorder (DMDD) - Clinical rotation at Adolescent Partial Hospitalization Program|
|Geriatric Psychiatry||- Clinical and reading elective in neuropsychological testing - Clinical elective at an integrated geriatric primary care clinic, with embedded geriatric psychiatrists|
|- Clinical rotation at Adolescent Partial Hospitalization Program||- Clinical and reading elective in neuropsychological testing - Clinical elective at an integrated geriatric primary care clinic, with embedded geriatric psychiatrists|
|International Psychiatry||- Introduction to Child and Adolescent Psychiatry in Taipei, Taiwan at the Taipei Municipal Gan-Dau Hospital - International mental health policy at the United Nations|
|Psychodynamic Psychotherapy and Psychoanalysis||- Trauma from a psychoanalytic perspective - Psychodynamic aspects of suicide - Theory and practice of group|
|Addiction Psychiatry||- Clinical and reading elective on Alcohol Use Disorder management, including the development of a clinical and operational study regarding Vivitrol implementation in a collaborative care setting|
|Forensics Psychiatry||- Forensic Psychiatry elective at the University of Maryland - History of involuntary psychiatric commitment in the USA -Characteristics and outcomes of treatment over objection|
|Consult-Liaison Psychiatry||- Palliative Care and Narrative Medicine at UCSF - Psychotherapy and End-of-Life Care (Hospice Care, Meaning-Centered Psychotherapy, Dignity Therapy) - Psychiatric comorbidities of chronic pain|
|Other||- Rotation on the Second Chance Inpatient Unit for patients with highly treatment-resistant psychotic illness - Mindfulness interventions in psychiatry - Popular science writing seminar - Medical student and resident education - Personalized medicine versus public health - Animal training: learning theory and behavioral shaping (Shedd Aquarium, Chicago and Busch Gardens, Tampa)|
PGY-II on-call coverage is via a night float system in which residents cover emergencies in the Payne Whitney Manhattan inpatient service.
16-18 weeks: General Adult Inpatient Psychiatry – NewYork-Presbyterian Hospital/Payne Whitney Manhattan
4-5 weeks: Personality Disorders Inpatient Service Service – Westchester Division
4-5 weeks: Psychiatric Emergency Department – NewYork-Presbyterian Hospital/Payne Whitney Manhattan
11-12 weeks: Consultation-Liaison Psychiatry – NewYork-Presbyterian Hospital/Memorial Sloan Kettering Cancer Center
4-5 weeks: Partial Hospital Program – NewYork-Presbyterian Hospital/PayneWhitney Manhattan
3-5 weeks: Elective
4-5 weeks: Night Float – NewYork-Presbyterian Hospital/Payne Whitney Manhattan
4 weeks of vacation
The PGY-II curriculum builds upon, expands, and deepens the knowledge and skills acquired during the first year, now including navigation of additional levels of care and more focused development of the resident’s understanding of psychopharmacology and psychotherapy.
The lecture series continues in a syndrome-specific model. Substance use and addictive disorders in the hospital setting and emergency psychiatry, including milieu management, acute undifferentiated agitation, intoxication and withdrawal states, and disposition-planning within a complex system-of-care, are reviewed in-depth. Case-based scholarly projects are completed during the inpatient consultation-liaison rotations, with many residents successfully submitting and presenting their work at national meetings. In addition, there is didactic and experiential coursework dedicated to critical reading of new research.
Special attention is also paid to developing junior residents' knowledge and appreciation of the social and cultural trends within the history of psychiatry, with focused didactic time from faculty of our unique DeWitt Wallace Institute for the History of Psychiatry. We focus heavily on historical developments in nosology across the last century, discussing readings from the neo-Kraepelinian turn, the epistemology of psychiatric symptoms and syndromes, and the pathologizing of normal diversity in human sexuality.
Finally, our PGY-IIs complete a 6-month course on the psychoanalytic model of the mind, another revered rite-of-passage in the Payne Whitney curriculum. In this seminar-style course with two senior psychoanalysts, residents begin with foundational texts in psychoanalytic thought and progress through the historical development of topographical, ego-psychology, object-relations, and self-psychology models. Major concepts of conflict- and deficit-based models of psychopathology, defense mechanisms, transference and countertransference phenomena, and psychodynamic therapeutic interventions are reviewed in preparation for the start of the outpatient year. We also cover the common factors model (emphasizing shared therapeutic features across psychotherapeutic modalities) in our introductory lecture series to psychotherapy.
Didactics are scheduled in an intensive 4-hour/week block during protected time. Additionally, all PGY-II residents participate in a weekly e-group (experiential group) in the fourth didactic hour. E-group provides an opportunity to learn about group process and discuss the task of becoming a psychiatrist in a collaborative and confidential group setting.
Supervision during the PGY-II year is from faculty and senior residents while on the clinical services. In addition, each PGY-II is paired with a specially-selected “off-unit” supervisor who helps to oversee their learning. Each resident meets individually with their “off-unit” supervisor weekly; the supervisory time can be spent in a variety of ways, ranging from interviewing patients together to discussing challenging clinical cases, to reviewing pertinent readings and research.