Psychiatry Residency Clinical Rotations

Clinical rotations are located in various nearby institutions, including a state hospital, a voluntary hospital, a municipal hospital and several community-based settings. During each year of the Residency Program, trainees develop skills and education to shape them into outstanding clinicians and emerging leaders in the field of psychiatry.

During a four-month rotation on the inpatient psychiatry unit (Klau 2/ Wakefield 7S), PGY-1 residents experience a multidisciplinary treatment team model.

Psychiatry Emergency Service
PGY-1 residents spend two months on rotation in the psychiatric observation suite (POS). The POS is a five-bed crisis intervention service within the general Emergency Department (ED) on the Moses Campus of Montefiore Einstein. The ED is not only consistently ranked as one of the busiest emergency services in New York City but recently was reported to be the second-busiest emergency department in the nation.

Patients are evaluated in the POS or as a psychiatry consult in the medical ED. This rotation offers an incomparable education in emergency psychiatry and crisis intervention. It allows residents to perform comprehensive evaluations, initiate treatment, observe patients and/or refer them to community resources or for admission. Attendings provide intensive, on-site supervision days and evenings.

Adult Psychiatry Inpatient Service
During a four-month rotation on the inpatient psychiatry unit (Klau 2), PGY-1 residents experience a multidisciplinary treatment team model. They are either the primary therapist assigned to acutely hospitalized patients or the psychopharmacologist co-managing with psychology interns or medical students.

The large multicultural community we serve ensures a rich immersion in severe psychopathology of all major syndromes, with evaluation, case formulation and treatment planning. In addition, patients may have comorbid medical problems and/or neuropsychiatric conditions. Klau 2 is a locked 22-bed psychiatric inpatient service at Montefiore Einstein, where the patient population ranges in age from late adolescent to geriatric, and the average length of stay is two to three weeks. The inpatient service’s overall function is to perform a psychiatric and psychosocial evaluation, establish a working diagnosis and provide immediate pharmacological, psychological, electroconvulsive therapy (ECT) and milieu treatment to return the patient to the family and community as soon as possible.

While working in the inpatient service department, residents are intensively supervised by one of three full-time attending psychiatrists assigned to the unit. They receive close and supportive supervision as they develop new skills and competence in psychopharmacology and individual, group and family therapy. Early in the training experience, they also learn to function as members of an interdisciplinary team and establish leadership skills.

Medicine or Pediatrics & Neurology
Residents participate in a required four-month rotation in medicine or pediatrics, which is conducted under the Departments of Medicine, Family Medicine or Pediatrics at Montefiore Einstein’s Weiler Hospital and Moses Campus.

During this rotation, the residents’ three months of inpatient experience is complemented by a month of adult outpatient work in a community psychiatric clinic. Completing the first year’s requirements, PGY-1 residents also spend two months in Neurology at Montefiore Einstein’s Moses Campus, working with the neurology inpatient and consult services.

PGY-2 is an exciting, eclectic year during which residents rotate in various clinical settings and psychiatry subspecialty areas. In addition to fostering an expansive breadth and depth of knowledge and experience, the second year provides residents with the exposure they need to begin to formulate long-term training and career objectives.

The long-term inpatient setting at the Bronx Psychiatric Center provides a rare opportunity for PGY-2 residents to intimately observe the course of mental illness over an extended period, not only from day to day but also from month to month.

Inpatient Psychiatry: Bronx Psychiatric Center
During their residency at the Bronx Psychiatric Center, our residents learn much more than stabilization and discharge; they are provided with the opportunity to delve into a psychodynamic exploration of their patients’ mental experiences and psychiatric illnesses. In addition, and of paramount importance to clinical and professional development, they also begin to learn how to examine and better understand their own reactions to their patient’s illnesses and life stories. This unique experience cultivates more profound and more sophisticated ways of thinking about psychiatric issues.

This unique, intensive training experience incorporates milieu, family and psychopharmacological approaches. Residents learn diverse clinical interventions in an environment that significantly enriches the training experience beyond the acute care inpatient units available in most residency programs. In addition, residents have abundant opportunities to explore the complexities of systems-based practice and forensic psychiatry and conduct scholarly projects.

Consultation-Liaison Psychiatry
The PGY-2 two-month rotation on the consultation-liaison (CL) service offers unique training focused on gaining expertise in this field. Our rotation is divided between the Moses Campus and Weiler Hospital of Montefiore Einstein, allowing our residents to work in reproductive psychiatry, medical/surgical floors and ICUs. Residents learn how to evaluate and manage psychiatric aspects of medical illness while liaising with our large university hospital’s medical/surgical services.

Attending psychiatrists supervise residents with subspecialty training, including consultation-liaison work, addiction, women’s mental health and transplant psychiatry. This rotation is unique because residents have the opportunity to diagnose and treat psychiatric problems in super-specialized services such as oncology, both inpatient and outpatient transplantation, pain and palliative care.

During this rotation, the residents are assigned to an attending team that may include a CL fellow, one resident and a medical student. Each team conducts daily clinical teaching rounds. All consults seen by trainees are also evaluated by the attending and discussed in rounds.

Patient interviews are observed and critiqued, histories and clinical findings are presented, management plans are developed and the medical literature is reviewed. Each team sees an average of two to four new consults each day. A clinical case conference is conducted weekly, where trainees present challenging cases to a panel of attendings.

Addiction Psychiatry 
A comprehensive addiction psychiatry training experience with a one-month rotation through multiple addiction sites during the PGY-2 year exposes residents to a wide array of substance abuse treatment modalities under the direct supervision of the addiction faculty. Residents rotate through the Moses Campus and Weiler Hospital, partnering with addiction consult services, where they can support medical/surgical colleagues in managing acute withdrawal and intoxication syndromes. Residents also rotate through the Department of Substance Abuse (DoSA), where they observe methadone-maintained patients with co-occurring psychiatric disorders.

Our residents learn to conduct psychiatric assessments of patients with substance use disorders and learn about the differential diagnosis of substance-induced versus primary psychiatric disorders and appropriate psychopharmacologic and psychotherapeutic treatment modalities. In addition, residents rotate at Jacobi Hospital, working on the ambulatory detox, suboxone and addiction consults that help to support a diverse and well-rounded experience. Residents work toward developing motivational interviewing skills and providing resources supporting patients in various stages of awareness about their substance use disorders.

Geriatric Psychiatry 
The month-long PGY-2 rotation in geriatric psychiatry allows residents to evaluate geriatric patients in various settings, including the psychiatry clinic, nursing home, home care service and senior citizens residing in the community. The rotation seeks to counter misconceptions regarding the capacity of older adults to respond to treatment and expand the resident’s perspective on providing care to frail elders and their families.

Direct supervision enhances each resident’s ability to assess impaired cognition and decision-making and consider aspects of diagnosis and treatment that are particularly relevant to the geriatric patient. Residents also become familiar with care sites and mental health services typically used by older adults, including home care services and nursing homes.

Residents are introduced to the “functional approach” to geriatric care that aims to restore or maintain the older adult’s optimal level of independence and well-being. They also become familiar with geriatric team care in which clinicians from various disciplines provide services that at times overlap but ideally complement the various treatments prescribed. Residents accompany geriatric psychiatry fellows and faculty on house call consultations in the community and to nursing homes. They also participate in weekly case conferences, journal clubs and research seminars held jointly by the Divisions of Geriatric Psychiatry and Geriatric Medicine.

Child & Adolescent Psychiatry 
Finally, a two-month rotation in child and adolescent psychiatry completes the PGY-2 year of training. During this rotation, residents provide behavioral care evaluation and consultation to medically ill child and adolescent inpatients on both the general and specialty pediatric units in the Children’s Hospital at Montefiore Einstein (CHAM), ranked in the 2014-15 U.S. News & World Report’s Best Children’s Hospitals. Residents conduct initial comprehensive evaluations of children and adolescents presenting to the psychiatric outpatient clinic (COPD) and conduct evaluation, treatment and crisis intervention for patients and families presenting to the pediatric emergency room at Montefiore Einstein. While on rotation, residents attend all unit-based rounds, conferences, treatment team meetings, therapeutic groups and the services on which they rotate. All patient experiences are supervised by senior faculty from the Division of Child/Adolescent Psychiatry.

The residents’ training experience is further enriched by their collegial interactions with fellowship trainees in the Division of Child/Adolescent Psychiatry, including attendance at classes and conferences with first-year fellows.

This rotation provides a unique opportunity to learn about child development and psychopathology for adult residents who will continue with advanced training in child/adolescent psychiatry. It enriches the experience of those residents who will continue with adult work.

Acute Inpatient Psychiatry 
Our residents can continue to explore acute inpatient psychiatry at the Montefiore Einstein Wakefield Campus. Similar to the PGY-1 experience on Klau-2, our PGY-2 residents work on a multidisciplinary treatment team and provide comprehensive treatment incorporating a variety of treatment modalities. The Wakefield Campus’s adult inpatient psychiatry unit is a locked 33-bed unit. The confidence and skills gained during PGY-1 allow the PGY-2 residents to operate more independently on this rotation while benefiting from robust and direct supervision from experienced attendings. They also can work with late second- and third-trimester women in acute psychiatric crises, as the Wakefield Campus also has a labor and delivery unit on-site.

Elective Time 
One month of the PGY-2 year is designated as elective time, allowing residents to explore specialized areas of psychiatry. Available options include forensic psychiatry, palliative care, sleep medicine, collaborative care, and community psychiatry.

• Palliative Care: Residents gain experience in pain management, hospice care, shared decision-making, and end-of-life issues, learning to integrate both medical and psychological treatments for this patient population.
• Collaborative Care: Embedded within a primary care setting, residents function as psychiatric consultants, integrating behavioral health services into the medical clinic and supporting holistic patient care.
• Forensic Psychiatry: Residents participate in the preparation of forensic psychiatry reports and build skills in working with patients who have forensic backgrounds.
• Sleep Medicine: Residents are involved in obtaining histories, conducting assessments, and developing treatment plans for patients presenting with signs and symptoms of sleep disorders.
• Community Psychiatry: Please see the Community Psychiatry concentration section for details on available programs. Residents may also revisit or expand upon these electives during their PGY-4 year.

One month of the PGY-2 year is considered elective time, where residents can participate in forensic psychiatry, palliative care, integrated care or community psychiatry.

Year three of the Psychiatry Residency Program is primarily devoted to outpatient work in the adult outpatient department at Montefiore Einstein. Residents evaluate and treat a diverse patient population presenting with a variety of psychiatric disorders and psychosocial challenges. Disorders treated in this clinic typically include various mood and anxiety disorders, personality disorders, psychotic disorders and psychiatric disorders associated with comorbid medical conditions or substance abuse. Treatment is provided in the context of a multidisciplinary team, and several treatment modalities are utilized.

During this year, residents learn brief and long-term individual psychodynamic psychotherapy, supportive, group, family and couple’s therapy, cognitive behavioral therapy (CBT) and evidence-based psychopharmacological approaches. Residents develop the diagnostic and therapeutic skills necessary to care for a broad spectrum of outpatients, including assessing and treating children and adolescents. They provide integrated psychotherapy and psychopharmacological therapies to their patients and also work collaboratively in a shared care model with social workers, psychologists and psychology interns.

An attending psychiatrist directly observes and supervises resident intakes in real time. In addition, various clinicians with expertise in psychoanalytic, psychodynamic or cognitive behavioral approaches supervise residents weekly. Psychopharmacology supervision also occurs weekly. Family, group and other specialty supervisors also provide regular guidance.

The final year of the Montefiore Einstein Psychiatry Residency Program is designed to support the resident’s pursuit of special interests. This unique year of training consists of elective opportunities and rotations, enabling residents to engage in many exciting clinical, teaching and research experiences that will further prepare them for the transition to practice, postgraduate fellowships or academia.

The chief residency experience, available to selected PGY-4 residents, promotes enhanced clinical, teaching, administrative and leadership development. Options include service in inpatient, outpatient, emergency or consultation-liaison medicine units. Several opportunities are also available for residents who wish to advance their knowledge and skills as medical educators.