Residency Training in Psychiatry
Introduction
The Department
Residency training is an exciting transition from student learner to apprentice practitioner. Much the same, Psychiatry is changing -- almost redefining itself in light of the new clinical and scientific knowledge shaping our understanding of mind, body and brain. The Department of Psychiatric Medicine embraces the dramatic changes that are overtaking our field-- in developing new knowledge, translating that knowledge into useful practice, and training physicians and scientists to excel in this developing culture. A priority of the Psychiatry Residency Program at the University of Virginia Health System is to remain both a superb clinical training program and to offer a balanced study of human behavior and clinical neuroscience. To date, no single theoretical model for addressing human behavior has sufficient explanatory power so as to exclude all others. At UVa this balance has been more fully realized by the introduction of our new Department Chairman Bankole Johnson. Working with faculty, staff and residents from UVa and our affiliate programs, Professor Johnson has worked to transform the department from a strong academically-based, clinical department to one with true research expertise in cutting edge areas of Clinical Neuroscience. He has expressed his commitment to continue to grow a balanced, world-class department with true excellence in the areas of Research, Medical Education and Clinical Services. In a short period oftime, we have clarified our overall mission and are well on the way toward implementing the evolving departmental vision. Since January, we have added more than 10 faculty members across a breadth of research, clinical and policy fields.
The UVa Health System, the department is with more than 550 patient beds, is the site for resident rotations in inpatient psychiatry, medicine, neurology, consultation-liaison and emergency psychiatry. In addition to our 20 bed inpatient psychiatric unit at University Hospital, we have a 20 bed unit at Martha Jefferson Hospital, a community based hospital located in Charlottesville. Psychiatry Outpatient Services are in the Northridge Ambulatory Care Center.
Western State Hospital is a 500 bed, JCAHO-accredited state psychiatric facility which serves a catchment area of more than 2 million people in northern, western and central Virginia. There are over 1300 acute admissions each year. The University of Virginia-Western State Hospital collaboration won the 1990 State/University Collaboration Award from the A.P.A. The majority of the psychiatric faculty (over 80%) are university-trained and board certified (over 75%). Over 30% are women. Residents and medical students rotate on selected teaching services. Western State Hospital is located about 30 miles from Charlottesville in Staunton, Virginia. Western State offers avariety of specialized elective rotations on the Clinical Studies (research), Forensic and Geriatric units.
Training opportunities are also available for residents throught the University of Virginia Health System, nursing homes, communitymental health centers and correctional facilities.
We have been responding to required changes in the nature and focus of evaluation in residency training with the integration of Core Competency Measures throughout all aspects of the training program. We have approached this challenge as one requiring a thoughtful and relevency based perspective, to ensure that what we measure is applicable to true competency, rather than arbitrary measures for regulatory compliance alone.
The internship year is divided intoa total of 4 to 5 months of internal and emergency medicine and 7 months of psychiatry and neurology, although the rotations are mixed, with typically no more than 3 months of each at a time. This allows interns to integrate into the psychiatry department, without spending 6 months consecutively away on other services. Psychiatry residents train on the internal medicine, pediatrics and emergency medicine services, alongside the housestaff from a host of other disciplines. Psychiatry training is accomplished on the inpatient units andconsultation-liaison/emergency services at the University Hospital and MarthaJefferson Hospital. Eight weeks are spent on neurology service, typically split between the wards and consult service. While on psychiatry, interns spend several hours each week in special seminars geared to integrating into a hospital practice in medicine and psychiatry. Morning report is a popular weekly seminar. Each Thursday there is a residents' meeting and lunch, providing an opportunity for all residents to take a welcome break during the busy week. In 1998, we started a process, supervision and support group for interns, which has been well received, and thus far, a great success. This group allows the interns to understand the basics of group process and get to know and shepherd each other through the first year of training.
Building on the foundation of theinternship year, the second year program further exposes the residents to avariety of training situations and opportunities in psychiatry. Residents continue their inpatient training at the University Hospital, Martha Jefferson Hospital and Western State Hospital for a total of nine to ten months of adult inpatient psychiatry. Didactic sessions continue one morning a week as inthe first year.
Child and Adolescent Psychiatry
Residents spend eight weeks treating child and adolescent patients at the Commonwealth Center for Children and Adolescents, a state psychiatric hospital in Staunton, VA. Residents participate in multidisciplinary patient evaluations, and are introduced to techniques of group, family, individual and pharmacologic therapies for children and adolescents. Topics of twice weekly seminars include development, psychodynamictheory and management of specific clinical problems.
Consultation-Liaison and EmergencyPsychiatry
The consultation-liaison service provides residents with a two to four month experience in the diagnosis and treatment of psychiatric problems in patients who are also being treated for other illnesses. This service sees approximately 1800 patients per year with a variety of diagnoses. Residents on this rotation also staff the University Emergency Room, gaining experience in the diagnosis and management of psychiatric emergencies and the interface of the university and the public mental health system. Residents on acute services receive training in the evaluation and management of acute intoxication and withdrawal.
Third Year
Residents spend the third year of residency in the Outpatient Psychiatric Clinic at Northridge Ambulatory Center gaining experience and training in the wide variety of psychotherapeutic andpsychopharmacological treatments used in outpatient psychiatric practice. The core of clinical experience is spent with individual adult patients, learning the spectrum of psychotherapeutic techniques, both short and long-term, under the supervision of an eclectic and energetic faculty. Each resident also receives training in 5 areas of psychotherapy, including group, cognitive, dynamic- long and short and supportive psychotherapy.
Supplementing the clinical experience are diverse seminars and didactics accounting for 15 hours of the work week. Popular seminars include a psychoanalytic seminar over breakfast each Monday morning, patient formulation conference, and weekly observation of psychotherapy. A weekly research seminar focuses on the development and implementation of a clinical research project, managed by the seminar group under the direction of a clinical and a behavioral epidemiologist. Residents utilize multiple supervisors to take advantage of the rich breadth of training, experience and theory that the University of Virginia faculty and adjunct faculty provide.
Fourth Year
Fourth year residents hone their skills and participate in the teaching of junior residents and medical students during their six month rotation as senior residents on the university inpatient units and consultation-liaison service. Senior residents gain supervisory and administrative experience that is invaluable in academic, private practice, or community psychiatry. Fourth year residents continue some long term psychotherapy cases from their third year.
The remainder of the fourth year is devoted to selectiveand elective time, which the residents tailor to their interests. Rotations in community mental health, Forensics and Substance Abuse are available to roundout the training. Popular electives include rotations in student mental health,community mental health, behavioral medicine and the HIV clinic.
For further information, please write, call ore-mail:
Psychiatry Residency Training Program
Department of Psychiatric Medicine
University of Virginia
Box 623 HSC
Charlottesville, Virginia 22908
TEL (434)924-2241
FAX (434) 924-5149
e-mail: psychresidency@virginia.edu
Combined Psychiatry and Internal Medicine Residency Program
The University of Virginia Departments of Psychiatric Medicine and Internal Medicine offer an accredited five year combined program in Internal Medicine and Psychiatry. Residents receive training in each specialty in both inpatient and outpatient settings. Emphasis is placed on the integrated evaluation and treatment of patients with co-morbid medical and psychiatric conditions, the behavioral management of the medically ill, and the neurological basis of severe mental illness, although residents are well prepared to practice in each area.
For further information please write or call:
Psychiatry/Internal Medicine Residency Program
Department of Psychiatric Medicine
Box 800623
Charlottesville, Virginia 22908
TEL (434)924-5408
FAX (434) 924-5149
e-mail: psychresidency@virginia.edu
Advanced Training Programs
Geriatric Psychiatry Residency Program
A one year ACGME fully accredited geriatric psychiatry residency is offered to those who have completed a general psychiatry residency. Clinical experiences include working with geriatric inpatients, outpatients and residents of local nursing homes and retirement villages, as well as an outreach program to homebound rural elderly. In addition to clinical experience, the resident is supervised in the selection and implementation of a research project in an area of interest. Regular didactic sessions in geriatric psychiatry are provided. Completion of the geriatric residency fulfills the requirements to allow taking the Board exam for Added Qualifications in Geriatric Psychiatry.
For further information please write, call or e-mail:
Suzanne Holroyd, M.D. Director, Geriatric Psychiatry Department of Psychiatric Medicine Box 623 HSC Charlottesville, Virginia 22901 (434) 924-2701 FAX (434) 924-5149 sh4s@virginia.edu
Child and Family Psychiatry Residency Program
This two year program is designed to facilitate the progressive development of the child psychiatry resident as he or she moves through a series of core clinical experiences with a high level of supervision and modeling of skills by child psychiatry faculty members. Clinical experiences include outpatient, inpatient, consultation-liaison, forensic, infant observation and school consultation. The exposure to different clinical populations under supervision is supplemented by an extensive, graduated didactic curriculum in modern child psychiatry.
For further information, please write, call or e-mail:
Roger Burket, M.D. Director, Division of Child and Family Psychiatry One Boar's Head Lane Charlottesville, Virginia 22901 (434) 243-6950 FAX: (434) 243- 6970 rcb8n@virginia.edu
Fellowship in Forensic Psychiatry
This one year fellowship program is designed to provide specialized opportunities in forensic psychiatry and the legal aspects of psychiatric practice for individuals who have completed a general psychiatric residency. This fellowship, sponsored by the Institute of Law and Psychiatry and Public Policy, includes participation in law school courses, inpatient and outpatient forensic assessment, an opportunity to attend all of the Institute's interdisciplinary training activities, and an opportunity to conduct a major research project under supervision of Institute faculty.
For further information, please write or call:
Richard J. Bonnie Director, Institute of Law Psychiatry and Public Policy Box 100 Blue Ridge Hospital Charlottesville, VA 22901 (434) 924-5435
Associated Services
Behavioral Medicine Center
The Behavioral Medicine Center operates seven clinics that specialize in the diagnosis, treatment and prevention of a variety of medical disorders that are either caused or affected by lifestyle or stress. Residents can spend fourth-year elective time working at the Center.
Center for Psychiatric Clinical Research
The Center for Psychiatric Clinical Research specializes in Phase II, III, and IV clinical research on drugs for the treatment of anxiety disorders, mood disorders, psychotic disorders as well as geriatric psychiatric disorders such as Alzheimer's Disease. The Center is located in the Outpatient Clinic at North Ridge and offers the residents myriad opportunities to collaborate with faculty in the clinical drug trials.
Psychology
Psychiatric residents receive didactic and clinical instruction from full-time psychology faculty on a variety of subjects. Psychology faculty perform psychological and neuropsychological testing and are available as consultants.
The Institute of Law, Psychiatry and Public Policy
The Institute for Law, Psychiatry and Public Policy provides a number of clinical, educational and consultative services. The multidisciplinary staff of psychiatrists, psychologists, social workers and attorneys lecture and publish on all areas where mental health and the law interface. Residents are invited to attend courses and lectures given by the Institute staff.