The second year of training (PGY2) offers a rich and diverse exposure to psychiatric illness and treatment through rotations in inpatient, outpatient, emergency and consultation liaison psychiatry. Inpatient rotations include four months on the community service at NYSPI and two months on NYSPI’s clinical research unit. PGY2 residents also spend an additional month at the Children’s Day Unit at NYSPI and two months in the Comprehensive Psychiatric Emergency Program (CPEP) working as part of a team evaluating patients in a busy urban psychiatric emergency room. In addition, PGY2s spend two months on the Consultation Liaison service. Finally, each resident has a two week rotation in Public Psychiatry and the Brain Stimulation services at NYP and NYSPI. During the year, PGY2 residents share night float responsibilities and weekend call admitting and covering the inpatient services of NYP and NYSPI. As in the first year of training, PGY2 residents receive substantial faculty supervision in psychotherapy and psychopharmacology in each clinical setting.
A highlight of the PGY2 is the Long Term Therapy (LTT) program. PGY2 residents are assigned outpatients for treatment with twice weekly, long-term psychodynamic psychotherapy. The residents are closely supervised on these cases by psychoanalysts from the clinical faculty. A theory and case-conference course for PGY2 residents augments this work.
The PGY2 also includes daily didactic sessions that include coursework in psychiatric interviewing, neuroscience, pathophysiology, psychotherapy, ethics, community psychiatry and others. The core curriculum in the PGY2 stresses a thorough understanding of the clinical syndromes and the biologic, psychological, familial and cultural factors that influence patients. Residents also develop sophisticated interviewing techniques for diagnosis and treatment. The integration of these clinical experiences with the core curriculum provides the essential foundation for each PGY2’s professional development.
Washington Heights Community Service Inpatient Unit (PI-4South)
PGY2 residents spend four months on the Washington Heights Community Service, a state-funded urban community mental health center which provides a comprehensive system of inpatient and outpatient care for the seriously ill patients in Washington Heights. Residents treat acutely ill patients on the NYSPI inpatient unit as part of a team, and work closely with the patients' families and outpatient case managers to ensure a smooth return to the community. The average length of stay is ample, usually three to four weeks. A program on cross-cultural psychiatry focuses on the Latino community living in Washington Heights.
General Clinical Research Service Inpatient Unit (PI-4 Center)
PGY2 residents spend two months on the General Clinical Research Service. This NYSPI unit conducts a variety of research programs in the study of affective disorders, eating disorders, suicidal behaviors and personality disorders in adults and adolescents. Recent research has focused on studying phenomenological and biochemical changes associated with suicide and eating disorders, and investigating new treatments. Research patients do not pay for their care. The average length of stay for patients is two to three months which allows residents to work with patients intensively during their two month rotation. Resident teaching is focused on evaluation and differential diagnosis, cognitive and psychodynamic psychotherapy, and an introduction to research methodology.
The Consultation-Liaison Service
PGY2 residents rotate for two months on the Consultation-Liaison Service at NYPH, one of the oldest and largest departments in the country. Residents are trained in a wide spectrum of psychological and pharmacological techniques. Special emphasis is directed towards treating patients with a variety of medical and surgical illnesses and in working in the consultative mode with patients and their physicians. Residents also gain experience in forensic issues, especially capacity assessments. Residents participate in daily clinical rounds run by an attending psychiatrist. These rounds serve as direct, case-oriented educational experiences. Residents have the opportunity to teach non-psychiatric house staff and learn how to conduct case conferences. Each week there is an active schedule of lectures and case presentations covering a variety of topics in general psychiatry as it impacts the medical setting.
Comprehensive Psychiatric Emergency Program (CPEP)
PGY2 residents rotate for two months in the Comprehensive Psychiatric Emergency Program (CPEP) where they gain proficiency in diagnostic interviewing and treatment of acute psychiatric emergencies. During this rotation, residents are trained in the evaluation and treatment of patients whose problems range from substance induced psychosis to family crisis. This emergency room setting is unique in that patients are able to stay for up to 72 hours, allowing time for a thorough evaluation and the best treatment and disposition.
During this two-week rotation, PGY2 residents spend one week with the staff and clients at the Ft Washington Men’s Shelter (FWMS) and one week at Fountain House (FH).
FWMS is part of a larger organization, Project Renewal that provides comprehensive services (housing, vocational, psychiatric and medical) to people with severe mental illness and substance abuse in the NYC area. The FWMS is a homeless shelter that serves men identified as having both mental health and substance abuse needs. The shelter uses recovery oriented principles, health care management (including mental health and substance abuse), education and money management to help clients prepare for discharge into supported housing programs. The shelter also provides medical and dental services. During this rotation residents participate in client intakes and in other clinical activities that are geared towards preparing the clients for discharge.
Fountain House is a world-famous “Club House” model program that is run jointly by peers and staff. The programming focuses on vocational rehabilitation and club house membership. Fountain House incorporates recovery principles including shared decision making, person centered services and achievement of personal goals. Residents have the opportunity to participate in one of five vocational units and work with clients/members in the caring out of FH services and vocational training.
Brain Stimulation Service
During this two-week concentration on Monday, Wednesday and Friday mornings, PGY2 residents rotate with faculty supervisors at the Brain Stimulation Service. Electroconvulsive Therapy (ECT) has been modernized substantially since it was first introduced over 70 years ago. ECT remains the most effective and rapidly acting treatment for severe treatment-resistant depression and NYP and NYSPI have long been recognized as leaders in the field of ECT research and clinical practice. During this rotation, residents learn how to evaluate patients under consideration for ECT treatment, create an ECT treatment plan and administer ECT under supervision.