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From the Faculty's Perspective

Deborah Cabaniss, M.D.

My name is Deborah Cabaniss, and I'm the Director of Psychotherapy Training. My job is to help Columbia psychiatry residents get the best education in psychotherapy that we can possibly offer them. I have a great job, not only because I love to teach and supervise, but also because I get to work with so many great teachers, supervisors and residents. At Columbia, we think of our residents as being learners. Each day, residents come together around lunchtime to go to class – and many of their classes relate to psychotherapy. Just to give you an example: I'm currently teaching a year-long course on psychoanalytic psychotherapy to the PGY-IIIs which addresses the questions of how it works, who it's for and how to do it. Because the residents get a full year for this course, we have the time to really focus on technique. In today's class, for example, we focused on learning to listen; next week we'll learn about how we process the material that we hear from patients. This didactic immersion is complemented by the “lab” component of the course – treating patients in long-term psychotherapy under the supervision of a psychoanalyst. At the end of the year each resident will write up one of their cases with a full psychodynamic formulation – and they'll do a great job! Teaching that group of 12 bright, diverse, enthusiastic residents is definitely one of the highlights of my week.

The Psychotherapy curriculum is structured to move from basic principles in the PGY-II year to advanced concepts in the PGY-IV year. PGY-IIs take classes that focus on assessment for psychotherapy, beginning the treatment, and writing a case formulation. The PGY-III year offers immersion in techniques of many different psychotherapies, such as cognitive behavioral therapy, dialectical behavioral therapy, interpersonal psychotherapy, and group psychotherapy. PGY-IVs study brief dynamic psychotherapy, as well as advanced concepts such as termination and the neuroscience of psychotherapy. PGY-II-IV residents treat patients in long-term psychodynamic psychotherapy with supervision from psychoanalysts, and PGY-IIIs and IVs receive supervision in CBT, IPT, and Supportive Psychotherapy as well. The best part is that all of the residents get this intensive training in psychotherapy – even the ones who will ultimately go on to do clinical and basic science research.

As for me... I'm a “homegrown” faculty member – I've been here ever since I graduated from college – and although I've had opportunities, I wouldn't go anywhere else. Meeting psychiatrists from all over the country keeps me constantly aware of how outstanding my Columbia training was. The psychotherapy training and supervision I received as a resident shaped my career, my interest in psychoanalysis, and my life. I had mentors who encouraged me to write and to do research, outstanding supervisors whose words still echo in my mind on a daily basis, and amazing clinical opportunities. Today, psychotherapy training is still prioritized in the residency program. Courses in psychotherapy are part of the core curriculum of every year of training, psychotherapy is taught on all of the PGY-II rotations, and classroom time is “protected” – even for residents in the ER and on the inpatient units.

This is a unique department of great breadth and depth. Whatever your interest, there's someone here who's doing cutting edge work in that area and who has trainees working with them. We're looking forward to meeting you!

Jay Gingrich, M.D., Ph.D.

I entered Residency training in 1993, when the biologic understanding of psychiatric illness was arguably...umm...lacking. Back then, I needed to defend my decision to become a psychiatrist to nearly everyone: peers, professors, and parents. Among my Residency classmates, we consoled ourselves by noting that we were the youngest branch of medicine. We took solace in the fact that the focus of our passion was surrounded by a dense bony structure that did not yield its secrets as easily as the immune system. The brain was a tough nut to crack...the final frontier... All true, yet, my experience at Columbia instilled something precious: optimism. During my training, I became certain that psychiatry had a future and was the future. The brain was ripe for discovery.

To be sure, we understood little to nothing about the etiology and pathophysiology of our disorders. Yet, as a curious clinician, I had found nirvana. Through my training, I learned that our therapeutic armamentarium of medication and psychotherapies were surprisingly effective. I learned how to use both with great confidence. Yet, there was so much left to learn about brain function, dysfunction, and how our treatments actually worked. Was there ever a better discipline as a clinician and as a researcher to make a difference?

Of course, I wasn't alone in seeing this potential. In the interim, neuroscientific and psychiatric research have exploded. We have advanced our understanding of normal and abnormal brain function substantially. Increasing numbers of researchers in neuropsychiatry have harvested the fruits of the human and mouse genome projects, the insights gained from functional brain imaging, as well as advances in cell biology, pharmacology, and electrophysiology. Proudly, Columbia has been among the leading institutions in producing these insights. We have two Nobel Laureates in our Department of Neuroscience and one of the most dynamic neurobiological and clinical research programs in the world. As part of this institutional endeavor, my research group has been doing its part to increase our understanding of normal and abnormal brain function using genetic, epigenetic, pharmacological, and whatever other tools are needed to answer our questions. Currently, we number 15 or so: a team of post doctoral fellows, graduate students, research associates, and undergraduate interns. Most of my time is devoted to guiding the research of these young scientists—helping with writing up their studies, securing grant funding, and keeping current with the ever advancing edge of knowledge and ideas in neurobiology.

As part of the teaching faculty, and an active participant in the research enterprise, our rapidly expanding knowledge base presents a challenge to helping Columbia Residents stay current. For the past eight years, I have directed a 26-lecture course that lays out the neurobiological underpinnings of psychiatric disorders and their treatment. As didactic instructors to the Residents, we receive no compensation. Unlike other institutions with which I am familiar, teaching Residents has always been a highly coveted assignment at Columbia. Why do we do it? Hard to explain, but Columbia Residents have always held a special status in the institution. Many of us were Columbia Residents ourselves and want to “give back” some of the intellectual generosity we enjoyed during our training. Moreover, Columbia has always attracted top Residents. Who wouldn't want to have a stake in helping to shape the next generation of leaders in our field?

In the ten years since I began my career as a psychiatrist, I haven't looked back. Since graduation, my immersion in cutting edge clinical and basic neuroscience has guided my group's research and allowed me to keep Residents up to date about what we know—and more importantly—what we still don't know about the brain. Before each seminar, I look over my notes to see whether I might be able to give the same lecture as last year. It hasn't happened yet. Each year brings too many notable advances...and that, is a good thing. It is an annual reminder that my youthful optimism about the future of Psychiatry was justified.

Joshua Gordon, M.D., Ph.D.

I consider myself first and foremost a neuroscientist. From my point of view, this isn’t at all at odds with being a psychiatrist – the two go hand in hand. Perhaps that’s why I was tapped to be the Director of Neuroscience Education and to help lead a revision of the neuroscience and psychopharmacology curriculum in the residency. It is an interesting challenge for me to think about how to teach the brain to a diverse group of psychiatry residents who come with a broad range of backgrounds and interests. Yet, this is exactly what we need to do if we are to fulfill our mission of training future leaders in this field.

My educational philosophy meets this challenge head-on by attempting to combine neuroscience and psychiatry at all levels and in all disciplines. I hope to ensure that our best teachers bring their expertise to the residents in a way that is clinically relevant, accessible, informative and entertaining. Our curriculum uses a case-based approach wherever possible; clinical questions are answered both from the theoretical perspective based on our understanding of the brain and from the practical perspective based on what’s been proven to work. The third-year Psychopharmacology & Neuroscience Course does exactly this, relying on experts in both disciplines to lead discussions built from the residents’ ongoing caseload. Similarly, the fourth-year Psychotherapy and Neural Science class examines the neurobiological basis of psychotherapeutic change.

The twin perspectives of neuroscience and psychiatry are well-represented here at Columbia, as I have found since choosing to come here for my residency training and research fellowship. I wanted to come to Columbia because I knew I would get excellent training in all aspects of psychiatry – somatic and psychological treatments alike – as well as in neuroscience. Indeed, once here, I found famous neuroscientists with deep interests in understanding the neurobiology of psychotherapy; psychotherapists who have built careers trying to discover how their treatments affect the brain; neuroscience Ph.D. students meeting patients to learn first-hand how illness and its treatments affect lives; and clinicians attending basic science seminars to see for themselves how brain functions are elucidated.

When I’m not teaching, I lead a small group of neurophysiologists who are trying to understand how genetic mutations that predispose to psychiatric illness alter brain activity. The end goal of this research is to understand the pathophysiological disturbances that underlie mental illness in sufficient detail that we can identify novel drug targets that might reverse or overcome these disturbances. Along the way, we try to learn as much as we can about the brain in its normal state, too; basic stuff that fuels us intellectually and provides a basis for everything I do as a psychiatrist, neuroscientist, and now teacher as well.

Philip R. Muskin, M.D.

Several years ago I had an epiphany. It had been a busy day; patients in the morning, many phone calls from residents about vexing patient problems on the Consultation-Liaison Service, several journeys on the internet to quickly research answers to questions by accessing literature, and a question from a faculty member about a spouse regarding when it is appropriate to use an implantable defibrillator for an arrhythmia (sending me into a frantic literature search in uncharted territory for me). What occurred to me on that day was how much fun it is to be a faculty member at Columbia. That luck is a combination of the remarkable resources available at one of the world's leading medical centers, a Department of Psychiatry that is arguably as “good as it gets,” residents who are culled from the most outstanding medical students in the country, and a faculty of wonderful and brilliant people.

I am an academic psychiatrist. For me, being an academic psychiatrist requires that the individual spend part of the workweek in the process of education. This activity must be a central part of the person's identity as a psychiatrist. Since I loved both medicine and psychiatry, it's not surprising that my area of academic psychiatry is Consultation-Liaison.

Although I also see patients in psychotherapy, psychoanalysis, and combined treatment with medication and psychotherapy, the majority of my workday is spent running the Consultation-Liaison Psychiatry Service at Columbia University Medical Center. We are a tertiary care medical center, which means that I see patients in consultation, but mostly it means that I have the pleasure of working with psychiatric and non-psychiatric residents. On an average day, I get at least a dozen telephone calls (it can be much, much more) from residents to discuss cases. I am available to join a resident to see a patient at the bedside, either a resident I am personally supervising or any of the residents rotating on the C-L service. When not in the office I carry a cell phone so the residents can speak with me. In the past 30 years of educating residents in psychiatry, I have never received a call that seemed unnecessary. Being on-call can be a terribly lonely experience and I hope that being available might make it a tad less lonely and a bit more educational for the resident. Typically, I talk to several colleagues from my own and other institutions about problematic cases, often focusing on difficult issues of psychotherapy or psychopharmacology. I round with the residents three times each week, discussing cases and trying to focus an academic discussion around the case material. I meet with one of the C-L fellows weekly to go over cases, to supervise his/her resident supervision, and to work on a writing project. Several years ago I realized it was more fun to write with someone else and since then I have collaborated with a junior colleague on most everything I write.

Columbia has been supportive of my involvement in national organizations such as the American Psychiatric Association, the Association for Academic Psychiatry, and the Academy of Psychosomatic Medicine. This puts me in contact with some of the most interesting people in the world at meetings and at home. E-mail now makes this fantastic sounding activity a reality. Attending meetings has exposed me to knowledge about which I previously had no idea (dopamine receptors, evolutionary biology, and the challenge of educating as an “expert” being the ones that stand out). Via organizational involvements, I face the challenge of taking education from the local setting to the large-scale as part of program committees. Working on program committees has given me the opportunity to spend time with several of the organizational leaders in our field.

Academic psychiatry may be under great pressure, but it cannot be permitted to disappear. Fortunately, at an institution such as ours, there will always be remarkable people who will employ their talents to guide others in learning the craft of clinical psychiatry and psychiatric research. I have the fantasy that some of you who read this “perspective” will become enthralled by the idea of being an academic psychiatrist and will choose to join the ranks of those of us in this noble, creative, flexible, and exciting career. If so, Columbia would be a great place to start your career.

Mary Sciutto, M.D.

My name is Mary Sciutto and I'm the director of the Intensive Outpatient Program (IOP), a training site for all PGY 2 Residents here at Columbia. I've been at Columbia for over fifteen years; twelve years ago I started the IOP as a crisis service for the Department of Psychiatry at New York-Presbyterian Hospital and as a teaching site for the Columbia Residency with a focus on higher-acuity psychiatric outpatients.

My experiences as a Fellow in Public Psychiatry at Columbia and as the Associate Director of the Psychiatric Emergency Department at Presbyterian Hospital helped shape the design of our program. At the IOP, psychiatry Attendings and Residents work as a team; our Residents have close supervision and work with difficult patients knowing that an attending is always on site. As a program, we have a broader mission of serving our Department and the larger medical center and that's part of the fun of my job. In the course of an average day I'll have contact with many people -- with our E.R. or inpatient unit, Residents, medical students, researchers over at the Psychiatric Institute or, perhaps, clinicians in the community, some of whom were Residents at the IOP not too long ago!

As I said, an average day for me means working with and learning from Residents, medical students and other people from different parts of the Columbia community. Typically, I'll arrive at the IOP shortly after 8:00 a.m. as we have our Resident/Attending “rounds” first thing in the morning. I work directly with all of the Residents and in rounds I get a chance to hear the Residents present new patients and review other patients on their service. I like to see the Residents master the “boards” style of presenting new patients – I'm always pleased when I help PGY 4 Residents prepare for their “mock boards” because I can see how much they've learned at the IOP and other training sites. Because we work as a team, we're bound to have lively debates about diagnoses or treatments in rounds. We also try to use rounds for learning and our Residents and fourth-year medical students often have articles relevant to one of our cases. I know I speak for the other IOP Attendings when I say how much I appreciate that – I keep learning because together we're keeping up on the ever-expanding psychiatric literature.

After rounds I often see patients with the Residents. I like to see any patients who present a diagnostic dilemma or demonstrate higher acuity. In some of these situations I may ask another one of the other IOP Attendings to see a patient with me so we can collaborate on a treatment plan. We often reach out to the many experts in the Columbia system if we feel we're stuck and we always appreciate that kind of access to experts in the field.

Part of my job has to do with getting patients to the IOP or getting patients from the IOP to their next treatment setting. On an average morning I may get a call from our inpatient unit about a patient soon to be discharged who might be helped by the group program of the IOP, or I may hear from the ER about a patient they feel doesn't need to be admitted, but may need more support than, say, once- or twice-weekly outpatient meetings. Clinicians in the community often send patients to the IOP because they feel their patients may need more structure; sometimes we get calls asking us to do second-opinions.

Another part of my job is teaching and organizing the classes and case conferences for our rotating Residents. In the weekly clinical seminar I teach we focus on issues including suicide assessment, risk management and the APA guidelines. I like learning about the new psychotherapies and cutting-edge treatments and I incorporate these topics into my seminar. I've served as one of the course directors for the Columbia Department's annual CME conference in recent years, so I may try to get one of the researchers I've heard at that conference to come to the IOP and share the latest information on a topic.

After I leave the medical center, at the end of the day, my responsibilities shift. I'm the mother of two sons, now ages 13 and 15, so I often go from helping Residents with cases to helping my sons with their homework. I'm often asked by Residents about the balance of family life with a career in academic psychiatry. I think I speak for many in the field, particularly women, when I say that the balance is always changing. I expect that my work life will evolve as my children grow older. Thus far I've developed a program I'm proud of, worked with great colleagues, and enjoyed my ongoing relationships with Residents and medical students. I think of Columbia's Department of Psychiatry as a place without limits and I feel secure that as I grow professionally I'll always have new opportunities in this setting to learn and grow as a psychiatrist and teacher. I am so lucky because I love coming to work everyday!


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