The PGY 2 year offers a rich and diverse exposure to psychiatric illness and treatment through rotations in inpatient, outpatient, emergency and consult-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 rotate through the Intensive Outpatient Program at PH for 2 months, and spend two months in the Comprehensive Psychiatric Emergency Program (CPEP) working as part of a team evaluating patients in a busy urban psychiatric emergency room. Finally, PGY2s spend 2 months on the consult liaison service, where they are assigned to a major medical or surgical service and are supervised by liaison psychiatry attendings in the care of medical inpatients with psychiatric issues. As in the PGY1 year, residents receive substantial faculty supervision in psychotherapy and psychopharmacology in each clinical setting.
PGY 2 residents share night and weekend call and each of the 12 residents averages about three calls per month.
A highlight of the PGY 2 year is the Long Term Therapy (LTT) program. PGY 2 residents are assigned outpatients for treatment with twice weekly, long-term psychoanalytically oriented psychotherapy. The residents are closely supervised on these cases by psychoanalysts from the clinical faculty and take a year-long theory and case-conference course which augments their work.
The PGY 2 year also includes daily didactic sessions that include coursework in psychiatric interviewing, neuroscience, pathophysiology, psychotherapy, ethics, community psychiatry and others. The core curriculum in the PGY 2 year 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 PGY 2’s professional development.
The Community Service is 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.
This NYSPI unit conducts a variety of research programs in the study of affective disorders, eating disorders, substance abuse, 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 introduction to research methodology.
On this Columbia/NYPH service, residents treat patients with a wide spectrum of psychiatric illnesses, including affective disorders, anxiety disorders, personality disorders and family problems. Ages range from adolescence to late life. Some patients are admitted directly to the IOP and others are referred immediately following a brief psychiatric hospitalization. The IOP provides an alternative to hospitalization, with discharge to conventional outpatient care after six to eight weeks. Biological treatments and individual psychotherapy, as well as group therapy are combined in the treatment of these acute patients. While rotating on this unit, residents participate in didactics on a wide variety of topics, including women’s mental health.
The CL Service at NYPH is one of the oldest and largest departments in the country and PGY 2 residents work on this service for a two-month block. Each Resident selects a major medical or surgical service and becomes part of their liaison psychiatry team, working under the supervision of the attending psychiatrist from that service. 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. While it is primarily a clinical department, faculty have made important research contributions including the delineation of ICU psychosis, work on post-cardiotomy delirium and ongoing studies of neuroendocrine effects on the heart, done in collaboration with the cardiac transplant team. In addition, the department has produced work focusing on the cost-effectiveness of psychiatric consultations on a surgical service, the management of patients who wish to sign out against medical advice and the negative effect of sleep deprivation on house staff.
An important experience of the PGY 2 year is the 2 months spent working in the CPEP, where Residents are trained in the evaluation and treatment of patients whose problems range from substance induced psychosis to family crisis. During this rotation, Residents gain expertise in diagnostic interviewing and treatment of acute psychiatric emergencies. 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.