Clinical Sequence

The First Year (PGY-1)

The first year is devoted to acquiring essential clinical skills in psychiatry and medicine, including interviewing, examination, diagnosis, and treatment. This year is divided as follows:

6 month block filling requirements in Internal Medicine, Neurology, and Emergency Medicine

During the six months on the Medical Services, the resident spends two months on inpatient medicine, one month doing a medicine outpatient, one month in the Emergency Room, and two months on the Neurology Service. Residents, always carefully supervised, are assigned acute-care patients along with medical interns on medicine and neurological services; case loads are monitored for breadth of experience. Residents attend teaching conferences of these departments.

2 months inpatient psychiatry at the VA Medical Center
3 months running the Admissions Department and on inpatient units at Hutchings Psychiatric Center (HPC)
1 month at St. Joseph's Hospital Comprehensive Psychiatric Emergency Program (CPEP) & ACT Team

Residents learn to interview and collect data efficiently; systematically observe and recognize psychopathology; organize these data and make a diagnosis; and develop a multidisciplinary treatment plan. Concomitantly, the course work (repeated each six months) focuses on interviewing, diagnostic clinical psychiatry, emergency psychiatry, and clinical psychopharmacology.

The Second Year (PGY-2)

The second year is divided as follows:

6 month block on "4B", our inpatient adult psychiatric unit at University Hospital
2 months working in the Outpatient Substance Abuse facility at Crouse Irving Memorial Hospital's 410 S. Crouse
2 months Consult-Liaison Psychiatry
2 months outpatient triage psychiatry as NPOD at the VA Medical Center

During this year, residents are first exposed to ECT at the University Hospital Inpatient Psychiatry Unit, the triage/evaluation service at the VA Hospital, Addiction Psychiatry, the Consultation Liaison Service of University Hospital and Geriatric Psychiatry. Residents on the Consultation Liaison Service evaluate acute medical/surgical patients at University Hospital and the VA Medical Center, dealing with often complex medical-psychiatric interactions and numerous interdisciplinary issues. Two hours of teaching rounds each day ensure close supervision.

Residents assigned to the Addiction Psychiatry treatment service gain experience in acute detoxification, an inpatient treatment program, methadone maintenance, a family program, and local self-help groups (AA, NA) under the supervision of a psychiatrist board-certified in addiction psychiatry. On each service, residents see patients with different socio-cultural and clinical presentations and gain more experience in individual, group, and family psychotherapy. The resident can also begin to acquire a small caseload of ambulatory patients who are former inpatients.

The course work shifts correspondingly. Seminars focus on advanced clinical psychiatry, basics of psychotherapy, and psychological testing. By the end of the PGY-2 year, residents have an in-depth knowledge of each of the major syndromes and can competently work with the entire range of acute inpatients, having used state-of-the-art treatment methods in a variety of settings. They can triage efficiently and choose the best treatment alternative for each patient presenting to an Emergency Service.

The Third Year (PGY-3)

Outpatient psychiatry at the Upstate Clinic (private office with computer and webcam for recording therapy sessions)
1/2 day/week VA Psychopharmacology Clinic
2 mornings/week Child & Adolescent Psychiatry
Elective time

Residents move into their own computer-equipped offices in the Outpatient Clinic for their third and fourth years. Their major task is to see outpatients while developing their skills in brief and long-term dynamically oriented psychotherapy, psychopharmacotherapy, and psychoanalytic theory, with additional experience in therapy with couples, families, and groups. Intensive short-term dynamic therapy, cognitive therapy, behavior therapy, eye movement desensitization and reprogramming, interpersonal therapy and hypnosis may also be used. Each week, residents see 10 to 15 carefully selected patients, spend one morning or afternoon in the Psychopharmacology Clinic, and receive three hours of individual supervision.

Seven hours per week are spent in Child and Adolescent seminars and exercises during which residents pick up child and adolescent patients and their families whom they will continue to follow for the rest of their residency.

Corresponding didactic courses emphasize the sophisticated treatment of the entire range of outpatients, both children and adults, utilizing a variety of specific therapeutic modalities. At the end of the third year residents are knowledgeable and experienced in all the basics of psychiatry. The fourth year, then, offers opportunities to gain further experience and special expertise.

The Fourth Year (PGY-4)

The outpatient experience, begun in PGY-3, which includes Psychopharmacology Clinic one afternoon a week, continues uninterrupted in the fourth year, but may be reduced to half-time. The other half-time is elective for the entire PGY-4 year in such areas as:

Group (DBT - Dialectical Behavioral Therapy; CBT - Cognitive Behavioral Therapy; SCT - Systems Centered Therapy)
Family Therapy
EMDR (Eye Movement Desensitization and Reprocessing)
IPT (Interpersonal Therapy)
Anxiety/Depression Clinic
SU Student Health Clinic
Indian Reservation
HOPE Clinic
Geriatric Psychiatry
Forensic Psychiatry
Research

In the past, residents have worked with individual faculty members in areas such as research, specific psychotherapies, psychopharmacology, additional experience with ECT, consultation-liaison with the AIDS Clinic, and even acupuncture. Residents have also arranged extramural electives at places such as the National Institute of Mental Health, Harvard Medical School, and the National Center for Disease Control.

The elective fourth year allows for residents to entertain their particular interests and build special areas of expertise on a very strong, broad-based psychiatric education.