Curriculum

Medicine (4 months: 2 inpatient, 1 outpatient, 1 ER). Interns serve as members of the medicine department's inpatient, outpatient, and ER services at MUH and the VA. Avg hr/wk - 70 for inpatient, 60 for ER, and 40 for outpatient service. Intern caseload avg 8 inpatients. Night call avg q 5th day. Upon request, one month of inpatient pediatrics can be substituted for one month of inpatient medicine.

Neurology (1 month: inpatient). Interns serve as members of the neurology department's inpatient service at the MUH. Intern caseload avg 8 inpatients.

IOP 3N General Psychiatry & ECT (2 months: inpatient). IOP 3N is a 24-bed inpatient service with two treatment teams (Drs. Short and Barth, attending). All patients are seen along with the attending in daily rounds. Intern caseload is 6-7 inpatients. There are weekend rounds but no night call (see nightfloat rotation below). While on this rotation, residents are asked to participate in evaluation and treatment for any patients needing electroconvulsive therapy (ECT) under the supervision of Dr. Nahas.

IOP 1N Psychiatry (1 month: acute inpatient). IOP 1N is a 12-14-bed intensive care service with one treatment team (Dr. Weinstein, attending). Common dx's are major depression, bipolar illness, schizophrenia, schizoaffective disorder, and anxiety disorders. Usual caseload is around 8 inpatients. There are weekend rounds but no night call during this rotation (see nightfloat rotation below).

VA General Psychiatry (2 months: inpatient). The VA mental health service has a 15-bed general psychiatry inpatient unit with an avg length of stay of 6 days. Prevalent dx's are major depression, schizophrenia, bipolar, schizoaffective, substance abuse, and anxiety disorders. Treatment modalities include individual and group psychotherapy and the range of state-of-the-art biological interventions. All inpatients are seen along with a supervising attending physician (Drs. Pelic, Huber or Haren) who is involved in all significant decisions. Intern caseload is 4-6 patients. Teaching rounds occur five days per week. There are weekend rounds but no night call during this rotation (see nightfloat rotation below).

IOP 2N Child/Adolescent Psychiatry (1 month: inpatient). IOP 2N is an inpatient service for youth aged 3 to 18 years, that has one treatment team. The usual caseload is approximately 10 patients. (Attending: Dr. Wagner). Common dx's are disruptive disorders - 70% (e.g., ADHD, conduct disorder), mood disorders - 20%, and thought disorders, pervasive developmental disorders, mental retardation, anxiety disorders and substance abuse - 10%. Treatment modalities include medication management and individual and family therapy. There are weekend rounds but no night call during this rotation (see nightfloat rotation below).

Emergency Psychiatry (2 months: night float). This service is the core of an organized 24/7 program, which provides emergency psychiatry consultation for patients presenting to our ER (e.g., diagnostic evaluation, crisis management, admission, or referral). On average, residents evaluate around four emergency patients per shift including youth, adult, and geriatric patients (childhood mental disorders 15%; substance use disorders 25%; psychoses or delirium 30%; agitation or mania 10%; trauma and victimization 5%; and other conditions presenting danger to self or others 15%). The night float team also cross-covers IOP and VA inpatients. Team members consist of two 1st or 2nd year residents (Junior Attending Residents - JARs), medical students, a 3rd year resident (Senior Attending Resident - SAR), who serves as team leader and triage officer, and an attending who is available for back up supervision. All patients seen in the emergency department are presented to an attending psychiatrist for supervision during morning check-out. Weekday shifts are 5 p.m. to 8 a.m. (15 hours). Weekend & Holiday shifts are from 8 a.m. to 8 a.m. (24 hours). In accordance with ACGME Duty Hours regulations, if a resident is assigned to two consecutive float shifts, that resident is permitted to arrive at the hospital at 6 PM on their second shift rather than at 5 PM. The resident is responsible for handling calls between 5 and 6 but is not required to perform in-house duties. Additionally, residents are not required to perform in-house duties (such as an afternoon continuity clinic) between consecutive shifts or following a 24-hour shift.

Please note: PGY1 lectures are held in 3 month blocks for all interns who are on-service. The block is repeated as interns rotate.

Essentials of Psychiatry & Psychopharmacology Series. Management of clinical scenarios likely to be encountered as psychiatric emergencies (e.g., identification of clinical syndromes, first line treatments, practical aspects of care such as involuntary commitment assessment and procedures). Lecture topics include: "call pearls," using the ental Status Examination in making differential diagnoses, identification and management of acute psychosis, mania, delirium, suicidal risk, substance abuse emergencies, overdose, and toxicities; crisis intervention techniques, and use of antipsychotics, antidepressants, mood stabilizers, and anxiolytics.

Psychopathology 101/Clinical Case Studies. This series provides an overview of major diagnostic categories in psychiatry, including epidemiology, diagnostic criteria, differential diagnosis, and treatment options for each illness category. The goal of this series is to provide a framework for the understanding the evaluation, diagnostic criteria, and differential diagnosis of each of the major DSM Axis I and II illnesses/categories to prepare residents to identify each disorder and consider treatment options. Individual seminar topics include: depression; bipolar disorder; anxiety disorders; personality disorders; schizophrenia and other psychotic disorders; alcohol abuse and dependence; cocaine abuse and dependence; opioid abuse and dependence; and other substances of abuse.

Psychiatric Interviewing. This series overviews selected concepts and techniques of psychiatric interviewing. Over several sessions, residents view segments of "Life Passage in the Face of Death”, which focuses on psychological engagement of the physically ill patient. Discussion of book chapters that are appropriate to the residents’ clinical experiences on rotations at the time (from Shawn Shea’s Psychiatric Interviewing: The Art of Understanding). Additional video tapes are used to augment the readings (i.e., Lionel Aldrich's experience with Schizophrenia).

Neurology 1 month (C/L). The resident serves as a member of the MUH neurology C/L service. Additionally, a neuropsychologist provides an overview of neuropsychological evaluation, including a practical demonstration of the administration of several common tests.

IOP 3N General Psychiatry & ECT 1 month (inpatient). See description in year 1. Resident caseload avg 8.

IOP 1N Psychiatry 1 month (acute inpatient). See description in year 1 above. Resident caseload avg 8 in 2nd year.

VA General Psychiatry 1 month (inpatient). See description in year 1. 2nd year resident caseload is 4-6 inpatients. 2nd yr residents also see patients in consultation and follow discharged inpatients one afternoon/wk in their continuity clinic (see VA Outpatient Psychiatry Clinic below).

Emergency Psychiatry 2 months (night float). See description in year 1.

IOP Senior Care Unit Geriatric Psychiatry 1 month (inpatient). The Senior Care Unit (SCU) at the IOP is a 10-bed inpatient service that provides clinical management of geriatric patients with a variety of psychiatric disorders (Dr. Weiss, attending). Prevalent dx's include major depression 20%, Alzheimer's disease (35%), vascular dementia (15%), other organic syndromes (15%), and other diagnoses (15%). Residents have weekend rounds one weekend day per week. There is no night call duty during this rotation. Cross-coverage for night calls is provided by the psychiatry float team. Average 2nd yr resident caseload is 10 inpatients.

IOP 4N Addiction Psychiatry 1 month (inpatient). This is a 10-bed service (Dr. Roberts, attending) where the clinical population usually has co-occurring mental illnesses and substance abuse disorders. Average resident caseload is 10 inpatients. Residents have weekend rounds one weekend day per week. There is no night call duty during this rotation. Cross-coverage for night calls is provided by the psychiatry float team.

VA SATC Addiction Psychiatry 1 month (outpatient). The resident works with attending psychiatrists Drs. Wright & Cusack at the VA’s Substance Abuse Treatment Center (SATC), an intensive outpatient treatment, support, and rehabilitation program. Residents gain experience with the identification and treatment of intoxication, withdrawal, and dependence and abuse for each substance, the clinical use of benzodiazepines and anticonvulsants in detoxification, Antabuse and Naltrexone in treatment, and Zyban and nicotine replacement therapy, familiarity with commonly available clinical and self-help resources. Residents have weekend rounds one weekend day per week. There is no night call duty during this rotation. Cross-coverage for night calls is provided by the psychiatry float team.

Consultation-Liaison Psychiatry 2 months. This is a two-month block rotation occurring in the 2nd year where residents respond to consultation requests from physicians caring for patients at the MUH hospital and clinics. Patients evaluated include those with a known psychiatric diagnosis as well as those with psychiatric issues that impact their medical treatment. Forensic experience is included for patients requiring capacity evaluations and right to refuse treatment evaluations. Residents see patients individually and then with the attending psychiatrist (Dr. Pelic). An average caseload is 1-2 new patients each day and 4 ongoing cases.

VA Outpatient Psychiatry Clinic ½ day/wk. The average resident caseload in the 2nd year VA clinic is 30-40 outpatients. Treatment modalities include individual support and case management, individual or group psychotherapy with or without cognitive-behavioral interventions, and the range of state-of-the-art psychopharmacotherapy. Patients can also be referred for more specialized evaluation and treatment (neuropsychological testing, substance abuse treatment, couples therapy, ECT, group PTSD therapy, etc.) as part of their overall mental health treatment. Prevalent diagnostic groups are major depression, schizophrenia, bipolar illness, schizoaffective illness, substance use disorders, anxiety disorders, and borderline personality disorders.

Neuroscience and Clinical Neurology. Year 2 lectures begin with a review of basic neuroscience in order to provide a solid foundation for understanding the neurobiological etiology of mental illness and its treatment. The year is rounded out by a series of lectures focused on clinical neurology.

Consultation-Liaison Psychiatry. Series of lectures focusing on assessment, diagnosis, and treatment of common psychiatric conditions encountered in other medical specialties including delirium, substance withdrawal, factitious disorders and malingering, and somatoform disorders.

Psychopathology II. This series builds on the 1st year series and expands the knowledge base on the epidemiology, etiology and related neurobiology, genetics, and course and prognosis of psychiatric disorders. The pharmacological treatments available for each of the following disorder will be discussed, emphasizing receptor-level function of psychotropic agents and treatment of refractory cases: Personality Disorders, Substance Use Disorders, Nonpharmacological Somatic Therapies, Fundamental Psychopharmacologic Principles, Mood Disorders, Psychotic Disorders, Cognitive Disorders, Sleep Disorders, Anxiety Disorders, Eating Disorders, Disorders First Diagnosed in Childhood, Adjustment Disorders and Bereavement, Impulse Control Disorders, Sexual and Gender Identity Disorders, Dissociative and Amnestic Disorders, Somatoform Disorders, Factitious and Malingering Disorders, Pain Disorders, and Consult/Liaison Psychiatry. Implications for diagnosing and treating these disorders in childhood and adolescence will be discussed when appropriate. The course director will conduct quarterly reviews of covered material to evaluate retention and comprehension of material presented.

Evaluation and Management of Geriatric Patients. Series of lectures focusing on assessment, diagnosis, and management of geriatric patient in psychiatry. Residents learn how to perform a thorough cognitive examination of a geriatric patient, specific cognitive disorders and their treatment, evaluation and management of common movement disorders, and management of aggression in a geriatric patient.

Introduction to Psychotherapy. Series of lectures focusing on basic theoretic framework of main schools of psychotherapy and practical aspects of becoming a psychotherapist. Residents learn about theoretic basis of crisis intervention, supportive psychotherapy, brief psychotherapy, psychodynamic psychotherapy, and cognitive-behavioral psychotherapy.

Developing Therapeutic Alliances. In-depth discussion about the psychiatric interview and mental status exam with follow up of patients by use of rating scales and standardized interviews as well as application of case formulation.

Adult Outpatient Psychiatry (IOP Clinic). This is an organized continuously supervised experience in the assessment, diagnosis and treatment of outpatients that emphasizes a developmental and biopsychosocial approach. Residents gain experience with a wide variety of patients and treatment modalities, experience both brief and long-term care of patients, individual psychotherapy (including psychodynamic, cognitive, behavioral, supportive, brief), and biological treatments approaches to outpatient treatment. Long-term psychotherapy experience must include a sufficient number of patients, seen at least weekly for at least one year, under supervision. Other long-term treatment experiences should include patients with differing disorders and patients who are chronically mentally ill. The IOP clinic provides a breadth of experience with regard to diagnoses, severity, complexity, and motivations and helps prepare residents for the real world of outpatient psychiatry. Many patients receive one or more psychotropic medications. The typical patient visits the clinic every two to four weeks, but all residents have at least two weekly (rarely twice weekly) patients, and several patients seen at less than monthly intervals. A typical caseload is 15-17 patient hours/week, including one or two new patient evaluations (1-½ hours each). Residents who see patients at Counseling and Psychological Services (Student Health) carry approximately 4 fewer hours/week. Each resident has 3-4 hours of individual supervision per week from faculty psychiatrists, psychiatric social workers, or psychologists, each providing 1 hour/wk of individual resident supervision. The seminars cover time-sensitive psychotherapy, psychodynamic psychotherapy, and cognitive-behavioral psychotherapy. There is formal teaching on group psychotherapy, family therapy, couples therapy, psychotherapy with special populations, psychotherapy termination, and psychotherapy research. A weekly clinical conference offers demonstrations and practice of different interview techniques.

VA Outpatient Psychiatry Clinic (Attendings: Drs. Lydiard, Levy, Everman and Pritchett). Required ½ day clinic where treatment modalities include individual support and case management, individual psychotherapy with or without cognitive-behavioral interventions, and the range of state-of-the-art somatic treatments (e.g., psycho-pharmacotherapy, electroconvulsive therapy) Patients can also be referred for more specialized evaluation and treatment (neuropsychological testing, substance abuse treatment, couples therapy, ECT, group PTSD therapy, etc.) as part of their overall mental health treatment. Prevalent diagnostic groups are major depression, schizophrenia, bipolar illness, schizoaffective illness, substance use disorders, anxiety disorders, and borderline personality disorders. The average resident caseload in the 3rd year VA continuity clinic is 30-45 outpatients.

Charleston Community Mental Health Center. Third year residents rotate scheduled half days at Charleston Mental Health, supervised by an attending psychiatrist. On this rotation, there are opportunities to see clinic patients, work with Mobile Crisis, or in the mental health urgent care. Residents provide care and treatment with appropriate pharmacologic, psychotherapeutic, and rehabilitative interventions. Prevalent diagnoses are major psychotic disorders, Schizophrenia, schizoaffective, bipolar disorders, other affective disorders, substance abuse disorders, and other disorders (e.g., anxiety disorders, PTSD, adjustment disorders, personality disorders). Under the direct supervision of full-time clinical faculty, the residents perform assessments and participate in developing and implementing the patient's individual community treatment and rehabilitation plans.

Child and Adolescent Outpatient (IOP and CMHC clinics). Residents can see patients in the IOP youth clinic 1/2 day per week for 6 months or see child & adolescent patients in their 5-South clinic with a child boarded psychiatrist. This gives residents exposure to and skill development in outpatient assessment and pharmacologic and psychosocial treatment modalities of a wide variety of child and adolescent psychiatric patients. Modalities offered include individual support and treatment in the context of individual, group, and family psychotherapies, pharmacological and behavioral interventions, and school consultations. All patients assigned to residents in these clinical settings are seen along with a supervising Attending physician.

Overview of Psychotherapeutic Theories. A survey of the history of psychotherapeutic theories including Freud and Ego Psychology, Sullivan and the Interpersonalists, contemporary Kleinian theory, Object Relations, and Self Psychology. Includes readings and case presentations to highlight practical applications and enhance understanding.

Dynamic Psychotherapy. Seminar discussion of readings from Greenson’s The Techniques and Practice of Psychoanalysis. Emphasizes the mechanisms of defense, transference, counter transference, resistance, and interpretation.

Time-Sensitive Psychotherapy. A series of seminars with accompanying readings on the principles of solution-oriented treatment and brief therapy. Topics include eliciting the patient’s request and negotiating goals, with a focus upon the language and assumptions of solution-oriented psychotherapy and brief treatment of specific issues such as loss and grief.

Motivational Enhancement Therapy. An introduction to and overview of motivational enhancement therapy with readings from Motivational Interviewing: Preparing People for Change by Miller and Rollnick. The series also includes videos of patients interviewed by Miller and Rollnick as well as role-play among the residents to highlight techniques and encourage practice.

Cognitive Behavioral Therapy. The series focuses on the basic elements of cognitive and behavioral theory with sessions dedicated to the therapeutic relationship, general psychotherapy skills, setting goals, structuring sessions, and applying CBT techniques to specific disorders. Techniques taught include evaluating automatic thoughts, anxiety management, exposure techniques, and problem-solving skills, social skills and behavior activation. Teaching methods also include required readings, role-playing, observation of faculty clinicians, critique of resident therapy tapes, and writing assignments.

Dialectical Behavior Therapy. An introduction to the principles of dialectical behavior therapy for the treatment of borderline personality disorder. The focus is to teach the therapist ways to help their patients acquire new skills and overcome motivational obstacles. Videos of therapy sessions enhance understanding of techniques.

Interpersonal Psychotherapy. An introduction to the principles of interpersonal psychotherapy. The focus is to teach the therapist ways to help their patients reduce interpersonal deficits by modifying faulty communication, exploring repetitive patterns in relationships, encouraging affect, and using the therapeutic relationship. Specific techniques and the therapist's role are considered.

Couples and Group Therapies. A brief series of lectures and seminars designed to provide the basic principles of couples therapy and group therapy. Focus is on improving communication skills and understanding dynamics between the participants. Videos of initial and follow-up couples and group therapies enhance understanding of technique.

Grief. Brief introduction to grief work with the goal to review depressive symptoms, explore associated symptoms, and teach the therapist how to help the patient reestablish interest and relationships and reconstruct their relationship with the deceased.

Children, Adolescents, and Families. Study of normal development and psychopathology in children, adolescents, and families. Includes overview and identification of major child/adolescent psychiatry syndromes and their management and treatment within the existing family context.

Psychotherapy Research. Introduction to research in psychotherapy, including issues of methodology and meta-analysis. Includes readings specific to psychotherapy research.

Culture and Spirituality. These lectures are part of the core series on spirituality in psychiatry. Specifically covered, are issues of noncompliance secondary to spiritual beliefs and end of life issues. The goal is to enhance the therapist’s awareness of the role of spirituality on treatment.

Termination. A focus on the principles and process of psychotherapy termination, with emphasis on “forced termination.” A review of dynamic techniques in relationship to the process of termination.

PGY-3 Psychopharmacology Seminar. This seminar has alternating weeks of readings and patient videos that correspond with the selected topics. Each of the readings has two assigned resident presenters, although all residents should be prepared to discuss the material.

Senior residents pursue individual areas of interest and design their year to include specific clinical service assignments, teaching, research and/or administrative experiences. Alternatively, a resident at the PGY4 level is eligible to begin training in Child & Adolescent Psychiatry.

Evaluation and Management of Sleep Disorders. Lectures focusing on primary and secondary sleep disorders, assessment, and diagnosis with respect to DSM-IV criteria, and behavioral and pharmacological management of these disorders.

Neuroscience and Neurology. The PGY4 review of Neuroscience and Neurology is focused on Board Exam preparation alternating didactic sessions and case reviews.

Forensic Psychiatry. Series of lectures focusing on principles and practice of forensic psychiatry including an introduction to forensic psychiatry, overview of legal system, competency and right to refuse treatment, informed consent, civil commitments, duty to protect, and criminal responsibility. Information on competency, writing court reports, jail evaluations, and other legal matters.

Principles and Applications of Neuroimaging. Series of lectures focusing on physical basis, indication and evaluation of neuroimaging including CT, MRI techniques, SPECT and PET. Residents further learn about scientific basis and clinical application of evolving treatment modalities such as deep brain stimulation, transcranial magnetic stimulation, and vagus nerve stimulation.

History of Psychiatry. Information on past diagnostic tools and treatment modalities.

Research. Information on research and design methods; how to read a research paper and to design a study; data entry and data analysis.

Ethics. Review and discussion of American Psychiatric Association's Code of Ethics, and the American Medical Association Code of Medical Ethics.

Domestic Violence, Abuse, and Neglect. Introduction to nature and prevalence of domestic violence, abuse, and neglect, including appropriate legal and medical interventions and available community resources.

Dreams. Brief introduction to dream work. Focuses on collaborating with the patients to examine various interpretations of their dreams. Readings and case presentations accompany this series.

Hypnosis. Brief introduction to hypnosis with a review of its historical components and basic principles. The course includes an exploration the clinical relevance of hypnosis as well as an overview of specific techniques.

Mood Disorders. Review of evidence-based treatments and practice guidelines for mood disorders.

Substance Use Disorders. Review of evidence-based treatments and practice guidelines for substance use disorders.

HIV/AIDS. Review of evidence-based treatments and practice guidelines for HIV/AIDS.

Practice Management. Basic information about setting up and running a practice; basic financial planning; malpractice information.

Preparing for the Oral Boards. Information on the board format and how to study for it. Board Review of Neurology. One hour per week, yearlong.