Residency in General Adult Psychiatry at Zucker Hillside Hospital
Behavioral health disorders are among the most common and disabling illnesses. Yet stigma combined with inadequate access to safe, equitable, effective, and high quality care leads to unnecessary suffering, poor outcomes, and excess cost. Healthcare reform must prioritize the unmet needs of those suffering from psychiatric disorders. To meet these challenges, our training program has a two-fold mission: to graduate outstanding clinicians and to foster emerging leaders in the field. Our learning environment and curriculum have been designed to prepare each resident for this future.
Our program embraces the biological, psychological, and socio-cultural aspects of psychiatry. In particular, we focus on the integration of neuroscience, research, and evidence-based decision-making with training in the diagnosis and management of psychiatric illness. Our trainees graduate with well-developed skills that cross the ‘dualisms’ of our field – pharmacotherapy and psychotherapy, acute and chronic, mind and brain, gene and environment, individual and population, inpatient and outpatient, consultation and management.
Our program follows nine guiding principles:
- Patient- and family-centered care
- Engaged methods of teaching and self-directed learning
- Cultivating humanism in medicine
- Responsibility and autonomy that increases with competency
- Orientation toward healthcare delivery system reform
- Flexibility for individualized pathways that launch leaders
- Habits of innovation and inquiry that drive evidence-based medicine, quality improvement, and patient safety
- Frequent and supportive feedback
- Continual learning together
Our outpatient training in psychotherapy and pharmacotherapy begins second year with placement in a Continuity Clinic. Psychotherapy training includes psychodynamic, CBT, and interpersonal therapy with extensive supervision.
Our Advising Program provides each resident with a four-year faculty advisor. Through regular meetings, the faculty advisors help trainees set career and learning goals, identify mentors and discover their professional callings.
Our Pathways to Expertise program helps trainees transform their interests into expertise. Through a series of individually designed electives and mentored scholarship over the second, third, and fourth years, trainees develop expertise and leadership in their chosen area of focus. This prepares trainees to graduate as future leaders in the field.
For those interested in a career as a physician investigator, we have the Resident Research Track Program, which is an intensive pathway with at least 33 percent protected time during the second year of residency, at least 50 percent during third year, and up to 90 percent during fourth year.
The training program is structured to help residents become outstanding clinicians and emerging leaders in their chosen area of interest – whether research, clinical care, education, public policy and/or health systems leadership. The program exposes residents to the full breadth of psychiatric knowledge and practice – with a strong grounding in medicine and the full spectrum of psychiatry, including:
- Inpatient psychiatry
- Consultation-liaison psychiatry
- Emergency psychiatry
- Child and adolescent, addiction, and geriatric psychiatry
- Ambulatory pharmacotherapy and psychotherapies
- Neuromodulation therapies, including electroconvulsive therapy
Residents learn how to integrate neuroscience, evidence-based medicine and measurement-based care with pharmacotherapy and psychotherapy. They develop skills in state-of-the-art, disease-specific clinical care through our specialty clinics and units. Residents learn a broad range of psychotherapies, including Cognitive Behavioral Therapy, Interpersonal Therapy, Supportive Therapy, Time Limited Dynamic Therapy, Psychodynamic Psychotherapy, Group Therapy, and Family Therapy. And residents have opportunities to supervise medical students, develop skills as educators with a required medical education rotation, and, as they progress, to lead clinical teams and contribute to quality improvement and patient safety initiatives.
Importantly, the training here prepares residents for the significant changes in the broader healthcare delivery system. As part of an integrated regional health system, residents participate in care delivery innovation, including:
- The integration of behavioral health into primary care
- Healthcare financing and policy
- Patient safety and quality improvement
- Patient centered outcomes
- Early detection and intervention
- The use of technology to enhance access (e.g., telepsychiatry)
Outpatient medication management and psychotherapy training begins during the R-2 year in the weekly half-day continuity clinics. Substantial elective time exists during the R-2, R-3, and R-4 years to support individualized training plans and participation in the pathways to expertise program – a program that links together elective experiences around a focused area in order to develop expertise and leadership in any topic or subspecialty that inspires passion and possible career ambition.
First post-graduate year (R-1)
The R-1 year is divided into 13 four-week periods. Interns spend five periods in Adult Inpatient Psychiatry at The Zucker Hillside Hospital, one period in Consultation-Liaison Psychiatry, one period in Neurology (particularly psychiatry-related neurology at Zucker Hillside Hospital), and four periods in Internal Medicine/Pediatrics (if interested, residents may do up to two periods in General Pediatrics at Cohen Children’s Medical Center in place of Internal Medicine). There are four weeks of vacation time and two weeks of night float. Interns also receive specialized supervision and training in structured clinical diagnosis with experts from our research department. Interns cover the evening short call at Zucker Hillside Monday through Friday and the day time shift on weekends with the North Shore Consultation-Liaison service.
- Inpatient Psychiatry
- Consultation-Liaison/Psychosomatic Medicine
- Call: ~2 evening and/or weekend day shifts per month, two weeks night float
Second post-graduate year (R-2)
The goal of the R-2 year is to continue to advance the resident's knowledge and skills of clinical diagnosis and treatment of acutely ill adult psychiatric patients in an inpatient setting. In addition, the R-2 year focuses on the treatment of acutely ill adolescent and geriatric inpatients, expands on their experiences in consultation-liaison psychiatry, and trains residents in emergency psychiatry, including the use of telepsychiatry.
All residents participate in a novel patient safety and medical education rotation in which they develop their precepting and feedback skills with interns and medical students and receive specialized training in patient safety and error analysis during this rotation. To support the development of individualized experiences and expertise, residents have up to 12 weeks for electives and may enroll in a Pathways program.
Finally, R-2s start their ambulatory training with a weekly half day continuity clinic in which they develop a panel of medication management patients and provide CBT or psychodynamic therapy. Residents remain in these clinics for the remainder of their training, affording a three year longitudinal experience with a panel of patients, an attending, and the clinical team.
- Continuity clinic: half day a week for outpatient medication management and psychotherapy
- Consultation-liaison/Psychosomatic medicine
- Inpatient psychiatry
- Patient safety and medical education rotation
- Up to 25% elective time (~12 weeks)
- Emergency psychiatry with telepsychiatry
- Optional participation in the Pathways program
- Call: night float at Zucker Hillside (~4 weeks)
Third post-graduate year (R-3)
During the third year, residents continue in their continuity clinics. R3s occupy their own offices in the adult outpatient department and develop a broad range of ambulatory psychiatry skills across disorders, patient populations, and treatment modalities, including specialized outpatient rotations in addiction, geriatric, and child and adolescent psychiatry. Psychotherapy training covers time-limited and open-ended modalities with expert supervision and experiences in cognitive behavioral therapy and psychodynamic therapy. R3s have up to 20 percent elective time that can be used toward developing a focused expertise, including participation in the pathways program.
- Continue in continuity clinic
- General adult clinic
- Intensive psychotherapy training, especially psychodynamic and CBT psychotherapy.
- Addiction clinic
- Geriatric clinic
- Up to 20% elective time
- Optional participation in the pathways program
- Call: no overnight call; LIJ ED weekday evenings and weekend days
Fourth post-graduate year (R-4)
Fifty percent of the R-4 year is devoted to the resident’s longitudinal training in outpatient psychiatry. The remaining 50 percent is elective time intended to allow the resident to develop a series of experiences tailored to their interests, with the goal of helping the resident develop focused expertise and launch themselves as emerging leaders. All residents are trained in interpersonal therapy and have the opportunity to gain certification.
- Continue in continuity clinic – precept R2s and R3s
- Longitudinal outpatient clinic, including medication management and psychotherapy
- Child and adolescent clinic (may do in 3rd year if preferred)
- Interpersonal therapy rotation
- 50% time for electives
- Optional participation in the pathways program
- No call
First post-graduate year (R-1)
Intern didactics are focused on building foundational knowledge and skills. The curriculum is divided into two sections. The first consists of two weeklong learning modules scheduled prior to starting clinical rotations.The learning modules focus on essential knowledge for the early resident, including diagnostic interviewing, oral presentations, written formulations, and suicide risk assessment. Interns practice these skills in our highly innovative Psychiatry Skills Lab at the medical school’s simulation center. Interns also receive intensive training in the use of the Structured Clinical Interview for DSM-V (SCID) and measurement-based assessment – critical components of modern psychiatric care.
During the five months that interns rotate in inpatient psychiatry, there are at least five hours of weekly didactics. These courses are highly interactive and utilize a small-group, skills-based format:
- Clinical Interviewing: each session emphasizes a specific micro-skill, incorporates role-playing and other exercises and then proceeds to a patient interview. Interns take turns performing the live patient interview and then receiving feedback from their peers and faculty. In addition, the class observes a master clinician interview a patient on a regular basis.
- Biopsychosocial formulation: in this weekly workshop, residents become comfortable writing case formulations based on resident write-ups of actual patients, as well as characters from short stories and films. Biological, psychological, and social experts periodically serve as guest consultants.
- DSM diagnosis and psychopharmacology basics
- Evidence-based medicine: focuses on how to critically appraise a randomized controlled trial and observational studies.
- Supportive psychotherapy: focuses on how to apply supportive techniques in the inpatient setting
Second post-graduate year (R-2)
Building on the first year’s foundational knowledge, the second year curriculum provides in-depth coverage of the diagnosis, neurobiology, and pharmacotherapy (DNP) of the major psychiatric disorders. Two highly interactive courses focus on evidence-based medicine in clinical decision making and on cultural and biopsychosocial formulation from multiple perspectives. Psychotherapy courses continue with an overview of the different theories of mind, and then proceed to cover cognitive behavioral therapies, family therapy, DBT, and introduction to psychodynamic principles and techniques. Subspecialty areas of child and adolescent psychiatry, consultation liaison psychiatry, emergency psychiatry, geriatric psychiatry, as well as ethics are also covered in the R-2 didactic curriculum. Most didactics occur during a half-day of protected time each week.
- Diagnosis, Neuroscience, and Pharmacotherapy of Major Psychiatric Disorders
- Subspecialty courses: Child and Adolescent, Medical Psychiatry, Perinatal Psychiatry, Emergency Psychiatry, Forensics, and Geriatric Psychiatry
- Psychotherapy: Overview of Theories of Mind, CBT, Time Limited Dynamic Therapy, Family Therapy, DBT, and Introduction to Psychodynamic Principles and Technique
- Evidence-Based Medicine in Clinical Practice – includes a focus on improving oral case presentation skills; mastering differential diagnosis; and practicing the application of the best available evidence to clinical dilemmas.
- Ethics, Culture, and Formulation Threads
Third and fourth post-graduate year (R-3 and R-4)
The third and fourth year didactic curricula delve deeper into understanding evidence based psychotherapies with an extensive curriculum that includes introductory couples therapy and group therapy and advanced courses in cognitive behavioral therapy, interpersonal therapy, and psychodynamic psychotherapy. In addition, there are core didactics on addiction and forensic psychiatry, quality improvement, reproductive psychiatry, advanced EBM, advanced pharmacotherapy with a focus on treatment resistance and a weekly psychotherapy case conference.
Residents attend weekly grand rounds which feature international experts. Every Thursday, all residents gather for lunch (provided) and several different types of learning sessions. These include:
- Twice a Month Journal Club
- Career Development Story Telling
- Knowledge Games – interactive, fun competitions aimed at building basic knowledge.
- Special Presentations