Psychiatry Residency Program - Second Year (R-2)

The Inpatient Adolescent Psychiatry rotation will take place at Zucker-Hillside Hospital. All other rotations are at SIUH. Residents will have both a general psychiatry adult inpatient experience, as well as a rotation on an inpatient unit that treats geriatric patients. The Consultation-Liaison experience will deepen the resident's exposure to and comfort with both Emergency Psychiatry and the practice of psychiatry with patients with co-morbid medical conditions. The Neurology Consultation/Clinic rotation will allow residents to fulfill the requirements for ABPN certification, and also expose them to a rich and constructive clinical experience.

Adolescent Psychiatry-Inpatient:

This is a required 4 week rotation on the Adolescent Pavilion during the R- 2 year, and occurs at Zucker-Hillside Hospital.

Faculty consists of two full time child and adolescent psychiatrists, one full time psychologist, a 0.75 FTE psychologist, two full time social workers, two full time rehabilitation therapists in addition to the nursing staff and four mental health workers.

Two hours of supervision by child and adolescent psychiatrists are provided weekly. This is in addition to the bedside discussion and other didactic discussion and/or consultations. Case loads are carefully monitored and controlled to provide a diverse and enriching experience in child psychiatry. The residents are expected to participate in team meetings twice a week where patient status, treatment plan and disposition are discussed. This is in addition to the core lecture and didactics provided on an annual basis to the residents.

There are approximately 400 admissions to the Adolescent pavilion every year. The Adolescent Pavilion is a co-ed inpatient unit whose population is characterized by heterogeneity of age, race and diagnosis. The mean age is 15 with a range from 12-18. Race: 45% Caucasian; 40% African American; 5% Hispanic; 5% Asian; 5% Other. Diagnoses: 45% Affective Disorders, 30% Disruptive Disorders; 20% Psychotic Disorders; 5% Personality Disorders. Each patient is given a full psychiatric and medical assessment. Treatment provided on the unit includes: individual, group and family therapy, psychopharmacology and cognitive/behavioral treatment approaches. While rotating on the adolescent pavilion, the resident becomes an integral part of the treatment team, attending all clinical meetings.

The average case load for each resident consists of four patients at a given time. A case load of this size affords the resident the opportunity to work-up each patient comprehensively, from a medical and biopsychosocial perspective, as well as treat patients from a wide variety of diagnostic categories. In addition, the resident has time allotted to participate in the rich clinical and academic environment of the unit, including, five community meetings per week, daily morning reports, and didactic classes. Each resident's case load is carefully monitored and supervised by the assigned attending psychiatrist. Therefore, the resident's level of responsibility increases as their knowledge base and clinical skills increase. The resident is in charge of both individual and family treatment for the patients in their case load. Also on this rotation, residents participate in the management of the medical and neurological conditions that their patients are afflicted with. This is done with the guidance of attending pediatricians and neurologists. This rotation is equivalent in its depth and scope to a general adult inpatient rotation with residents functioning in a manner identical to that of a general adult inpatient rotation.

All residents have two hours of supervision provided by the attending psychiatrist. Additional supervision is provided on an individual basis. There is also one and a half hour per week of supervision for family meetings. This is supervised by the unit social workers.

Inpatient Psychiatry Rotation (R-1, R-2 and R-4):

This constitutes a required 4 month rotation in the R-1 year; two (2) required four month rotations in the R-2 year; and a 2-3 month part-time required rotation as team leader during the R-4 year (can be lengthened if elected).

There are a total of 3 full-time psychiatrists on our inpatient unit: The unit consists of a 15 bed mixed geriatric and adult unit contiguous with a 20-bed adult psychiatry unit. There are additionally a total of 30 registered nurses, 30 Patient Care Assistants, 4 Patient Engagement Specialists, 4 social workers, 2 Activities Therapists, one Nurse Managers, who is a registered nurses and two Assistant Managers.

Residents will attend 8 hours weekly of scheduled seminars and lectures, and as well unit-specific case conferences weekly, and team rounds daily. Teaching will take place in all these venues, and attending psychiatry staff will additionally be available at all times for consultation and informal teaching opportunities.

The inpatient rotations will occur one each of two acute inpatient psychiatry units having a mean length of stay of approximately 10 days. One unit includes an inpatient geriatric psychiatry unit as noted above, where the length of stay is slightly longer due to occasional discharge planning issues.

There is a mixture (males and females) of patients ranging in age from 18 years old to 65 years old on the adult inpatient services; and adults over 65 on the geriatric psychiatry unit. The 29-bed adult unit provides care for predominantly young adult psychiatric patients with psychotic and major affective disorders, frequently complicated by comorbid substance abuse disorders. The unit has a high number of individuals retained by court order, and unit psychiatrists are frequently testifying in court, providing an opportunity for residents to be exposed to forensic psychiatric issues.

The second, 15-bed adult unit typically serves a slightly older population with major affective disorders. The geriatric psychiatry unit treats individuals with major affective disorders, as well as persons with comorbid psychiatric and cognitive disorders.

Patients at all sites are predominantly middle class, with commercial insurance covering approximately 40%, Medicare 35% and Medicaid 25%. The demographics, including ethnicities, reflect the heterogeneous nature of Staten Island's population.

The unit provides assessment and treatment with; individual, family and group treatment as well as utilization review, quality/performance improvement, educational seminars, discharge planning and advocacy.

Residents would have a typical case load of six patients and would be closely supervised by the attending psychiatrists as well as participating in the various unit therapeutic activities, including group therapies.

All residents will receive individual supervision twice weekly, including one on-unit and one off-unit supervisor, as well as weekly group supervision with the unit medical director.

The unit faculty includes psychiatrists with a breadth of clinical experience, as well as a board-certified geriatric psychiatry specialist, who is also board-certified in forensic psychiatry. Supervising faculty will include psychiatrists and social workers with expertise in psychopharmacology, as well as cognitive behavioral therapy, psychodynamic psychotherapy and group therapy.

Addiction and Recovery Services Rotation (R-2):

Residents will rotate through the Inpatient Detox, Inpatient Rehabilitation and Outpatient Rehabilitation programs during each of these years, with increasing outpatient exposure and independent practice responsibility commensurate with their training. Programs will also in the coming year include a new Outpatient Detox Program that is part of the New York State DSRIP initiative.