Psychiatry Residency Program - Third Year (R-3) and Fourth Year (R-4)

Adult Outpatient Psychiatry Rotation:

All residents will be required to spend 60% of their time, for the full 12 months, in their R-3 year, and 40% of their time, for the full 12 months, in their R-4 year, in the Adult Outpatient Clinic.

Faculty staffing includes the Outpatient Clinic Co-Director, who is full-time; three additional full-time psychiatrists, and the Program Director, who is the Clinical Director of the Urgent Care Clinic and works in the clinic part-time. Additionally, the Clinic Administrative Director, a licensed social worker, will participate in supervision of the residents. The clinic is further staffed by a Nurse Practitioner; one full-time and one part-time Registered Nurse; 11 full-time and 4 part-time social workers.

Residents will spend 8 hours each week in educational programming, including the Research Seminar, Journal Club, seminars and lectures. In addition, faculty will be available, informally, for supervision at all times. As noted below, caseloads will be closely monitored and managed to allow for depth, breadth and variety of the resident's clinical experience.

The clinic population mirrors the Island's demographics, with 68 % white, mostly middle class clients; 15 % Hispanic and 10 % Black/African American, together with an additional number of diverse populations including ethnic Balkan and Middle Eastern individuals, most of whom are Muslim. The clinic sees clients over the age of 18 and including a significant number of persons over the age of 65, comprising our new geropsychiatry clinic. Approximately 50 % of the patients receive Medicare or Medicaid, and the remainder are covered by commercial insurance plans. In the North Site clinic the predominant diagnoses are Affective Disorders, including Bipolar Disorder, Major Depressive Illness and Anxiety Disorders; and a smaller number (approximately 20 %) of individuals with serious mental illness. We are opening a new First Episode Psychosis clinic in the fall of 2016 and residents will be able to participate in that clinical setting as well.

Residents will be assigned caseloads, over the course of the rotation, of between 50 and 75 patients for whom they will have direct and ongoing responsibility. This will include patients seen for individual therapy, couples or family therapy, medication management, and at least one group experience. Residents will be provided patients, with whom they will be able to employ a range of supervised treatments, including Cognitive Therapy, Behavioral Therapy for Mood and Anxiety Disorders, Insight-oriented psychotherapy, Group Therapy Couples Therapy, Evaluation and Brief Treatment, and Medication Management of Chronic Mental Illness.

In addition, in order to ensure they see a range of patients for psychopharmacology practice, we will utilize the Fazzio Complexity Scale (as described in the ASCP Mode Psychopharmacology Curriculum 6th edition) in order to determine proper core assignments. In order to assure a varied clinical experience, residents will see patients in our General Psychiatric Clinic; Geriatric Psychiatry Clinic; Bipolar Disorders Clinic; Mood Disorders Clinic; Anxiety and Phobia Clinic; and our Urgent Care Center, which takes direct referrals from our Emergency Room, and provides Diagnostic Assessment, Treatment Planning and Referral, as well as Brief Treatment using a CBT model.

The Clinic at SIUH has recently undergone a clinical renovation, with the introduction of available briefer treatment models, where clinically appropriate, in addition to the provision of longer-term psychotherapies and long-term medication management of chronic mental illness. Staff members in the clinic have been trained in the fundamentals of Cognitive therapy, and Behavioral Activation, as well as Social Rhythm Therapy.

Select staff members have also been trained to provide DBT skills training in group therapies targeting individuals with a history of troubled, unstable relationships; behavioral (not seriously violent) impulsivity; and emotional dysregulation

During their Outpatient Rotation, residents will receive regular, individual supervision for at least 3 hours each week from Departmental Faculty, in addition to didactic and other educational activities. Caseloads will be monitored by the Residency Training Director as well as the Medical Director of the Outpatient Clinic. In addition, when performing intakes, residents will be directly supervised during the evaluation itself, and afterwards as they discuss, with the attending psychiatrist, the patient's presentation: the history, the findings on exam, and the case formulation, as well as reflections on the resident's conduct of the interview.

The full-time faculty are experienced in a range of treatment modalities, as noted above, including supportive psychotherapy, psychodynamic psychotherapy, psychoanalytic therapies, Cognitive Behavior Therapy, Dialectical Behavior Therapy, couples and family counseling, and group therapy.

R-3 Year Child and Adolescent Training:

R- 3 residents receive training in child and adolescent psychiatry by following patients and their families over the course of one year. Residents learn to evaluate, diagnose and treat a wide range of psychiatric disorders in youths, and receive weekly supervision from child/adolescent psychiatry faculty.

Residents are highly supervised in their work during the R-3 year, and this case load is kept to a moderate number of patients with a wide range of psychopathology including a mix of Attention Deficit/Hyperactivity Disorder, Disruptive Behavior Disorders (e.g. Oppositional Defiant Disorder, Affective Disorders, pervasive Developmental Disorders and family therapy. The focus is on providing the resident with a broad based understanding of the childhood disorders and an experience in diagnosing and treating these disorders. A collaborative team based approach is emphasized with ample supervision and input from the supervisors.

The residents work under the direct supervision of the Director of Child Adolescent Psychiatry for one day per week through several months of their R-3 year. The resident will evaluate and manage patients and develop their skills in psychotherapeutic techniques. A central aim is to help the resident learn to manage cases as a primary therapist with close supervision as needed in an outpatient clinical setting.

Residents perform comprehensive intake evaluations with every intake being monitored by by Dr. Peng Pang the Director of Child Psychiatry for the department. Residents will be working with pediatricians in an integrated care model. After initial evaluation and recommendations further care will be provided by pediatrician with assistance as needed by the resident.

Residents will spend a majority of their time evaluating a cross section of the children and their families and providing continuing care for the families. The focus will remain on training the adult psychiatrist to understanding childhood disorders and developing competency in diagnosing and referring for treatment appropriately. Gathering of information and working with the multiple agencies involved in providing care to a child will remain a key component of this rotation. Resident's perform intakes, work with families, and treat patients individually and with co-therapists, all under supervision of Dr. Pang. Each resident will spend 1 full day/week for 5 months at integrated care site some of which are located in area high schools.

Outpatient Addiction Services Rotation:

This is a required 12 month rotation in the R-3 year consisting of one full clinic day per week.

Faculty consists of 3 full-time attending psychiatrists who have board certification in Psychiatry and extensive experience/certification in Addiction Psychiatry. Additionally, there is a Program Manager who is an LCSW; 2 full-time and 1 part-time LCSW therapists; 3 full-time and 1 part-time Chemical Dependency Level II Counselors, and 2 full-time and 1 part-time Chemical Dependency Level III Counselors.

Residents will attend eight (8) hours of scheduled educational activity each week. Evaluate and formally present all new cases to the attending followed by review and discussion of the case. The case loads will be carefully monitored by the attending psychiatrist

The Outpatient Addiction Recovery service at SIUH has an active treatment population of between 250 and 300 individuals at any given time. Approximately 85 % of the patients are white; 5% Hispanic and 5% are Black/African American. 65% are men and 35% are women. The average age is 40 and 75% are between ages 26 and 55. Over half of the patient population, 55%, has never been married. 43% have finished high school and some College. Twenty five percent (25%) are employed and about 47% are unemployed. The vast majority of the patients, 98%, are from Richmond County (i.e. Staten Island). Primary substance: alcohol=43%, opioids, including heroin = 23%, cocaine/crack = 13%. Thirty six percent (36%) of the patients have had a psychiatric hospitalization; 61% have been treated for a mental health condition. Very few are involved in the criminal justice system; 9% are on probation or parole.

The residents will evaluate 2 or 3 new patients a week and develop a comprehensive treatment plan and will be assigned a case load of 5 to 10 patients for pharmacologic management of psychiatric conditions and substance induced disorders. The residents are exposed to an interdisciplinary team approach to the care and treatment of people with substance use disorders. The residents will participate in on-going groups, such as relapse prevention and motivational enhancement therapy groups, and in treatment planning conferences.

The resident will be closely supervised by the attending faculty during the substance abuse rotation. The resident's interpersonal and communications skills and professionalism will be assessed by the attending and by the clerical and allied health professionals.

Elective (R-4):

Each resident is required to have at least 12, and as much as 16 hours per week of scheduled elective time during the R-4 year. Each resident has their program individually structured by the Program Director. In the spring of the R-3 year, the Program Director meets with each resident to discuss their future career plans and how the elective time in the R-4 year should be structured to give the resident advanced training in an area of their particular interest. Each resident is then provided with an elective brochure which outlines in detail standard electives available in our department.

Residents then discuss each elective that they are interested in with the faculty member offering the elective. Next, each R-3 resident meets again with the Program Director to outline a preliminary elective program. Residents then go back to the faculty members offering the electives to finalize their elective plans and residents meet one more time with the Program director to finalize the schedule for the R-4 year. Residents also are allowed to develop electives of their own choosing under the guidance and supervision of the Program Director. For this reason residents have approximately 4 hours per week of "Flex time", which they may devote to their elective experience, to their research, or to other career development experiences, at the discretion of, and after communication with, the Program Director.

The faculty for electives consists of the full complement of full time, part time and voluntary faculty at Staten Island University Hospital, South Beach Psychiatric Center and Staten Island Mental Health.

Residents may spend several hours per week in seminars and case conferences related to their elective program.

Standard electives offered in the residency elective brochure include: Child and Adolescent Psychiatry; Pediatric-Consultation Psychiatry; Adolescent Inpatient Services (South Research); Research (Clinical Research; research in psychosocial treatment of schizophrenia and psychotic disorders; Behavior Therapy-Anxiety Disorders Research). Consultation-Liaison Elective in Primary Care; Consultation-Liaison Psychiatry; Geropsychiatry; Adult Psychiatric Day Program; Addiction Psychiatry/Dual diagnosis (Several) Clinical ECT; Bipolar Disorder Clinic; LGBT Clinic; Health Home Clinic; ACT team; First Episode Psychosis Clinic, Eating Disorder Clinic, and Addiction Services.

Case loads vary based on the electives chosen.

All elective experiences are closely supervised by senior faculty members and elective programs are designed by the Program Director to ensure that there is close supervision.

The broad scope of the clinical and research resources at Staten Island University Hospital and the North Shore LIJ Health System make it possible for each senior resident to develop an elective experience that will give them depth in an area of individual interest. Having this elective period run longitudinally throughout the R-4 year will enable residents to choose electives that require a full year for either clinical training or research endeavors. As residents are required to write a paper in published form during their R-4 year, residents may choose electives that coincide with the paper that they are writing.