The Residency Training Program
PGY 1 Year
The PGY 1 year includes six months of internal medicine (of which three months have on-call obligations), two months of neurology, and four months of psychiatry. The internal medicine rotations include two months of general inpatient medicine, one month of intensive care, one month of emergency medicine, one month of geriatrics, and one month of day float. The neurology rotations include one month of inpatient neurology and one month of consultation neurology. PGY-1 residents are an integral and well-respected part of the house staff on medicine and neurology, and finish the year with a solid grounding in clinical medicine. The psychiatry rotations include 2 months on the Intensive Outpatient Program at Presbyterian Hospital and two months on the inpatient general adult psychiatric service, also at Presbyterian Hospital. On each psychiatry rotation, residents receive substantial one-on-one supervision by attending psychiatrists who guide them through these early, crucial experiences in psychiatry.
Our PGY 1 residents maintain a close connection to the Department of Psychiatry while on medicine and neurology through the monthly Intern Luncheon Series. These lunches offer protected time for the class to come together and enjoy a meal. Interns also have one-to-one supervision in the Department of Psychiatry's outpatient clinics during medicine rotations.
The Intensive Outpatient Service (IOP)
On this Columbia/NYPH service, residents treat patients with a wide spectrum of psychiatric illnesses, including affective disorders, anxiety disorders, personality disorders and family problems. Ages range from adolescence to late life. Some patients are admitted directly to the IOP and others are referred immediately following a brief psychiatric hospitalization. The IOP provides an alternative to hospitalization, with discharge to conventional outpatient care after six to eight weeks. Biological treatments and individual psychotherapy, as well as group therapy are combined in the treatment of these acute patients. While rotating on this unit, residents participate in didactics on a wide variety of topics, including dialectical behavioral therapy (DBT), interpersonal therapy (IPT), and women’s mental health.
9 Garden North (9GN)
The Columbia Inpatient Psychiatry Service is a 24 bed inpatient program located on 9 Garden North at Presbyterian Hospital. It is a general inpatient unit with particular expertise in the treatment of affective and psychotic disorders, dual diagnosis, and complex medical/psychiatric problems. As the primary referral unit for the medical center, patients often present with complicated diagnostic and treatment dilemmas. During the two month rotation each resident is paired individually with an Attending Psychiatrist and works closely with PGY 4s doing senior electives, Psychology Interns, and Columbia third and fourth year medical students. Residents learn to work in a managed care setting (average length of stay about 14 days) and develop expertise in complex psychopharmacology, geriatric psychiatry, individual and group psychotherapy for affective illness and addiction, cognitive behavioral therapy for depressive and anxiety disorders, individual and family psychotherapy and electro-convulsive therapy.
PGY 2 Year
The PGY 2 year offers a rich and diverse exposure to psychiatric illness and treatment through rotations in inpatient, outpatient, emergency and consult-liaison psychiatry. Inpatient rotations include four months on the community service at NYSPI and two months on NYSPI’s clinical research unit. PGY2 residents return to the Intensive Outpatient Program at PH for 2 additional months, and spend two months in the Comprehensive Psychiatric Emergency Program (CPEP) working as part of a team evaluating patients in a busy urban psychiatric emergency room. Finally, PGY2s spend 2 months on the consult liaison service, where they are assigned to a major medical or surgical service and are supervised by liaison psychiatry attendings in the care of medical inpatients with psychiatric issues. As in the PGY1 year, residents receive substantial faculty supervision in psychotherapy and psychopharmacology in each clinical setting. For a complete description of each rotation, please visit our residency website at www.cumc.columbia.edu/dept/pi/residency/residency.html.
PGY 2 residents share night and weekend call and each of the 12 residents averages about three calls per month.
A highlight of the PGY 2 year is the Long Term Therapy (LTT) program. PGY 2 residents are assigned outpatients for treatment with twice weekly, long-term psychoanalytically oriented psychotherapy. The residents are closely supervised on these cases by psychoanalysts from the clinical faculty and take a year-long theory and case-conference course which augments their work.
The PGY 2 year also includes daily didactic sessions that include coursework in psychiatric interviewing, neuroscience, pathophysiology, psychotherapy, ethics, community psychiatry and others. The core curriculum in the PGY 2 year stresses a thorough understanding of the clinical syndromes and the biologic, psychological, familial and cultural factors that influence patients. Residents also develop sophisticated interviewing techniques for diagnosis and treatment. The integration of these clinical experiences with the core curriculum provides the essential foundation for each PGY 2’s professional development.
Washington Heights Community Service Inpatient Unit (PI-4South)
The Community Service is a state-funded urban community mental health center which provides a comprehensive system of inpatient and outpatient care for the seriously ill patients in Washington Heights. Residents treat acutely ill patients on the NYSPI inpatient unit as part of a team, and work closely with the patients' families and outpatient case managers to ensure a smooth return to the community. The average length of stay is ample, usually three to four weeks. A program on cross-cultural psychiatry focuses on the Latino community living in Washington Heights.
General Clinical Research Service Inpatient Unit (PI-4 Center)
This NYSPI unit conducts a variety of research programs in the study of affective disorders, eating disorders, substance abuse, suicidal behaviors and personality disorders in adults and adolescents. Recent research has focused on studying phenomenological and biochemical changes associated with suicide and eating disorders, and investigating new treatments. Research patients do not pay for their care. The average length of stay for patients is two to three months which allows residents to work with patients intensively during their two month rotation. Resident teaching is focused on evaluation and differential diagnosis, cognitive and psychodynamic psychotherapy, and introduction to research methodology.
The Consultation-Liaison Service
The CL Service at NYPH is one of the oldest and largest departments in the country and PGY 2 residents work on this service for a two-month block. Each Resident selects a major medical or surgical service and becomes part of their liaison psychiatry team, working under the supervision of the attending psychiatrist from that service. Residents have the opportunity to teach non-psychiatric house staff and learn how to conduct case conferences. Each week there is an active schedule of lectures and case presentations covering a variety of topics in general psychiatry as it impacts the medical setting. While it is primarily a clinical department, faculty have made important research contributions including the delineation of ICU psychosis, work on post-cardiotomy delirium and ongoing studies of neuroendocrine effects on the heart, done in collaboration with the cardiac transplant team. In addition, the department has produced work focusing on the cost-effectiveness of psychiatric consultations on a surgical service, the management of patients who wish to sign out against medical advice and the negative effect of sleep deprivation on house staff.
Comprehensive Psychiatric Emergency Program (CPEP)
An important experience of the PGY 2 year is the 2 months spent working in the CPEP, where Residents are trained in the evaluation and treatment of patients whose problems range from substance induced psychosis to family crisis. During this rotation, Residents gain expertise in diagnostic interviewing and treatment of acute psychiatric emergencies. This emergency room setting is unique in that patients are able to stay for up to 72 hours, allowing time for a thorough evaluation and the best treatment and disposition.
PGY 3 Year
The PGY 3 year marks a transition for our residents as they shift from working primarily in inpatient settings to primarily outpatient settings and begin to function independently as psychiatrists. Each resident has an office in the NYSPI and is given primary responsibility for patient care with individual supervision from faculty. There are two major components of the third year: evaluating and treating outpatients in the clinics and evaluating and treating children and adolescents through Columbia's Child Psychiatry Department.
Residents are trained in many forms of outpatient treatment during the third year, including advanced psychopharmacology and multiple psychotherapeutic modalities, including cognitive behavioral, interpersonal, dialectical-behavioral, psychodynamic, group and family. Residents also have access to supervisors who specialize in transference-focused, dialectal-behavioral, and schema-based therapies.
PGY 3 residents return to the CPEP where they share overnight and weekend call.
We take pride in the quality and amount of supervision provided to PGY 3 residents, who each receive 8 hours per week of supervision by expert faculty. There are 5 hours for individual psychotherapy and brief treatments, 1 hour each for psychopharmacology and evaluation, and 1 hour for rotations in child psychiatry, substance abuse and family therapy. In addition to supervision, residents have daily didactic sessions building on themes first explored in PGY 2 year. 20% of the year is available for elective opportunities, including research.
The Child and Adolescent Psychiatry Service
Education and training in child and adolescent psychiatry is incorporated throughout residency. PGY 2 residents learn child and adolescent development in a 3 month course, and, with faculty supervision, may treat minors on the inpatient units. The PGY 2 year begins with a course on interviewing children and adolescents in which the application of a developmental perspective is emphasized. It is followed by a two-month course on psychopathology in children and adolescents. These courses draw upon the expertise of the large faculty in the division of child and adolescent psychiatry. PGY 3 residents apply and consolidate their skills in child and adolescent psychiatry during a 2 month rotation in the department of child and adolescent psychiatry, with experiences on the child consult liaison service and the child CPEP. PGY 4 residents interested in additional training with children and adolescents may continue with their outpatient treatment cases and can choose from a number of electives, including the Child & Adolescent Psychiatric Evaluation Service at NYSPI and the School-Based Mental Health Program at NYPH.
PGY 4 Year
The PGY-IV year is an entirely elective year, designed to allow residents the maximum flexibility in pursuing special interests of their choice. The range of electives is exceptionally broad and may be tailored to suit individual needs. Residents who are interested in research careers may elect to use some or all of the year to immerse themselves in a research project under the tutelage of a member of the faculty. Research opportunities are available in both clinical and basic science research. Many residents choose to serve as junior attendings on one of the inpatient units or in the Intensive Outpatient Program. Other recent electives have included senior rotations at the undergraduate student health center, the psychoanalytic center, the women's mental health center, and mental health clinics for the homeless. Many residents begin teaching this year, with electives available in medical student teaching and in how to plan and teach a course. During this year, residents continue to see outpatients and to receive psychotherapy and psychopharmacology supervision, helping them to consolidate their learning in these areas. Daily didactics and the weekly process group continue, which help to maintain a sense of class cohesion. This year solidifies the residents' psychiatric knowledge and skills, and helps them to prepare for their future psychiatric careers.
