Inpatient Psychiatry

Site: Department of Medicine, Harlem Hospital Center, New York

  • This is a required eight-month rotation, usually in the postgraduate years (PGY) 1 and 2. However residents entering in the PGY 2 year or later may have to spend time on the inpatient service in their PGY 4 year to make up the required eighth month. Residents with a special interest in inpatient psychiatry may elect to spend additional time in their senior year functioning as a junior attending.
  • The 52-bed inpatient unit has four, full-time attending psychiatrists, a full-time neuro-psychologist, two full-time social workers and two activity therapists. This staff complement is supported by a nursing staff of fifteen registered nurses, nine licensed practical nurses, six nurses' aides, two substance abuse counselors, one case worker, and one ward clerk or institutional aide. The unit is divided into two sides, north and south. Each side has two treatment teams headed by an attending psychiatrist. These teams constitute the multidisciplinary teams, of which the residents are a part, serving as co-team leaders with the psychiatric attending.
  • The educational methods: case conferences, lectures, individual and group supervision. The residents, along with other team members, regularly conduct therapeutic community meetings (TCM), small psychotherapy groups, substance abuse groups, medication groups, and discharge planning groups. Each week residents also get group supervision from a senior attending psychiatrist. The residents also frequently take part in conferences with family members and conference with other agencies.
  • The diagnostic categories of these patients were as follows: bipolar disorder, 27%; schizophrenia, paranoid type, 18%; schizo-affective disorder, 12%; major depression, 4%; schizophrenia, chronic undifferentiated type, 16%;  and other disorders, 22%.
  • The average caseload of residents on the inpatient service ranges from 7 to 11 patients under the supervision of the attending psychiatrist.
  • Residents receive two hours of individual supervision from the attendings each week. Residents are also supervised by attendings in team rounds. All new admissions are interviewed with the attending and subsequently group supervision occurs in rounds and small group discussions as well as in clinical pathways and discharge planning conference presentations. Every two weeks a resident during his or her inpatient rotation presents a case to a visiting columbia psychiatrist, and the diagnostic assessment and treatment planning issues are discussed together with the other residents and attendings.
  • The inpatient service gives the residents practical experience in law and psychiatry. Issues of involuntary commitment and informed consent are reviewed in collaboration with corporation’s legal staff and the mental hygiene legal service. Residents, together with the inpatient attendings, take part in the involuntary commitment and retention hearings before the supreme court of new york. Other in-service/continuing educational activities occur ; residents also receive periodic in-service training (patient safety, security awareness, crisis management and prevention) via the Columbia affiliation and the Hospital and Health Corporation.