The PGY2 year starts the formal full-time psychiatric training for the MGH/McLean psychiatry resident. The goal of this year is to establish a foundation of knowledge in the diagnosis and treatment of acutely and seriously ill psychiatric patients. Residents will become proficient in the assessment of patients in a variety of settings, and will become familiar with the fundamental treatment modalities now available to psychiatrists. Residents are assigned to a balanced set of core experiences. Throughout the year, residents attend core didactic seminars, T-group and interdisciplinary case conferences to supplement their clinical experience.
Residents rotate for three months through the MGH Acute Psychiatry Service (APS), a high-volume inner-city emergency service within the MGH Emergency Department. During this rotation, the resident will assess patients with acute psychiatric illnesses and manage the early manifestation and disposition of cases to a variety of settings. Residents take three sets of week-long nightfloat during this rotation. There are no weekend shifts during the APS rotation, and the rotation is divided into two portions, with half the rotation in the first half of the year, and half the rotation in the second half of the year.
This unit is located in the heart of MGH’s Medical/Surgical inpatient facility. A wide variety of psychiatric problems in patients with concurrent medical illness are treated. Residents will treat patients with a variety of acute and severe mental illness, including bipolar disorder, depression, obsessive-compulsive disorder, eating disorders, personality disorders, and substance use disorders. Residents become well-versed in the use of pharmacotherapies, management of side effects, and the use of electroconvulsive therapy.
Residents spend six weeks based at the Erich Lindemann Mental Health Center (ELMHC), Boston’s Downtown Public Sector community resources facility. Residents work with clients in a homeless shelter for people with serious mental illness and have numerous experiences with the integration of mental health, substance abuse and medical treatment as needed by the homeless individual. This care is provided by a multidisciplinary team in which our residents participate as a member. Residents evaluate patients in crisis, perform evaluations, and provide treatment in the shelter to facilitate ongoing care. This experience allows residents to work on multidisciplinary teams while becoming familiar with the interface between public agencies, federal agencies, the courts, other clinicians, and managed care systems.
The Psychiatry Consultation Service at MGH in many ways represents a capstone rotation for residents, allowing them to serve as ambassadors for psychiatry to the rest of the hospital. Residents draw on their medicine, psychiatry, psychotherapy and group therapy knowledge to serve a diverse population of patients, helping to manage up to 20% of all patients receiving care at MGH. The consultation-liaison service is a robust inpatient service where residents see patients throughout the hospital who have psychiatric issues complicating their medical or surgical care. Residents also have the opportunity to rotate on sub-specialty CL services, including the Psycho-oncology and Burns and Trauma Services. Residents spend 6 weeks on the Consultation service as PGY2s and then return for an additional 6 weeks as PGY3s.
The Geriatrics rotation includes 3 weeks of inpatient geriatrics, and provides residents with clinical skills relevant to treating geriatric patients with dementia and other degenerative and neuropsychiatric illnesses. Most, if not all, patients have significant medical co-morbidity and residents learn to integrate biological, psychological, and sociocultural factors in caring for these complex patients. Residents gain additional exposure to outpatient geriatric psychiatry in the PGY3 year.
The McLean Adolescent Partial Hospital Program serves adolescents from the ages of 12 to 19 with a variety of psychiatric disorders. This includes mood disorders, anxiety, autism spectrum disorders, substance use disorders, and those with a persistent pattern of self-injurious or suicidal behavior. The heart of their treatment is their participation in our daily cognitive behavioral therapy milieu program. Over the course of their rotation, MGH/McLean residents work with members of a multidisciplinary team where they evaluate adolescent patients and work closely with their families. They are also immersed in a milieu therapy model that focuses on the transformative power of safety, containment, and prosocial behavior. Residents co-lead psychotherapy groups including both skills-based groups and more traditional process-oriented groups. On this rotation, residents learn about childhood development, how to identify primary mental illness in childhood and adolescence, and how to deploy evidence-based treatments to adolescents across multiple different diagnostic categories.
PGY2 residents have one afternoon per week dedicated to learning psychodynamic psychotherapy (through 1-2 patient cases) as well as the opportunity to engage in a longitudinal elective of their choosing. Starting psychodynamic psychotherapy training in the PGY2 year provides residents with the opportunity to see a patient longitudinally for three years (PGY2-PGY4). Residents choose either MGH or McLean for their outpatient clinic site.
These seminars are held throughout the year on Wednesdays from Noon to 5:00 pm, and rotate between the MGH and McLean Hospital campuses every six months. Residents are protected from clinical responsibilities during this time. The required seminars for the PGY2 year are comprehensive, extending over the entire year. Speakers are leaders in their fields, exposing residents to current research and theory as applied to everyday clinical situations. Topics include introductory and basic psychodynamic psychotherapy, psychopharmacology, psychiatric diagnosis, neuroscience, scholarly activity, medical ethics, case formulation, forensic psychiatry, and an introduction to cognitive behavioral therapy and group therapy. Residents from all classes interact together during the noon hour for the Resident Association Meeting, meetings with the training director or Chief of Psychiatry, or Journal Club. All classes have a T-group prior to the start of the afternoon seminars, in which the class meets weekly with a trained group therapist.
6 weeks of nightfloat over the course of the year (3 weeks at MGH and 3 weeks at McLean, divided in 1-2 week blocks). PGY2 residents are also scheduled for weekend calls (Friday night, Saturday/night, or Sunday) at MGH or McLean throughout the year, at an average of 1-2 weekend calls per month. When rotating at McLean, PGY2s also work evening shifts (5-9pm) in the Clinical Evaluation Center, at an average of 1 shift per month.
Four weeks vacation, in 1 week blocks spread out over the course of the year.
