OVERVIEW OF CLINICAL
ROTATIONS
PGY-1
The
clinical rotations and course curriculum in the PGY-1 year foster the
resident’s developing identity as a competent and caring physician,
through
rotations in medicine, neurology and psychiatry that offer broad
clinical
experience, excellent teaching, and appropriate levels of
responsibility. In addition, residents
begin to develop
knowledge and skills in the diagnosis, management and treatment of
severely
disturbed and mentally ill inpatients. PGY-1
year is divided into six months of medicine and neurology, four months
of adult
inpatient psychiatry, and two months of rotations on the
consult/liaison and ECT services. Residents
take
call at The University of Chicago Hospitals while on psychiatry,
covering the
Emergency Room and the general hospital for psychiatric emergencies,
and providing supervision for emergent care issues arising on the
University of Chicago inpatient psychiatry service at Mercy
Hospital. Senior residents and faculty provide supervision to the
on-call resident, initially on-site one-on-one back-up, and later, as
the resident develops confidence and expertise, supervision by phone.
Medicine/Pediatrics
and
Neurology: Most residents spend four
months on
the inpatient medical wards at MacNeal
Hospital in Berwyn, IL,
a 427-bed community hospital with strong links to The University of
Chicago. PGY-1 interns are supervised by
PGY-3 residents in The University of Chicago Department of Medicine
while at
MacNeal. Residents spend an additional
two months on the outpatient and consultation Neurology service at
MacNeal. Those residents who have a
particular
interest in child psychiatry may choose to spend part or all of their
four
months of medicine on the pediatrics service at The University of
Chicago Comer
Children’s Hospital, and may spend one month on the child neurology
service
there in addition to one month of adult neurology at MacNeal.
Adult
Psychiatry: Four of the six months of
psychiatry in PGY-1 are spent at The
University of Chicago adult inpatient psychiatry service at Mercy
Hospital, a large inner-city community hospital close to the University
of Chicago. This
general psychiatry unit treats acute patients with all major
psychiatric
disorders, as well as patients with comorbid substance abuse and
dependence, and those with comorbid medical problems.
Patients
come from the University community of students and faculty, from the
varied
communities on the South Side of Chicago, and from within the medical
center
itself.
ECT and Consult/Liaison:
Residents on this service provide evaluation, treatment and
monitoring
for inpatients and outpatients receiving ECT at Mercy Hospital.
Residents learn the history, techniques and complications of
ECT, and participate
in the ongoing research protocols on this service.
Residents also participate as members of the Consult/Liaison
service, which consults to the pediatric, medical and surgical services
at the University of Chicago Hospitals.
Courses:
All PGY-1 residents, no matter what their rotation assignments,
attend
the Psychiatry Summer Introductory Series of lectures.
Designed to introduce residents to basic
concepts in psychiatry, these lectures cover topics in emergency
psychiatry,
psychopathology, psychopharmacology, psychotherapy, and
psychological and neuropsychologic assessments.
Residents on psychiatry rotations also attend Morning Report, a
daily
review of patients seen in the emergency room and those admitted to The
University of Chicago inpatient service; Professor’s Rounds, a teaching
conference directed by Department faculty; and the Basic Clinical
Skills
course, an introductory course on diagnostic interviewing.
Residents also attend Departmental Grand
Rounds and the Thursday afternoon series of courses for all residents: Clinical Case Conferences, Psychopharmacology
Conference, and Multicultural Issues in Mental Health.
PGY-2
The
PGY-2
year builds on the PGY-1 experiences in medicine and psychiatry,
exposing
residents to inpatient psychiatric treatment in academic, public and
private settings
with more complex, dually diagnosed and medically complex patients. Residents spend two
months on
each of six services: Mercy Hospital
Inpatient Service, Tinley Park
Hospital,
Consultation/Liaison, the University of Chicago Emergency
Service, Chemical Dependency at Chicago Lakeshore Hospital, and
Community Psychiatry, an outpatient rotation at Thresholds. PGY-2
residents develop skills as psychiatric educators through increased
responsibility for the teaching and supervision of medical students,
and through
coursework and supervision on education and educational techniques. Residents take call at The University of
Chicago Hospitals.
Mercy
Hospital
Inpatient Psychiatry:
PGY-2 residents treat psychiatric inpatients including those
with comorbid medical and substance abuse problems. The patient
population includes University of Chicago students and employees
as well as patients from the community surrounding Mercy Hospital.
Tinley Park Hospital:
This public sector psychiatry rotation introduces residents to
the
Metro-South region of the State of Illinois Office of Mental Health
(Department
of Human Services) which includes 23 community mental health agencies. Tinley Park, a State Hospital,
treats a large population with serious mental illness and comorbid
substance
abuse as well as significant social and economic problems.
Consultation/Liaison: The C/L service at The
University
of Chicago Hospitals provides consultation to all medical and surgical
services
in the general hospital. PGY-2 residents
in psychiatry and neurology rotate
on this
service, which performs more than 400 consults per year.
The CL service hosts an interdisciplinary
case conference at which medicine, surgery and specialty services such
as the
ethics service can discuss with psychiatry particular cases around
which there
has been consultation.
Chemical
Dependency: Residents spend five
half-days for two months on the Chemical
Dependency service at Chicago Lakeshore Hospital, under the direction
of Dr. Martin Paisner, where
patients
are admitted for detoxification from a variety of substances of abuse. Residents participate in groups and
individual treatment for addictions, attend AA meetings, and become
familiar
with detoxification protocols.
Community
Psychiatry: Residents spend two
months at Thresholds, one of the nation's largest non-profit providers
of mental health services. Thresholds offers case management,
education, job training and placement, housing, and operates Assertive
Community Treatment Teams providing services to people with serious and
persistent mental illness.
Residents evaluate new patients and function as part of a team,
providing outreach to people in the community in their homes and on the
streets as well as in clinics.
Outpatients:
Residents
are expected to pick up and follow three hours of
outpatients per week during the PGY-2 year. Some
will be treated in weekly psychotherapy,
while others may be seen less frequently.
Patients are referred from The University of Chicago student
health service,
as well as the outpatient clinics and inpatient units at The University
of
Chicago and Mercy Hospital. Residents have two hours of
individual supervision, provided
by
faculty within the Department and at SCRS, the Student Counseling
Resource Center
on campus. Residents also rotate through the Continuing
Care Clinic
at the Univerisity of Chicago, which provides ongoing
medication management, emergency drop-in
services, and a large group experience for many patients with severe
and
persistent mental illness, serious economic and social problems, and
major
needs for rehabilitation services. This
clinic
works collaboratively with Thresholds.
Courses: Courses
in the PGY-2 year are organized to
solidify the resident’s understanding of phenomenology and
psychopathology and
to develop an understanding of approaches to psychotherapy. Residents continue to attend Morning Report
and Professor’s Rounds, and continue courses in psychopathology,
neurobiology,
neuropsychiatry, and developmental and geriatric psychiatry. They begin psychotherapy training in
supportive psychotherapy, a sequence of courses on psychodynamic
psychotherapy
and psychodynamic interviewing, and finish the year with an
introduction to CBT
(cognitive behavior therapy). Throughout
the year, there is a Consultation/ER Case Conference. Additional
courses address systems of care,
and ethical issues in psychiatry. Residents
begin to attend a three-year Research
Seminar, focusing on developing critical reading skills, understanding
research
methodologies, and identifying a research project to pursue in the
PGY-3 and
PGY-4 years. Residents also attend Departmental Grand Rounds and the
Thursday
afternoon series of courses for all residents:
Clinical Case Conference, Psychopharmacology Conference,
CBT Case Conference, and Interdisciplinary Case Conference.
PGY-3
The
PGY-3
year is exclusively an outpatient year.
Designed to enable residents to function more independently and
to follow
a large number of patients longitudinally, PGY-3 provides year-long
experience
in the general psychiatry clinics, several half-day sessions set aside
to see
psychotherapy patients, and six-month rotations in subspecialty clinics. Subspecialty clinics include neuropsychiatry,
geriatrics, child psychiatry, refractory psychosis, anxiety disorders,
personality disorders, refractory affective disorders, and several
medical/psychiatric clinics including a transplant clinic and a
psycho-oncology clinic .
Residents provide teaching
and supervision for medical students and provide back-up for PGY-1 and
PGY-2
residents who take call.
The
General Clinics: Adult
patients are referred to our clinics
from within The University of Chicago Hospitals system, from inpatient
stays on
our inpatient psychiatry service, from the surrounding community of
Hyde Park
where students and faculty live, from the population of hospital and
university
employees, and from the South Side of Chicago and the greater Northern Indiana area. Problems
vary
from complex diagnostic issues to more common affective, anxiety and
adjustment
disorders. Residents are assigned to two
general clinics per week, performing intakes and providing
psychiatric
follow-up to many patients for the PGY-3 and PGY-4 year.
The clinics are designed to enable residents
to pick up a large caseload of patients with varied diagnoses and
treatments. Residents follow some
patients in long-term psychodynamic psychotherapy, offer Cognitive
Behavior
Therapy to others, follow some family or couples cases, and have ample
opportunity to work collaboratively with psychologists in
coordinated treatment. Faculty include
Dr.Judith Badner, Dr. Michael Marcangelo, Dr. Deborah
Spitz, and
Dr. Daniel Yohanna.
Specialty Clinics: Residents
rotate for six months in a variety of specialty clinics:
Child
Psychiatry—under
the direction of our Child Psychiatry faculty, Dr. Sharon Hirsch,
Dr. Woodard-Faust and Dr. Paul Jones, residents provide diagnostic
assessment
and treatment for patients with pervasive developmental disorders,
disorders of
attention, affective disorders, anxiety disorders, psychosis, and
eating
disorders.
Geriatrics—residents
rotate through one or more geriatric clinics at The University of
Chicago
Hospitals, under the direction of a geriatric psychiatrist. In
addition, working with a geriatric psychiatrist, residents assess and
treat patients in nursing homes.
Neuropsychiatry—directed by Dr. Fred
Ovsiew, this clinic treats patients with complex
neuropsychiatric problems including Parkinson’s Disease, epilepsy, MS,
traumatic brain injury as well as conversion disorders.
Refractory
Psychosis—under
the direction of Dr. Morris Goldman, this clinic offers
consultation to patients, families and community agencies, providing
comprehensive evaluation and treatment of patients with schizophrenia,
schizoaffective disorder and other refractory psychoses.
Anxiety
Disorders—directed
by Dr. Emil Coccaro and staffed by a psychologist and psychology
trainees as well as by residents, this clinic serves patients with
severe
anxiety disorders, obsessional disorders, panic disorders and other
comorbid
psychiatric problems. It offers
comprehensive evaluation and neuroimaging, pharmacologic treatment, and
CBT.
Medical/Psychiatry--under the direction of
Dr. Marie Tobin, who leads the psychiatric consultation/liaison service
in the University of Chicago Hospitals, this clinic offers evaluation
and follow-up to patients seen on the C/L service and other patients
with comorbid medical and psychiatric problems. Residents also
rotate in the Transplant clinic,
led by Dr. Michael Marcangelo, and in the Psycho-oncology clinic, led by Dr.
Tobin.
Personality
Disorders—directed
by Dr. Royce Lee, this clinic offers assessment
and treatment to complex patients with personality disorders and often
comorbid
affective disorders.
Outpatients:
In
addition to patients followed within the general and
subspecialty clinics, residents are expected to follow eight hours of
outpatients in various modalities of psychotherapy, including
psychodynamic
psychotherapy, supportive psychotherapy, CBT, combined pharmacologic
and
psychological treatment, and family therapy.
Residents receive two hours per week of individual supervision,
and
additional supervision is available for family and marital cases as
well as individual cases for those who request it.
Courses:
PGY-3
courses continue the psychotherapy, psychopharmacology
and neuroscience sequences. Third-year
residents collaborate with faculty to develop and present lectures in
the psychopharmacology
conference attended by all residents. A
six-month neuroscience course addresses molecular biology and genetics,
epidemiology, neuroanatomy and neuroimaging, and other topics. In the
research
sequence, residents identify a research team in the Department with
whom to
work, and begin to pursue a mentored research project.
In the psychotherapy sequence, residents take
courses in group and family therapy, attend a 6-month seminar and
supervision
group on cognitive behavior therapy for disorders of mood, anxiety and
emotion
regulation, and continue to study psychodynamic psychotherapy in a
longitudinal
case conference and a course in advanced psychodynamic theories at the
end of the
PGY-3 year. In addition, there are
courses in forensic and addiction psychiatry.
Residents attend Departmental Grand Rounds and the Thursday
afternoon
series of courses for all residents:
Clinical Case Conference, Psychopharmacology Conference,
CBT Case Conference
and Interdisciplinary Case Conference.
PGY-4
In
the
PGY-4 year, residents solidify administrative and leadership skills,
enlarge
clinical confidence and autonomy, and focus on individual specialized
areas of interest. Each resident assumes a
Chief Resident
position with significant administrative, supervision and teaching
components. Each resident completes a
research project and
makes a presentation to the Department.
Residents continue to follow outpatients in a variety of
psychotherapeutic modalities, and may choose elective clinical
experiences in
specialized psychotherapies, such as group or family therapy,
psychodynamic
psychotherapy, or dialectical behavior therapy, to name a few. In conjunction with faculty advisors, each
resident develops an individualized schedule for the fourth year that
reflects
the serious pursuit of particular interests.
Some residents choose to focus on research, some emphasize
clinical
experiences, others assume increased teaching responsibility. The year is designed to allow maximum
flexibility
so that each resident may pursue a meaningful area in depth.
Chief Residencies:
One chief resident serves as Administrative Chief resident,
leading
Residents’ Meeting and working closely with the Residency Training
Director on
administrative issues. Chief
residents
on the Mercy inpatient unit, the consultation/liaison service, and the
emergency
service at The University of Chicago Hospitals provide
administrative leadership, teaching and supervision for medical
students and
junior residents on those services, leading case conferences and
morning report
and designing and teaching specialized courses.
There is flexibility in each of these roles, and specific duties
may be
negotiated with the Program Director, based on the resident’s
interests; for
example, one fourth year resident devised a Chief residency in
Medical
Student Education, helping to redesign the psychiatry clerkship and
focus on
recruitment of medical students into psychiatry.
Research: Under the supervision of
faculty
research mentors and with the guidance of the Research Seminar led by
the
Chair, Dr. Emil Coccaro, each resident completes a research project in
collaboration with one of several research groups in the Department. The resident presents the research to the
Department in December of the PGY-4 year.
With feedback and discussion following that presentation, each
resident
writes up the research as a publishable paper.
Some residents choose to spend a large portion of the PGY-4 year
on
larger research projects.
Forensic Psychiatry:
PGY-3 and PGY-4 residents evaluate and write up forensic cases
under the
direction of one of the Department’s forensic psychiatrists, Dr. Steve
Dinwiddie or Dr. Daniel Yohanna.
Elective
Clinics:
Refractory
Affective Disorders—under the direction of
Dr. Eliot Gershon, this clinic offers
highly specialized treatment for patients with severe and refractory
unipolar
and bipolar disorders. It offers
residents the opportunity to use sophisticated psychopharmacologic
interventions and gain an understanding of the long-term evolution of
severe
affective illness.
Geriatric
Clinics—residents
may elect additional geriatric experience at the South Shore Clinic,
which offers geriatric medical and psychiatric care in Hyde Park, close to The University of Chicago.
Student
Counseling Resource Center (SCRS)—under the direction of
Dr. Tom Kramer,
the SCRS provides emergency consultation, psychoeducation,
psychotherapy and
medication management for undergraduate and graduate students at The
University
of Chicago.
Intensive
Sequence
Elective: In conjunction with a
course which reviews classic
psychoanalytic theory under the direction of Dr. Harry Trosman, a
senior
psychoanalyst, the resident treats 2-3 patients for one year in
intensive (two or three times per week)
psychotherapy, with supervision provided by psychoanalysts affiliated
with the
Chicago Institute for Psychoanalysis.
Family
Institute Elective:
Under the supervision of Dr. John Rolland, residents take
courses and
evaluate and treat families at the Family Institute in Downtown Chicago.
Other
Electives:
Clinical, research and educational electives are arranged
individually.
