PGY 2 Year

This year extends the psychiatric training begun in the PGY I year, enhancing and expanding on that beginning experience. The PGY II year is designed to provide residents a solid foundation in the diagnosis and treatment of acute and chronic mental illness. Our residents become proficient in the assessment of patients in every part of the health care delivery system: public sector, city and state, private and federal. Residents also have exposure to children and adolescents, as well as to specialized patient populations. There is an opportunity for dedicated research time, focused on public psychiatry and the chronically mentally ill. Residents end the year competent in the fundamental treatment modalities available to psychiatrists.

The year is divided into thirteen four week blocks. All residents spend between one and five blocks on each of the following over the course of the PGY I and PGY II years.

BELLEVUE HOSPITAL CENTER

20West

Of the 15 inpatient psychiatric units at Bellevue Hospital Center, only one, 20West is designated a resident teaching service. This is a 28-bed unit for men and women, handling patients with the most atypical, complex and unusual psychopathology admitted through the CPEP. Diagnoses include the entire spectrum of major Axis I disorders, some with co-morbid personality disorders and substance abuse problems.

21South - Child Inpatient Unit*

The child inpatient unit at Bellevue Hospital Center is the oldest inpatient child service of its kind in the country. This 15-bed unit serves children below the age of 12 with diagnoses ranging from Conduct Disorder, Attention Deficit Hyperactivity Disorder and Mood Disorders, to Autistic Disorder, Pervasive Developmental Disorders and Psychotic Disorders. The unit has a therapeutic nursery for autistic children and a program for school-age children with various diagnoses.

21West - Adolescent Inpatient Unit*

The adolescent inpatient unit at Bellevue Hospital Center is a 15-bed unit that provides acute psychiatric care to boys and girls between 12 and 17 years of age. Adolescents admitted to the unit receive treatment for the signs, symptoms and impairments caused by most major psychiatric disorders.

*Residents rotate for one block on either the child or adolescent inpatient unit. Every effort is made to accommodate the resident’s preference.

NYU LANGONE MEDICAL CENTER

HCC-10 COOP

This is a 22-bed unit for patients with acute psychiatric illnesses ranging in age from adolescence through late life. This rotation provides the resident with the opportunity to serve as the primary psychiatrist while working closely with an attending. A thorough neuro-psychiatric and psychosocial understanding of each patient is emphasized. Because of the diverse patient population, with a focus on complex and refractory clinical conditions, residents gain experience in many treatment modalities including state-of-the-art psychopharmacology, electro-convulsive therapy, individual, group and family psychotherapies. Residents also gain exposure to clinical research trials for appropriate patients.

THE DEPARTMENT OF VETERANS AFFAIRS NEW YORK HARBOR HEALTHCARE SYSTEM (MANHATTAN VA MEDICAL CENTER)

17 North

This is a 26-bed acute psychiatric unit for adult veterans who are predominantly male. The population is varied with regard to ethnicity, race, cultural background and socio-economic status. Diagnostically, the patients suffer from schizophrenia, mood disorders, several personality disorders, acute adjustment disorders, PTSD and a variety of organic disorders.

8-Uris

The 27-bed multidisciplinary adult inpatient service treats patients with a full spectrum of psychiatric disorders on a voluntary or involuntary basis. During this rotation residents gain exposure to electro-convulsive therapy, learn to manage complex psychopharmacology treatments, and have opportunity to run group sessions.

Intensive Behavioral Management Ward (1 block) (Required)

This unit treats patients involuntarily committed under the New York Criminal Law (insanity aquitees and defendants found incompetent to stand trial) and involuntarily committed civil patients found to be dangerous and unmanageable in other state facilities. Residents also develop the forensic skills to perform evaluations of these patients for legal purposes. During this rotation, residents gain experience in caring for treatment-resistant and dangerous psychotic patients and patients with severe personality disorders. In addition, they learn how to prepare a report for court, addressing commitment, competency and treatment over objection.

MANHATTAN PSYCHIATRIC CENTER (MPC)

STAIR Unit (Service for the Treatment and Abatement of Interpersonal Risk) (1block) (Required)

STAIR is a manualized cognitive behavioral program for mentally ill violent criminal recidivists. Residents are assigned to one of the STAIR wards and see patients both individually and in the cognitive skills groups. Residents are educated in the latest assessment tools and remedial techniques in the field of cognitive rehabilitation. At the conclusion of the rotation, residents present a comprehensive violence risk assessment to the STAIR staff as well as other teaching faculty.

125th Street Clinic (1 block) (Required)

The 125th Street Outpatient Clinic treats approximately 450 patients suffering from severe and persistent mental illness, many of whom have a history of incarceration in the criminal justice system. Educative experiences provided by this rotation include the specifics of the intake examination of the mentally ill criminal recidivist as well as participation in medication management and group modalities. Emphasis is on the systems approach, familiarizing residents with basic principles of public psychiatry.

ROCKLAND PSYCHIATRIC CENTER/NKI (Nathan Kline Institute)

CREF Unit (Clinical Research and Evaluation Facility) (1-2 blocks) (Selective)*

The CREF is a 24-bed locked unit with 12 beds dedicated to the assessment and research of patients with persistent aggressive behavior. Residents gain experience evaluating and treating seriously and persistently mentally ill patients in a research setting.

White Plains Service Center (1-2 blocks) (Selective)*

Residents gain experience providing active outpatient treatment to seriously and persistently mentally ill adults in a community setting. The diversity of the population, the range of diagnoses and the different levels of functioning enhance residents’ knowledge of treatment outcomes and of the potential for this population to readjust to life in the community through the process of recovery and rehabilitation.

*Selective – one to two residents can select to work at these sites

PUBLIC PSYCHIATRY "ELECTIVE"

All residents elect to do one block of time in a public psychiatry "elective" based at Bellevue Hospital Center in one of the following areas of interest:

1. Research: This elective, focused on severe and persistent mental illness as it affects the lives of the chronically mentally ill and underserved, provides the resident with an opportunity to identify a mentor, define a project from existing databases, and formulate a time-line for its completion.

Elective Supervisor: Dr. Dolores Malaspina

2. Assisted Out-patient Treatment (AOT): This elective exposes the resident to the NYU-Bellevue Hospital Center AOT Program, which serves as the public mental health designated site servicing severe and persistent mentally ill court-mandated to out-patient psychiatric treatment for Manhattan and Rikers Island.  There is a focus on the interface between this program and various public mental health policy regulatory agencies, like OMH and HHC.

Elective Supervisors: Dr. Gary Collins and Dr. Scott Soloway

3. Substance Abuse: This elective exposes residents to substance abuse care delivery services, from out-patient chemical dependency programs, to opiate maintenance programs (Methadone and Buprenorphine); from detoxification units to dual diagnosis units, and a MICA Greenhouse (a therapeutic community for homeless dually diagnosed men). There is a focus on the liaison between these services and the Central Office of Substance Abuse.

Elective Supervisor: Dr. Stephen Ross

4. Mobile Crisis Unit: This elective exposes residents to emergency psychiatric services outside of the emergency room setting.  With the goal of keeping patients in their communities, residents learn to evaluate, assess and stablize patients, providing crisis intervention in the field.

Elective Supervisor: Dr. Fadi Haddad

PGY II OUTPATIENT EXPERIENCE

Outpatient psychodynamic treatment begins in the fall of the PGY II year for those residents interested in working in this modality early in training. Residents are assigned a carefully selected patient for weekly or twice weekly therapy, and a psychodynamic supervisor for weekly supervision. Cases are assigned at either Bellevue Hospital or the NYU Behavioral Health program, the out-patient clinic of NYU Langone Medical Center.

Didactics

Throughout the academic year, PGY II residents meet for four hours of formal didactic seminars during protected time on Wednesday afternoons. These seminars are in addition to the substantial formal and informal teaching and direct supervision provided by each rotation site. The curriculum covers the major psychiatric disorders using a format integrating the role of psychological and social factors in the etiology and course of mental illness. The core curriculum focuses in particular on psychotic disorders, mood disorders and anxiety disorders. The PGY II didactic curriculum also includes courses in forensic psychiatry, child and adolescent psychiatry, public psychiatry, substance abuse, personality disorders and geriatrics. Additional courses cover dynamic and supportive psychotherapies and psychodynamic models of psychological functioning.

On-Call

Residents take call as night float in two week blocks for a total of 6-8 weeks of night float during the year. Night float at the Manhattan VA covers from Sunday night through Thursday night, and night float at Lenox Hill Hospital covers from Monday night through Thursday night. Residents on state rotations, in-patient psychiatric units, and child & adolescent services provide weekend coverage at the VA in three shifts from Friday night through Sunday day. There are no weekend call responsibilities at Lenox Hill Hospital.

Residents are entitled to four weeks of vacation during their PGY-II year. Two weeks must be taken during the first half of the year, and 2 weeks during the second half of the year.