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Clinical Rotations |
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Residency & Fellowship Programs > Psychiatry > Clinical Rotations |
MedicineConsulation/Liaison Psychiatry
Intensive Outpatient Psychiatry
Child and Adolescent Psychiatry
PGY-I residents complete four months of medicine: two months of inpatient medicine, one month of primary care consultation on the inpatient psychiatry unit, and one month of a medicine selective, all located at the Fletcher Allen Hospital on the Medical Center Campus in Burlington. When possible, these months are scheduled in separate pairs to allow residents to maintain close contact with the Department of Psychiatry. On inpatient medicine, residents work as a member of a house staff team with a caseload of 10-12 patients and take short call with their medicine team until 10:00 PM every third night. Residents cap at 5 new admissions per night. Residents do not participate in psychiatry call while on medicine rotations.
For the primary care consultation month, residents work on the Inpatient Psychiatry Unit with a board certified internist who provides medical consultation and care to psychiatric patients. During this month, residents will attend daily treatment rounds with the internist on the Inpatient Psychiatry Unit to coordinate care.
Medicine selectives include rheumatology, dermatology, endocrinology, pediatrics, and palliative care.
Residents complete two months of neurology in the first two years of training. PGY-I residents are assigned to the neurology consultation service, supervised by an attending neurologist in daily rounds. The resident attends neurology grand rounds and case conferences while on service as well as weekly neuroradiology rounds. Residents gain experience in reading EEGs, MRIs, and CTs and perform extended neurological exams and lumbar punctures. Residents also learn how to medically manage acute cerebral hemorrhages and infarcts and plan for long-term treatment and rehabilitation.
PGY-II residents complete a neuropsychiatry/behavioral neurology rotation at the Vermont State Hospital (VSH). Under the supervision of a board certified neurologist, residents gain experience in performing thorough neurobehavioral assessments on psychiatric inpatients, many of whom are chronically mentally ill. Serving as a consultant to VSH psychiatrists, residents will learn to produce dynamic formulations of the patient's illness, commenting on the interaction between neurological dysfunction and clinical psychiatric symptoms. During this month, residents participate in public psychiatry seminars, journal clubs, and neurology grand rounds.
Inpatient Psychiatry is a required nine-month rotation divided between the PGY-I and PGY-II years. It is located at Fetcher Allen Hospital on the Medical Center Campus in Burlington. Four psychiatric teams provide care for patients on two inpatients units, one locked and one open. Each team is comprised of one attending psychiatrist, one resident and 1-3 medical students, one of whom may be serving as an acting intern. PGY-I and II residents are responsible for a maximum of 6 and 8 patients, respectively.
Clinical teaching is provided by daily walk rounds, team rounds, and case presentations. On daily walk rounds, all members of the psychiatric team see patients together. Team rounds are sit-down rounds, which include any member of the staff who has contact with a patient. Case presentation occurs with the admission of every new patient and at specified clinical rounds. In addition to rounds, each resident receives at least one hour of individual supervision per week by a full-time faculty psychiatrist.
There are three major learning tasks for residents on the inpatient service: acquiring a psychiatric knowledge base, becoming proficient at psychiatric assessment and treatment, and interacting with the treatment team as an effective member. Learning takes place by observing, practicing, reading, and teaching in a closely supervised environment. Residents work with four psychiatric hospitalists who love their job and feel privileged to teach residents and students. Daily thirty minute "power teaching" sessions allow medical students and residents to select a clinically relevant topic to discuss with their attending psychiatrist.
Several adjunct learning sessions occur regularly on the inpatient psychiatry rotations. Case conferences (combined rounds) occur weekly with a 1.5 hour session devoted to interviewing a challenging patient and subsequently discussing the case. In the basic psychiatry skills series, inpatient psychiatry faculty introduce interviewing principles and psychotherapeutic concepts on a weekly basis. Teaching topics include case formulation, suicide risk assessment, trauma, attachment, and dissociation. Morbidity and mortality rounds are held monthly. Competencies required by the ACGME are assessed monthly and at the end of each full rotation.
Consultation/Liaison Psychiatry
PGY-II residents spend three months on the Psychiatric Consultation Service (PCS) in the general hospital on the Main Center Campus. Residents work closely with medical students, one of three psychiatry attendings, and a master's level social worker to provide psychiatric consultation to other inpatient services, notably Nephrology, Oncology, Cardiology, Surgery, Pediatrics, Internal Medicine, and OB-GYN. Bedside teaching complements a broad range of seminars, rounds, and conferences, representing the breadth and depth of contemporary psychiatric consultation practice. The PCS provides the resident with both clinical and scholarly experiences that complements psychiatry and medicine. Among other skills, residents will gain competence in assessing decision-making capacity, treating delirium, managing alcohol withdrawal and substance intoxication, and assessing suicide risk. Types of treatment include supportive and brief psychotherapy, family and team interventions, and pharmacologic consultation to house-staff and attending physicians.
On this rotation residents also participate in the ECT service, pain management service, and Fletcher Allen's palliative care team. Finally, residents perform telemedicine evaluations with a PCS psychiatry attending.
Intensive Outpatient Psychiatry
PGY-II residents spend one month working in an intensive outpatient/psychiatric partial hospitalization program at Fletcher Allen's Seneca Center located on the University Health Center (UHC) campus in Burlington. The Seneca Center provides comprehensive evaluation and evidence-based treatment for patients experiencing moderate- to severe- exacerbations of mood and anxiety disorders, adjustment disorders, and personality disorders that interfere with daily functioning. After undergoing a full psychosocial and medical evaluation, patients attend 3-6 hours of group psychotherapy and coping skills training a day for 2-4 weeks using a cognitive behavioral (CBT) and dialectical behavioral therapy (DBT) approach.
On this rotation, residents work closely with a multidisciplinary team of five master's level clinicians, a psychiatrist, and the clinical director to develop individualized treatment plans, co-lead skills groups with a clinician, and assist with individual case management. Residents are exposed to a wide variety of clinical presentations, treatments and dispositions.
PGY-I & II residents participate in a two-month emergency psychiatry rotation with the Crisis Services of Chittenden County (CSCC), a unique service that collaborates with the local community mental health center (Howard Center for Human Services or HCHS), Fletcher Allen Health Care, and the University of Vermont's Department of Psychiatry to provide psychiatric emergency services for the community and support services for HCHS.
This rotation provides intensive clinical and didactic training in managing patients in crisis. PGY-I residents spend one month with the Mobile Crisis Team (MCT) learning to evaluate and triage patients with acute psychiatric symptoms. Residents become competent in assessing patient safety, developing patient management strategies, and planning and implementing treatment. Treatment modalities include crisis intervention, supportive and dynamic individual therapy, marital and family therapy, and consultation to other agencies and physicians.
Residents on the emergency rotation evaluate approximately ten new patients per week, consult with clinician staff on about 20-25 patients per week, and carry 5-10 patients for short term assessment or treatment. Through this evaluation process, residents learn the legal aspects of Vermont's involuntary hospitalization proceedings. A psychiatry attending is available on site during the day and by phone at night for consultation. Residents work closely with the service director, including twice daily patient rounds and daily individual supervision. Through these functions, residents have substantial exposure to the functioning and resources of the community mental health center as well as the community at large. Competencies are assessed at the end of each month.
As part of an interdisciplinary team, residents also care for clients in several hospital-diversion programs designed to stabilize individuals in the community who are experiencing an acute psychiatric or substance abuse crisis. Residents will also participate in home visits with the outreach team to assess mental status. Finally, PGY-I through PGY-III residents collaborate with clinicians from the area's mental health centers to provide crisis intervention while on call.
Child and Adolescent Psychiatry
PGY-III residents spend one day per week working in the Pediatric Psychiatry Clinic, where they develop competence in the diagnosis and treatment of children and adolescents with emotional and behavioral concerns. This clinic receives requests for assessment and treatment from families and clinicians across Vermont, New Hampshire, and northeastern New York. In collaboration with the internationally acclaimed Vermont Center for Children, Youth, and Families (VCCYF), strong emphasis is placed on a family based approach that involves multi-informant assessment of the child and his/her family using the empirically based Child Behavior Checklist (CBCL) with the current diagnostic system of DSM-IV. Residents become adept at interacting with other members of the child's treatment team, including individuals from community agencies, schools, and primary care clinicians.
Residents develop competence in a broad spectrum of treatment approaches to children with highly complex psychiatric illnesses. Residents also encounter children and adolescents during their on-call experiences in the PGY-I through PGY-III years. Research opportunities are also available for residents. For more information on the child psychiatry fellowship and the integrated 5 year adult/child and adolescent psychiatry track, visit the child and adolescent psychiatry training website.
PGY-III residents spend approximately one day per week in the psychopharmacology clinic. New patient evaluations are scheduled weekly, allowing residents to sharpen their diagnostic and treatment skills in an outpatient setting. Many patients will remain in the clinic for 1-2 years, giving residents a longitudinal experience in assessment and treatment. Residents become proficient in pharmacotherapy of illnesses commonly seen in psychiatric clinics, such as mood and anxiety disorders, psychosis, and attention-deficit disorders. Residents also provide periodic evaluations of patients referred to the MindBody Medicine Clinic for treatment of chronic pain . Weekly psychopharmacology rounds allow the residents to present cases, discuss pertinent clinical topics, and present journal articles.
The geriatric psychiatry rotation is a year-long, four-hour per week outpatient rotation, in which PGY-III residents gain experience in providing clinical psychiatric care for elderly patients who present with affective disorders, neurodegenerative diseases, late-life psychotic disorders, and other mental disorders of old age. Residents acquire a small caseload of geriatric patients and care for them longitudinally, becoming adept at balancing psychiatric treatment with medical comorbidities, while also managing issues related to family dynamics and caregiver burden.
Psychotherapy training takes places in a variety of settings across all four years of the residency. The educational and clinical experiences are designed to promote competence in several psychotherapeutic modalities, including supportive psychotherapy, long-term psychodynamic psychotherapy, brief psychotherapies, cognitive behavioral psychotherapy, and combining psychotherapies with pharmacotherapy.
All residents spend one month in our Intensive Outpatient and Partial Hospital Program, learning to conduct cognitive behavioral psychotherapy in group settings. Psychotherapy seminars begin in PGY-II and continue longitudinally into PGY-IV. Supervised individual psychotherapy begins in PGY-II, at which time each resident is expected to treat at least one outpatient in ongoing psychotherapy sessions. Psychotherapy cases accruex during the second year are continued into PGY-III, during which ongoing conduct of a minimum of four psychotherapies is also required. Weekly individual and group supervision sessions provide ample opportunity for residents to discuss and process their caseloads. Residents are encouraged to continue psychotherapeutic treatments and supervision through the PGY-IV year.
A required one month rotation, the clinical abuse rotation takes place at several clinical sites, including Day One and the Substance Abuse Treatment Center (SATC) at UHC; the Community Health Center of Burlington; and Maple Leaf Farm in Underhill, VT. Residents may also spend time at methadone clinics in Berlin, St. Johnsbury, and Newport, VT. Residents develop competence in diagnostic interviewing for substance dependence and abuse, treatment planning for initial rehabilitation; management of relapse; pharmacologic treatment for alcoholism; and diagnosis and treatment of opiate dependence. Residents may also become certified for suboxone treatment during this rotation.
Day One is a chemical dependency program offering intensive outpatient treatment, individual treatment, and aftercare. Residents perform initial evaluations, co-lead cognitive behavior therapy based groups, and receive individual supervision regarding psychotherapeutic techniques used with substance dependence disorders.
The SATC is a UVM-based research center that offers treatment for opioid and cocaine dependence within the context of research protocols managed by department faculty. Residents perform clinical and medical evaluations; learn optimal dosing regiments of duprenorphone, naltrexone, and clonidine; and provide individual behavioral counseling and skills training.
Maple Leaf Farm is a residential treatment center emphasizing twelve-step methods, education and spiritual growth, and family therapy in both group and individual settings.
PGY-II residents spend one month at the Vermont State Hospital (VSH), a 54-bed facility in Waterbury, VT, dedicated to treating patients on involuntary status for whom a less restrictive setting is not appropriate. Psychiatric residents care for up to eight inpatients as part of an interdisciplinary team. Under the supervision of core and clinical faculty, residents expand their inpatient treatment skills as they gain experience treating patients with severe mental illness and those who need forensic evaluations. Residents learn to navigate Vermont's mental health legal system, assessing competency to stand trial and testifying in court hearings for both involuntary commitments and motions for involuntary treatment. Basic patient rights, the physician's responsibilities in situations of dual agency, and the role of the physician in court are emphasized.
Mood and Anxiety Disorders Clinic
Administration
ECT
Pain Management
Child Research
Psychiatric Consultative Research
Palliative Care
Human Behavioral Pharmacology Lab
