Psychiatry Residency Postgraduate Year 2
The Psychiatry Residency’s postgraduate year 2 (PGY-2) expands on psychiatric training begun in your first year, providing you with a solid foundation in the diagnosis and treatment of acute and chronic mental illness.
During your second year, you become proficient in the assessment of patients in every part of the healthcare delivery system, including the public, city and state, private, and federal sectors. You also gain exposure to outpatient psychiatry, child and adolescent psychiatry, and consultation–liaison psychiatry.
Inpatient Psychiatry Clinical Training for Residents
During your second year of residency, you rotate through several inpatient psychiatry sites for 4 to 10 weeks at a time. Some of these sites are the same as those offered in PGY-1, including 20 West at NYC Health + Hospitals/Bellevue and Health Care Center at NYU Langone Medical Center. In addition, you have the opportunity to rotate in the Manhattan Campus of the VA NY Harbor Healthcare System.
In PGY-2, you also have the opportunity to train at the Kirby Forensic Psychiatric Center.
Kirby Forensic Psychiatric Center
At the Kirby Forensic Psychiatric Center, you spend four weeks working with patients involuntarily committed under New York criminal law, including insanity acquittees and defendants found incompetent to stand trial, and involuntarily committed civil patients found to be dangerous and unmanageable in other state facilities. You also develop the forensic skills to perform evaluations of these patients for legal purposes.
During this rotation, you care for people whose conditions are treatment resistant, people with dangerous psychotic conditions, and those with severe personality disorders. In addition, you learn how to prepare a report for court, addressing commitment, competency, and treatment over objection.
Outpatient Psychiatry Clinical Training for Residents
Outpatient clinical training psychiatry takes place at two locations.
Rockland Psychiatric Center
Rockland Psychiatric Center (RPC) is the largest state hospital in New York, serving 370 adult inpatients and 3,500 outpatients in 10 clinics and 2 assertive community treatment teams in 7 counties. You can choose to rotate through one of these clinics in White Plains or on campus where you spend time at the clinic in Orangeburg in the Recovery Center clubhouse on campus, and on the Clinical Research Evaluation Facility (CREF) run by RPC and housed in The Nathan S. Kline Institute for Psychiatric Research. In the on-campus rotation, you are instructed by faculty with additional training and expertise in public psychiatry and receive additional supervision and discussion time around psychiatric leadership and systems-based care. All residents rotate for two weeks at RPC.
Outpatient Psychiatry Clinical Training and Observation for Residents
Beginning in your first year of residency, you have the opportunity to train in the outpatient setting at the Manhattan Psychiatric Center (MPC). Through observation, you also gain exposure to various community organizations dedicated to the sustained recovery of people who have severe and persistent mental illness.
Manhattan Psychiatric Center
Physicians at the 125th Street Clinic in Harlem, an outpatient facility of the MPC, are dedicated to treating patients who have severe and persistent mental illness. Many of these patients also have a history of incarceration. During this six-week rotation, you learn about the intake examination of mentally ill and criminal recidivists and participate in medication management and group modalities. Emphasis is on the systems approach, integrated care, recovery, and basic principles of public psychiatry. In addition to seeing clinic patients, you gain exposure to psychosocial treatment models that aid in the treatment of this population.
Established in 1948, Fountain House works on the clubhouse model for recovery for people living with acute mental illness. This rotation allows you to observe Fountain House members who live, work, learn, and contribute their talents in a mutually supportive community. Peer participation is at the heart of this model, and by being actively involved in the running of Fountain House, members restore confidence, make friends, learn new skills, and make progress toward achieving their employment and educational goals.
Howie the Harp Advocacy Center
This peer-run program offers employment resources to people living with mental health conditions. The Howie the Harp Advocacy Center is known for its peer training program, which allows people with mental health conditions to support others seeking recovery services in the mental healthcare system.
Parachute NYC Crisis Respite Center
People can stay overnight in the Parachute NYC Crisis Respite Center, which offers a calm, open, and supportive environment and provides an alternative to hospitalization during times of intense psychiatric distress. Parachute NYC is largely driven by peer-to-peer counseling within the mental health system.
Intensive Case Management
An alternative to institutionalization, intensive case management promotes optimal health and wellness for adults diagnosed with acute mental illness. You spend the day observing a traveling case manager, who helps people gain control over their lives and expand opportunities for engagement in their communities. Case management provides access to services that encourage people to resolve problems interfering with attainment or maintenance of independence or self-sufficiency in their community.
Manhattan Psychiatric Center Transitional Living Residence
The Manhattan Psychiatric Center Transitional Living Residence is for people who have difficulty transitioning directly from the hospital to a community residence. At this interim supportive residence, people further develop the necessary skills to live in the community and develop a positive track record of these skills. The residence also promotes recovery and self-advocacy to live more independently.
HELP USA Keener
Through a contract with the New York City Department of Homeless Services, HELP USA Keener, also known as Wards Island Shelter, is open 24 hours a day, 7 days a week, providing shelter to 326 homeless single men. The facility also offers case management, skills building, education and recreation, support groups, housing services, employment and internship training, and daily meals.
Project for Psychiatric Outreach to the Homeless
The Project for Psychiatric Outreach to the Homeless assesses and treats people where they live, including the street, shelters, drop-in centers, and residences. It helps those whose ability to pursue standard avenues of treatment has been significantly limited by mental illness, homelessness, and poverty. Grand rounds and didactics focus on topics relevant to community-based psychiatry such as treating homeless and formerly homeless people.
Consultation–Liaison Psychiatry Clinical Training for Residents
As a second-year resident, you spend four weeks on the consultation–liaison psychiatry service at either Bellevue, NYU Langone’s Tisch Hospital, or the VA NY Harbor Healthcare System.
During your rotation on the Bellevue consultation–liaison service, you join a multidisciplinary team that includes a psychosomatic medicine fellow, a social worker, a neuropsychologist, and multiple attending consultation–liaison psychiatrists. You conduct psychiatric consultations in the general hospital for many different services, including internal medicine, surgery, surgical subspecialties, obstetrics and gynecology, neurology, rehabilitation medicine, HIV and tuberculosis units, trauma, toxicology, and the traumatic brain injury unit. You also have the opportunity to provide consults with the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, to engage hospitalized patients with substance use disorders, and to initiate medication for addiction treatment for those patients who are interested.
At Tisch Hospital, you work closely with a team of several attendings with subspecialty interests and training, including addiction and women’s health, a psychosomatic medicine fellow, a geriatric psychiatry fellow, a behavioral nurse liaison, and a psychologist. The consultation–liaison service offers a wide breadth of psychiatric consultations across all inpatient medical and surgical units and on the Rusk Rehabilitation unit. Additionally, you may work with and teach medical students who rotate on the service during the academic year.
Residents participate in a weekly didactic session on the consultation–liaison service. Sessions alternate between reviews of journal articles and presentations on various clinical topics. Daily morning teaching rounds and weekly walk rounds are also part of your didactic training.
VA NY Harbor Healthcare System
During your rotation on the VA NY Harbor Healthcare System consultation–liaison service, you join a multispecialty team that includes a psychosomatic medicine fellow, neurology residents, pain medicine fellows, and postdoctoral health psychology fellows.
Key teaching areas covered in this rotation include the evaluation of new-onset neuropsychiatric symptoms in people with medically complex conditions, psychological adjustment to illness and hospitalization, and liaison aspects of working with medical and surgical services. In addition to daily teaching rounds, you participate in weekly consultation–liaison journal club.
Child and Adolescent Psychiatry Clinical Training for Residents
As a second-year resident, you rotate for four weeks on one of the inpatient adolescent units. Every effort is made to accommodate your preference.
Bellevue Child Inpatient Unit
The child inpatient unit at Bellevue, 21 South, is the oldest inpatient child service of its kind in the country. During your rotation on this 15-bed unit, you interact with children younger than age 12 with diagnoses such as autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), and conduct, mood, pervasive developmental, and psychotic disorders. The unit has a therapeutic nursery for children with autism and a program for school-age children with various diagnoses.
Bellevue Adolescent Inpatient Service
Bellevue’s adolescent inpatient service consists of two acute care psychiatric units, with 21 West serving adolescents ages 12 to 14 and 21 North serving those ages 15 to 17. During your rotation, you can expect to see a wide range of pathology, including autism spectrum disorders, mood disorders, PTSD, and first-break psychosis.
Patients admitted to the units receive diagnostic evaluations and treatment for the signs, symptoms, and impairments caused by most major psychiatric disorders. You are part of the multidisciplinary treatment team, serve as the primary clinician for your patients, and co-lead a substance use support group. A weekly journal club and case conference are also part of the rotation.
During your second year of residency, you have two weeks of elective time and choose your electives based on interest, from the same electives catalog as PGY-1 residents. Residents can also gain further experience in the reverse integration model and the inpatient co-management model through electives.
Residency Didactic Training
Throughout the academic year, you meet for four hours of formal didactic seminars during dedicated time on Thursday afternoons. These seminars follow weekly Psychiatry Grand Rounds and all residents meetings. These didactics are in addition to the substantial formal and informal teaching and direct supervision provided at each rotation site.
Our 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 on the diagnosis and management of psychotic, mood, and anxiety disorders. It also includes courses in forensic psychiatry, child and adolescent psychiatry, public psychiatry, geriatric psychiatry, substance abuse, and personality disorders. Additional courses cover dynamic and supportive psychotherapies and psychodynamic models of psychological functioning. Residents can also meet with and hear brief talks from cutting-edge clinician–scientists and researchers during dedicated research seminar time.
On-Call Shifts for Residents
In PGY-2, you are on call for 2-week blocks (4:00PM to 12:00AM for 1 week at the VA NY Harbor Healthcare System and 1 week at Bellevue) for a total of 6 to 8 weeks. You also take weekend call at these two locations.