PGY I

Psychiatry residents-PGY1, 2018

The PGY I year focuses on developing and consolidating medical knowledge and skills. Our interns learn to treat and manage seriously ill medical and neurological patients from all socio-economic and cultural backgrounds, many with complex social issues.

The year is divided into thirteen four-week blocks. All residents have four blocks (sixteen weeks) of internal medicine, two blocks (eight weeks) of neurology, six to eight weeks in the Comprehensive Psychiatry Emergency Program (CPEP), ten to fourteen weeks on inpatient psychiatry units, and two weeks of elective. All residents complete their medicine rotations by April of the PGY I year. Some residents will also rotate at Rockland Psychiatric Center for four weeks, and for some select residents who are interested in a career in research, there are opportunities for protected research time.

Medicine

Residents rotate through the inpatient medical services of NYC Health and Hospitals/Bellevue, NYU Langone Medical Center and the Manhattan VA Medical Center. While on these rotations, residents function as first-year medical interns. Supervision, didactic experiences and on-call are taken on each service in accordance with the policies of that service and hospital. Medicine residents function on a night float system in which our psychiatry interns participate for two weeks. In addition, all interns rotate for two weeks in ambulatory care medicine and for two weeks in emergency medicine at Bellevue.

Neurology

Neurology rotations are at NYC Health and Hospitals/Bellevue and at the Manhattan VA Medical Center on the consultation services and neurology clinics. On the wards, residents have primary responsibility for neurological patients under senior resident and faculty supervision. Residents also participate in neurology conferences, rounds, and other educational activities. During neurology rotations the residents take weekend call shifts in psychiatry, in the psychiatric emergency room at Bellevue (CPEP).

Psychiatry

NYC Health and Hospitals/Bellevue Comprehensive Psychiatric Emergency Room (CPEP)

The Bellevue CPEP is a core clinical rotation in emergency psychiatry in the PGY 1 year. The Bellevue CPEP is the busiest psychiatric emergency service in New York City, providing care for over 13,000 presentations annually in the core emergency service. The CPEP consists of the psychiatric emergency room (with 6 beds reserved for extended observation of patients for up to 72 hours), the interim crisis clinic (an innovative program for providing short term follow-up for patients discharged from the emergency room), and the mobile crisis team (where a multidisciplinary team can visit individuals in the community when there is a concern that they may be suffering from a mental illness and are in need of treatment).

The rotation consists of two segments (four weeks in the first half of the year and two-four weeks in the second half of the year.) Two residents rotate in CPEP at the same time, one on day shifts and one on night shifts. Each resident spends half the rotation on days and half the rotation on nights. During this rotation, residents learn the basic principles of psychiatric evaluation, diagnosis and treatment with a particular focus on emergency psychiatric issues. They will learn how to manage an incredible array of complex patient presentations. Residents function as their patients’ primary clinician while working with the multidisciplinary team in the evaluation and treatment planning of their patients under attending supervision. Residents also work in the interim crisis clinic when they are assigned to day shifts. The weekend shifts in the CPEP (3 shifts from Saturday 8:30am through Sunday 8:30pm) are covered by residents rotating in neurology or general psychiatry.

Inpatient Psychiatry:

All PGY I residents rotate on two of the three inpatient psychiatry units, spending ten–fourteen weeks total on inpatient psychiatry in the PGY I year.

NYC Health and Hospitals/Bellevue - 20W

Of the 9 adult inpatient psychiatric units at Bellevue, only 20 West is designated as the resident teaching service. This is a 28-bed unit for men and women, handling patients with the most atypical, complex, unusual psychopathology and neuropsychiatric diseases admitted through the CPEP. Diagnoses treated include the entire spectrum of major Axis I disorders, Schizophrenia and Bipolar Disorders being predominant, many with co-morbid personality disorders and substance abuse problems. Although the unit admits patients from all walks of life, regardless of means, the unit tends to focus on public psychiatry, serving a multicultural population of seriously and persistently mentally ill persons, with a focus on educating trainees.

NYU Langone Medical Center - HCC-10 COOP

HCC10 is a 22 bed inpatient unit that treats voluntary patients exclusively. HCC10 functions as the inpatient psychiatric hospital for New York University undergraduate students although residents will work also with geriatric, dual diagnosis, and neuropsychiatric patients. This rotation provides the resident an experience of serving as a patient’s primary psychiatrist while being supervised one-on-one by an attending psychiatrist, a dedicated social worker, and a small cadre of nurses. Emphasis is given to the differential diagnosis of mood and personality disorders and residents gain introductory experience in a variety of psychotherapies and in ECT. Site-based didactics focus on psychopharmacology, methods of patient formulation, therapeutic use of the milieu, and leadership of an interdisciplinary team.

The Department of Veterans Affairs New York Harbor Health Care System
Manhattan VA Medical Center - 17 North

17N is a 23-bed inpatient unit at the Manhattan VA. Residents rotate here for one to three months at a time during their PGY-1 and 2 years. Most of the veterans are admitted voluntarily to the unit, although a small number are eventually converted to involuntary status. The patient population is diverse and includes the severely and persistently mentally ill, PTSD, personality disorders, and patients with complicated medical comorbidities. Residents work closely with nursing and social work to help patients take advantage of the wealth of resources available to meet the patients' often complicated psychosocial needs. 17N also provides the opportunity to work within an integrated system of care and a comprehensive electronic medical record. Residents work closely with all three attendings during their rotations. The length of stay at the VA also allows residents to get to know their patient's well, see longitudinal changes in the course of psychiatric illness, and gain experience titrating and switching medications.

Rockland Psychiatric Center

Rockland Psychiatric Center is the largest state hospital in New York, serving 370 adult inpatients and 3500 outpatients in clinics and ACT teams in 7 counties. Residents can choose to rotate through one of these clinics in White Plains, or do a rotation on campus where they will spend time at the clinic in Orangeburg, in the Recovery Center clubhouse on campus, and on the research unit (the CREF) run by RPC and housed in the Nathan Kline research institute. In the on-campus rotation, residents will be exposed to faculty with additional training and expertise in public psychiatry and will get additional supervision and discussion time around psychiatric leadership and systems-based care. Six PGY 1 residents rotate for four weeks at Rockland Psychiatric Center.

Electives

PGY I residents have two weeks of elective time.

Vacation

Residents are entitled to four weeks of vacation during their PGY-I year.

On-Call

The medicine services utilize a night float system in which our psychiatry residents participate for two weeks during the intern year.  The CPEP rotation consists of both night and day shifts. PGY I residents on their general psychiatry and neurology rotations cover the CPEP weekend shifts, from Saturday 8:30am through Sunday 8:30pm.