PGY II

Psychiatry residents-PGY2, 2018

The PGY II year extends the psychiatric training begun in the PGY I year, enhancing and expanding on that 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 and consultation-liaison psychiatry.

INPATIENT PSYCHIATRY

NYC Health and Hospitals/Bellevue - 20 West

Of the 14 inpatient psychiatric units at Bellevue, only 20 West is designated a 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.

All PGY II residents spend four to eight weeks on 20 West.

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.

All PGY II residents spend four to eight weeks on HCC-10 COOP.

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.

All PGY II residents spend four to eight weeks on 17 North.

KIRBY FORENSIC PSYCHIATIC CENTER

PGY II residents work with patients involuntarily committed under the New York Criminal Law (insanity acquittees 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.

All PGY II residents spend four weeks at Kirby.

MANHATTAN PSYCHIATRIC CENTER (MPC)

The MPC 125th Street Outpatient Clinic treats approximately 600 patients suffering from severe and persistent mental illness, many of whom have a history of incarceration in the criminal justice system. Educational experiences provided by this rotation include the specifics of the intake examination of the mentally ill, criminal recidivists, as well as participation in medication management and group modalities. Emphasis is on the systems approach, integrated care, recovery, and familiarizing residents with basic principles of public psychiatry.
 
All PGY II residents spend six weeks at the 125th Street Clinic.
 
In addition to seeing patients in the clinic setting, residents will also gain exposure to psychosocial treatment models that are key aspects of aiding in the treatment of this population. Residents will go on site visits to community organizations dedicated to the sustained recovery of clients suffering from severe and persistent mental illness. These sites include:
 
Fountain House — established since 1948, Fountain House is the perfect representation of the clubhouse model for recovery. It provides opportunities for its members to live, work, and learn, while contributing their talents through a community of mutual support. Peer participation is at the heart of its model. By being actively involved in the running of Fountain House, members regain confidence, make friends, learn new skills, and make progress towards achieving their employment and educational goals. This opportunity to be a part of a successful working community is restorative and builds dignity and self-esteem.
 
Howie the Harp — a peer-run program that provides employment resources to people with mental health conditions. Howie the Harp is known for its Peer Training Program, which allows clients mental health conditions to support others seeking recovery services in the mental health care system.
 
Community Access Crisis Respite Center — individuals can stay overnight in a calm, open, and supportive environment, offering an alternative to hospitalization during times of intense distress. The respite offers a range of recovery-oriented services including 24-hour support by on-site peers, self-advocacy education, self-help training, as well as numerous group and one-on-one activities.

Intensive Case Management – services promote optimal health and wellness for adults diagnosed with severe mental illness. Residents spend the day with a Case Manager, who works in partnership with recipients to advance the process of individuals gaining control over their lives and expanding opportunities for engagement in their communities. All case management programs are organized around goals aimed at providing access to services that encourage people to resolve problems that interfere with their attainment or maintenance of independence or self-sufficiency and maintain themselves in the community rather than an institution.
 
MPC Transitional Living Residence – located on the grounds of Manhattan Psychiatric Center, the MPC TLR is for individuals experiencing difficulty with the transition directly from the hospital to a community residence. MPC TLR is an interim supportive residence from which they can further develop the necessary skills to live in the community, develop a positive track record demonstrating community living skills, and to further promote recovery and self-advocacy to live more independently in the greater community.
 
MPC MIT - In order to achieve the mission of promoting mental wellness and recovery in the most integrated setting – an individual’s home and community – the Office of Mental Health has embarked on a transformation plan that when completed will yield a spectrum of community-based services built on the idea that individuals should not live in a state-operated psychiatric hospital. The Mobile Integration Team (MIT) is designed to provide the clinical intervention and support necessary for adults with serious mental illness (SMI) to not only remain in the community but also continue moving forward on their recovery journey. The MPC MIT is a multidisciplinary team of social workers and nurses dedicated to partnering with people with SMI and their families to keep them living in their communities. The team brings services to the individual and their family in the borough of Manhattan.
 
HELP USA Clarke Thomas Men's Shelter (aka Ward’s Island Men’s Shelter) – through a contract with NYC Department of Homeless Services, the shelter is open 24/7, providing shelter to approximately 326 homeless single men. They also offer other services and referrals including case management, skills building, education and recreation, support groups, housing services, employment/internship training and daily meals.
 
Janian/CUCS – clinicians and case managers assess and treat people where they live—in the street, shelters, drop-in centers, residences—accessing people 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, specifically on treating homeless and formerly-homeless individuals using the organizations’ signature model of housing, psychiatric, and medical services.
 
Program for Residency Education, Community Engagement, and Peer Support Training (PRECEPT) – an experiential educational experience that exposes resident psychiatrists to the process of developing partnerships with local agencies that provide key, often essential services (e.g. residences, food pantries) that help patients form stable support systems within the community. The PRECEPT Team, under the supervision of Dr. Helena Hansen, includes peers with lived psychiatric experience to train junior psychiatrists how to navigate community services. The project focuses on interviewing staff and service users of community agencies; each visited site is added to an interactive community resources map and data gathered from interviews contributes to an ongoing community mental health needs assessment.

CONSULTATION-LIAISON PSYCHIATRY

All PGY II residents spend four weeks on the Consultation-Liaison psychiatry service at either Bellevue Hospital Center, NYU Langone Medical Center or the Manhattan VA Medical Center.

NYC Health and Hospitals/Bellevue – Child Inpatient Unit

During their rotation on the Bellevue Consultation-Liaison service, PGY II and PGY IV psychiatry residents join a multi-disciplinary team that includes a psychosomatic medicine fellow, social worker, and multiple attending CL psychiatrists. Many of the Bellevue CL attendings have sub-specialty areas of expertise in substance abuse, palliative care, reproductive psychiatry, and child psychiatry. Residents conduct psychiatric consultations in the general hospital to many different services, including: Internal Medicine, Surgery, Surgical Subspecialties, OB-GYN, Neurology, Rehabilitation Medicine, HIV and TB Units, Trauma service, Toxicology, the Medical Forensic Unit, and the Traumatic Brain Injury Unit.

NYU Langone Medical Center

At NYU Langone Medical Center, PGY II and PGY IV psychiatry residents work closely with a team of 5 attendings with sub-specialty 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 NYU CL service offers a wide breadth of psychiatric consultations across all inpatient medical/surgical units and on the Rusk Rehabilitation unit.  Residents participate in a weekly didactic on the CL service consisting of alternating reviews of journal articles and presentations on various clinical topics.  They attend daily morning teaching rounds as well as weekly Walk Rounds. Residents also have opportunities to work with and teach medical students who rotate on the service during the academic year.

Manhattan VA Medical Center

During their rotation on the VA consultation-Liaison service, PGY II and PGY IV psychiatry residents join a multi-specialty team that includes a psychosomatic medicine fellow, neurology residents, pain medicine fellows, and post-doctoral health psychology fellows. The VA patient population suffers from a high prevalence of post-traumatic stress disorder, mood disorders, and addictive disorders which frequently complicate the delivery of medical and surgical care. The VA also has an aging population, largely consisting of veterans from the Vietnam War, Korean War and World War II eras, resulting in a high prevalence of dementia, delirium, and other disorders common to older persons. Key teaching areas include the evaluation of new-onset neuropsychiatric symptoms in medically complex patients, psychological adjustment to illness and hospitalization, and liaison aspects of working with medical and surgical services. In addition to daily teaching rounds, residents participate in weekly CL journal club.

CHILD & ADOLESCENT PSYCHIATRY

PGY II Residents rotate for four weeks on one of the inpatient units. Every effort is made to accommodate the resident’s preference.

NYC Health and Hospitals/Bellevue – Child Inpatient Unit

The child inpatient unit (21 South) at Bellevue 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 Attention Deficit Hyperactivity Disorder and Posttraumatic Stress Disorder and Mood and Anxiety Disorders to Autism spectrum Disorder. The unit features cognitive behavioral therapy based programming for trauma related pathology as well as a program for managing autistic children. Residents will join the multidisciplinary treatment team and serve as the primary clinicians for their patients, lead groups, observe family therapy, and participate in journal club and case conferences.

NYC Health and Hospitals/Bellevue – Adolescent Inpatient Service

The adolescent inpatient service at Bellevue is made up of two acute care psychiatric units (21 West and 21N North), which both serve youths from ages 12 to 17. Patients admitted to the units receive diagnostic evaluations and treatment for the signs, symptoms and impairments caused by most major psychiatric disorders. Residents can expect to see a wide range of pathology, including patients with autism spectrum disorders, mood disorders, posttraumatic stress disorder and first-break psychosis. During their rotation on this service, residents are part of the multidisciplinary treatment team and serve as the primary clinicians for their patients. Residents also participate in weekly journal club and case conference and co-lead a substance use group for the patients.

Electives

PGY II residents each have two weeks of elective time.

On-Call

Residents take call as a two week block (one week of night float at the Manhattan VA and one week of evening float at Bellevue) for a total of six to eight weeks during the year. PGY II residents also take weekend call at the Manhattan VA and at Bellevue Hospital.

Vacation

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