The Residency Training Program
PGY 1 Year
Our Residency offers eleven PGY I positions. All are in a four-year categorical program with an internship at New York Presbyterian Hospital (NYPH). There is one additional position for a Resident to enter at the PGY 2 level. Each of these options offers additional training in research.
The PGY 1 year, based at Presbyterian Hospital, offers excellent medical, pediatric, psychiatric and neurologic training. Psychiatric Interns work as an integral and well-respected part of the house staff on these services and finish the year with a solid grounding in clinical medicine. All Interns have six months on internal medicine and the choice of three months elective on pediatrics, neurology, medicine or inpatient psychiatry. There is also a research interest option, with the three-month elective on a psychiatric clinical research unit and time available to pursue individual research interests. Two months are spent on the neurology service at Columbia’s excellent Neurologic Institute. Internship also includes a one-month rotation in the psychiatric emergency service where Interns are given one-on-one supervision by PGY 3s, Chief Residents and faculty. Even during the PGY 1 year our Interns maintain a close connection to the Department of Psychiatry through the monthly Intern Luncheon Lecture Series and the monthly Intern Dinner Group. These popular events give our Interns protected time to come together as a class and to enjoy a group meal.
Columbia fully participates in the National Residency Matching Program (NRMP) and the Electronic Residency Application Services (ERAS). Applicants should file an application in the early fall. Columbia has two NRMP match numbers as a result of having one 4-year categorical psychiatry program plus a PGY 2 entry option. Applicants applying for the PGY 2 entry should concurrently apply for one-year PGY 1 positions such as transitional or preliminary medicine.
PGY 2 Year
The clinical training for this year utilizes the clinical facilities at the New York State Psychiatric Institute (NYSPI) and Presbyterian Hospital (PH). Residents rotate to four quite different services, which offesr a balanced training in acute psychiatric care. Four months are spent on an inpatient community service at NYSPI, two months are spent on an inpatient clinical research service at NYSPI, two months are spent on an inpatient general adult unit at PH, and four months are spent on an intensive outpatient service at PH (see below). On each unit, Residents are given a generous amount of one-on-one faculty supervision. Each rotation emphasizes different aspects of hospital psychiatry, exposing the Resident to the diversity of psychiatric illnesses and treatment approaches. Residents share night and weekend call, which is spread amongst the twelve Residents for an average of about three calls per month.
A highlight of the PGY 2 year is the Long Term Therapy (LTT) program. During this year Residents are assigned outpatients for treatment with twice weekly, long-term psychoanalytically oriented psychotherapy. The Residents are closely supervised on these cases by psychoanalysts from the clinical faculty and take a year-long theory and case-conference course which augments their work. There is an option in this year to gain further experience with long-term psychotherapy or to begin preparation for a research project of the Resident’s choosing to be carried out in the third and fourth years.
The core curriculum in the PGY 2 year stresses a thorough understanding of the clinical syndromes and the biologic, psychological, familial and cultural factors which influence the patient. Residents also develop sophisticated interviewing techniques for diagnosis and treatment. The integration of these initial clinical experiences with the core curriculum provides the fundamental skills and concepts that become the foundation for the Resident’s future development.
Washington Heights Community Service Inpatient Unit (PI-4South)
The Community Service is a state-funded urban community mental health center which provides a comprehensive system of inpatient and outpatient care for the seriously ill patients in Washington Heights. Residents treat acutely ill patients on the NYSPI inpatient unit as part of a team, and work closely with the patients' families and outpatient case managers to ensure a smooth return to the community. The average length of stay is ample, usually three to four weeks. A program on cross-cultural psychiatry focuses on the Latino community living in Washington Heights.
General Clinical Research Service Inpatient Unit (PI-4 Center)
This NYSPI unit conducts a variety of research programs in the study of affective disorders, eating disorders, substance abuse, suicidal behaviors and personality disorders in adults and adolescents. Recent research has focused on studying phenomenological and biochemical changes associated with suicide and eating disorders, and investigating new treatments. Research patients do not pay for their care. The average length of stay for patients is two to three months which allows residents to work with patients intensively during their two month rotation. Resident teaching is focused on evaluation and differential diagnosis, cognitive and psychodynamic psychotherapy, and introduction to research methodology.
The Intensive Outpatient Service (IOP)
On this Columbia/NYPH service, residents treat patients with a wide spectrum of psychiatric illnesses, including affective disorders, anxiety disorders, personality disorders and family problems. Ages range from adolescence to late life. Some patients are admitted directly to the IOP and others are referred immediately following a brief psychiatric hospitalization. The IOP provides an alternative to hospitalization, with discharge to conventional outpatient care after six to eight weeks. Biological treatments and individual psychotherapy, as well as family and group therapy are combined in the treatment of these acute patients. While rotating on this unit, residents participate in a weekly seminars on literature and psychiatry, dialectical behavioral therapy (DBT), interpersonal therapy (IPT), and women’s mental health.
9 Garden North (9GN)
The Columbia Inpatient Psychiatry Service is a 24 bed inpatient program located on 9 Garden North at Presbyterian Hospital. It is a general inpatient unit with particular expertise in the treatment of affective and psychotic disorders, dual diagnosis, and complex medical/psychiatric problems. As the primary referral unit for the medical center, patients often present with complicated diagnostic and treatment dilemmas. During the two month rotation each resident is paired individually with an Attending Psychiatrist and works closely with PGY 4s doing senior electives, Psychology Interns, and Columbia third and fourth year medical students. Residents learn to work in a managed care setting (average length of stay about 14 days) and develop expertise in complex psychopharmacology, geriatric psychiatry, individual and group psychotherapy for affective illness and addiction, cognitive behavioral therapy for depressive and anxiety disorders, individual and family psychotherapy and electro-convulsive therapy.
PGY 3 Year
This year marks a transition for the Residents as they shift their clinical skills from the inpatient to the outpatient setting, begin to function independently and gain confidence in their identity as psychiatrists. Clinical resources of New York Presbyterian Hospital (NYPH), the New York State Psychiatric Institute (NYSPI) and Columbia University are all used in order to provide a well-rounded experience. Each Resident has their own office in the NYSPI and they are given primary responsibility for patient care with individual supervision form faculty. There are three major components of the third year: evaluating and treating outpatients in the Residents’ Clinic, evaluating and treating children and adolescents through Columbia's Child Psychiatry Department, and working as a member of the treatment team in Comprehensive Psychiatric Emergency Program (CPEP).
Residents are trained in many forms of outpatient therapy during the third year that equips them to care for their outpatient adult and child caseloads. The therapies include advanced psychopharmacology, long-term psychodynamic, brief psychodynamic, cognitive, interpersonal, behavioral, substance abuse, family and group. Interested Residents also have access to supervisors who specialize in transference-focused, dialectal-behavioral as well as schema-based therapies.
We take pride in the quality and amount of supervision provided in each year of the residency. PGY 3 Residents receive 8 hours per week of supervision by faculty who are experts in their fields. There are 5 hours for individual psychotherapy and brief treatments, 1 hour each for psychopharmacology and evaluation, and 1 hour for rotations in child psychiatry, substance abuse and family therapy which are divided throughout the year. Residents who are interested in research are able to devote up to 25% of their time to research work of their own choosing, conducted in one of the clinical or basic science research divisions.
Comprehensive Psychiatric Emergency Program (CPEP)
A central experience of the PGY 3 year is the CPEP where Residents are trained in the evaluation and treatment of patients whose problems range from substance induced psychosis to family crisis. Each Resident spends approximately one day per week working in the CPEP and there are three to four weeks of night-float per year. During this time, Residents gain expertise in diagnostic interviewing and treatment of acute psychiatric emergencies. This emergency room setting is unique in that patients are able to stay for up to 72 hours allowing time for a thorough evaluation and the best treatment and disposition.
The Child Psychiatry Service
Columbia's Child Psychiatry Department is a major center for child psychiatry research and provides large clinical services for outpatients at NYPH and day hospital patients at NYSPI. All psychiatric Residents receive training in child psychiatry with children and adolescents. This training stresses interviewing, thorough diagnostic evaluation and treatment planning, mostly during the PGY 3 year. In the PGY 4 year Residents receive individual supervision on their treatment of a long-term child case.
PGY 4 Year
The PGY 4 year is designed to allow Residents the maximum flexibility in pursuing special interests of their choice. Overall, 25% of the Residents' time is spent on the Consultation-Liaison (CL) Service at NYPH, 10% is devoted to the continuing care of outpatients and 65% of the year is left open for an approved elective or research experience. Residents continue to have their own office. Didactics and process group continue, which maintains a sense of class community and cohesion. PGY 4 Residents can select a year-long seminar and individual supervision in brief dynamic psychotherapy, and have a wide array of advanced courses of psychotherapy, psychopharmacology and other clinical topics. This year solidifies the Residents' knowledge of psychiatry, refines therapeutic skills and helps Residents to prepare for their future psychiatric careers.
The Consultation-Liaison Service
The CL Service at NYPH is one of the oldest and largest departments in the country and PGY 4 Residents work on this service for a four-month block with a 75% time commitment. Each Resident selects a major medical or surgical service and becomes part of their liaison psychiatry team, working under the supervision of the attending psychiatrist from that service. Residents have the opportunity to teach non-psychiatric house staff and learn how to conduct case conferences. Each week there is an active schedule of lectures and case presentations covering a variety of topics in general psychiatry as it impacts the medical setting. While it is primarily a clinical department, faculty have made important research contributions including the delineation of ICU psychosis, work on post-cardiotomy delirium and ongoing studies of neuroendocrine effects on the heart, done in collaboration with the cardiac transplant team. In addition, the department has produced work focusing on the cost-effectiveness of psychiatric consultations on a surgical service, the management of patients who wish to sign out against medical advice and the negative effect of sleep deprivation on house staff.
PGY4 Elective Experiences
The remaining eight months of the year are open for electives. Given the resources of the Department, the range of elective choice is exceptionally broad and may be tailored to suit individual interests. Some recent examples include senior rotations on one of the inpatient services, the undergraduate student health center, the community mental health centers, the psychoanalytic center, the women’s mental health center and homeless clinics in the city. Other Residents take these eight months to immerse themselves in a research project under the tutelage of one of Columbia’s many research scientists and often elect to begin a research fellowship upon graduation.
