PGY 2 Year
The second year of training (PGY2) offers a rich and diverse exposure to psychiatric illness and treatment through rotations in inpatient, outpatient, emergency, and consultation liaison psychiatry. Inpatient rotations include one month on the community service at NYSPI, two months on an inpatient general adult psychiatric service, two months in the Comprehensive Psychiatric Emergency Program (CPEP) working as part of a team evaluating patients in a busy urban adult psychiatric emergency room and two months on the Consultation Liaison Psychiatry service at New York Presbyterian Hospital. Additionally, PGY2 residents spend an additional month working in the child CPEP and Consultation service. During the year, PGY2 residents share night team responsibilities and weekend call admitting and covering the inpatient services of NYP and NYSPI, and working as a team with the PGY3’s. As in the first year of training, PGY2 residents receive substantial faculty supervision in psychotherapy and psychopharmacology in each clinical setting.
A highlight of the PGY2 is a two-month rotation in the outpatient community psychiatry clinic at New York Presbyterian. This rotation will help PGY2’s learn about community and public psychiatry and integrated psychiatry models within primary care settings. PGY2s will learn comprehensive diagnostic and assessment skills and begin to develop basic psychotherapy skills and provide brief outpatient treatment in a clinic serving the diverse needs of the Northern Manhattan communities.
The PGY2 also includes daily didactic sessions that include coursework in psychiatric interviewing, neuroscience, pathophysiology, psychotherapy, ethics, community psychiatry and others. The core curriculum in the PGY2 stresses a thorough understanding of the clinical syndromes and the biologic, psychological, familial and cultural factors that influence patients. Residents also develop sophisticated interviewing techniques for diagnosis and treatment. The integration of these clinical experiences with the core curriculum provides the essential foundation for each PGY2’s professional development.
Call Responsibilities for PGY2s
During the year, PGY2 residents share night call responsibilities and weekend call admitting and covering the inpatient psychiatric services of New York Presbyterian and New York State Psychiatric Institute. They work as a night and weekend call team with the PGY3’s.
Washington Heights Community Service Inpatient Unit (PI - 4South)
PGY2 residents spend one month on the Washington Heights Community Service, 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 Latinx community living in Washington Heights.
9 Garden North (9GN) Inpatient Psychiatry
PGY2 residents rotate for two months on the Columbia Inpatient Psychiatry Service at Milstein Hospital of New York Presbyterian, a 24-bed inpatient unit located on 9 Garden North. 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 rotation, each resident is paired with an attending psychiatrist and works closely with PGY4s 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 electroconvulsive therapy.
Adult Consultation - Liaison Service
PGY2 residents rotate for two months on the adult Consultation-Liaison Service at NYPH, one of the oldest and largest departments in the country. Residents are trained in a wide spectrum of psychological and pharmacological techniques. Special emphasis is directed towards treating patients with a variety of medical and surgical illnesses and in working in the consultative mode with patients and their physicians. Residents also gain experience in forensic issues, especially capacity assessments. Residents participate in daily clinical rounds run by an attending psychiatrist. These rounds serve as direct, case-oriented educational experiences. 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.
Addictions Psychiatry at the NYP Comprehensive Psychiatry Emergency Program (CPEP)
PGY2 residents rotate for two months in the Comprehensive Psychiatric Emergency Program (CPEP) where they gain proficiency in diagnostic interviewing and treatment of acute psychiatric emergencies. This emergency room setting is unique in that patients can stay for up to 72 hours, allowing time for a thorough evaluation and the best treatment and disposition. Patients enter the NYP CPEP with a range of psychiatric symptoms and diagnoses, which frequently include primary or co-occurring substance use disorders. A particular focus on treating patients with addiction is imbedded into this rotation with additional supervision from experts in addiction psychiatry. Throughout this rotation, residents learn to assess the nature of the substance use and the role it plays in the patient’s presentation. They also learn to treat withdrawal symptoms, provide brief treatment interventions, and arrange for appropriate follow up (e.g., inpatient psychiatry, inpatient rehab, outpatient MICA clinic).
Pediatric Psychiatry Emergency Service and Immediate Treatment Clinic
PGY2 residents rotate for one month on the Pediatric Psychiatry Emergency Service in the Morgan Stanley Children’s Hospital of NYPH. Residents work on a team with the first-year Pediatric Psychiatry fellows where they are trained in diagnostic interviewing of children and adolescents, focused family work and integrating information from broader systems of care. Educational activities include daily Emergency Psychiatry Rounds, weekly attending rounds on the Consultation-Liaison service and weekly Case Conference. Additionally, residents follow one child or adolescent patient in the Immediate Treatment Clinic (ITC), a rapid linkage clinic located within the Pediatric Psychiatry Outpatient clinic. During the COVID-19 pandemic, clinical work on this service is being conducted in both in-person and telehealth formats.
Adult Outpatient Community Psychiatry Clinic
PGY 2 residents rotate for 2 months in the Adult Outpatient Community Psychiatry Clinic and learn about the rich tapestry of community and cultural services within Northern Manhattan. The clinic offers comprehensive and diverse outpatient services to a predominantly Hispanic community in Washington Heights/Inwood population as well as those receiving care at the CUIMC Medical Center. Residents will have the opportunity to treat a wide range of diagnostic disorders including anxiety, bipolar, depression, psychosis, trauma, personality disorders, and psychiatric comorbidities with medical conditions. Residents will gain expertise in understanding the outpatient and community continuum of care. Learning how to manage acute outpatient crises, rapid stabilization, and linkage to ongoing care requires an understanding of the importance of the social determinants of health and network of psychiatric services. PGY2s learn to formulate a treatment plan in collaboration with the supervisor and patient with the goal of reducing acute symptoms, ensuring safety and optimizing individual functioning. Residents will also learn the unique contributions ofgender, sexuality, medical complexity, and culture affect evaluation and treatment. Residents will work within multidisciplinary teams to provide intensive treatment to high risk/ high acuity patients and participate in twice weekly rounds. As part the outpatient experience, residents will learn how to establish a therapeutic alliance and set a treatment frame. Residents will co-lead a 6 week skills group and become familiar with the principles of supportive psychotherapy. Residents will also become familiar with the collaborative care model in an integrated primary care practice within the Ambulatory Care Network. In the spirit of community and public psychiatry, residents will learn about hospital and community resources to address social determinants of mental health including transportation, finances, housing, and other barriers to care. Residents will gain expertise in evaluating and treating patients using telepsychiatry/tele mental health interventions and the spectrum of clinic to community care.