Second Year

PGY-II Inpatient Experience

Under the supervision of ward administrators, who are members of the psychiatry faculty, residents on acute inpatient units have the clinical responsibility for the evaluation and treatment of more severely ill patients. Particular emphasis is placed on obtaining a thorough psychiatric history, evaluating the many physical illness that may be causing or contributing to the patient's psychiatric signs and symptoms, and reaching an accurate psychiatric diagnosis. The application of such skills is central to developing a comprehensive treatment plan that adequately addresses the multiple factors that can contribute to the development and course of mental illness. Through formal conferences and supervision, residents learn to deal simultaneously with psychopharmacological and psychotherapeutic approaches to hospitalized patients. The appropriate use of individual psychotherapy and family therapy is integrated into a ward environment that emphasizes the therapeutic community and its role in helping patients to achieve rapid recovery. While assigned to the inpatient service, the resident functions as part of a multidisciplinary system, including nurses, psychologists, psychiatric social workers, occupational and recreational therapists, psychodramatists and others. Since psychiatrists are often called upon to work with other medical and non- medical disciplines, the development of collaborative skills is essential to the overall development of psychiatric residents. St. Elizabeths Acute Care Hospital is the only public psychiatric hospital in the District of Columbia and receives the full range of patients requiring hospitalization. This includes well functioning individuals without insurance, persons whose insurance limit has been exceeded, persons with dual diagnoses of addiction plus another disorder and more chronic patients who relapsed. Approximately 60% of patients in the Acute Care Hospital are involuntary committed.

Inpatient Psychiatry

Throughout the inpatient experience, members of the psychiatry training faculty teach residents to engage the families of their patients and to assess these families and mobilize their strengths. In addition to ad hoc consultation about families of their patients, the residents have a weekly family assessment and brief treatment conference. Initial sessions are didactic, thereafter, the sessions are used primarily for live interviews of patients and their families, first by faculty members and then by residents with the faculty member observing and critiquing.

The residents will periodically testify as witnesses to the Mental Health Commission and the courts in judicial proceedings involving committed patients. This forensic experience may be supplemented during the fourth year with an elective rotation in forensic psychiatry, thus providing a unique opportunity to participate actively in the forensic system. During their inpatient year residents further develop their knowledge of acute mental illness through on call weekend coverage of the training wards and thorough evening work in the Emergency Psychiatric Response Division (EPRD) and which provides a psychiatric emergency room experience.

One month of elective time is available during the PGY-II year. Residents may select experiences from a wide range of possibilities throughout the Commission.

Residents also work with and teach medical students from George Washington University and other medical schools, supervising their clinical work, and reviewing their written case studies.

Night and Weekend Call: After the rotation in medicine, residents are on call in-house only during their inpatient PGY-II year and in subsequent years on back-up call by beeper (weekends only) to inpatient residents. Resident weekend call is from 8:30 am to 5 pm and week night call is from 5:30 pm to 11 pm. Night call usually occurs once per week.

Didactic Program of Inpatient - PGY-II Clinical Program

The didactic program of the inpatient year provides a firm foundation in clinical psychiatry with seminars and courses in the major areas of modern psychiatry. In the first two months there is a weekly seminar in clinical interviewing and an introductory course in clinical psychopharmacology. There is also a series of lectures on the major psychiatric disorders, psychiatric emergencies, principles of ward management, child psychiatry, family therapy, and psychological testing.

In the fall and winter, there is a six-month course on clinical biologic psychiatry, a series of lectures on prediction of violence and suicide, and a training course in psychopathology rating scales. In the fall there is a two and a half-month introductory seminar on psychodynamic principles and therapy. During the winter there is a three-month course in child development.

In the spring there is a two-month course in biological principles of behavior and emotion, month long seminars in geriatric psychiatry, alcoholism/drug abuse, the human life cycle, and a two-month seminar in family therapy that extends into the beginning of the second year.

Throughout the year, residents participate in a bi-weekly departmental resident case presentation conference, attend a bi-weekly grand rounds at which distinguished speakers are invited to speak on topics of interest, and participate in a monthly journal club of all residents. In addition residents receive weekly supervision from off-ward attending and from two ward supervisors.