FOURTH YEAR GOALS

Outpatient PGY-IV Psychopharmacology

During their PGY-IV year, residents continue to follow the patients and on a half-time basis, engage in specialty rotations and electives. In their PGY-IV year residents have a half time rotation in outpatient psychopharmacology at one of three community health centers. Some patients have chronic psychotic disorders, have been hospitalized within the past three years, and are monitored once a month by a team consisting of a case manager, a nurse and psychiatrist. Other patients have depressive and anxieties disorders and are frequently receiving psychotherapy from another mental health professional. The goal of this rotation is to learn to medicate and monitor chronically mentally ill patients, and patients who require pharmacotherapy for less severe disorders. In addition residents learn to work with non-psychiatric mental health professionals and non-professionals in an outpatient setting. The resident has complete psychiatric responsibility for the care of the patient. The psychiatric faculty provides supervision. During each elective rotation, PGY-IV residents continue their clinical work with patients seen both at St. Elizabeths Hospital and at the outlying clinics. This schedule insures the continuity of patient care including continuing work and supervision on child and adolescent cases.

Teaching Experience

Psychiatrists are often called upon to teach as a part of representing themselves and the profession to community and professional groups. This year, residents build upon their PGY-II experience teaching medical students. With guidance, they prepare and present, on a regular basis, a formal lecture on a psychiatric topic to medical students, and sometimes to staff in order to polish the necessary skills. Also, they provide supervision to medical students doing an in-depth case study. In these ways, they learn a new skill area and appreciate the interconnections between being a good teacher and a good clinician.

Consultation - Liaison

The rotation in consultation-liaison psychiatry is held at The Washington Hospital Center or at George Washington Hospital. It is a half-time rotation and involves psychiatric consultations, the discussion of assigned readings, application of readings to actual consultations, case presentations, patient interviews. When consultations involve particular specialty areas, outside experts are invited. Readings cover many areas, including psychiatric consultation on medical and surgical wards, consultation in coronary care and intensive care units, treatment of the dying patient, psychiatric reaction to physical illness, and work with hospital staff.

Community Consultation

In addition to the above, PGY-IV residents conduct a weekly ongoing consultation to a community organization such as a school or public service agency. This experience allows the development of consultation skills and provides the opportunity to apply knowledge of individuals and groups to a working organization. Supervision and participation in the Community Consultation Seminar are part of this experience.

Electives

A wide range of elective experiences is available to the resident. An elective rotation is available for an advanced psychopharmacology experience in which residents work at the Psychopharmacology Division of the Department of Psychiatry where they evaluate and provide recommendations for treatment resistant patients. Residents can also participate in ongoing research studies. Elective rotations are also available in the inpatient treatment of alcoholism and drug abuse, outpatient work with a multidisciplinary team in a community mental health center, research with the infants and their psychiatrically impaired mothers, further work in group psychotherapy and family psychotherapy, and psychiatric work with the deaf.

An elective in forensic psychiatry is also available and has given St. Elizabeths a central spot in the history of forensic psychiatry in the United States and deserves special mentioning: