PGY: Postgraduate Year
SEH-DMH: St Elizabeths Hospital/ D.C. Department of Mental Health: This includes the inpatient units on the civil and forensic sides of St Elizabeths Hospital, as well as the clinics run by the D.C. Department of Mental Health/ Community Services Agency, the Comprehensive Psychiatric Emergency Program (CPEP), and the Homeless Outreach Services.
WSP: Washington School of Psychiatry
UDC: University of the District of Columbia
CNMC: Children’s National Medical Center
NIMH: National Institute of Mental Health
UMD: University of Maryland Medical Center

PGY-I consists of four months in internal medicine, four months in neurology, and four months of Inpatient Psychiatry. During this year, residents begin to develop skills in evaluation, differential diagnosis, pharmacotherapy, supportive psychotherapy and treatment planning. In addition, during the PGY-I year residents become familiar with the range of facilities and services available to the mentally ill in the District of Columbia. Such knowledge and experience greatly facilitates the learning, which occurs in the PGY-II inpatient year and improves the quality of care provided to hospitalized patients. By the end of the PGY-I year, the resident has solidified his/her identity as a physician and learned basic psychiatric and neurological skills. Residents with prior residency training in medicine, pediatrics, or family medicine enter the program at the PGY-II level and may be required to complete some of the PGY-I rotations.

This is a required, PGY-I rotation of 4 months duration (100% FTE) that occurs either at Prince George Hospital Center or Providence Hospital, both of which have ACGME-accredited Internal Medicine residency programs. Residents are supervised by several board-certified internists and medical specialists who spend on average 50% of their time teaching residents. Teaching takes place in seminars, case conferences, rounds, and in individual/ group supervision. These inpatient services usually consist of 3 months of general medicine and a month of ICU, or emergency room. Both of these hospitals are large general hospitals that serve predominantly urban populations. There is a great variety of patients with respect to background, religion, race, nationality, etc. Generally there is a predominance of lower socioeconomic African Americans with some Hispanic and Caucasian representation. Average case load is 10 patients. Maximum case load is 12 patients. Supervised training in assessment and planning of treatment, disposition, and management of emergencies, requesting investigations, and seeking appropriate consultations is done. There are regularly scheduled conferences and seminars in addition to daily rounds and individual supervision when needed.

This four-month rotation offers residents an experience in neurology directly relevant to their careers as psychiatrists and provides a superb opportunity to evaluate disorders at the interface of neurology and psychiatry, unlike conventional neurology rotations. The Neurology Service, which is staffed by John Stiller, M.D., provides consultation to physicians throughout the Department of Mental Health, including St. Elizabeths Hospital, serving a referral population of approximately 8000 patients, mostly adults or geriatric. Patients with dementias, neuropsychiatric sequelae of stroke or head trauma, acute confusional states, epilepsy, tardive dyskinesia and other psychotropic-induced movement disorders, as well as neurological problems common to the general population, are seen during ward consultations and in the neurology clinic. Teaching emphasizes "hands-on" clinical education. In addition, there are weekly didactic sessions covering a broad array of neurological topics, including in-services on EEG and MRI, and a monthly brain cutting conference at the Medical Examiner's Office.

This rotation occurs at St. Elizabeths Acute Care Hospital, which 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. Majority of patients in the Acute Care Hospital are involuntary patients who have been committed to the hospital.

Under the supervision of ward attending psychiatrists, residents on acute inpatient units have the clinical responsibility for the evaluation and treatment of more severely and acutely ill patients. Particular emphasis is placed on obtaining a thorough psychiatric history, evaluating the many physical illnesses 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, which adequately addresses the multiple factors, which 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. During the inpatient rotation, a resident's caseload is limited to eight patients. Through extensive experience in long-term treatment of adults and children, residents learn to understand the patient's psychodynamics and to use this understanding to facilitate making timely, helpful interventions.

Beginning 2006, the PGY-I resident in the Inpatient rotation shares evening and weekend overnight calls on inpatient units with PGY-II residents. They are supervised by attending psychiatrists on call, and have morning rounds where they present all the cases they have either admitted or seen during there call period. They also learn how to perform the evaluation and treatment of more severely and acutely ill patients. Particular emphasis is placed on obtaining a thorough psychiatric history, evaluating the many physical illnesses that may be causing or contributing to the patient's psychiatric signs and symptoms, and reaching an accurate psychiatric diagnosis.

Interviewing/Case Presentations (Dr. Kushner): Dr. Kushner initially interviews patients to demonstrate how to interview. The interviews take about 30 minutes and residents are specifically directed to NOT do an Initial Assessment. Subsequently, each resident interviews a new patient. There is a discussion with the peers about how the interview went. The focus is on the interview, not the patient.

Supportive Psychotherapy and Introduction to Group Psychotherapy (Dr. Kushner): Introductory lectures about Supportive Therapy, including a contrast with exploratory therapy. In addition, there will be some lectures on group therapy. Residents must begin treatment with patients and may present their cases in the seminar. Discussions about clinical group therapy are also invited.

DSM-IV TR (Dr. Mohyuddin): Major diagnostic categories of DSM-IV-TR are reviewed with clinical textbook examples after each diagnostic category has been discussed. There is a patient interview in the acute care building to illustrate the pathology studied. This course is given one hour per week for two trimesters.

Introduction to Psychopharmacology (Dr. Shreeram): The new residents are introduced to broad classes of medications including antipsychotics, antidepressants, mood stabilizers, and anti anxiety agents. There are seven sessions which cover each of the four broad classes mentioned above. In addition, residents learn medication indications, choice of medications, pharmacokinetics and side effects.

Pre-school Child Observation (Dr. Kolansky): Residents also have an opportunity to observe normal children in a preschool setting with supervision from our child psychiatrist, S. Kalman Kolansky, M.D.

Molecular Psychopharmacology (Dr. Jose Apud): Is a four session course taught by Dr. Apud, a psychopharmacology researcher at the NIMH in Bethesda, Maryland. The course will be given on the N.I.H. grounds.

History of Psychiatry (Dr. Kenneth Gorelick): Will focus on the last 200 years in American Psychiatry, using the history of Saint Elizabeths Hospital as a mirror of the history of the field. The sessions will be seminar style with presentations by each resident.

PGY-II consists of 3 months of General Inpatient Psychiatry, 3 months of Consultation-Liaison psychiatry, and 1.5 months each of Addictions Psychiatry, Geriatric Psychiatry, Forensic Psychiatry, and Emergency Psychiatry. During the second year, residents will move to a more advanced level of utilizing foundation received during their first year of training and will demonstrate the ability of evaluating and treating patients with complex medical and psychiatric issues requiring inpatient psychiatric care. Such knowledge and experience greatly facilitates the learning which occurs in the PGY-II inpatient year and improves the quality of care provided to hospitalized patients.

Residents consolidate the skills that they have learnt during the General Inpatient Psychiatry rotation during PGY-I. The appropriate use of individual psychotherapy, group therapy 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 and others. Since psychiatrists are often called upon to work with other medical and nonmedical disciplines, the development of collaborative skills is essential to the overall development of psychiatric residents.

Residents also work with and teach medical students from George Washington University, the Uniformed University of the Health Sciences, and Ross University, supervising their clinical work and reviewing their written case studies.This continues for an additional 6 months in the

This is a required 4-6 week rotation during the PGY-II year and occurs at the John Howard Pavilion, the forensic section of St Elizabeths Hospital. For those residents who joined in the PGY-II year, it occurs in the PGY-IV year. Primary supervision is by a staff psychiatrist who is on the faculty. Two full-time Social Workers, Ward Manager, and PhD psychologists spend considerable time with the residents. Individual teaching on forensic and other legal issues; Case conferences on difficult pre-trial patients; a “competency” group with the psychiatric staff; reviewing of selected cases with discussions with the psychiatrists; interviews with patients with the required write-ups; attendance at review boards as cases are presented by ward staff; attendance at downtown, Washington DC Court Hearings, if a patient is to appear; treatment planning with treatment teams and patients; writing psychiatric treatment orders under supervision and discussion of medications and other treatments.

The Pre-Trial ward has 23 beds and 12 patients are in a security area. Dr. Gupta discusses all patients with each resident. Subjects include Milieu structure, working with Forensic Ward staff, security and safety issues, community re-entry, and intensive treatment unit, medication treatment, occupational treatment, and recreational therapy, emergency treatment of violent or out-of-control patients. The patient population involves persons committing serious federal crimes including multiple murders and serious crimes against property. The population comes from all walks of life. Case load is 8 patients. Supervisor is onsite at all times that residents are working at this rotation and is available for consultations.

This rotation, required of all PGY-II residents, is a 1.5-month fulltime FTE rotation that occurs in the Geriatric Psychiatry inpatient unit at St. Elizabeths Hospital. Faculty comprises one full-time board-certified faculty psychiatrist.

Clinical population consists primarily of adults over age 55-60, of both sexes. Ethnic/cultural mix includes African Americans (80%) and Caucasians (10%), Hispanics (5%), and in recent years, patients from many other countries. Diagnoses include the schizophrenic disorders, the major affective disorders, posttraumatic stress disorders, paranoid disorders, substance dependence, atypical psychosis, and many kinds of dementia. Type of treatment includes pharmacotherapy, individual psychotherapy, group therapy, crisis intervention, and family therapy. An average caseload is 6-7 patients. Maximum caseload is not to exceed 8 patients. Scheduled Supervision for o ne hour once a week with onsite supervisor is also required.

Electro-Convulsive Therapy (Dr. Frank Moscarillo) : This four to five session course will be part of the Geriatric Psychiatry rotation. Residents attend the sessions at Sibley Hospital will be introduced to ECT, and will have classes with Dr. Moscarillo, a private practice psychiatrist regarding the uses and various effects of ECT on range of Psychiatric disorders.

This is a required 1.5-month FTE PGY-II rotation that takes place in Providence Hospital Dual Diagnosis Unit. Faculty consists of 2 psychiatrists who are on staff at Providence Hospital, both of whom are 90% FTE. Residents spend 6 hours weekly in seminars and case conferences; faculty is always available for consultations and case loads are closely monitored for breadth and variety of experience. Residents schedule should allow them to elect to participate and see every aspect of modern substance abuse and dual diagnosis treatment from inpatient to outpatient programs. In addition they attend 6-7 hours/week of didactics scheduled for all PGY-I residents.

The patient population is 80% dually diagnosed adult 60% male 40% female population, all 18 years or older. Approximately 30% are diagnosed with psychosis; 20% with affective psychosis; 45% mood disorders and 5% anxiety disorders. Residents spend majority of their time learning assessment and treatment planning for dually diagnosed and detoxification patients. They also have experience in longer-term treatment planning on outpatient basis.

Average caseload will be 3 patients with anticipated maximum of 5 patients. Each resident will be supervised individually during clinical encounters. They will be in weekly supervision (group supervision 1:2 ratio) and will participate in weekly case conference (joint case conference with PGY-III and PGY-IV residents). Residents continue to attend the didactics on Saint Elizabeths campus during the rotation.

This is a required rotation that occurs during PGY-II, over 3 months at Providence Hospital under the supervision of Asim Haracic, M.D. Faculty consists of 2 psychiatrists who are on staff at Providence Hospital. The aim is to teach residents the process of psychiatric consultation and the ongoing clinical management of medical and surgical patients who have concomitant psychiatric and behavioral problems. At the end of the rotation, the resident is expected to: 1) Competently asses and manage common clinical problems in the consultation-liaison setting at a general hospital; 2) Demonstrate competent and adequate interviewing skills of a general hospital patient presenting with psychiatric problems and after the interview be able to competently present the case, the diagnosis and the treatment plans; 3) Demonstrate knowledge of relevant literature related to the cases he/she is assessing and following at a level commensurate with his/her postgraduate level; 4) Be able to effectively communicate with the medical staff that is asking for consultation; 5) Be able to work with peer and ancillary staff at a general hospital setting; 6) Demonstrate incremental progress in each of the above four areas during the four month rotation. Most of the referrals are for psychological problems secondary to illness, separation, etc. and some more intimately with the pathology such as asthma, irritable bowel, delirium dementia, and alcoholism. The hospital, because of its location, has many outside national and international patients.

Residents see a maximum of 4 new patients per day with no maximum limits to follow-ups. They rarely carry more than 5 or 6 patients because of patient turnover. All patients must be presented to an attending. The latter is done individually and in groups such as rounds or case conferences. Residents triage their own cases and are responsible for them from initial consultation to discharge. Written consultations must be discussed with the attending before entered onto the chart. The attending decides whether he/she sees the patient. These are informal mid-rotation evaluations and a written final examination. Rounds are 1-2 hours consisting of reviewing the resident’s consultations with some interviewing of the patients by the attending.

This six-week to two-month rotation during weekdays supplements the resident's weeknight experiences in the emergency room on call, which occurs from 5 to 11 pm throughout the year. Residents are involved in crisis intervention, acute treatment of patients in the 72-hour observation facility, and community-based crisis intervention with a mobile outreach team.

Beginning 2006, the PGY-II residents take evening and weekend overnight calls on inpatient units where they are supervised by attendings on call. They have morning rounds where they present all the cases they have either admitted or seen during there call period. They also learn how to perform the evaluation and treatment of more severely and acutely ill patients. Particular emphasis is placed on obtaining a thorough psychiatric history, evaluating the many physical illnesses that may be causing or contributing to the patient's psychiatric signs and symptoms, and reaching an accurate psychiatric diagnosis.

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, an introductory course in clinical psychopharmacology, and a series of lectures on psychiatric emergencies, principles of ward management, couples therapy, family therapy, psychological testing, teaching medical students, violence, substance abuse, and legal matters. During the summer, there begins a year-long weekly course on the essentials of hospital psychiatry and a year long resident process group.

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 participate in family assessment and brief treatment conference on the clinical wards and do family therapy.

The residents will periodically testify as witnesses before 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 on the training wards and through evening work in the CPEP emergency room.

There are other courses as the year progresses. There is a six-month course on psychopathology and biologic psychiatry and a two and half-month introductory seminar on psychodynamic principles and therapy and a month course on violence and its management. As the year progresses, when deemed ready, residents pick up several chronically ill persons as outpatients, who they hope to follow throughout their residency.

Throughout the year, residents participate in a bi-weekly departmental resident case presentation conference, attend monthly grand rounds, and participate in a monthly journal club of all residents. In addition residents receive weekly supervision from an off-ward attending and daily, as needed, attention from their ward supervisors.

Outpatient Adult Psychiatry is a required two-year part-time rotation during the PGY-III and PGY-IV years. This is a 70% FTE rotation throughout the PGY-III year and a 30 % rotation throughout the PGY-IV year. An additional 4- to 8-month 50% FTE elective rotation is available during the PGY-IV year. In addition to the assignment to one of the Department of Mental Health clinics for outpatient psychopharmacology experience, assignment is done at one of the following facilities: The Student Health Center at the University of the District of Columbia, The Treatment Center of the Washington School of Psychiatry, or Providence Hospital Psychiatry Clinic.

Faculty consists of 10 psychiatrists, and one psychiatric social worker. Two of the psychiatrists provide individual psychotherapy and group psychotherapy supervision. The other 8 are fulltime psychiatrists at the Department of Mental Health clinics. The faculty is very eclectic, representing strengths in psychoanalysis, group therapy, cognitive behavior therapy, family therapy, and psychopharmacology.

Residents spend 7-8 hours in case conferences, seminars. In addition, the residents join other clinic staff in a weekly clinical team meeting. Caseloads are monitored for diagnostic variety and breadth of experience. Faculty members are always available for consultations.

Clinical Population: The Department of Mental Health clinics average about 48 % male and 52 % female with 65% African American, 12 % Hispanic, 10% Caucasian, 8 % Hispanic, and 5% other. The other clinics average about 45% male patients and 55% female patients; 58% Caucasian, 35% African American, 5% Hispanics, and 2% other. There are all ages of patients with approximately 75% falling in the 20-55 age range. Diagnostically, the Department of Mental Health clinics have approximately 40% of the patients with psychotic disorders, 30 % with affective disorders, and 30 % with anxiety disorders/ somatoform disorders/ personality disorders and other conditions. About a third is comorbid for substance use disorders. In the affiliated clinics, 50% are neurotic or personality disorder; 25% are affective disorders, 20% are schizophrenic, and 5% suffer from substance abuse.

Case load: Case load for PGY-III residents is 8 to 12 patients (eight hours per week of insight psychotherapy and 4 hours per week of supportive psychotherapy, plus one patient in CBT) They must also have at least one group, 16-20 patients on medication management, and spend two hours per week on intakes. Through extensive experience in long-term treatment of adults and children, residents learn to understand the patient's psychodynamics and to use this understanding to facilitate making timely, helpful interventions.

Scheduled Supervision: All residents have a minimum of two weekly 1:1 supervision hours with two different psychiatrists for psychodynamic (brief and long-term, supportive and explorative) psychotherapy, plus one group supervision session, and weekly supervision of cognitive behavior therapy. Each PGY-III resident has an out of clinic group therapy supervisor.

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. Residents also provide supervision to medical students doing an in-depth case study. In these ways, they learn new skills and appreciate the connections between being a good teacher and a good clinician.

This is a required 1-month FTE PGY-III rotation that takes place in various shelters and community facilities throughout the city. Faculty consists of a psychiatrist who is the Medical Director of Homeless Outreach Services division of the Department of Mental Health. Residents spend 4 hours a week evaluating homeless persons in various shelters for whom psychiatric consultation was requested and discussing the cases with supervisor to determine appropriate disposition. Supervision and participation in the Community Consultation Seminar and Administrative Psychiatry Class are part of this experience.

Beginning 2006, PGY-III take evening calls from 5:30 PM-11PM at Comprehensive Psychiatric Emergency Program (CPEP), where they are involved in crisis intervention, acute treatment of patients in the 72-hour observation facility, and community-based crisis intervention with a mobile outreach team. Didactic Program

Basic Psychodynamic Literature: This weekly seminar runs throughout the year after Labor Day. The theory of psychoanalytically oriented psychotherapy, both brief and extended, is the major focus of this course. Regularly assigned readings in each session successively review the development of the psychoanalytic theory of therapy beginning with Freud's early writings and continuing with the elaborations of ego psychology. An extended study of Franz Alexander and other revisionists of classical theory are also presented. The course is illustrated with clinical vignettes from the work of both the instructor and the residents.

Cognitive-Behavioral Seminar and seminar (Dr. Scrofani): A seven week summer didactic seminar is followed by a year-long cognitive behavioral therapy supervision.

Individual Psychotherapy Conference (Dr. Baughman): This weekly conference utilizes process notes presented by residents to senior faculty members to focus on various aspects of the case material. Such subjects as anxiety, defense, interpretation, transference and countertransference are explored, with a particular emphasis being placed on therapeutic techniques.

Continuous Case Conference (Consultants): Four residents, rotating on a weekly basis, present material from an ongoing case to one of four senior consultants. Residents thus have an opportunity to study the longitudinal development of four treatment cases throughout the year and to gain a sense of the variation in personal technique among four experienced psychiatrists. One of the four cases is a child, and one of the cases is treated with cognitive-behavioral techniques. This conference is given throughout the year, after Labor Day.

Group Psychotherapy Literature Seminar: Residents consider the three major perspectives from which groups can be examined: the focus upon the individual in the group, the focus upon interaction within the group, and the focus upon the group as a whole. Case material is presented to highlight these three major perspectives. Meetings are every other week, all year.

Continuous Group Psychotherapy Conference ( Dr. Kushner): In this every other week year long seminar, residents, on a rotating basis, present their psychotherapy group for critique by peers and consultants.

Child Psychiatry, Psychopathology, and Psychopharmacology (Dr. Kolansky): This course meets weekly all year and uses readings from the recent and classical literature to provide an overview of the major areas of the psychopathology of children. It alternates with child/adolescent diagnostic and disposition conference through the year. Emphasis is placed on the development of practical treatment interventions based on a biologic and dynamic understanding of the child's psychopathology. Topics considered include childhood psychosis, retardation, organic brain syndromes, arrests of psychological development, enuresis and encores syndromes, neurotic conflicts, learning problems, attention deficit hyperactivity disorders, adoption, drug abuse and mood and anxiety disorders, and pediatric liaison. There is a separate child/adolescent psychopharmacology component by Dr. Shreeram.

In the Child/Adolescent diagnostic conference, residents present recently evaluated cases and hone diagnostic skills in assessment of children and learn to work with parents of children they see. In addition to diagnostic evaluation, these sessions develop the resident’s ability for thoughtful treatment planning.There is also a monthly child case conference headed by Dr. Stephen Kwass where, therapy issues including work with parents, transference and countertransference issues are discussed.

Biological Psychiatry and Psychopharmacology (Dr. Livingood): This weekly course meets for six months. Residents learn more clinical psychopharmacology, focusing on outpatient medication work, and the biological theories of non-psychotic conditions.

Behavioral Neuroscience Principles (Dr. Schwartz): This weekly course meets for four months. Emphasis is on ethologic and neurobiological data about affect. Readings by LeDoux, Kandel, and Schwartz focus on how associative learning provides a model for psychopathology as well as a model for how therapy can ameliorate symptoms.

Patient #1: 35 WF law student who entered treatment to deal with anxietyassociated with the Bar exam, but has spent most of the therapy dealing interpersonal problems.

Patient #2: 24 BF student who is struggling with feelings of low self-esteem associated with breakup of a relationship.

Patient #3 :32 WM assistant manager of a. restaurant who is in therapy because he is unable to establish relationships or complete goals.

Patient #5: 22 WF who failed out of college and is in therapy because she is apprehensive about approaching marriage.

Patient #6: 26 WF college student who is struggling with feelings of being sexually attracted to other women.

Patient #2 30 WF With obsessive - compulsive personality disorder seen twice a week, on clomipramine.

Patient #1 9 BM with attention deficit disorder who is seen weekly in his elementary school.

Family #1 Mother of two children aged 16 and 23 who are living at home and abusing drugs. Seen once week.

During their PGY-IV, residents continue to follow their patients and on a half-time basis, engage in specialty rotations and electives. During each elective rotation, PGY-IV residents continue their clinical work with patients seen at St. Elizabeths and at the outpatient clinics. This schedule insures the continuity of patient care including continuing work and supervision on child and adolescent cases.

A wide range of elective experiences is available to the resident. Some residents have chosen an elective in research at the NIMH. Specific areas in which our residents have worked include clinical studies of schizophrenia and affective disorders and research on sleeping and dreaming. Other elective rotations include the inpatient treatment of alcoholism and drug abuse, outpatient work with a multidisciplinary team in a community mental health center, research with infants and their psychiatrically impaired mothers, a rotation in electroconvulsive therapy, further work in group psychotherapy and family psychotherapy, psychiatric work with the deaf, and an advanced medical student teaching elective. Residents are encouraged to develop elective experiences that best meet their needs and interests. In addition, each year PGY-IV residents are chosen as chief residents, and gain experience in administrative psychiatry and supervision.

Forensic Psychiatry: The forensic psychiatry rotation occurs in the John Howard Pavilion on the St. Elizabeths Campus. St. Elizabeths has a long history of being at the center of forensic psychiatry in the United States. John Howard Pavilion is responsible for treatment of all individuals in the District of Columbia who either need psychiatric evaluation for the determination of competency or who have been found not guilty by reason of insanity and have been committed for psychiatric treatment. It provides a unique elective experience for our residents. Residents have an opportunity to work on a 'pretrial' ward, during which they develop skills in determining competency to stand trial as well as determine whether or not patients meet the criteria for 'not guilty by reason of insanity' (NGRI). Residents may gain experience on a post-trial ward, which is responsible for the treatment of individuals who have been found NGRI. During this aspect of the rotation, residents will participate in 'Bolton' hearings, which determine whether a patient is ready for discharge from the hospital. Residents learn about the special problems of providing treatment for forensic patients and may provide testimony to the U.S. District Court and the D.C. Superior Court during their work on the post-trial ward. Regular supervision, preceptorship meetings, and didactic seminars help the resident to understand the field of forensic psychiatry. The opportunity to gain direct courtroom experience and work alongside experienced psychiatrists is an integral part of this experience.

Chief Residency/Junior attending on the ward
Research at the NIMH or at University of Maryland
Advanced group therapy
Advanced family therapy
Advanced medical student teaching
Mother/ infant program working with psychotic mothers and their children
Dual diagnosis patients: psychiatric disorders and drug abuse
Child and Adolescent inpatient psychiatry
Advanced behavioral neurology
Geriatric psychiatry
Psychiatric work in shelters for the homeless
Alternative individual psychotherapy
Advanced consultation-liaison
Junior attending on the wards.

Administrative Consultation and Community Psychiatry Seminars & Homeless Rotation Seminar (Dr. Brown). This year-long seminar elucidates techniques of mental health consultation, utilizing the resident's concurrent practical experiences as a basis for discussion.

Consultation-Liaison Psychiatry Seminar (Dr.Taub). This seminar meets every other week and considers cases seen on the consultation service. Assigned readings are also discussed.

The Advanced Psychoanalytic Literature Seminar ( Dr. Baughman). This seminar focuses on further readings in Freud, including dreams and dream interpretation, character development symptom formation, narcissism and masochism. Freud's earlier ideas are compared with more current authors, such as Arlow, Brenner, Kohut and Kemberg. The seminar meets weekly for three months.

Clinical Psychopharrnacology Seminar (Dr. Livingood.) This weekly seminar is an open discussion supervisory seminar about clinical psychopharmacology centering on the PGY-IV residents' current patients.

Advanced Child and Adolescent Psychiatry Continuous Case Seminar alternating with Literature Review (Dr. Kolansky) A continuing focus on treatment issues utilizing resident presentations of their clinical work. This seminar lasts all year, alternating with a Literature Review of Child and Adolescent Psychiatry, an advanced course looking at issues of ongoing current importance in child development, psychopathology and treatment, and with an Advanced

Journal Club: A resident discusses an article of his or her choice with the colleagues in presence of a faculty member with experience in research.

Resident-Faculty Case Conference - Several times a month residents and faculty participate in a 1 and a 1/2 hour conference in which a second, third or fourth year resident presents a clinical case. The format may vary, and the resident may present individual work with children and adults or ongoing therapy with group or family. The residents select a consultant who serves as moderator and discussant. Residents will present at this conference at least once during their residency.

The Psychiatry Overview/Review, Interviewing Technique, and PRITE Preparation Seminar. Is a weekly seminar on review of psychiatry and is organized by the chief residents. It is open to all residents from July through September.

Grand Rounds Lecture Series . Once a month, invited speakers, usually from outside the residency program, give a 1 and a 1/2 hour presentation on a selected psychiatric topic. This meeting is open to the entire staff of the Department of Mental Health (DMH).

Mini-Boards . Each Spring, all residents participate in the Mini-Boards, which is an experience similar to the American Board of Psychiatry and Neurology Oral Examination. Each resident interviews a patient for 30 minutes. The interview is observed by one or two faculty members. After the interview, the resident presents the case for 30 minutes, after which the interview and presentation are critiqued.

Psychiatry Residency Inservice Training Exam (PRITE ) . This written five hour exam is given each year and is used to address and evaluate the strengths and weaknesses of the residents and the residency. It is a national examination in which many Psychiatry Programs participate.

Resident Peer Meeting . Each week residents have a meeting where they discuss issues of special relevance to their own training. Other educational events occur regularly on the St. Elizabeths Campus and are available to residents as time permits.

Open Meetin g . Three times throughout the year, residents and faculty have an open meeting to discuss any issues of general concern.

Resident's Special Event Day , Each Spring, the residents are responsible for creating a day for the Residency Program, including a special topic, a visiting speaker for the day, and other activities, such as special movies.

Program Evaluation Conferences . Near the end of the year, there are two meetings with the residents and faculty to comprehensively evaluate the residency program.

Many organizations invite nominations of outstanding residents for fellowships which involve active participation in the organization and participation in meetings during the year. In past years, our residents have won fellowships from the following:

In addition, one resident was awarded the A.E. Bennett Award for basic research; one resident was a member of the Committee of Residents for the APA and was selected to be an editor of the Jefferson Journal of Psychiatry (which is devoted to the publication of articles by psychiatry residents); and another resident had been a member in training and representative to the Assembly of the American Psychiatric Association.

Following graduation, some residents pursue subspecialty training. In recent years, residents have taken positions in child psychiatry, forensic psychiatry, geriatric psychiatry, psychiatric research, neurology, and psychoanalysis. This postgraduate education has occurred in universities and analytic institutes throughout the country. Approximately 35% of the staff psychiatrists of the DMH are graduates of our training program. Many graduates have pursued successful careers in academic centers and the private sector, both locally and elsewhere.

PGY-I

Duration

4 months

Rotation

General Inpatient Psychiatry

Internal Medicine

Neurology

Site

SEH/DMH

Providence Hospital/ Prince George Hospital

SEH/DMH

PGY-II

Duration

3 months

1.5 months

3 months

Rotation

General Inpatient Psychiatry

Forensic Inpatient Psych.

Geriatric Inpatient Psych.

Addiction Inpatient Psych.

Emerg. Psych.

Consultation Liaison Psychiatry

Site

SEH-DMH

Providence Hospital

SEH-DMH

To be Determined

PGY-III

Duration

12 months

Rotation

Outpatient Psychiatry (80% Adult; 20% Child & Adolescent)

Site

Adult Outpatient Psychiatry @

WSP or UDC or SEH-DMH or Providence Hospital

Child & Adolescent Outpatient Psychiaty @

SEH-DMH or CNMC or Andromeda

PGY-IV

Duration

4 months

8 months

Rotation

Inpatient Psychiatry

Junior Attending (50%)

Outpatient Adult (30%)

Child Psychiatry (10%)

Community Psychiatry (10%)

Electives (50%)

Outpatient Adult (30%)

Child Psychiatry (10%)

Community Psychiatry (10%)

Site

Electives: SEH/DMH or CNMC or NIMH or UMD or Sibley Memorial Hospital

Outpatient Adult Psychiatry: WSP or UDC or SEH/DMH or Providence Hospital

Child Psychiatry: SEH/DMH or CNMC or Andromeda

Community Psychiatry: SEH/DMH (Homeless Outreach Services)