Rotations PGY III

 

GENERAL MENTAL HEALTH CLINIC
 

Location
VA Boston Healthcare System, Brockton Campus

Educational Objectives

The outpatient psychiatry rotation at the Mental Health Clinic is intended to provide the resident skill-development in performing a comprehensive biopsychosocial assessment of his/her patients in an outpatient setting; formulating individualized treatment plans for outpatients; working effectively with a multidisciplinary outpatient treatment team; and treating and monitoring patients with various forms and combinations of somatic therapies and psychotherapy, with a strong emphasis on pharmacotherapy.

Description of Rotation

Residents spend a required, 1-year rotation (approximately 2 days/week) at the General Mental Health Clinic in their PGY-III year. The residents evaluate, diagnose, and treat outpatients needing psychiatric care.

The PGY-III resident works closely with the Mental Health Clinic Team, including a psychiatrist, the PGY-IV level outpatient psychiatry chief resident, PGY-III level psychiatry residents, a part-time psychologist, and 2 part-time social workers. There is a weekly staff meeting and/or an evaluation meeting on Thursday mornings for new outpatients or those outpatients with treatment issues requiring interdisciplinary input. The resident typically sees his/her patients at least every 4-6 weeks for pharmacotherapy and weekly/biweekly for individual or group therapy. The resident will make sure each patient receives an adequate supply of medications until his/her next appointment. Assessment and Recommendations are then discussed after the interview. Each resident will meet individually on a weekly basis with their assigned caseload supervisors. Resident will discuss their Initial Assessment of their patients and will review their full patient case loads over the course of the PGY-III academic year.

The autonomy and independence of the resident's decision-making will be consistent with his/her clinical abilities. The outpatient supervisor assigned to each PG-III resident provides caseload oversight and in-depth biopsychosocial supervision for individual patients. This caseload supervision is supplemented by additional psychotherapy supervision.

Expected Caseload

Approximately 35 patients.

 

POST-TRAUMATIC STRESS DISORDER (PTSD) CLINIC
 

Location
VA Boston Healthcare System, Brockton Campus

Educational Objectives

The PTSD Clinic rotation at the VA Medical Center is intended to provide the resident specialized experience in performing a comprehensive biopsychosocial assessment of PTSD patients in an outpatient setting; formulating individualized treatment plans for this population; working effectively with a multidisciplinary outpatient treatment team; and treating and monitoring patients with various forms of somatic therapies and psychotherapy.

Description of Rotation

Residents spend a required, 1-year rotation (approximately 1/2 day/week) at the PTSD clinic in their PGY-III year. The residents evaluate, diagnose, and treat outpatients meeting a diagnosis of PTSD (Posttraumatic stress disorder.

The PGY-III resident works closely with the PTSD Team, which includes 3 psychiatrists, PGY-III level psychiatry residents, 2 psychologists, and 3 social workers. The resident evaluates, diagnoses, and treats assigned outpatients under the supervision of the attending psychiatrists. Supervision is augmented by psychotherapy supervision by team psychologists for individual patients. There is a weekly staff meeting and/or an evaluation meeting on Tuesday mornings for new outpatients or those outpatients with treatment issues requiring interdisciplinary input. Close coordination with the Returning Veterans Program (for Iraq/Afghanistan veterans) ensures exposure to PTSD in both women and men across multiple generations.

Expected Caseload

The PGY-III resident will carry a caseload of approximately 10 PTSD patients, including 2 psychotherapy patients.

 

ALCOHOL AND DRUG TREATMENT PROGRAM (ADTP)
 

Location VA Boston Healthcare System, Brockton Campus Alcohol and Drug Outpatient Clinic

Educational Objectives

The ADTP rotation at the VA Medical Center is intended to provide the resident with specialized experience in performing a comprehensive biopsychosocial assessment of patients with alcohol and/or other psychoactive substance use often with other comorbid disorders; formulating individualized treatment plans; applying evidence-based treatment, and working effectively with an interdisciplinary team.

Description of Rotation

Residents spend a required, one year rotation (approximately a half day a week) at the ADTP Clinic in their PGY-III year. The resident works closely with the ADTP Team, which includes a psychiatrist, PGY-III level psychiatry residents, a psychologist, psychology intern, a social worker, and an addictions therapist. The resident will evaluate, diagnose, and treat the assigned patients under the direct supervision of the attending psychiatrist. A psychologist will provide adjunctive supervision for psychotherapy cases. The major goal of treatment in the ADTP Outpatient Clinic is to motivate behavioral change related to alcohol and/or drug use. Other goals include psychiatric stabilization, establishment of a support network, improved relationships in the community, improved physical health, and resolution of employment, legal, and other psychosocial problems (e.g., housing). Residents learn and are supervised in psychosocial treatment modalities such as Motivational Interviewing to assist patients in achieving these changes. Psychopharmacology management is also offered. The resident is required to attend supervision on Mondays from 12:30 PM – 2:00 PM, and a "didactic" session on Wednesdays.

Expected Caseload

The PGY-III resident will carry a caseload of approximately ten patients enrolled in the ADTP Outpatient Clinic, including two psychotherapy cases.

 

HOMELESS VETERANS PROGRAM (PROJECT REACH)
 

Location
VA Boston Healthcare System, Brockton Campus

Educational Objectives

This domiciliary-based rotation at the VA Boston Healthcare System's Brockton Campus is intended to provide the PGY-III resident experience in assessment and treatment of a predominantly homeless, substance-abusing population, including performing a comprehensive biopsychosocial assessment of his/her patients in an outpatient setting; formulating individualized treatment plans for outpatients; working effectively with a multidisciplinary outpatient treatment team; working closely with the primary care physician on problems on the interface between medicine and psychiatry; and treating and monitoring patients with pharmacotherapy and psychotherapy. There is a strong emphasis on use of evidence-based, cost-effective psychopharmacology of mood and anxiety disorders and insomnia.

Description of Rotation

Residents augment their outpatient substance abuse experience with a required 2-month rotation at the Domiciliary Program (Project REACH) in their PGY-III year. The residents evaluate, diagnose, and treat psychiatric disorders affecting outpatients living in the Domiciliary Unit.

The Domiciliary Unit is staffed by the following personnel: a psychiatrist, a psychologist, an internist, social workers, and mental health workers. The PGY-III resident will evaluate, diagnose, follow, and treat his/her assigned outpatients under attending supervision.

Expected Caseload

The PGY-III resident is assigned one new case per week to assess, treat psychopharmacologically, and then follow. Residents gain experience in intensive diagnostic interviewing in the 30-minute Boards format.

 

COMMUNITY MENTAL HEALTH:
THE BROCKTON MULTI-SERVICE CENTER
 

Location
Brockton Multi-Service Center Brockton, MA

Educational Objectives

The Community Psychiatry rotation at the Brockton Multi-Service Center (BMSC) is intended to provide residents with experience in making a comprehensive biopsychosocial assessment of patients in the community psychiatry setting, formulating individualized treatment plans for outpatients, working effectively with a multidisciplinary outpatient treatment team, and treating and monitoring patients using various forms of somatic therapy and psychotherapy. In addition, a formal didactic component will introduce theoretical underpinnings of community mental health care delivery while some exposure to programming commonly used by community based clinics will illustrate some of the didactic material.

 

Description of Rotation

PGY-III residents spend a required one-year rotation (1/2 day/5 hours/week) either at Brockton Multi-Service Center or the Corrigan Mental Health Center. The Brockton Multi-Service Center is a facility of the Massachusetts Department of Mental Health (DMH) Southeastern Area network. This DMH-funded facility serves as a catchment area that includes Brockton and surrounding towns. The Center is a fully-accredited Joint Commission facility.

Residents evaluate, diagnose, and treat clients in the Intake Department, the Outpatient Clinic, and in Emergency Services. Residents spend a half-day a week in the outpatient clinic, seeing their patients every 2-4 weeks for pharmacotherapy and/or weekly for individual therapy. Newly added to this rotation is the assignment to the Center’s Intake Department where residents will be the first to provide comprehensive assessments of clients who have just been made eligible for DMH services; they will follow some of these clients throughout the year with regular participation in the client’s treatment team. During the rotation, residents also spend a half-day or more a month working in Emergency Services where they evaluate, diagnose, and treat patients in crisis and make decisions about disposition under supervision. Residents will also have the opportunity to visit the various community programs at the center and in the community, include Program for Assertive Community Treatment (PACT teams), residential programs, and the peer-run Club House. Supervision is provided for intake, psychopharmacology, psychotherapy and crisis work. A seminar series on topical issues in community psychiatry is also held on a monthly basis.

 

Expected Caseload

PGY-III residents carry a caseload of 12-14 outpatients for pharmacotherapy and/or psychotherapy. In Emergency Services, the resident evaluates approximately 2 patients per afternoon.

 

COMMUNITY MENTAL HEALTH:
THE DR. JOHN C. CORRIGAN MENTAL HEALTH CENTER
 

Location
Corrigan Mental Health Center Fall River, MA

Educational Objectives

The Community Mental Health rotation at the Dr. John C. Corrigan Mental Health Center is intended to provide residents with experience in making a comprehensive biopsychosocial assessment of patients in the community psychiatry setting. Residents develop skills in acute care and integrated inpatient-outpatient treatment in a community-based setting.

Description of Rotations

PGY-III residents spend a required, one-year rotation (1/2 day per week)  at the Corrigan Mental Health Center. The Dr. John C. Corrigan Mental Health Center in Fall River, MA is a DMH-funded facility serving a catchment area that includes Fall River, New Bedford, and surrounding towns. The Center is a fully accredited, JCAHO facility that provides a variety of training experiences. The Center has, among its multiple facilities, a busy Crisis or emergency services unit which operates on a 24-hour basis; a locked Inpatient Unit with 16 beds; and a Day Treatment rehabilitation unit (Partial Hospital Program) which has a capacity of 20 beds.  Residents rotate in the Crisis Intervention Service/Urgent Care and the Day Treatment Rehabilitation Unit (Partial Hospital Program)

The Crisis Intervention Service/Urgent Care is staffed by two full-time psychiatrists who have extensive experience in the area of crisis intervention and assessment. Urgent Care is a crisis unit-related outpatient clinic where clinical evaluations, initial treatment and referrals are completed.  Residents perform evaluation interviews and is supplemented by case-based teaching thru “mini-lectures” addressing relevant topics.  The Resident learns skills necessary for rapid assessment, differential diagnosis, formulation, clinical planning and intervention. Residents work in this service seeing new patients under Attending supervision.  

Another component to this rotation is an exposure to the Partial Hospital Program which parallels that of the Crisis Unit.  The Partial Hospital program is designed as a step-down to hospitalization both for patients coming from the Crisis Unit and for patients who might enter the hospital or come out of the hospital, are less acute, more stable, and capable of benefiting from other clinical intervention.  The program is organized around medical and recovery oriented interventions involving individual assessment and management by the residents and supervised by the Attending Psychiatrist.  The resident will perform assessments on admissions to the Partial Hospital program, participate in varied activities which will include assisting in or leading group sessions, and providing brief individual therapy to patients in need of additional support beyond that provided by the group meetings.  The resident also attends family meetings and interdisciplinary treatment meetings that may occur in the course of care for an individual in the program.  This part of the rotation provides an opportunity to follow a patient for longer periods.  

The rotation provides an opportunity for supervision of individual cases with one of the Attending supervisors.  Supervision will involve review of patients, clinical issues having to do with providing care, and fostering understanding of the nature of community patient problems.  

 

Expected Case Load

PGY-III residents could evaluate up to 4 patients an afternoon in the Crisis Intervention Unit or up to 2-3 admissions in  the Partial Hospital Program.  Each PGY-III resident is also expected to follow 1-2 patients for long-term individual psychotherapy for the year. 

 

CONTINUITY CLINIC
 

Location
VA Boston Healthcare System, Brockton Campus

Educational Objectives

The Continuity Clinic at the VA Brockton provides an opportunity for residents to follow patients over 2-3 years emphasizing psychotherapeutic and especially psychodynamic modalities.

Description of Rotation

In this required 24-month part-time rotation, the resident will have the opportunity to initiate, conduct, and to terminate long-term psychotherapy. This allows the resident to learn the vicissitudes of chronic psychiatric illness by following the patients whom they have known l over a longer course of illness and to emphasize developing and managing a long-term psychotherapeutic relationship. The resident will have the ability to improve skills and competencies in all core competencies during the rotation, with special emphasis on improvement in interpersonal communication managing transference, and psychodynamic assessment, interpretation, and intervention.

Residents begin the Continuity Clinic in their PGY-II year in order to have long-term follow-up of outpatients for pharmacotherapy and psychotherapy, and continue to follow patients through their PGY-III year and if desire, their PGY-IV year. Each resident evaluates, diagnoses, and treats outpatients needing psychiatric treatment. Residents also participate in the weekly intake Case Conference in which a new patient is interviewed by a senior attending psychiatrist.

 

Expected Caseload

Each resident will be assigned 3 long-term psychotherapy cases, in the PGY-II year with increase to up to 6-8 patients in the PGY-III year.