|
Clinical Rotations
Year I
Required rotations in Year I include the child and adolescent psychiatric
outpatient program and the child and adolescent psychiatric inpatient unit at
St. Vincent's Hospital, the adolescent day treatment program at South Beach
Psychiatric Center and the Staten Island Family Court Services.
1. CHILD AND ADOLESCENT PSYCHIATRY OUTPATIENT PROGRAM
During their first year of training, residents develop initial experience in
outpatient assessment and management of children and adolescents through
rotations on the child and adolescent psychiatry outpatient program at St.
Vincent's. The outpatient program provides comprehensive psychiatric evaluation
and treatment for children from infancy through age 17 years, serves a
socio-economically and culturally diverse population, and has long-standing ties
with local community agencies, schools and courts. The multidisciplinary staff
includes two attending child and adolescent psychiatrists as well as a
psychologist, psychiatric nurse and social workers.
In Year I, residents spend 10 % FTE on this rotation during the eight months
they are assigned to the children's psychiatric inpatient unit and 20% FTE (1
day per week) they are assigned to South Beach Psychiatric Center.
2. CHILD AND ADOLESCENT PSYCHIATRIC INPATIENT UNIT
Residents in Year I are assigned to the child and adolescent psychiatric
inpatient unit for eight months at 90% FTE. This unit has an average census of
16 to 19 patients. During the school year, from September through June, the
predominant age range is from four years through 12 years of age, but the unit
also accommodates children younger than age four and adolescents from ages 13
through 17 years when clinically indicated. During summer months, programming on
the children's unit and the adolescent psychiatric inpatient unit (see
description below under Year II) is combined, and approximately half the
patients on the unit are from 13 through 17 years of age. The multidisciplinary
unit staff includes a full-time attending in child and adolescent psychiatry,
nurses, social workers and specialists in therapeutic activities, as well as
special education teachers assigned to the New York City Board of Education
school program housed on the unit. Average resident caseload is five to seven
patients.
3. SOUTH BEACH PSYCHIATRIC CENTER: ADOLESCENT DAY TREATMENT PROGRAM
Residents in Year I are assigned to this rotation for four months at 60% FTE
(three days per week). The adolescent day treatment program at South Beach has
an average daily census of 18 to 20 patients. Age range is from 13 to 18 years
of age; about 60% of patients are male and 40% are female; ethnic distribution
is multicultural with a predominance of caucasians; diagnostic categories
represented include mood disorders, schizophrenia, autism and other pervasive
developmental disorders, post-traumatic stress disorder, obsessive-compulsive
and other anxiety disorders, and co-morbid substance abuse disorders. Treatment
approaches include milieu and behavioral management, community meetings,
individual, group and family therapy, and pharmacotherapy.
Residents have an average caseload of four to five patients on this rotation.
This rotation complements clinical experiences available at St. Vincent's
Hospital by providing residents with experience in the evaluation and treatment
of seriously disturbed adolescents with a wide range of psychiatric disorders,
including co-morbid substance abuse, in a day treatment setting.
4. SOUTH BEACH PSYCHIATRIC CENTER: STATEN ISLAND FAMILY COURT SERVICES
Residents in Year I are assigned to this rotation for four months at 20% FTE
(1 day per week). The staff of the Family Court Services is provided by South
Beach Psychiatric Center and includes one full-time attending child and
adolescent psychiatrist, 3.5 FTE psychologists and 4 FTE social
workers.
Residents on this rotation observe and participate in forensic evaluations of
cases involving legal issues in child and adolescent psychiatry, assist in the
preparation of written reports, observe courtroom procedure and testimony, and
become familiar with the family court system in New York City. Forensic issues
with which residents gain experience include custody and visitation, neglect and
abuse, termination of parental rights, petitions by parents for court
supervision of minor children, and juvenile delinquency.
During this four-month rotation, residents participate in the evaluation of
an average of one to two cases per week.This experience provides an excellent
practical and supervised introduction to the role of the child and adolescent
psychiatrist in legal proceedings involving children and adolescents and
complements experiences available at St. Vincent's Hospital.
Year II
Required rotations in Year II include the child and adolescent psychiatry
outpatient program, pediatric consultation program, pediatric neurology,
consultation to the adolescent psychiatric inpatient unit and the school
consultation program. All rotations are at St. Vincent's Hospital, with the
exception of the school consultation program, which is located in a public
school across the street from the hospital.
Clinical Rotations in Year II:
1. CHILD AND ADOLESCENT PSYCHIATRY OUTPATIENT PROGRAM
Residents in year II are assigned to this rotation for eight months at 70%
FTE and four months at 80% FTE. The outpatient program is described under
rotation 1 in year I above.
During this rotation in year II, residents gain increased experience with the
evaluation and treatment of children and adolescents in an outpatient setting.
These experiences include walk-in and emergency evaluations, scheduled intakes,
short- and long-term therapies, pharmacological management and collaboration
with the multidisciplinary program staff in evaluation and treatment disposition
planning. Residents in year II have an average outpatient caseload of 15 to 20
visits per week and receive three hours of individual supervision and one hour
of group supervision per week.
2. PEDIATRIC CONSULTATION PROGRAM
This rotation includes consults in inpatient and outpatient components of the
department of pediatrics and in the emergency department at St. Vincent's.
Residents in the second year are assigned for four months at 20% FTE as primary
consultants to pediatrics and for eight months at 10% FTE as back-ups to the
primary consultant.
Average caseload for residents in year II consists of about one consult per
week to the pediatric inpatient unit during the four month assignment as primary
consultant to pediatrics and one to two consults per week to the emergency
department. Residents receive attending supervision on all cases on which they
perform consults in the department of pediatrics or in the emergency
department.
3. PEDIATRIC NEUROLOGY
During this four-month rotation at 10% FTE in year II, residents spend two
hours per week in the pediatric neurology outpatient clinic and one hour per
week on an elective basis in the pediatric neurology teaching conference.
Faculty for this rotation consists of one full-time attending neurologist, who
is certified in neurology by the American Board of Psychiatry and Neurology with
special competency in child neurology and by the American Board of Pediatrics.
The population seen includes neonates to late adolescents from diverse
socioeconomic and ethnic backgrounds who have a wide range of neurological
disorders, including seizures, traumatic brain injuries, hereditary illnesses,
mental retardation and other developmental disorders.
This rotation is supplemented by experiences with children and adolescents
with neurological and developmental problems on other clinical rotations,
including the child and adolescent psychiatric inpatient units, the child and
adolescent psychiatry outpatient clinic, the pediatric consultation program, and
the adolescent day treatment program and Staten Island Family Court Service.
4. ADOLESCENT PSYCHIATRIC INPATIENT CONSULTATION
Residents in year II are assigned as consultants to the adolescent
psychiatric inpatient program for four months at 10% FTE. The program is
situated on a 23-bed acute care general psychiatric unit for adults and
adolescents in the psychiatric inpatient pavilion at St. Vincent's. During the
school year, from September through June, there are usually eight to ten
adolescent patients between the ages of 13 and 17 on the unit; sex ratio is
approximately equally divided between males and females; patients come from
diverse socioeconomic and ethnic backgrounds; diagnoses include mood disorders,
conduct disorders, schizophrenia, substance abuse disorders, developmental
disorders, borderline and other personality disorders. Treatment modalities
employed include individual group, family, behavioral, and psychopharmacological
interventions.
Residents in child and adolescent psychiatry on this rotation act (1)
consultants to the unit chief and to residents in general psychiatry regarding
the evaluation and treatment of adolescent inpatients; (2) supervisors for
general psychiatry residents on specific adolescent inpatient cases; and (3)
educators for unit staff regarding adolescent development, psychopathology and
treatment. Residents provide consultations on an average of one case per week,
spend one or more hours per week in supervision of general psychiatry residents,
and receive individual supervision on each case on which they provide
consultations as well as on their own supervision of other residents.
5. SCHOOL CONSULTATION
Residents on this rotation spend two to three hours a week for three months
at P.S. 41, a public elementary school located directly across the street from
St. Vincent's Hospital, and also may participate in school consultation
activities at other public schools at which the child and adolescent psychiatry
service from St. Vincent's provides on-site clinical programs. P.S. 41 has about
900 students from kindergarten through ninth grade, is located in Greenwich
Village and serves children from a diversity of ethnic and socio-economic
backgrounds. Residents observe children in classroom settings and participate in
the delivery of services in the schools to children or adolescents who are
registered in the child and adolescent psychiatry outpatient program of the
department of psychiatry of St. Vincent's Hospital.
Faculty includes an attending child and adolescent psychiatrist and a
psychiatric nurse specialist, both of whom are on the staff of the child and
adolescent psychiatry service at St. Vincent's Hospital.
Residents receive individual supervision on classroom observations,
consultations and in the schools from the chief of the pediatric, school and
community outreach program.
The on-site outreach program from the child and adolescent psychiatry service
to the school that is the principal site for this rotation has been in existence
for over 25 years and has received special recognition from the New York City
Board of Education for the services provided. In recent years, the clinical
program has expanded to other public schools at the request of the Board of
Education, leading to additional opportunities for residents to gain experience
in mainstream school settings.
In addition to this rotation, residents observe non-clinically referred
infants and toddlers in the parenting education program and gain extensive
experience in the observation and treatment of clinically referred children and
adolescents in special education classroom settings on the child and adolescent
psychiatric inpatient units and in the New York City Board of Education Special
Education School programs at St. Vincent"s Hospital, and the adolescent day
treatment program at South Beach Psychiatric Center.
CHILD AND ADOLESCENT PSYCHIATRY ON-CALL RESPONSIBILITIES
Residents are required to participate in the child and adolescent psychiatry
evening, weekend and holiday on-call schedule in years I and II.
On-call responsibilities include availability by beeper call from home to
assist residents in general psychiatry in evaluation and management of emergency
and crisis situations in children and adolescents, including those who present
to the emergency department, those who require acute psychiatric inpatient
admission, pediatric inpatients who experience psychiatric crises in the
hospital, and psychiatric inpatients in whom medical or psychiatric crises
develop while in the hospital. Residents in child and adolescent psychiatry make
rounds on the children's psychiatric inpatient unit on weekends and are
available to come in to provide on-site assistance to general psychiatry
residents in evaluation and management of child and adolescent patients on
evenings and weekends if needed. Residents in child and adolescent psychiatry
are supervised in these activities by the attending on call for child and
adolescent psychiatry, who makes rounds with the resident on weekends and who is
available by telephone at all times. Call is shared equally among the six
residents in the program (three in year I and three in year II).
SUPERVISION
Each resident in each year of the child and adolescent psychiatry training
program receives a minimum of two hours of individual supervision per week with
additional supervision as noted in the above descriptions of clinical rotations.
Attending supervisors are available at all times as needed, and supervision on
emergency cases on evenings, weekends, and holidays is provided through the
attending on-call schedule.
ELECTIVES
Residents in the second year of training may select clinical or research
electives in which specific interests can be pursued. The time allocated for
such electives is 10% FTE for four months but may be flexibly distributed over a
longer period if warranted. This time may be devoted to a clinical elective,
participation in clinical research or other academic projects, or a combination
of the two. Clinical electives include opportunities to gain additional
experience in pediatric consultation as consultant to the pediatric subspecialty
clinics, the adolescent medicine clinic, the parent education program, or the
school consultation program. Residents who choose clinical electives are
supervised by the program chief of the rotation on which the elective takes
place. Residents who choose electives in clinical research or other academic
projects are assigned faculty mentors. Other elective options and additional
time for elective rotations may be arranged when in keeping with the educational
and training goals of the program and by approval of the program director.
CLINICAL RESEARCH AND OTHER SCHOLARLY ACTIVITIES
Participation in clinical research or other scholarly projects is a
requirement for graduation from the program. Residents are assigned faculty
mentors for specific projects, which are selected with the approval of the
program director. Recent projects by residents have led to presentations at
regional, national and international meetings of major professional
organizations and publications in the professional literature.
|
