SUNY Downstate Health Sciences University
Department of Psychiatry & Behavioral Sciences
Residency at a Glance
PGY-1: Learning the ropes
If you're like lots of us, you were terrified to start residency."What do you mean this login doesn't work? How do I order this? What do you mean my patient wants to speak to their Doctor? What? Oh wait…I am their Doctor."
Well, there's no denying that the first day, even the first week, are anxious ones, there's enough support from orientation, from the upper years, training office, and your attendings, that the whole transition becomes pretty painless.
First year is half Medicine/Neurology and half Inpatient Psychiatry. For our medicine months, there are two months of Inpatient Medicine, one month of Outpatient Medicine and one month of Outpatient Medicine at the Behavioral Health Clinic. Medicine's tough, but definitely manageable... there's no overnight calls, rounds are usually quick, and the team usually includes medical and pharmacy students, physician assistants, and of course, your resident and co-intern. Outpatient Medicine at the Behavioral Health Clinic is awesome, we get familiar with the medical problems our patient population tends to have like metabolic syndrome, hypertension, etc. There's lots of interesting cases in Neurology, we do one month of Inpatient Neurology and one month of Neurology Consults. Again, short calls till 8-9pm, no overnight calls.
The six months of Psychiatry during the PGY-1 year are divided among Adult Inpatient, Addictions, and the Partial Hospital Program (PHP). The four inpatient months are split between the teaching units at Kings County Hospital and Coney Island Hosptal, both community hosptials that serve two markedly different patient populations.
The month in PHP, which is a day treatment program, gives us early exposure to work in an outpatient setting with patients who come to the program for six weeks. It's a great way to get to know your patients on a more long-term basis.
The Addiction rotation exposes us to patients with substance use disorders on both the Detox unit and in an outpatient setting as well. You get to run groups and manage patients as they recover from alcohol, benzodiazepine, and opioid withdrawal. This helps us leard how to manage patients who have comorbid substance use disorders and psychiatric illness. It's a good introduction to using Motivational Interviewing with patients.
As for the Didactics, 1st years have a half day (Thursdays, noon to five) of lectures on Psychopharmacology, Psychiatric Interviewing, and Emergency Psychiatry to name just a few. This is protected time, so even when you're on Medicine or Neurology (even when on call!) sign out to your senior resident at 11:45 and off to class! Most important part of the Didactic Day is 12-lpm, when we have our weekly resident meetings, so you can catch up with the residents on different services.
PGY-2: Discovering Your Path
The PGY-2 year is when you are exposed to a variety of psychiatric sub-specialties and truly begin to hone your psychiatric skills and develop your own personal style. During your second year, you will rotate at a variety of clinical sites, which serves to expose you to different clinical experiences including pubic, private, veterans' affairs, and state hospitals.
This year includes inpatient rotations on geriatric, adult, adolescent and child units at hospitals where you will be treating patients with an impressive variety of acute and severe mental illnesses. You will also develop your skills in diagnosing and treating patients at the intersection of medicine and psychiatry during your consultation liaison rotations.
One of the highlights of this year is the opportunity to learn Emergency Psychiatry by working for a month in the Comprehensive Psychiatric Evaluation Program (CPEP). dedicated psychiatric emergency room. In addition, you will have the unique experience of learning addiction psychiatry via inpatient detox, inpatient rehab, and outpatient rehab settings. Another highlight of your PGY-2 year will be your exposure to forensic psychiatry, which includes evaluating defendants and working at the State Supreme Court.
Perhaps the most revered of the experiences during your second year includes a dedicated research month, where you will have the opportunity to work with your choice of distinguished research mentors. In addition, you will begin the first of your outpatient experiences in psychiatry where you will be treating patients whom you will continue to follow for the duration of your residency.
- "During my PG-2 year I feel like I have really grown as a psychiatrist. I have a fuller appreciation for the entire breadth of psychiatry and have started to carve out my own niche."
- "Second year is full of awesome clinical experiences. We have rotations at all major healthcare systems currently in the U.S. and we have valuable research opportunities."
- "Second year provides many opportunities for professional self-expression. There are opportunities to try almost every branch of psychiatry, including my personal favorite, geriatrics. We also have more time to volunteer at the Brooklyn Free Clinic, enroll in a Master's program, and work on our own research projects."
Core Didactics continue to be on Thursdays from 9 a.m. to 5 p.m. The curriculum is broad yet salient to your clinical experiences during your second year. It includes topics such as human development, cultural psychiatry, supportive psychiatry, advanced psychopharmacology, ethics, and the subjective experience of psychosis.
PGY-3: A Journey to Independence
The PGY 3 year introduces the resident to outpatient and integrative psychiatry. We experience a variety of modalities including group therapy, cognitive behavioral therapy and dynamic therapy.
Learning to become an independent provider and thinking on our feet is one of the main goals of the PGY-3 year. Besides carrying our own patients in the outpatient department at Kings County Hospital Center, once a week we provide services to veterans at the PTSD Clinic in the VA Brooklyn Medical Center. During this year we are also immersed in the art of psychotherapy and receive intensive training from experts in the field.
- "I love the challenge of treating outpatients; I can always turn to a supervisor but I have to empathetically face the dilemmas of my patients' struggles with everyday mental illness myself first."
- "The variety of experiences we get in 3rd year is so exciting. You see the realities of PTSD at the VA while really immersing ourselves in community psychiatry in PPOH. Its fantastic."
- "One of the best things about the OPD is the camaraderie. I like coming to work to see everyone and discuss challenging cases, articles and share ideas. It's really a unique opportunity to socialize and brainstorm everyday 9-5.
Core Didactics continue to be on Thursdays from 9 am to 5 pm. The curriculum is very comprehensive and well balanced. It includes topics such as long term psychotherapy, one way mirror treatment, neuroscience, psychopharmacology, neurobiology of mood and anxiety disorders and CBT for psychosis.
PGY-4 - Becoming a Leader
Our final year of training is tailored to our individual interests and needs. We are encouraged to pursue fellowships, apply for research positions and prepare for the careers that we seek, be it in academia, private practice or leadership in the APA. Mentors are available both at SUNY Downstate and at Kings County to help residents and guide them on the path to success.
During the 4th year of residency we continue our outpatient experience as well as our long term psychodynamic cases. We have the opportunity to choose from a variety of electives including pain medicine, forensics, addiction, psychopharmacology, and a slew of research projects.
Everybody gets the chance to act as a leader for junior residents and medical students. Possible settings to choose from include outpatient, inpatient, C/L, as well as administrative roles. It is during the PGY 4 year that Chief Residents are active in their roles as well, and we have one chief for each year of training, acting in both an administrative and advocacy role.
- "As I prepare to leave training I feel confident in my skills and ready to face inpatient practice in a large hospital. I know that working at County and the variety of patients we saw here made me more than ready."
- "I have always been a researcher at heart, and having the opportunity to hone my research skills during the years spent here allowed me to continue on to a research career now."
- "It has always been outpatient psychiatry for me and working at Kings County R-OPD for the past two years made me sure of this. I cannot wait for my fellowship in psychopharmacology as I set up my private practice!"
Core Didactics continue to be on Thursdays from 9 am to 5 pm. The curriculum is very interesting and dynamic. It includes topics such as couples therapy, human sexuality, sex therapy, and hypnosis