The Third Post-Graduate Year
The Third Post-Graduate Year
The PGY-3 year is a longitudinal outpatient experience, designed to allow the resident to gain experience in a variety of psychiatric modalities. The major emphasis is on continuity of care, and experiences are designed to span the entire 12-month period.
The resident assumes primary psychiatric care for outpatients in a number of different settings. Residents spend time each week treating patients with psychotherapy and pharmacotherapy at one of several community-based mental health clinics and at the Desert Vista Outpatient Clinic. Residents may see a limited number of child cases under the supervision of a Child/Adolescent psychiatrist. Residents will also have opportunities to rotate through community-based multidisciplinary treatment settings, where they provide treatment to patients who are seriously and persistently mentally ill.
The didactic curriculum in the third year emphasizes psychotherapies. Courses in supportive, brief, marital/sexual, family, and dialectical behavioral therapies (DBT) occur throughout the year. Residents complete coursework in contemporary treatment modalities, child/adolescent psychiatry, and psychiatric administration. A two-year continuous psychodynamic case conference and a DBT Consultation Group are initiated in the third year.
PSYCHIATRIC OUTPATIENT CLINIC, MIHS Desert Vista Behavioral Health
This mandatory PGY-3 rotation occupies 62.5% time for 12 months. Residents usually continue seeing outpatients during their PGY-4 year.
The Desert Vista Psychiatric Outpatient Clinic faculty consists of one full-time board certified psychiatrist who acts as Clinic Director and provides overall management and psychopharmacologic supervision for all patients; one part-time board certified psychiatrist who is a psychoanalyst and who provides supervision of psychodynamic psychotherapy; one part-time Ph.D. psychologist who provides CBT supervision; one part-time licensed MSW social worker who provides DBT supervision; and one full-time and one part-time board certified child/adolescent psychiatrist who supervises child and adolescent cases.
The clinic only treats patients who have no insurance and no public benefits. Many of these patients work; they are not so disabled as to be seen as Seriously Mentally Ill (SMI) by the State. Nonetheless, they often have significant functional impairment due to mental illness. The outpatient population is comprised of an equal distribution of males and females. Diagnostically, approximately 50% of cases have affective disorders, 20% have anxiety disorders, and the remaining 30% have adjustment disorders, personality disorders, thought disturbances, and other disorders that include the less common diagnoses of obsessive compulsive disorder and eating disorders. Approximately 15% of patients have a comorbid substance abuse diagnosis. Treatment follows careful assessment and may include the provision of psychotropic medications, supportive therapy, psychodynamic therapy, CBT, DBT, and/or the involvement of families or significant others if indicated. Webcams located in each office are used to record sessions for supervision.
Experience with long-term individual child/adolescent psychotherapy is also provided in during the PGY-3 year and is complimentary to the Child Rotation taken during the PGY-4 year.
Individual supervision is heavily emphasized in this rotation and each resident is provided with:
- One hour/week of supervision to review medication management, supportive psychotherapy, combined psychotherapy and psychopharmacology, and overall management of patients;
- One hour/week for supervision of psychodynamic patients;
- One hour/week with a child/adolescent psychiatrist for the supervision of the long-term child or adolescent treatment cases; and
- One hour/week for supervision of cognitive-behavioral (CBT) and dialectical behavioral (DBT) therapy cases
In addition, PGY-3 and PGY-4 residents attend a weekly 1.5 hour Psychodynamic Case Conference in which residents present and discuss therapy material, including recordings of therapy sessions, with a psychiatrist who is a psychoanalyst.. They also attend a DBT Consultation Group.
Weekly clinic meetings address the administrative aspects of running a clinic practice. Faculty is always available for consultation, and caseloads are carefully monitored and controlled for size, intensity, and variety of experience. Record review occurs weekly in supervision and by means of resident peer review, which also occurs weekly.
Residents seeing patients in this clinic are expected to address issues of payment within the context of therapy. While the clinic is not expected to “profit” from the patients seen, there is a reduced fee that is applied and residents must routinely deal with such issues. Further, due to the shortage of community resources for pharmaceuticals, residents are expected to gain an understanding of cost effective prescribing and the available mechanisms for obtaining medication for patients through assistance programs.
OFF-CAMPUS OUTPATIENT: ST. VINCENT De PAUL CLINIC
This rotation may be selected as one of the off-campus outpatient rotations required during the PGY-3 residency year. It is a 12.5% time rotation for a 6-month period .
St. Vincent de Paul runs a multi-specialty free clinic for working people who cannot afford health care and do not have a third party payer. Ninety-three percent of patients are between 21 and 60 years of age. Major conditions include depressive disorders (75%), bipolar disorder (4%), and anxiety disorders (20%), with additional diagnoses including adjustment disorders, phobias, and dissociative identity disorder. Residents evaluate and treat patients, some of whom are referred by physicians of other specialties at the clinic. Treatment follows careful assessment and includes the provision of psychotropic medications and, as indicated and allowed by the patient’s circumstances, psychotherapy. Many of the patients are Spanish speaking only. Residents learn to work with an interpreter to evaluate and treat patients. Residents learn to work effectively with other physicians and social service agencies in providing care for patients.
Each of the two residents on the service receives one hour of supervision per week from a faculty psychiatrist.
OFF-CAMPUS OUTPATIENT: ARIZONA STATE UNIVERSITY (ASU) COUNSELING AND CONSULTATION SERVICE
This off-site rotation may be selected as one of the off-campus outpatient rotations required during the resident’s PGY-3 year. The rotation is 37.5%-time for a 6-month period.
Residents receive supervision from board certified psychiatrists for psychopharmacology and receive psychotherapy supervision from a LCSW, a Masters-level counselor, and two Ph.D. psychologists, all of whom are full-time faculty at the ASU Counseling and Consultation training program and of the MIHS Adult Residency Program.
Clinical assignment is allocated such that the resident spends approximately one-third of the time conducting supervised psychotherapy and two-thirds of the time performing evaluation and providing medication management. Psychotherapy sessions are video recorded and supervised by a doctoral level psychologist or Masters level social worker or counselor.
Residents evaluate and treat ASU college and graduate students. Major conditions treated include depressive disorders (32%), anxiety disorders (24%), adjustment disorders (12%), substance abuse disorders (19%), eating disorders (7%), and conditions not classified as psychiatric disorders but nonetheless benefiting from treatment (i.e., V codes) (38%). Residents evaluate and treat patients who often have been referred by non-physician therapists. Residents learn to work with therapists in coordinating care. The clinic limits psychotherapy to 12 weeks; hence, all psychotherapy follows a brief therapy model.
Each of the up to two residents on the service receives one hour/week of supervision for psychotherapy, including review of video recorded sessions, with a social worker, master’s-level counselor, or psychologist and one hour/week of supervision for evaluations and medication management with a board certified psychiatrist.
OFF-CAMPUS OUTPATIENT: PHOENIX INTERFAITH COUNSELING (PIC)
This PGY-3 rotation may be selected as one of several off-campus outpatient rotations. The rotation runs 37.5% time for a 6-month period .
Residents evaluate and treat patients of this private, non-profit, community-based agency. Clinical assignment is allocated such that the resident spends approximately one-third of the time conducting supervised psychotherapy and two-thirds time performing evaluation and medication management. In addition to coordinating medication evaluation and management for patients with non-medical therapists, residents provide supervised individual cognitive-behavioral therapies (CBT), attend cognitive-behavioral and DBT skills groups, attend DBT consultation groups, and attend agency staff meetings where broader issues related to providing services in the community mental health system are discussed.
PIC is a community agency that provides psychotherapy and medication management to a range of SMI and non-SMI patients. The agency has developed expertise in cognitive-behavioral and dialectical behavioral therapies and often treats patients with severe personality disorders that significantly disrupt functioning. Residents evaluate and treat patients with medication and psychotherapy. The patient population is 74% female, with major primary diagnoses including mood disorders, anxiety disorders, adjustment disorders, schizophrenia and other psychotic disorders, and ADHD. There is a high degree of comorbid personality disorder in this patient population. Treatment follows careful assessment and includes the provision of psychotropic medications and, as indicated, psychotherapy.
The resident receives one hour/week of supervision for psychotherapy from the Clinic Director, who is a licensed marriage and family therapist with considerable training and experience in CBT and DBT, and one hour/week of supervision for evaluations and medication management with a board certified psychiatrist.
OFF-CAMPUS OUTPATIENT: CARL T HAYDEN VA MEDICAL CENTER, CSTAT CLINIC
This rotation may be selected as one of the available off-campus outpatient rotations required in the PGY-3 residency year. The rotation runs 25-37.5%-time for a 6-month period .
CSTAT is a psychiatric walk-in clinic located in a large VA medical Center. The patients comprise a typical VA population with depressive disorders, PTSD, substance use disorders, and some psychotic disorders being the most common clinical presentations. Treatment follows careful assessment and includes the provision of psychotropic medications, crisis intervention, and disposition. Residents learn the structure and resources of the VA system.
Residents at this location receive supervision on cases as they present with the faculty psychiatrist and receive at least an hour of supervision per week (on site).
OFF-CAMPUS OUTPATIENT: CARL T HAYDEN VA MEDICAL CENTER, COMPLEX CARE CLINIC
This rotation may be selected as one of the off-campus outpatient rotations required during the PGY-3 year. The rotation runs at 25-37.5%-time for a 6-month period (1.5-2.25 mo. FTE).
The Complex Care Clinic is located in a large VA medical center and is intended to treat veterans with serious mental illnesses who require long-term follow-up care. The patients comprise a typical VA population with depressive disorders, PTSD, substance use disorders, and psychotic disorders. Treatment follows careful assessment and includes the provision of psychotropic medications, crisis intervention, and disposition. Residents learn the structure and resources of the VA system.
One full-time board certified faculty psychiatrist supervises on site. Residents receive supervision on cases as they present, with the faculty psychiatrist and receive at least one hour of supervision per week.
OFF-CAMPUS OUTPATIENT: CASE MANAGEMENT CLINICS
PARTNERS IN RECOVERY: EAST MESA CLINIC
CHOICES NETWORK: HEATHERBRAE CLINIC
TEMPE CLINIC
These rotations may be selected as one of the available off-campus outpatient rotations required during the PGY-3 year. The rotations runs at 25-37.5%-time for a 6-month period .
This clinics are part of the outpatient support system for persons with a Serious Mental Illness (SMI) run by the Regional Behavioral Health Authority (RBHA) of Maricopa County. Adult patients are seen for medication management in the context of a multidisciplinary case management team. Many patients have long-term mental illnesses that cause functional impairment and require continuing support and treatment. Typical clinical presentations include psychotic disorders, mood disorders, and anxiety disorders. Comorbid personality disorders and substance abuse disorders are also treated. Residents evaluate and treat patients under the supervision of the clinic faculty psychiatrist. They learn to work with other professionals and non-professionals in providing outpatient treatment and supporting the functioning of a challenging group of individuals. Residents learn about the structure and resources available in the public mental health system and are exposed to the principles of recovery and psychiatric rehabilitation. Residents develop an understanding of how Seriously Mentally Ill persons live in the community. Residents may join an ACT team which goes into the community to provide services to the most ill patients.
A board certified faculty psychiatrist supervises the rotation. In addition, the resident interacts with a multidisciplinary treatment team, including nurses, case managers, and team leaders. Residents receive individual supervision around case contacts and the operation of the clinic from the faculty psychiatrist amounting to at least one hour per week.
4th Post-Grad Year
Last updated on
December 16, 2009
Family Violence