Rotations

The program's clinical rotations provide opportunities to work with diverse patient populations, to gain increasing levels of skill and responsibility under supervision, and to progress from required clinical experiences to any of a wide variety of elective rotations.

PGY-1

The PGY-1 year includes an Internship comprised of 4 months of Medicine and/or Pediatrics and 2 months of Neurology.  Residents may choose 4 months of Medicine, 4 months of Pediatrics, or 2 months of Medicine and 2 months of Pediatrics.  Residents interested in Child Psychiatry may do one month of Pediatric Neurology.  The remaining 6 months of the first year are spent on 2 inpatient psychiatry rotations of 3 months each, learning assessment and treatment planning for acutely ill inpatients in a highly-structured clinical environment.  For one of these rotations, the resident is assigned to the Harborview Medical Center inpatient psychiatry service.  This block includes exposure to public sector psychiatry and the civil commitment process, as well as a night float rotation through the Harborview emergency psychiatry service.  The other inpatient block is spent at either UWMC or the VA.  Throughout the year all PGY-1 residents (including those doing Medicine, Pediatrics and Neurology rotations) attend formal didactics each Thursday.

The program’s clinical rotations provide opportunities to work with diverse patient populations; to gain increasing levels of skill and responsibility under supervision; and to progress from required clinical experiences to a wide variety of elective rotations.

PGY-2

In the PGY-2 year, residents complete 1 month of emergency psychiatry, 3 months of consultation/liaison psychiatry, 2 months of addictions, and 6 months of outpatient psychiatry, along with 12 months in a long-term care clinic experience.   During the PGY-2 year, residents begin outpatient and psychotherapy training in their continuity clinic one half-day per week.  The continuity clinic allows residents to follow patients over a prolonged period of time.  During their clinic time in the PGY-2 year, residents start to see psychotherapy patients under supervision and participate in small-group seminars, including Introduction to Psychotherapy, Basic Psychodynamic Psychotherapy, Supportive Therapy and Cognitive-Behavioral Therapy. All PGY-2 residents have protected time for didactics on Thursday mornings.

Beginning in Spokane…

PGY-3

For the first 6 months in Spokane, the PGY-3 year consists of inpatient adult, geriatric, and child/adolescent psychiatry rotations, as well as a long-term care clinic with assigned psychotherapy patients and supervisors, clinical interaction and/or psychodynamic psychotherapy seminars, and didactics on Tuesday mornings. During the second half of the year, residents begin outpatient adult and child psychiatry rotations on a half-time basis (2 full days/week) combined with forensics, consultation/liaison, and primary care outpatient consultation psychiatry the other 2 days of the week for 2 months each. The PGY-3 year goals include training and developing proficiency in outpatient diagnosis and evaluation, formulation of treatment plans, learning and applying different psychotherapeutic modalities, and integration of pharmacotherapy and psychotherapy.  During this time the resident will have a variety of experiences in treating chronically mentally ill patients in the public sector, patients struggling with anxiety and depression, medically-ill patients in both hospital and primary care settings with psychiatric issues, special populations such as minorities, the elderly, developmental disabilities, and those with particular diagnoses such as PTSD, co-occurring mental health and chemical dependency, and personality disorders.  During the PGY-3 year, the formal didactic program continues on Tuesdays from 8-11a.m, with T-group from 11-12:00.

PGY-4

During the first 6 months of the PGY-4 year, residents continue their continuity clinic and complete their outpatient training requirements. The remainder of their time is devoted to elective rotations in sleep, intensive outpatient programs for children and adults, brief research experiences, ECT, community clinics, specialty services including crisis intervention, community mental health, jails, the state hospital, student health centers, Alaska (Fairbanks, Juneau, or Anchorage), Montana (Bozeman), or Casper, Wyoming. Residents choose elective rotations to enhance or develop their skills in areas consistent with their career goals.  Residents interested in Child and Adolescent psychiatry may begin their Child training in the PGY-4 year.  Some residents may be offered a Chief Resident position, which is at least half-time in the PGY-4 year.

SUMMARY OF ROTATIONS BY YEAR

PGY-1	Internship 4 months Medicine OR 4 months Pediatrics OR 2 months Medicine, 2 months Pediatrics may do 1 month Family Medicine in Wyoming, if desired	AND 2 months Neurology (1 month may be Pediatric Neurology)	6 months Inpatient Psychiatry 3-4 months Haborview (includes night float) 2-3 months UW or VA (includes night float)
	Didactics (Thursday afternoons all year )

PGY-2	3 months Consultation/Liaison Psychiatry	2 months Addiction Psychiatry	1 month Emergency Psychiatry	6 months Outpatient Psychiatry
	Didactics (Thursday mornings all year) 12 months - Long Term Care Clinic

PGY-3	6 months Inpatient Psychiatry 3 months adult 1 month geriatrics 2 months child/adolescent	6 months of outpatient psychiatry, combined with specialty psychiatry rotations (half-time, 2 full days/week each) 2 months primary care 2 months forensics 2 months consultation/liaison 6 months outpatient adult/child
	Didactics (Tuesday 8am -11am), T-group (11am – 12pm), Clinical Interaction Seminar or Psychodynamic Psychotherapy Seminar (1pm – 2pm), 12 months long term care clinic

PGY-4

The first 6 months of the 4th year will be outpatient psychiatry essentially full-time until the training requirements are fulfilled. Electives begin the second half of the 4th year, unless you are the Chief Resident. Elective Rotations Advanced inpatient, outpatient, consults Away rotations Community psychiatry Cross-cultural psychiatry Electroconvulsive Therapy BEST elective (behavioral education for child/adolescent psychiatry) Research Sleep Forensics If coming into the program as a PGY-2 without 2 months of neurology training, this training will be added during the last two months of your 4th year, thus reducing electives by two months

Didactics (Tuesday 8am -11am,) T-group (11am – 12pm), Clinical Interaction or Psychodynamic Psychotherapy Seminar (1pm – 2pm) 12 months long term care clinic

Residents who enter as PGY-2s in the three-year program have a slightly different rotation structure.  This includes 12 months of inpatient psychiatry, rotating through Seattle and Spokane sites; one month of emergency psychiatry; 4 months consultation/liaison psychiatry, 2 months of addiction psychiatry, 2 months of primary care psychiatry, 2 months of forensic psychiatry, 12 months outpatient psychiatry; and 6 months elective time.  In individual cases, this program may be modified, depending on the resident’s past training and future goals.  Of note, 2 months of Neurology are required to be Board eligible.  Incoming PGY-2s without prior training in Neurology will complete 2 months of Neurology during their 4th year.

Residents in the Spokane Track follow the same program of required and elective rotations. However, as this track is designed to take advantage of the particular strengths of rotations that are located both in Seattle and Spokane, these residents may take certain rotations at other times in the curriculum than Seattle Track residents.

CRITERIA FOR GRADUATION

To graduate from the program, and to be eligible to sit for the American Board of Psychiatry and Neurology examinations in Psychiatry, residents must complete 48 months of approved training, including a PGY-1 year (see below, under Application Procedures, for a description of acceptable PGY-1 experiences for those residents entering as PGY-2s).  To graduate, each resident must also:

1. Complete, in a satisfactory manner, all required clinical rotations, as well as sufficient elective rotations to total 48 months of training.
2. Pass a total of 3 clinical skills examinations that include interviewing a psychiatric patient and answering a board-certified psychiatrist examiner’s questions regarding diagnostic formulation, assessment methods, and treatment approaches.
3. Be approved for graduation by the department’s Resident Education Steering Committee (RESC).  In considering residents for graduation, the RESC considers clinical competence, interpersonal skills, ethical standards, and professional conduct.