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 a wide variety of elective rotations.

PGY-1

The PGY-1 year consists of 4 months of Medicine and/or Pediatrics, 2 months of Neurology, and 6 months of Inpatient Psychiatry.  Each resident completes four 3-month blocks – two 3-month Medicine/Pediatrics/Neurology blocks and two 3-month Inpatient Psychiatry blocks.  Half the class starts with Medicine/Pediatrics/Neurology, while the other half starts with Inpatient Psychiatry.

Block 1	Block 2	Block 3	Block 4
Med/Peds/Neuro	Psychiatry	Med/Peds/Neuro	Psychiatry
Psychiatry	Med/Peds/Neuro	Psychiatry	Med/Peds/Neuro

Residents may choose to do 4 months Medicine, 4 months Pediatrics, or some of each.  Medicine rotations include ward medicine, emergency medicine, and medicine consults.  Residents interested in Child and Adolescent Psychiatry may do one month of Pediatric Neurology.  PGY-1s may also choose to do one month of Neurology as a Neurology clinic rotation later in residency, and instead do a month of Emergency or Consultation-Liaison Psychiatry or Research in the PGY-1 year.

Inpatient psychiatry rotations focus on assessment and treatment of acutely ill patients, and include a rotation at Harborview, providing exposure to public sector psychiatry, involuntary treatment and the civil commitment process, and electroconvulsive treatment (ECT), as well as a night float rotation in the Harborview Psychiatric Emergency Service.  The other inpatient rotation is at either UWMC or the VA.  Throughout the year, all PGY-1 residents (including those on Medicine, Pediatrics, and Neurology rotations) attend formal didactics on Thursday afternoons.

PGY-2

The PGY-2 year consists of:

• 4 months inpatient psychiatry
• 4 months consultation-liaison psychiatry
• 1 month emergency psychiatry (Harborview)
• 1 month night float (2 weeks) + scholarly time
• 2 months selectives (options include child and adolescent psychiatry, outpatient addictions, community psychiatry (recovery model), forensic psychiatry, research, teaching elective, neuroradiology)
• Continuity clinic half a day per week

Over the total of 10 months inpatient psychiatry in the PGY-1 and PGY-2 years, residents rotate through all three core adult sites (Harborview, UWMC, VA).  The 4 months of consultation-liaison psychiatry usually include rotations at all three of these sites.

In the PGY-2 year, residents begin outpatient and psychotherapy training in continuity clinic half a day per week.  The continuity clinic extends for the remainder of the residency and allows residents to follow patients for a prolonged period of time.  During continuity clinic in the PGY-2 year, residents begin to see psychotherapy patients under supervision and participate in required small-group psychotherapy seminars, including Supportive Psychotherapy, Basic Psychodynamic Psychotherapy, and Cognitive-Behavioral Therapy. 

PGY-3

The PGY-3 year consists of 12 months of outpatient psychiatry.  At least one day per week must be continuity clinic.  Outpatient rotations in child and adolescent psychiatry, addiction psychiatry, and geriatric psychiatry are required, unless the resident has completed one of these requirements during PGY-2 selective time.  The remainder of the time is spent in outpatient clinics of the resident’s choice at our three adult clinical sites.

The outpatient year focuses on outpatient evaluation and diagnosis, formulation, treatment planning, medication management, different psychotherapeutic modalities, and integration of psychotherapy and pharmacotherapy.  Depending on the sites and clinics selected, residents can emphasize experiences in psychotherapy, treating chronically mentally ill patients in the public sector, or working with special populations such as minority and refugee populations, persons with HIV/AIDS, those with specific diagnoses such as dual diagnosis, post-traumatic stress disorder (PTSD), or borderline personality disorder.

PGY-4

The PGY-4 year is an elective year.  Each resident has at least half a day per week of continuity clinic, and completes a required rotation providing psychiatric consultation to a primary care clinic half a day per week.  The remainder of the time is devoted to elective rotations designed to consolidate the resident’s skills and pursue areas of special interest to facilitate career development.

Elective rotations include research, teaching/curriculum development electives, ECT certification, and rotations in community clinics, community mental health centers, Western State Hospital, student health centers, couples and family therapy, specialty areas such as neuropsychological testing.  Residents may elect additional rotations in inpatient, outpatient, consultation-liaison, or emergency psychiatry, including rotations as a junior attending.  Away rotations are available in Anchorage, Juneau, and Fairbanks, Alaska; Casper, Wyoming; and Bozeman, Montana.  Residents interested in Child and Adolescent Psychiatry may begin their Child training in their PGY-4 year.  Some residents will be offered a Chief Resident position, which is a half-time position in the PGY-4 year.

THE 3-YEAR PROGRAM

Residents in the three-year program, who enter as PGY-2s, have a slightly different rotation schedule.  This consists of 8-9 months inpatient psychiatry, 3-4 months consultation-liaison psychiatry, 1 month emergency psychiatry, 12 months outpatient psychiatry (including child and adolescent, addiction, and geriatric psychiatry outpatient rotations), primary care consultation half a day per week for 12 months, and elective time.  In individual cases, this program may be modified depending on the resident’s past training and future goals.  Residents in the three-year program complete the same continuity clinic and psychotherapy training requirements as those in the four-year program.

Of note, 2 months Neurology is required.  Incoming PGY-2s without prior training in Neurology will need to include an outpatient neurology clinic rotation in their elective time.

SPOKANE AND IDAHO TRACK ROTATIONS

Residents in the Spokane and Idaho Tracks complete the same program of required and elective rotations.  However, because these tracks are designed to take advantage of the particular strengths of rotations in Seattle and in Spokane or Idaho, these residents may do certain rotations at different times than Seattle Track residents.

CRITERIA FOR GRADUATION

To graduate from the residency program, and to be eligible to sit for the American Board of Psychiatry and Neurology examination in Psychiatry, residents must complete 48 months of approved training, including a PGY-1 year (see Application 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 rotations, as well as sufficient elective rotations to total 48 months of training.
2. Complete all requirements for the PGY-4 year, as specified in Goals and Objectives.
3. Pass an oral clinical examination that includes the resident’s interviewing a patient and assessment by a faculty examiner of the resident’s skills in establishing a doctor-patient relationship, conducting an interview, case presentation, formulation, diagnosis and differential diagnosis, assessment, and treatment planning.
4. Be approved for graduation by the department’s Resident Education Steering Committee (RESC).  In considering residents for graduation, the RESC considers points 1-3 above, as well as the resident’s overall demonstration of satisfactory performance and achievement on the ACGME competencies (patient care, knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice).