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 4 months of training in 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 year are spent in inpatient psychiatry rotations, learning assessment and treatment planning for acutely ill inpatients.  For one of these rotations, the resident is assigned to the Harborview 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 afternoon.

PGY-2

In the PGY-2 year, residents complete an additional 4 months of inpatient psychiatry, 1 month emergency psychiatry, 4 months consultation liaison psychiatry, and 3 months of selective rotations (child/addictions/forensics/geriatrics/
research/additional consults).  Over the total of 10 months of inpatient psychiatry, the resident rotates through all three clinical sites (UWMC, VA, HMC).  During the PGY-2 year, residents begin outpatient and psychotherapy training in their continuity clinic one half-day per week.  The continuity clinic extends for the remainder of the residency and 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, and Cognitive-Behavioral Therapy. All PGY-2 residents have protected time for didactics on Thursday mornings.

PGY-3

The PGY-3 year consists of 12 months of outpatient psychiatry.  This includes one day per week of outpatient Child psychiatry, as well as assignments to two of the three adult outpatient sites (UWPOC, HMC and VA outpatient clinics).  This year includes training in outpatient diagnosis and evaluation, formulation of treatment plans, different psychotherapeutic modalities, and integration of pharmacotherapy and psychotherapy.  Depending on the sites and clinics selected, the resident can emphasize experiences in psychotherapies; in treating chronically mentally ill patients in the public sector; or working with special populations such as minority and refugee populations, patients with HIV/AIDS, the elderly, and those with particular diagnoses such as PTSD, dual diagnosis, or borderline personality disorder.  Experience in Addictions and Geriatrics is required, either during the PGY-2 year selective rotations or as part of the PGY-3 outpatient rotations.  During the PGY-3 year, the formal didactic program continues on Thursday, 8-3.

PGY-4

During the PGY-4 year, residents continue their continuity clinic at least one half day per week and complete a required rotation consulting to a primary care clinic one half day per week.  The remainder of their time is devoted to elective rotations.  These include rotations in research, ECT, community clinics, specialty services, community mental health centers, jails, the state hospital, student health centers, Alaska (Fairbanks, Juneau, or Anchorage), Montana (Missoula or Bozeman), or Casper, Woyming. 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	4 months Medicine OR 4 months Pediatrics OR 2 months Medicine, 2 months Pediatrics	2 months Neurology	6 months Inpatient Psychiatry
	PGY-1 Didactics (Thursdays 12-5)

PGY-2	4 months Consultation-Liaison Psychiatry	4 months Inpatient Psychiatry	1 month Emergency Psychiatry	3 months Selective (e.g. addictions, child, forensics, geriatrics, research)
	PGY-2 Didactics (Thursdays 8-1:30) Continuity Clinic (Tuesday or Wednesday afternoon)

PGY-3	12 months Outpatient Psychiatry one day/week Continuity Clinic one day/week Outpatient Child Psychiatry (or adult outpatient, if child rotation done in PGY-2 year) two days/week Adult Outpatient Psychiatry (includes geriatric & addiction psychiatry, if not done in PGY-2 year
	PGY-3 Didactics (Thursdays 8-3)

PGY-4	12 months Elective Rotations (70% time), including Advanced clinical electives Community Psychiatry Research and/or Teaching electives Chief resident Away rotations (Alaska, Montana, Wyoming) Child Fellowship
	PGY-4 Didactics (Thursdays 8-1:30) Continuity Clinic (half a day per week) Primary Care Consultation (half a day per week)

Residents in the three-year program, who enter as PGY-2s, have a slightly different program.  This includes 9 months of inpatient psychiatry, rotating through all 3 sites; one month of emergency room; 4 months consultation-liaison psychiatry; 12 months outpatient psychiatry; and 10 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 need to include an outpatient neurology clinic rotation in their elective time.

Residents in the Spokane and Idaho Tracks follow the same program of required and elective rotations. However, as these tracks are designed to take advantage of the particular strengths of rotations that are located both in Seattle and Spokane or Idaho, 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 an oral examination that includes interviewing a psychiatric patient and answering examiners’ 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.