Training Program

General Description of Clinical and Research Training: PGY-1 through PGY-6

The Integrated Child, Adolescent, and Adult Psychiatry Program is designed to provide the clinical experiences essential for the development of basic knowledge and skills necessary for practice in all sectors of contemporary psychiatry. The specialized objective of the training program is to insure that each graduating resident demonstrates clinical competence in the evaluation and treatment of children and adolescents with psychiatric disturbance and their families, a strong sense of responsibility for patients, and a commitment to high ethical standards. Each resident should have clinical competence in the following core areas:

• Clinical Science/medical knowledge
• Patient Care
• Interpersonal and communication skills
• Practice-based learning and improvement
• Professionalism
• Systems-based practice

Upon completion of the child, adolescent, and adult psychiatry residency at the Yale Child Study Center, each resident is expected to be able to provide competent evaluations and appropriate treatment to children, adolescents and adults with psychiatric disorders, and their families. Additionally, the graduate should be able to provide competent consultation services to a variety of professionals in medical and non-medical disciplines about children and adolescents with psychiatric disorders. And finally, a strong commitment to the treatment of patients and high ethical conduct will have been demonstrated.

Facilities

• The Connecticut Mental Health Center (CMHC)
• Yale New Haven Hospital (YNHH) Adult Psychiatry Services
• Veterans Administration Connecticut Hospital System (VACHS)
• Yale University Health Service (YUHS)
• Yale New Haven Hospital (YNHH) Child Psychiatry Services
• Child Study Center Outpatient Psychiatric Services

Program Description

Four months of the PG-I year are devoted to psychiatry. Residents begin with a 3 month rotation on an inpatient adult psychiatry unit at the Veterans Administration Connecticut Mental Health Center. Residents are then able to transition to the Yale Department of Pediatrics for 6 months of general pediatrics. This includes 4 inpatient months, one emergency pediatrics month, and a pediatrics acute care month. Residents then complete the 2-month neurology requirement and are able to spend one of these two months with the Child Neurology service. The PG-I year concludes with one month of child psychiatry on the Winchester-One inpatient child psychiatry unit. This is the start of a 3 month rotation extending into the PG-II year.

The PG-II year begins with the completion of the 3-month rotation in child psychiatry. Work with long-term psychotherapy patients and in the Pediatric Continuity Experience also begins in PGY-II and continues throughout the Residency. These longitudinal experiences that may last up to 5 years are one of the many advantages to the integrated format of this program. Residents may have long-term relationships with patients that will greatly inform outpatient clinical work they pursue upon completion of their residency.  However, the emphasis of the PG-II year is on developing basic skills in research settings. Residents work in child and adult outpatient research settings as well as begin to establish an independent research project. Trainees select their own research mentor who will foster their growth as an academic child psychiatrist and help them start a successful research project. Residents are able to take seminars in research development as well as courses in other topics that might interest them. Participation in the Yale Child Study Center Research Seminar begins this year and continues until the end of the residency, providing residents with continual research mentorship and the support and knowledge necessary to pursue an academic career in child psychiatry.

The PG-III year is similar to the PG-II year that Yale Adult Psychiatry Residents complete. It consists of two 3-month adult psychiatry inpatient rotations, a 2-month consultation/liaison rotation, a one month emergency psychiatry rotation, and a three month community services child psychiatry rotation. Long Term clinical experiences continue as does the participation in the Yale Child Study Center research seminar.

The PG-IV year is similar to the PG-III year which Yale Adult Psychiatry Residents complete, although clinical experiences equally emphasize child and adult psychiatry. This year consists of 12 months of outpatient psychiatry and includes supervised clinical experience in addiction and child psychiatry. Residents again continue to work in their long-term programs as well as the Child Study Center research seminar.

The PG-V and VI years are designed to allow residents to focus on the research interests they have developed in the preceding years while maintaining clinical training experiences in outpatient psychiatry. Residents will use many of the basic skills they gained in the PGY-II year to establish an independent research direction under the mentorship of senior faculty members. For one day a week, training in long- and short-term outpatient psychiatry will also continue.

PG-I Internship Year
Inpatient Adult Psychiatry 3 months	General Pediatrics 6 months	Child and Adult Neurology 2 months	Inpt. Child Psychiatry 1 month
1st month call free. 5 Calls in each of 2nd & 3rd month	Q4 call on inpatient months	Q4 call in Adult month	4 from-home eve/wknd calls

PG-II- Basic Skills Year
Inpt. Child Psychiatry 2 months	Outpatient Child (1 ½ days/wk) and Adult (1 ½ days/wk) Psych, Didactics/Seminars  (1/2 day/wk), and Research (1 day/wk) 10 months
Long Term Psychotherapy Program & Pediatric Continuity Experience
10 from-home eve/wknd calls	10 months Call-free

PG-III Intensive Services Year
Inpt. Adult Psychiatry 3 months	Inpt. Adult Psychiatry 3 months	Child & Adult Consulation/ Liaison Psych 1 month	Emerg. Psych. 1 month	Child Psychiatry Community Services Selective 3 months
Long Term Psychotherapy Program & Pediatric Continuity Experience & Research Seminar
Approximately 20-25 calls throughout the year

PG-IV- Outpatient Services Year

Outpatient Child (2 days/wk) and Adult (2 days/wk) Psych, and Research (1 day/wk) 12 months

Long Term Psychotherapy Program & Pediatric Continuity Experience & Research Seminar

Approximately 15 overnight ED shifts throughout the year

Call Free Year

PG-V & VI- Research Years

Mentored Research and Formal Coursework (4 days/wk), and Outpatient Child and Adult Psych (1 day/wk) 12 months

Long Term Psychotherapy Program & Pediatric Continuity Experience

Call Free Years

Pediatric Continuity Experience for Integrated Psychiatry Residents Objectives:

To observe first-hand the development of a child without known psychiatric diagnoses from birth through age 4, including, but not limited to:

• Physical development
• Language development
• Cognitive development
• Emotional development
• Motor development (fine and gross)

“The child's personality is a product of slow gradual growth. His nervous system matures by stages and natural sequences…. The task of child care is not to force him into a predetermined pattern but to guide his growth.”
-Gesell and Ilg

To observe first hand the growth and changes that occur in a family with the birth of an additional child including:

• The difference in parental response to different children’s personalities
• The attachment between the children and parents
• The changes parents go through in adjusting to having more children in their care
• The changes (an) older sibling(s) go through in adjusting to a new younger sibling

“No matter how calmly you try to referee, parenting will eventually produce bizarre behavior, and I'm not talking about the kids. Their behavior is always normal.”
-Bill Cosby

To understand the challenges and rewards of parenthood and the changes it brings about in the life of an adult.

“The parents exist to teach the child, but also they must learn what the child has to teach them; and the child has a very great deal to teach them.”
-Arnold Bennett

To understand the developmental and behavioral issues for which the parents seek help from their pediatrician and the feedback that the pediatrician is able to offer in these cases.

“Having children makes one no more a parent than having a piano makes you a pianist.”
-Michael Levine

These objectives will be accomplished through the following activities:

1. At the start of the resident’s PG-II year, the participating pediatrician will identify a family of one of his patients who is expecting the birth of an additional child in 2-3 months time. The parents of this family will be asked if they are wiling to participate in the Pediatric Continuity Experience and given the information sheet regarding the program.
2. Once a family has been identified and agrees to being involved the program, the integrated resident will contact the family and arrange a pre-natal meeting for approximately one hour with the parents (a home visit). During this visit, the resident will interview the parents about:
   • Their previous parenting experience
   • Their expectations regarding the expected child
   • Their plans regarding the expected child including:
     • Their previous parenting experience
     • Their expectations regarding the expected child
     • Their plans regarding the expected child including:
3. The integrated resident will attend well-child visits of the child with the pediatrician from their birth onward.
   • The integrated resident will observe the well-child pediatric visit.
   ?
   • Following the visit, the integrated resident will spend an additional 15-30 minutes with the child and parents(s) during which time the resident may:
     • Continue to observe the child's behavior and the relationship between the child and parent(s).
     • Follow-up with the parent(s) about issues raised in discussion with the pediatrician
     • As the parent(s) to reflect on their experiences raising their children—both their experiences with their previous child(ren) and this new, youngest child.
     • Interact with the child in an age appropriate way.
4. Meet with the pediatrician twice a year to discuss the child’s development, the type of attachment developing between the child and parents, and any important behavioral issues the pediatrician has identified and addressed with the parents to assist the child.