One of the benefits of starting our outpatient training in the second year is the ability to follow patients for up to three years. During the second year, residents are assigned a minimum of two individual supervisors. At least one of these has considerable psychodynamic or psychoanalytic training while the other is a more general psychiatrist. Second year residents also have Cognitive Behavioral Therapy supervision every other week. Additionally, residents work directly with attending supervisors on their clinical rotations.
Individual supervision of a trainee by a faculty member provides the psychiatric resident an opportunity to review in detail the patients with whom they are working. We find immediate feedback to be a major part of training and encourage residents and supervisors to review recorded psychotherapy sessions in supervision.
Our program offers the opportunity to explore diagnostic and treatment issues in the context of the systems, family, and experiences that the patient is coming from. We encourage residents to understand themselves and the role that they play in their patient’s care.
We believe that resident input is crucial to the smooth functioning of the program. After all, it is the resident who is closest to the experience. The Chief Residents are the principal liaisons between residents and faculty. As such, they also attend the monthly Education Policy Committee meeting and meet regularly with the Residency Director. Residents from all four years are active on our recruitment committee.
Our Annual Program Review Committee is made up of the residency director, associate directors, chiefs, select faculty, and residents. We review both written and verbal feedback of each aspect of our residency—from specific didactics to rotations to retreats. In fact, our Psychiatric Crisis Service Night Float Rotation was developed through a collaboration of residents and faculty. To date, the feedback has been that it is a very educational and enjoyable experience.
The Chief Residents meet with all residents weekly during the Resident Business Meeting (RBM). This is a time for the residents to get together for lunch and to stay up to date on residency happenings. Residents are encouraged to express any concerns they may wish to discuss with the chiefs during this meeting. Additionally, the residency and associate directors have lunch with each PGY class every quarter, and our chairman meets with residents quarterly.
The Psychiatric Crisis Service and Admission Center at the Milwaukee County Behavioral Health Division is an active emergency psychiatry intervention program with 11,000 visits per year. Residents learn how to make emergency and initial assessments, sharpen their diagnostic skills, and perform emergency recommendations for care.
This is the setting of our PGY3 night rotation, where residents spend three 1/2-month blocks. The night rotation is from Monday through Thursday, allowing the subsequent three days off. This is the only overnight in-house responsibility of residents.
PGY1 residents do not take overnight call on any psychiatry rotations. PGY2 residents do weekday “power shifts” from 6-10pm about once a month to help them prepare for the night rotation. A PGY4 works with the PGY2 resident on the first three power shifts and will continue if more supervision is needed. PGY2 and 3 residents provide pager backup to the VA about 11 nights a year and share pager responsibility with the other residents while on their consultation-liaison rotation.
Becoming an excellent psychiatrist does not happen easily. It takes hard work, sacrifice, and dedication. At the same time, we recognize that you need to develop yourself as a person and that you need time and energy to do that. For you, that may mean having time to spend with your family, or it may mean having the chance to connect with other residents in our experiential group. Or, it may mean using your $1,500 annual working condition fringe benefit money and $300 annual book fund to attend conferences or present posters or workshops. Psychiatry training can be intense, exciting, and fulfilling.