View an outline of the schedule for clinical rotations (PDF).
Clinical Rotation Descriptions
PGY1 residents complete four months of medicine: one month of inpatient medicine or pediatrics (for child track residents), one month of inpatient family medicine, one month in the Emergency Department, and one month of family medicine or pediatric selective. All medicine rotations (except for the family practice outpatient rotation in nearby Milton Vermont) are located at the UVM Medical Center Hospital in Burlington. When possible, these four months are scheduled in separate pairs to allow residents to maintain close contact with the Department of Psychiatry.
On inpatient rotations, residents work as a member of a house staff team with a caseload of 5-10 patients and accept admissions on a rotating schedule. There is no overnight call but there is weekend call on pediatric inpatient and 1 day off in 7 on inpatient medicine and family medicine. In the Emergency Department, residents see patients as they arrive, with an average of 8-10 patient assignments per 12-hour shift.
In the Emergency Department, residents work 16 ten hour shifts during the month which include day, evening and night shifts progressively scheduled. Psychiatry residents see a wide variety of patients and work side-by-side with the same EM physicians and staff with whom they will interact with during their future years of psychiatry call.
In the outpatient clinics, residents are scheduled cases on
Residents complete two months of neurology in the first two years of training. PGY1 residents are assigned to the neurology consultation and inpatient service, supervised by an attending neurologist in daily rounds. The resident attends neurology grand rounds and case conferences while on service as well as weekly neuroradiology rounds. Residents on this rotation gain experience in reading EEGs, MRIs, and CTs and perform extended neurological exams and lumbar punctures. Residents also learn how to medically manage acute cerebral hemorrhages and infarcts and plan for long-term treatment and rehabilitation. PGY2 residents complete a month of outpatient neurology in areas such as sleep medicine, neurophysiology, neuro-oncology, headache, and movement disorders.
Inpatient Psychiatry is a required nine-month rotation divided between the PGY1 and PGY2 years. It is located at UVM Medical Center Hospital on the Medical Center Campus in Burlington. Residents provide care for patients on two inpatient units, one 16-bed secure unit with a seclusion room and one 12-bed unit with lower acuity. Patients are treated in a multidisciplinary team model consisting of an attending, a resident (or an acting intern), a medical student, a social worker, a nurse, and several activity therapists. PGY1 and 2 residents are responsible for a maximum of 6 and 8 patients, respectively.
Clinical teaching is provided in several venues. On daily work rounds, members of the psychiatric team see patients together or separately and discuss findings from the interview afterward. Multidisciplinary team rounds occur daily and are sit-down rounds during which each discipline (nursing, activity therapy, medical, and social work) presents their observations, findings, and treatment recommendations for discussion. Residents lead these daily multidisciplinary rounds following a highly efficient format which was designed with assistance from students at the UVM business school. We recently have been piloting patient-centered rounds using open dialogue techniques, and will be assessing its efficacy and efficiency over the 2018-19 academic year.
Case presentation occurs with the admission of every new patient and at a specified weekly case conference in which an outside consultant comes in to interview and discuss a challenging patient. There is also a clinical pharmacologist from Albany College of Pharmacy joins rounds several times a week and runs an intern psychopharm crash course in July and August each year. We also have a full-time psychologist who works with patients individually, oversees group programming, and provides continuity across weekend.
There are three major learning tasks for residents on the inpatient service: acquiring a psychiatric knowledge base, becoming proficient at psychiatric assessment and treatment, and interacting well with patients and other members of the multidisciplinary team. These qualities are modeled well by five psychiatric hospitalists who love psychiatry, are intrigued by the challenges of complex patients, and feel privileged to teach residents and students. Thus, learning takes place by observing, practicing, reading, and teaching in a closely supervised environment.
Quality improvement and patient safety initiatives are an integral part of the culture on the inpatient service. Morbidity and mortality rounds are held monthly, the journal club is held weekly, debriefing sessions are held after every restraint or seclusion event and every patient fall. Staff meetings regularly review untoward events on the units. Residents are encouraged to join the operations and quality inpatient committees. Discussions about the outcome and adverse events are a routine part of daily supervision.
ACGME competency and milestone assessments are assessed monthly in the PGY1&2 years and three times yearly in the PGY3&4 years. An annual clinical skills examination (CSE) is held on the inpatient units in June and consists of two faculty members serving as examiners for each resident in the PGY1-3 years. These exams, which have replaced the oral board examination, are designed to give residents formative and summative feedback on their interview skills, oral presentations, and formulations/treatment plans. Less formal CSEs are conducted at least twice per year by individual faculty in the course of the everyday workflow in all residency years.
PGY1 residents spend one month on an emergency psychiatry rotation seeing patients in the Emergency Department with an attending who specializes in crisis intervention psychiatry. This rotation provides intensive clinical and didactic training in managing patients in crisis. Residents become competent in assessing patient safety, developing patient management strategies, and planning and implementing treatment, and working with crisis workers. Treatment modalities include crisis intervention, supportive psychotherapy, and consultation
PGY2 residents spend two or three months on the Psychiatric Consultation Service (PCS) in the general hospital on the Main Center Campus. Residents work closely with medical students, three psychiatry attendings (who alternate coverage of the service), and a master's level social worker to provide psychiatric consultation to other inpatient services, notably Nephrology, Oncology, Cardiology, Surgery, Pediatrics, Internal Medicine, and OB-GYN.
Bedside teaching complements a broad range of seminars, teaching rounds, and conferences which capture the breadth and depth of contemporary psychiatric consultation practice. Among other skills, residents will gain competence in assessing decision-making capacity, treating delirium, managing alcohol withdrawal
On this rotation residents also participate in the ECT service and can elect to participate in the telepsychiatry service.
Global Mental Health
PGY2 residents have the opportunity to do a month-long Global Mental Health rotation in Kampala Uganda. This unique experience is made possible through the Larner College of Medicine's Global Health partnership with the Western Connecticut Health Network, which supports a robust Global Health curriculum for medical students and residents in 5 specialties, including OBGYN, Family Medicine, Pediatrics, and Psychiatry. For this rotation, the clinical assignment occurs in two hospitals in Kampala: a psychiatry outpatient clinic at Mulago Hospital in Kampala, and at Butabika Hospital, Uganda's only national free-standing psychiatric hospital which is 20 km outside of Kampala. Attendings from Makerere University provide on-site supervision and residents debrief once a week with a supervisor in Vermont. Residents are closely mentored by their
Interested residents may continue a Global Mental Health elective in their PGY4 year either by returning to Uganda to complete a scholarly project or by working with the local refugee population in Burlington in collaboration with the UVM Psychology Department's Connecting Cultures program.
Geriatric psychiatry teaching occurs across all four years of the
Residents in the PGY3 year spend one day a week at one of three Community Mental Health Centers in Vermont: The Howard Center in Burlington, Washington County Mental Health Center located in Montpelier, and Northwest Counseling and Support Services located in St. Albans.
At the Howard Center, residents evaluate and
Northwestern Counseling and Support Services(NCSS) is located approximately 30 minutes north of Burlington, just off I-87 and is the designated community mental health agency for Franklin and Grand Isle Counties. NCSS provides psychiatric services to individuals experiencing a range of psychiatric disorders, focusing on those with serious mental illness and/or unable to obtain care in other outpatient settings due to their need for a comprehensive array of services. Resident involvement is tailored to the individual interests of the resident, as much as possible. In addition to working with our CRT population (those with severe and persistent mental illnesses such as schizophrenia
For their electives, residents may choose among: the Community Rehabilitation and Treatment program (CRT) which is similar to the Community Support Program at Howard; Community Developmental Services (CDS) which serves people suffering from developmental disorders and mental retardation; and Second Spring which is a recovery model residential program serving people with various combinations of serious illness who have become inappropriately stuck at intensive levels of service for lack of appropriate community resources.
PGY3 residents spend approximately 1/2 day per week doing psychopharmacology evaluations and treatments in the Adult Psychiatry Clinic (APC) or at the VA Burlington Lakeside Clinic. New patient evaluations are scheduled weekly, allowing residents to sharpen their diagnostic and treatment skills in an outpatient setting. Many patients will remain in the clinic for 1-2 years, giving residents a longitudinal experience in assessment and treatment.
Residents become proficient in
Psychotherapy training takes places in a variety of settings across all four years of the residency. The educational and clinical experiences are designed to promote competence in several psychotherapeutic modalities, including supportive psychotherapy, long-term psychodynamic psychotherapy, brief psychotherapies,
Psychotherapy seminars begin in the PGY1 year and continue longitudinally into the PGY4 year. Supervised individual psychotherapy begins in the PGY2 year, at which time each resident is expected to treat at least one outpatient in ongoing psychotherapy. Psychotherapy cases accrued during the second year continue into the PGY3 year, during which ongoing conduct of a minimum of four psychotherapies is required.
Weekly individual and group supervision sessions provide ample opportunity for residents to discuss and process their caseloads. Residents are encouraged to continue psychotherapeutic treatments and supervision through the PGY4 year. Residents also learn both individual and group CBT treatment either in the Mood and Anxiety Disorder Clinic or at the VA Burlington Lakeside Clinic. In either setting, they co-lead a weekly group and take on one time-limited CBT client at a time under the weekly supervision of experienced CBT supervisors.
Child and Adolescent Psychiatry
PGY3 residents spend one day per week working in the Pediatric Psychiatry Clinic, where they develop competence in the diagnosis and treatment of children and adolescents with emotional and behavioral concerns. This clinic receives requests for assessment and treatment from families and clinicians across Vermont, New Hampshire, and northeastern New York. In collaboration with the internationally acclaimed Vermont Center for Children, Youth, and Families (VCCYF), strong emphasis is placed on a family-based approach that involves multi-informant assessment of the child and his/her family using the empirically based Child Behavior Checklist (CBCL) with the current diagnostic system of DSM5.
In the PPC, residents develop competence in a broad spectrum of treatment approaches to children with highly complex psychiatric illnesses. They become adept at interacting with other members of the child's treatment team, including individuals from community agencies, schools, and primary care clinicians. Residents also observe and receive training in parental coaching methods and are referred parents from this clinic for individual assessment and treatment.
Residents develop competence in a broad spectrum of treatment approaches to children with highly complex psychiatric illnesses. Residents also encounter children and adolescents during their on-call experiences in the PGY1 through PGY3 years. Research opportunities are also available for residents. For more information on the child psychiatry fellowship and the combined
Burlington Lakeside VA Clinic (BLC) Track
PGY-3 residents on the VA track spend one year stationed in the Burlington Lakeside VA Clinic (BLC), a Community-Based Outpatient Clinic of the White River Junction VA. The BLC offers a wide variety of services to military veterans including Primary Care, Mental Health, Audiology, Cardiology, Sleep Medicine, and Physical Therapy. The UVMMC/VA Residency track provides comprehensive training in veteran-centered and evidence-based psychopharmacological and psychotherapeutic treatments for mental health conditions such as Posttraumatic Stress Disorder [PTSD]. On this
The overall goals of the UVMMC/VA Residency track are to provide training in several core-competencies ranging across patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Training in evidence-based psychotherapy treatment modalities (e.g., Cognitive Processing Therapy for PTSD, Acceptance and Commitment Therapy) includes weekly one-hour individual supervision and clinical case co-management with expert clinical psychologists. Residents may also participate and/or lead veteran-centered behavioral health groups.
The UVM/VA Residency Track trains psychiatric physicians to perform evaluations using history-taking, physical examination, mental status examination, rating scales, brief cognitive screening and more formal neuropsychiatric testing, neuroimaging studies, electroencephalogram, and laboratory tests. In the outpatient VA clinic setting, residents will build skills in
The required addiction psychiatry rotation in the PGY2 year at the White River Junction VA is described above. There, residents are trained by an addiction psychiatrist and fellows in the Dartmouth addiction fellowship. Residents unable to travel are offered a rotation locally at our local Day One chemical dependency program, buprenorphine clinic, and the Chittenden Center methadone clinic. During this one-month rotation, residents develop competence in diagnostic interviewing for substance dependence and abuse, treatment planning for initial rehabilitation; management of relapse; pharmacologic treatment for alcoholism; and diagnosis and treatment of opiate dependence. Residents become certified for buprenorphine treatment during their residency.
In addition, PGY4 residents are required to spend additional time in our Addiction Treatment Program (ATP) gaining advanced level expertise in substance use assessments, buprenorphine induction, and the management of complex addicted patients.
to Primary Care
PGY4 residents spend ½ day per week in one primary care setting to learn collaborative/integrative care models. Available settings include the Burlington Lakeside VA Clinic and the Given Health Center at UHC. During this advanced consultation month, residents learn to provide psychiatric consultation, education, and support to a primary care practice. This rotation offers the chance to care for outpatients with a diverse range of medical disorders (e.g., cancer, diabetes, congestive heart failure, thyroid disorder, and seizure disorder) who present with psychiatric manifestations. The resident will gain
- Seneca Partial Hospital and Intensive Outpatient Program
- Mood and Anxiety Disorders Clinic
- Child Psychiatry at Woodside Residential Treatment Center
- Child Inpatient at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY
- Child Research
- Adult Research
- Human Behavioral Pharmacology Lab
- Forensic Psychiatry at Vermont Psychiatric Care Hospital (VPCH) in Berlin, VT
- Community Psychiatry
- Sleep medicine and EEG
- Junior Attending, Inpatient Psychiatry
- Refugee Mental Health
- Junior Attending, Consultation Psychiatry
- Medication Side-Effect Clinic