Medicine
PGY1 residents complete four blocks of medicine: one block of inpatient medicine or pediatrics (for child track residents), one block of inpatient family medicine, one block of emergency medicine, and one block of outpatient family medicine or pediatrics. 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 blocks 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 patient caseload 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.
On the emergency medicine service, residents work 16 ten-hour shifts during the block, which include day, evening and night shifts. 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.
Residents on inpatient and emergency medicine rotations are not on call in the department of psychiatry.
Neurology
Residents complete two blocks of neurology in the first two years of training. Residents spend one block in the PGY1 year on the inpatient neurology service and one block in the PGY2 year on the neurology consultation service. 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, infarcts, and plan for long-term treatment and rehabilitation.
Inpatient Psychiatry
Inpatient Psychiatry is a required nine-block rotation divided between the PGY1 and PGY2 years. It is located at UVM Medical Center 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 clerkship medical student, a social worker, a nurse, and several group therapists. PGY1 and 2 residents are responsible for caring for a maximum of 6 and 8 patients, respectively.
Clinical teaching is provided in several venues. Members of the psychiatric team see patients together or separately on daily work rounds, and discuss findings from the interview. Multidisciplinary team rounds occur daily.
There are three major learning tasks for residents on the inpatient service: (1) acquiring a psychiatric knowledge base, (2) becoming proficient at psychiatric assessment and treatment, and (3) collaborating with patients and their families, community providers, and other members of the inpatient multidisciplinary team. These qualities are modeled by psychiatric hospitalists who are passionate about 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 supervised environment.
Quality improvement and patient safety initiatives are an integral part of the culture on the inpatient service. Morbidity and mortality rounds occur quarterly. Resident journal club is held regularly. Staff meetings regularly review and debrief safety events on the units. Discussions about the outcome of adverse events are a routine part of daily supervision.
ACGME competency and milestone assessments are assessed by block in the PGY1 & 2 years and quarterly in the PGY3 & 4 years. Annually, residents complete one clinical skills examination (CSE) and a clinical skills verification (CSV) is completed as a PGY2, 3, & 4 – all of which are conducted by individual faculty. CSE’s, 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.
Emergency Psychiatry
PGY1 residents spend one-to-two blocks on the 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, planning and implementing treatment, and working with crisis staff. Treatment modalities include crisis intervention, supportive psychotherapy, and consultation to other agencies and providers. On this rotation, residents learn the legal aspects of Vermont's involuntary hospitalization proceedings and have substantial exposure to the functioning and resources of the community mental health center as well as the community at large. Senior residents also have the option to visit various community sites (homeless shelters, walk-in medical clinics, respite beds, detox center, community mental health facilities, the state hospital, and a group home) with half-day excursions scattered throughout the block.
Consultation/Liaison Psychiatry
PGY2 residents spend two or three blocks on the Psychiatric Consultation Service (PCS) in the general hospital on the Main Center Campus. Residents work closely with medical students, psychiatry attendings (who alternate coverage of the service), and a licensed social worker to provide psychiatric consultation to other inpatient services.
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 and substance intoxication, and assessing suicide risk. Types of treatment include supportive and brief psychotherapy, family and team interventions, and pharmacologic consultation.
On this rotation, residents also participate in the ECT service.
Global Mental Health
PGY2 residents have the opportunity to do a four-week block-long Global Mental Health rotation in Gaborone, Botswana. For this rotation, the clinical assignment occurs in outpatient clinics, community settings, and Sbrana Hospital, the large national referral mental health hospital in Lobatse, an hour outside of Gaborone. Attendings from the University of Botswana provide on-site supervision, and residents attend didactics with University of Botswana residents. Botswana is generally viewed as a safe, politically stable country within the region of southern Africa. Gaborone is the largest city and the capital of the country. We are in the third year of this rotation and are in the process of establishing a bi-directional exchange with the University of Botswana residents coming to the University of Vermont. Airfare from New York City and lodging are all covered and residents typically go in pairs starting in February of their PGY2 year.
Interested residents may continue a Global Mental Health elective in their PGY4 year either by returning to Botswana 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
Geriatric psychiatry teaching occurs across all four years of the curriculum but is concentrated during a required block rotation in the PGY2 year. During this time, residents see patients under the supervision of a geriatric psychiatrist for evaluation and treatment in the outpatient clinic, on the consultation service at Champlain Valley Physicians Hospital (CVPH), and in a local nursing home with the geriatric medicine service (Birchwood). Residents also spend time in the memory clinic where they learn both bedside cognitive and more formal neuropsychiatric testing.
Community Psychiatry
Residents complete their Community Psychiatry rotation either during their PGY3 or PGY4 year. Current community sites include The Howard Center in Burlington or Washington County Mental Health Center located in Barre.
During this yearlong community assignment, residehts gain improved competency in the evaluation, treatment, and long-term management of people who experience severe and persistent mental illness. They also learn about the systems of care for these individuals that currently exist in Vermont and develop the ability to coordinate care within that system. Residents who have a special interest in this area of psychiatric practice also have the opportunity to return for elective time in the PGY4 year.
- At the Howard Center, residents evaluate and offer follow up psychiatric treatment to patients who are enrolled in the Community Support Program. This program is designed for people who suffer from a serious mental illness (such as schizophrenia and other psychotic disorders) and also have significant impairment in functioning. This is a community-based program staffed by case managers, vocational specialists, and support workers. It is a progressive recovery focused program and the resident is considered an integral part of the interdisciplinary team. In contrast to the experience of working on an inpatient unit when people are more acutely ill, this is an opportunity for residents to learn more about working with individuals when they are residing in the community. Residents have the opportunity to do community outreach as the need arises. Residents at the Howard Center work closely with and are supervised by the Howard Center medical staff, all of whom are clinical faculty members in the Department of Psychiatry.
- At Washington County Mental Health Center, residents spend ½ of their day working in the Adult Outpatient Program (AOP), and ½ in an elective from among the programs at WCMH. The AOP sees patients who do not meet CRT or DS criteria and yet are indigent and suffering functional impairment from one or more of the following: anxiety, depression, substance abuse, psychological effects of trauma, personality disorder, TBI, milder developmental disorders and various medical problems. Residents will work closely with the individual therapists of patients referred to them by those therapists, manage their own schedules, and have opportunity to develop their independent evaluation, treatment, and case coordination skills. Supervision is provided by Karin Reed, MD.
Adult Outpatient Psychiatry
PGY3 residents spend approximately half-day per week doing adult psychiatric evaluations in the Adult Psychiatry Residency Clinic (APRC) at 1 South Prospect Street. New patient evaluations are scheduled weekly, allowing residents to sharpen their diagnostic and treatment skills in an outpatient setting.This clinic consists of both patients who are seen longitudinally and those who require a one-time consultation. Additionally, residents have a dedicated half-day for psychopharmacology-focused evaluations and follow-up.
Residents become proficient in pharmacotherapy of illnesses commonly seen in outpatient clinics, such as mood and anxiety disorders, psychosis, and attention-deficit disorders. In addition to this clinical experience, there is a group supervisory/advanced psychopharmacology didactic for PGY3 and 4 residents which provides a weekly opportunity for residents to present cases, discuss journal articles, and hear presentations from faculty on advanced psychopharmacologic topics.
Adult Psychotherapy
Psychotherapy training takes place 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, cognitive behavioral psychotherapy, and combining psychotherapies with pharmacotherapy.
Psychotherapy seminars begin in the PGY1 year and continue longitudinally through the PGY3 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. PGY4 residents are encouraged to continue to develop their psychotherapeutic skills and possibly pursue additional training in a therapy modality of their preference.
Child and Adolescent Psychiatry
PGY3 residents spend one day per week working in the Pediatric Psychiatry Residency Clinic (PPRC), 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 PPRC, 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 providers. Residents also observe and receive training in parent 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. For more information on the child psychiatry fellowship and the combined 5 year adult/child and adolescent psychiatry track, visit the Child and Adolescent Fellowship training website.
Burlington Lakeside VA Clinic (BLC) Track
PGY-3 residents on the VA track spend two days a week for 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 Post-traumatic Stress Disorder [PTSD]. On this rotation residents work as part of an interdisciplinary team consisting of psychiatrists, physicians assistants, psychologists, licensed clinical social workers, licensed alcohol and drug counselors, and peer support specialists.
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 management of symptoms and behaviors related to PTSD, dementia, mood, psychotic, anxiety, sleep, and substance use disorders through practice of psychopharmacology and psychotherapy. Residents will focus on caring for our veterans through stabilization and amelioration of their mental health conditions, with the goal of improving functioning and quality of life.
Addiction Psychiatry
The required addiction psychiatry rotation in the PGY2 year occurs at the White River Junction VA. It is an in-person rotation (three-days a week in White River Junction and one day at Burlington VA Community Based Outpatient Clinic) with a half-day dedicated to independent study. It is overseen by an addiction psychiatrist and fellows in the Dartmouth addiction fellowship. During this one-block rotation, residents develop competence in diagnostic interviewing for substance use disorders, treatment planning for initial rehabilitation; management of relapse; and treatment of substance use disorders.
In addition, PGY4 residents can spend additional elective time in our Addiction Treatment Program (ATP) gaining advanced level expertise in substance use assessments, buprenorphine induction, and the management of complex addicted patients.
Consultation to Primary Care
PGY4 residents spend a half day per week in one primary care setting to learn collaborative/integrative care models. Available settings include internal and family medicine sites in Burlington, Colchester, Essex, or South Burlington. During this advanced consultation block, 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 better understanding of the potential for psychiatric conditions to precipitate and/or exacerbate medical illness and will train residents to be clinician-educators within a busy primary care clinic.
Psychiatry Electives
- Seneca Partial Hospital and Intensive Outpatient Program
- Mood and Anxiety Disorders Clinic
- Electroconvulsive Therapy (ECT) & Transmagnetic Stimulation (coming soon)
- Child Inpatient at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY
- Child Consultation Service
- Child & Adult Psychiatry Research
- Addiction Research
- Forensic Psychiatry with individual assessments
- Community Psychiatry
- Junior Attending, Inpatient Psychiatry
- Neuropsychiatry
- Refugee Mental Health
- Junior Attending, Consultation Psychiatry
- Suicide-focused care at the ASHA Clinic
- Comprehensive Pain Program
