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 14 ten-hour shifts during the month, 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.
In the outpatient clinics, residents are scheduled cases on an every half hour basis or longer for new workups. Residents on inpatient and emergency room rotations are not on call in the department of psychiatry.
Residents complete two months of neurology in the first two years of training. Residents spend one month in the PGY1 year on the inpatient neurology service and one month in the PGY2 year on either the neurology consultation service or the neuropediatric outpatient clinic (child track), 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, infarcts, and plan for long-term treatment and rehabilitation.
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. Members of the psychiatric team see patients together or separately on daily work rounds, 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.
Residents learn how to present cases on call, 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 who joins rounds several times a week and runs an intern psychopharm crash course each July and August.
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 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 occur monthly. 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 regular members of the operations and quality inpatient committees. Discussions about the outcome of adverse events are a routine part of daily supervision.
ACGME competency and milestone assessments are assessed monthly in the PGY1 & 2 years and quarterly in the PGY3 & 4 years. Every year, residents complete one annual clinical skills examination (CSE) and one less formal CSE exam, both of which occur “in the workflow” and 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.
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 to other agencies and physicians. 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. The resident 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 month.
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, two 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 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 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 freestanding 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 home stay family and dedicated on-site staff. Uganda is generally viewed as a safe, politically stable country within the region of central Africa. Kampala, its largest city and the capital of the country, is situated at some distance from its borders where most of the unrest occurs, has a strong police presence, and has seen its crime towards tourists (most commonly, theft) drop substantially in recent years. We are in the second year of this rotation, and are in the process of establishing a mutually collaborative relationship with the psychiatry residency at Makerere University and with a local community outreach provider. Airfare, lodging, and transport are all covered and residents typically go in pairs starting in February or March of their PGY2 year.
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.
*Unfortunately, this rotation has been suspended since March 2020 due to COVID-19. We will resume this rotation as soon as it is safe.
Geriatric psychiatry teaching occurs across all four years of the curriculum, but is concentrated during a required month-long 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 and in two local nursing homes (Starr Farm and Green Mountain). Residents also spend time in the memory clinic and with a clinical neuropsychologist, where they learn both bedside cognitive and more formal neuropsychiatric testing.
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.
During this yearlong community assignment, residents gain improved competency in the evaluation, treatment, and long-term management of people who suffer from 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 Jessica O’Neil, DO, a member of the clinical faculty at UVM.
- 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) , this could include working with developmental services, adult outpatient services, providing consultations for primary care physicians and nursing home consultations, for example. The resident attends the daily crisis services meeting where cases are reviewed. There are opportunities for teaching and involvement in innovative projects (such as developing specialized groups). As a resident, you are a member of a multidisciplinary team and have the opportunity to interact with crisis clinicians, community support workers, and therapists. In addition, individual supervision is provided by Steve Sobel, MD to discuss cases, treatment planning and developments in the field relevant to those cases. In early 2020, NCSS started a Transcranial Magnetic Stimulation (TMS) program.
PGY3 residents spend approximately 1/2 day per week doing psychopharmacology evaluations and treatments in the Adult Psychiatry Clinic (APC) at the University Health Center. 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 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.
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 Clinic (PPC), 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 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, case managers, 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.
The required addiction psychiatry rotation in the PGY2 year occurs at the White River Junction VA. It is currently configured as a hybrid rotation: in person (one day a week) and remote (3.5 days a week). It is overseen by an addiction psychiatrist and fellows in the Dartmouth addiction fellowship. Residents unable to travel can do the on-site portion locally at our Day One chemical dependency program, buprenorphine clinic, or 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 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.
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 Given Health Center at UHC, Colchester Family Practice, and Timberlane Adult Primary Care Clinic in South Burlington. 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 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.
- Seneca Partial Hospital and Intensive Outpatient Program
- Mood and Anxiety Disorders Clinic
- Child Inpatient at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, NY
- Child Consultation Service
- Child Research
- Adult Research
- Human Behavioral Pharmacology Lab
- Forensic Psychiatry at Vermont Psychiatric Care Hospital (VPCH) in Berlin, VT
- Community Psychiatry
- Sleep Medicine at BLC VA
- Junior Attending, Inpatient Psychiatry
- Refugee Mental Health
- Junior Attending, Consultation Psychiatry