Residents Meghan Musselman (left) and Kristina Cieslak (right) discuss their caseloads on the McLean Schizophrenia and Bipolar Disorders Unit, a major clinical rotation of the PGY2 year.

Residents Meghan Musselman (left) and Kristina Cieslak (right) discuss their caseloads on the McLean Schizophrenia and Bipolar Disorders Unit, a major clinical rotation of the PGY2 year.

PGY2: A New Beginning

The PGY2 year starts the formal full-time psychiatric training for the MGH-McLean psychiatry resident. The goal of this year is to establish a foundation of knowledge in the diagnosis and treatment of acutely and seriously ill psychiatric patients. Residents will become proficient in the assessment of patients in a variety of settings, and will become familiar with the fundamental treatment modalities now available to psychiatrists. Residents are assigned to a balanced set of core experiences. Throughout the year, residents attend core didactic seminars, training group and interdisciplinary case conferences to supplement their clinical experience. PGY2 Rotations are divided into four 3-month blocks, listed below.

Core Rotation – MGH Acute Psychiatry Service (Three months)

Residents rotate for three months through the MGH Acute Psychiatry Service (APS), a high-volume inner-city emergency service within the MGH Emergency Department. During this rotation, the resident will assess patients with acute psychiatric illnesses, and manage the early manifestation and disposition of cases to a variety of settings. Residents take three sets of week-long nightfloat during this rotation.

Core Rotation – Schizophrenia and Bipolar Program AB2 – McLean (Three months)

Residents rotate for three months at the McLean Schizophrenia and Bipolar Disorders Unit dedicated to the intensive treatment of severely ill inpatients with psychotic and affective disorders. During this rotation residents become familiar with extended treatment, in a biopsychosocial model, for patients recovering from an acute episode of illness. Residents learn psychopharmacologic management and case administration, and become familiar with individual, group, and family therapy under the supervision of full-time staff psychiatrists. In tune with the clinical, teaching and research mission of this unit, residents will have special didactics on psychotic disorders and case conferences.

Core Rotation – Community First (Six Weeks)

Residents spend six weeks based at the Erich Lindemann Mental Health Center (ELMHC), Boston’s Downtown Public Sector community resources facility. Residents work with clients in a homeless shelter for people with serious mental illness and have numerous experiences with the integration of mental health, substance abuse and medical treatment as needed by the homeless individual. This care is provided by a multidisciplinary team in which our residents participate as a member. Residents evaluate patients in crisis, perform evaluations and provide treatment in the shelter to facilitate ongoing care. This experience allows residents to work on multidisciplinary teams while becoming familiar with the interface between public agencies, federal agencies, the courts, other clinicians, and managed care systems.

Core Rotation – Inpatient Psychiatry MGH Blake 11 (Six Weeks)

Residents spend six weeks on this Resident-as-Teacher Rotation, providing clinical and educational oversight to the PGY1s, supervising, teaching, and coordinating daily activities. They also complete a Quality Improvement Project during the rotation.

Core Rotation – McLean Geriatrics (One month)

The rotation on the Geriatric Psychiatry Inpatient Service at McLean Hospital provides residents with clinical skills relevant to treating geriatric patients with dementia and other degenerative and neuropsychiatric illnesses. Most, if not all, patients have significant medical co-morbidity and residents learn to integrate biological, psychological, and sociocultural factors in caring for these complex patients. Residents are taught to gather, organize and integrate data into a comprehensive treatment plan. They also implement treatment and follow-up care as required. The training provides residents with opportunities to develop knowledge, clinical skills, sensitivity to cultural diversity, and professional principles.

Core Rotation – McLean Addiction (Two Weeks)

The rotation on the Proctor House I unit at McLean Hospital (Inpatient Unit of the Alcohol and Drug Abuse Treatment Program) provides residents with clinical skills relevant to treating acutely ill patients with alcohol and/or drug use disorders, often complicated by co-occurring psychiatric or medical conditions, in an inpatient setting. Residents learn to conceptualize alcohol and drug dependence in terms of biological, psychological, and sociocultural factors. They are taught to gather and organize data, integrate these data within a comprehensive formulation, formulate a treatment plan, and implement treatment and follow-up care as required. The training provides residents with opportunities to develop knowledge, clinical skills, sensitivity to cultural diversity, and professional principles.

Core Rotation – McLean Adolescent Acute Residential Treatment (Four Weeks)

The McLean Hospital Adolescent Acute Residential Treatment Program (ART) serves adolescents from the ages of 12 to 19 with a variety of emotional disorders. This includes mood disorders, anxiety, autism spectrum disorders, substance use disorders, as treatment for those with a persistent pattern of self-injurious or suicidal behavior. Adolescents are typically admitted to the ART program for approximately two weeks, and the heart of their treatment is their participation in our daily cognitive behavioral therapy milieu program. Over the course of their rotation, MGH/McLean residents work with members of a multidisciplinary team where they evaluate adolescent patients and work closely with their families. They are also immersed in a milieu therapy model that focuses on the transformative power of safety, containment, and prosocial behavior. Residents co-lead psychotherapy groups including both skills-based groups and more traditional process-oriented groups. On this rotation, residents learn about childhood development, how to identify primary mental illness in childhood and adolescence, and how to deploy evidence-based treatments to adolescents across multiple different diagnostic categories.

Outpatient Psychiatry, 6 hours weekly Core Experience:

PGY2 residents spend one afternoon per week treating outpatients and providing both individual psychotherapy and psychopharmacologic treatment. Residents choose either MGH or McLean for their outpatient clinic site. Residents typically carry a caseload of 6-7 patients throughout the year, including 1-2 weekly therapy cases. Residents spend an average of 3 hours weekly seeing outpatients, and have 3 hours weekly of supervision related to their outpatient practice.

Core Didactic Curriculum

These seminars are held throughout the year on Wednesdays from Noon – 5:00 pm, and rotate between the MGH and McLean Hospital campuses every six months. Residents are protected from clinical responsibilities during this time.The required seminars for the PGY2 year are comprehensive, extending over the entire year. Speakers are leaders in their fields, exposing residents to current research and theory as applied to everyday clinical situations. Topics include introductory and basic psychodynamic psychotherapy, neuroscience, scholarly activity, human development, child psychiatry, medical ethics, case formulation, forensic psychiatry, and an introduction to cognitive behavioral therapy and group therapy. Residents from all classes interact together during the noon hour for the Resident Association Meeting, meetings with the training director or Chief of Psychiatry, or Journal Club. All classes have a training group prior to the start of the afternoon seminars.

Call Obligations

The on-call system is primarily night float for PGY2 residents at both MGH and McLean.

PGY2 Timeline

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As a resident on the Schizophrenia and Bipolar Disorder Unit, I have the privilege to work with patients with first-break psychosis, delirious mania and bipolar depression. I learn from my patients, their families, and the talented and accessible clinicians at McLean. Meghan Musselman, Class of 2019