Didactic Thematic Structures and Values of the Program
The bio-psycho-social-cultural model of mental illness provides the framework for the entire educational experience. The principles and application of evidence-based medicine are incorporated throughout the didactic and rotation-based seminars.
Psychotherapy, psychopharmacology, neurobiology/ neuropsychiatry, sociocultural dimensions of care, evidence-based medicine and critical thinking are major themes throughout the four years of didactics and clinical rotations. All seminars are intended to supplement the clinical training with theory and the research findings to support the best clinical outcomes possible.
PGY-1
In the Post-Graduate Year 1, residents participate in didactics along with the internal medicine and transitional interns for half of the year, learning about basic clinical medicine and preparing for Step 3 of the Boards.
In the second half of the intern year, PGY1 residents begin to meet with senior residents and faculty for psychiatry didactics one half-day per week. In the last three months of the PGY1 year, interns additionally meet for Wednesday didactics (in addition to the Tuesday afternoon didactics beginning in January) in the Department of Psychiatry.
Winter/Spring PGY1 Didactics
Introduction to Emergency Psychiatry and the DOC role
Intro to Psychopharmacology
Core topics in psychiatry (Depression, Personality Disorders, Trauma, Psychotic Disorders, etc)
Sociocultural Psychiatry
Couples and Family
Supportive Psychotherapy
Quality Improvement
Population Health
Preparing for clinical interviewing and CSV exams
Professional Identity Development: Transitioning from Physician to Physician/Psychiatrist
Preparation Seminar for the PGY-2 year (spring PGY1 year): Chief Residents
PGY-2
In the Post-Graduate Year 2, core courses include C/L Psychiatry, Psychopathology, Psychopharmacology, Psychotherapy, Journal Club, Grand Rounds, and T-Group.
In addition to core courses, a comprehensive seminar on rehabilitation and recovery for people with chronic and persistent mental illness introduces the residents to the possibilities of enhancing strengths and resilience to improve the lives of patients. Our forensics curriculum begins in the PGY2 summer with an introduction to core topics and continues in case conferences, an expert witness experience, advanced didactics, and elective experiences (e.g. at the Cambridge Court Clinic) in subsequent years. Residents also have an interdisciplinary Multicultural Seminar with Child and Adolescent Psychiatry Fellows and Psychology Interns. The practice of teaching within the clinical environment is introduced in the Resident as Teacher summer didactics series, and interested residents have many opportunities for teaching and medical education scholarship throughout residency.
PGY2 Didactics
Supportive Psychotherapy
Introduction to Formulation and Psychodynamic Psychotherapy
Intro to Addiction Psychiatry
Intro to Forensic Psychiatry
Rehabilitation and Recovery from Serious Mental Illness
Multicultural Seminar
Psychopathology
Psychopharmacology
Consult-Liaison Seminar
Journal Club
Resident as Teacher
T-Group
PGY-3
In the Post-Graduate Year 3, residents are introduced to the paradigms that we have used in psychiatry to understand human development and function. The Normal and Abnormal Child and Adolescent Development seminar provides a foundation for understanding the roots of childhood, adolescent, and adult behavior and psychopathology. The course is directed by a child psychiatrist who invites experts in the field of separation attachment, moral development, adolescent sexuality, childhood psychopathology and other critical issues in child development to enhance the seminar and showcase leaders in the field. Other seminars deepen the residents’ education in neuroscience, psychotherapy, and psychopharmacology. Shorter courses round out topics like spirituality, sexuality, and the history of psychiatry.
PGY3 Didactics
Human Development & Developmental Psychopathology
Psychotherapy Seminar:
- CBT
- Dynamic Therapy
- Group Therapy
Population Health and Quality Improvement
Psychopharmacology
Trauma Seminar/supervision
Brain and Behavior (PGY3 Neuroscience)
Journal Club
Forensic Psychiatry
Geriatric Psychiatry
History of Psychiatry
Psychology and Neuropsychological Testing
Sexuality and Psychiatry
Spirituality
Buprenorphine Training
Preparation Seminar for the PGY-2 year (spring PGY1 year): Chief Residents
PGY-4
In the Post-Graduate Year 4, seminars continue to enhance knowledge and practice in the areas of psychotherapy, psychopharmacology and neuropsychiatry. Residents may choose to pursue and deepen their knowledge in a specific area by enrolling in specialized seminars. A large number of elective seminars are open to trainees and staff at Cambridge Health Alliance. Residents may choose to acquire expertise in a specific area by becoming advanced trainees in specialized programs within our system, which offer didactics, supervision, and clinical experience. Examples of such programs are as follows:
- Outpatient Trauma Services (formerly Victims of violence program (VOV)), a nationally known program targeted towards treating trauma founded by faculty member Judith Herman, MD
- Program for psychotherapy (PFP), where residents treat patients with intensive psychodynamic psychotherapy
- Latinx, Portuguese, and Haitian Creole cultural treatment teams, which focus on bringing community-based care to particular non-English-speaking populations, addressing the nuances of treating patients of particular cultural and immigrant backgrounds
- Center for Mindfulness and Compassion (CMC), a specialty center dedicated to researching the impact of mindfulness interventions in a community-based setting, offering mindfulness-based groups for CHA patients and the larger community, and providing numerous community education programs, including a new fellowship for trainees
- Primary Care Behavioral Health Integration treatment teams, involving collaborative care within primary care clinics throughout CHA, using patient registries and care partners to help track population-based outcomes, provide short-term behavioral activation, and refer patients to appropriate specialty care when needed
- Center for Health Equity Education and Advocacy (CHEEA), which offers educational programs on health inequities to provide training and advocacy skills to improve health care, and is a growing hub for research on health equity education
- Health Equity Research Lab, an interdisciplinary group of researchers, clinicians, and community partners conducting research to improve physical and mental health and diverse communities
- Healthcare for the Homeless, a CHA interdisciplinary team which provides care in soup kitchens, drop in centers, or on the streets, and partners with human services agencies to provide mental health and other medical services to patients
The focus of the fourth year is integration of the biological, psychological and social aspects of mental illness into a comprehensive view of a person within the context of his/her/their biology, family, and community.
Core PGY4 Didactics
Advanced psychodynamic psychotherapy
Supervision Seminar
Neurobiology and Neuropsychiatry
Advanced Topics in Psychopharmacology
Transition to Practice
Advanced Couples and Family Therapy Seminar and Supervision
Ethics in Psychiatry
Psychiatry and Neurology Boards Review
Annual Observed Clinical Exams and ABPN Certification Exams: Core Faculty
Advanced Supervision in Trauma
Advanced Supervision in Psychodynamics or CBT
Biological Therapies and Neuroscience
This four-year sequence is designed to establish a solid base of knowledge in the areas of biologic therapy and neuroscience. In the PGY1, interns learn about the principles of psychopharmacology. In the PGY2 seminar, instruction is organized around the major classes of psychotropic medications. Other topics include drug interactions, toxicities, ECT, the use of medication in special patient populations, and psychodynamic issues in the practice of psychopharmacology. PGY1 residents experience a brief immersion in ECT and TMS treatment modalities at Beth Israel Deaconess Medical Center.
The PGY3 seminar focuses on medication management in the outpatient population. The major classes of medications are discussed with an emphasis on the literature supporting their use for specific diagnoses and conditions. The mechanism of action of these drugs is reviewed and the neurobiology of major psychiatric disorders presented. In an ongoing Journal Club, residents read relevant articles and learn to critically assess their value.
The PGY4 seminar features focused review of advanced resident case material, and residents also join our faculty psychopharm seminar.
The psychopathology, neurobiology and neuropsychiatry seminars provide a basic anatomical and neurobiological framework on which to place the clinical neuropsychiatric syndromes encountered by the residents in patients with complex medical and psychiatric disorders.
Psychotherapy Seminars
Psychotherapy is taught over the course of three years as a series of seminars that focus on clinical work at each stage of training. In the PGY2, when residents are primarily on inpatient units in an acute care setting, the focus of the seminar is on crisis management, alliance formation, and underlying dynamic processes in the patient-therapist relationship. In the first month of the seminar, the discussion centers on meeting and beginning therapy with outpatients. Subsequently, residents are asked to present transcribed material from inpatient cases or from their outpatient psychotherapy sessions. Adjunctive readings are assigned. The case-based format encourages residents to learn experientially about basic concepts of psychotherapy, such as transference, countertransference, resistance, and interpretation.
The PGY3 psychotherapy seminar introduces residents to a variety of therapeutic modalities while they are working on multidisciplinary outpatient treatment teams. Residents learn about cognitive behavioral therapy, dialectical behavioral therapy, and short-term therapy. They continue to deepen their understanding of dynamic psychotherapy with guided reading and case-based discussions. The two PGY4 psychotherapy seminars are advanced courses that introduce multiple theoretical perspectives and techniques. An integrative approach is emphasized in topics such as process and outcome research, models of brain/mind, and the interaction between psychopharmacology and psychodynamics. Case-based discussions with senior staff help the residents gain insight into their own therapeutic style. Residents with particular interests in psychotherapy also can obtain additional training in other psychotherapeutic modalities, such as MB-CT, trauma psychotherapy, and Internal Family Systems.
Over the span of three years, the resident emerges with a solid foundation in psychotherapy practice and theory as preparation for the further study of psychotherapy or for a career as a general psychiatrist.
Evidence Based Medicine/Research Seminar
Evidence Based Medicine, Journal Club and research seminars are woven throughout each of the 4 years of training. Residents learn to ground their treatment skills based on evidence-based medicine, and identify areas for further study through the critical reading of published research articles in the Journal Club. Residents are encouraged to find mentors in the areas of interest to begin thinking about the scholarly project that is required by the end of the program. While not all residents will choose to pursue clinical research in the fourth year, or afterwards, every resident will develop the skills required to be critical evaluators of research in order to bring the highest quality of care to their patients, and to develop the skills necessary for lifelong learning. A theme that is explored in various ways throughout the program is how best to deliver evidence-based, population-focused care to vulnerable populations, utilizing community resources and innovative paradigms of care to creatively meet patient needs.
As part of the residency experience, residents are required to engage in a Scholarly Project. In the past, projects have included review articles, pilot research studies, case reports, development of teaching materials and curriculum, presentations at national meetings, a literature review, participation in an ongoing research project, a teaching experience with written assessment and critique, amongst many others. Common areas of scholarship for residents include quality improvement, medical education scholarship, medical humanities, and social justice scholarship, in addition to traditional research. Research at CHA focuses on areas most relevant to our clinical populations, including health equity, addictions, mindfulness, early childhood development, and population health.