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| Department of Behavioral Medicine and Psychiatry General Psychiatry - Didactic Experience The primary focus of the training program is education. The clinical experiences are paralleled by a comprehensive didactic curriculum that serves to prepare residents for clinical practice and for passing the national boards examination. The curriculum has been carefully designed with five goals in mind: 1) offer residents a progressive educational experience that provides the basics first, then advances them through a detailed understanding of all aspects of psychiatry as a discipline; 2) offer a variety of teaching settings that meets each residents unique manner of learning to include individual and group sessions, case conferences, video presentations and formal lectures, among others; 3) match best outcomes data that shows concurrent (versus consecutive) topic presentation results in better long-term retention; 4) ensure an environment of learning that absolutely supports attendance and participation in the curriculum by all residents; and 5) strive for excellence in residency measures of education to include, for example upper tier in-service exam scores and 100% boards pass rates. The curriculum content, schedule, attendance rates, faculty and guest speakers, and exam scores are continuously monitored so that the overall curriculum adjusts to the needs of the residents. A corollary component of the education curriculum is the resident role in teaching others. All residents serve to work with and teach other students during clinical rotations. In addition, upper-level residents support the formal curriculum by teaching first year residents in select courses. Teaching is itself taught by nationally-recognized Teaching Scholars faculty so that residents receive feedback regarding their content development, organizational, and presentation skills. Resident teaching excellence is showcased through several annual departmental awards. - Didactic Descriptions This seminar introduces the importance of developing a differential diagnosis based on the DSM IV diagnostic categories. Select adult and child disorders are discussed to illustrate the proper use of the DSM system and to learn criterion-based diagnosing. The mental status examination is also emphasized. Psychodiagnostic tests are reviewed. Incorporation of investigational information into the biospsychosocial model and formulation prepares residents for appropriate clinical care. Readings are from DSM-IV in Clinical Practice. Emergency Psychiatry and Crisis Intervention These seminars provide an orientation to emergency psychiatry and the diagnosis and management of substance-related disorders, the acute management of violent behaviors, the assessment of suicide, the ethical and legal ramifications of crisis situations, and the evaluation of medical illnesses that present as psychiatric emergencies. Introduction to Psychopharmacology The pharmacology of all classes of psychotropic medications is presented with an emphasis on practical issues regarding their clinical use. Additionally, synaptic physiology, drug interactions, pharmacokinetics, and therapeutic drug monitoring is covered. Residents learn about informed consent, compliance, and the right to refuse medications. Current research is discussed. The primary text is Stahl=s Essential Psychopharmacology. Psychotic Disorders These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of psychotic disorders including schizophrenia, schizoaffective and psychotic disorders due to medical conditions. Residents learn methods to accurately diagnose and apply a biopsychosocial model of treatment. Medications in several classes, including typical and atypical agents, are discussed with regard to dose, adverse effects, appropriate labs to follow, and expected outcomes. Augmentation strategies are reviewed. Recent research is covered. Substance-Related Disorders These seminars comprehensively review the epidemiology, diagnosis and management of substance-related disorders, including alcohol, benzodiazepines, cocaine, opioids, cannabis, nicotine and hallucinogens. Various invited guest lecturers as well as updated information regarding substance abuse, dependence, detoxification and rehabilitation is included in the course material. Cognitive Disorders (part of Neuroscience series) These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of cognitive disorders including dementia, delirium, and amnestic disorders. Residents learn methods to accurately diagnose and to apply a biopsychosocial model to treatment. Psychological testing instruments are discussed. Medications in several classes, including anticholinesterase inhibitors, are reviewed with regard to dose, adverse effects, appropriate labs to follow, and expected outcomes. Augmentation strategies and social implications are reviewed. Recent research is covered. Mood Disorders These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of mood disorders including depression, bipolar disorder, dysthymia and cyclothymia. Residents learn methods to accurately diagnose and to apply a biopsychosocial model to treatment. Medications in several classes are discussed with regard to dose, adverse effects, appropriate labs to follow, and expected outcomes. Augmentation strategies are reviewed. Recent research is covered. Anxiety Disorders These seminars provide an in depth study of the DSM-IV symptoms and management of anxiety disorders, such as posttraumatic stress, obsessive compulsive, panic, acute stress, and generalized anxiety disorders. Theoretical conceptualization of these disorders is discussed. Residents learn common methods Child and Adolescent Disorders & Abuse and Neglect These seminars focus on the epidemiology, assessment, diagnosis, and short and long term management of childhood and adolescent disorders including attention deficit hyperactivity, conduct, learning, pervasive developmental, mood, and anxiety disorders. Diagnosis and management of mental retardation is covered. Additionally, this series presents information about abuse and neglect. Residents learn interview techniques to develop an alliance with children, to work with families, and how to integrate into social systems to produce positive outcomes. Common diagnostic assessment instruments are introduced. Pharmacological and specific therapies are discussed relative to childhood illnesses. Guest speakers employ a range of teaching techniques including role-playing, lectures, group-based learning, and case studies. Medical Ethics These seminars review the American Psychiatric Association’s Principles of Ethics with Special Annotations for Psychiatry and the American Medical Association’s Code of Ethics. Case studies provide residents with examples of ethical dilemmas commonly encountered and provide a guide to appropriate clinical practice. Internal Medicine Grand Rounds These weekly conferences provide residents a forum to learn about contemporary issues in medicine. The presentations are often made by nationally recognized speakers. Neurology Grand Rounds These weekly conferences provide residents a forum to learn about contemporary issues in neurology. The presentations are often made by nationally recognized speakers. Internal Medicine Didactic Series These seminars present residents with information about internal medicine. Neurology Didactic Series These seminars present residents with information about neurology. Family Medicine Didactic Series These seminars present residents with information about family medicine. Emergency Medicine Didactic Series These seminars present residents with information about emergency medicine. Psychiatry Journal Review These conferences teach residents to critically assess the scientific literature. Interpersonal and communication skills, are learned while residents gain experience and appreciate the importance of practice-based continuing education. Special Child Topics These conferences allow for the discussion of unique topics in child and adolescent psychiatry. Residents may suggest topics of interest. The informal setting affords residents an opportunity to share intriguing cases derived from inpatient and outpatient experiences, ideas, or research interests. Administrative Conference These conferences allow residents to engage in discourse about a range of contemporary administrative and practice management topics. Topics include business development, setting career goals, finding a mentor, and the process of legislative change. Leadership qualities, professionalism, ethical behavior and understanding organized health-care systems are emphasized. Psychiatry Grand Rounds These weekly conferences provide residents a forum to learn about contemporary issues in psychiatry. The presentations are often made by nationally recognized speakers. Residents present twice during the training program, allowing for experience in educating others and to augment the practice-based learning. Peer review is an important component of feedback. Clinical Case Conference These interactive conferences provide residents with practical exposure to the assessment and management of adult problems. Residents present a case and pose pertinent clinical questions about adult issues. Faculty interview or demonstrate methods of interviewing a patient followed by a resident-guided discussion among peers and faculty to address the queries originally posed. This conference augments information provided in the associated seminar series. The conferences also provide residents with practical exposure to the assessment and management of childhood and adolescent problems. Residents present a case and pose pertinent clinical questions about childhood and adolescent issues. Faculty interview or demonstrate methods of interviewing a patient followed by a resident-guided discussion among peers and faculty to address the queries originally posed. This conference augments information provided in the associated seminar series. Consultation Liaison Case Conference These interactive conferences provide residents with practical exposure to the assessment and management of a range of psychiatric consultation problems. Residents present a case or specific problem and pose pertinent clinical questions. Faculty interview or demonstrate methods of interviewing a patient followed by a resident-guided discussion among peers and faculty to address the queries originally posed. This conference augments information provided in the associated seminar series. Psychotherapy Case Conference These interactive conferences provide residents with practical exposure to the assessment and management of psychotherapy cases. Residents present a case and pose pertinent clinical questions about a range of psychotherapy issues. Faculty interview or demonstrate methods of interviewing a patient followed by a resident-guided discussion among peers and faculty to address the queries originally posed. This conference augments information provided in the associated seminar series. Special Adult Topics These conferences allow for the discussion of unique topics in adult psychiatry. Residents may suggest topics of interest. The informal setting affords residents an opportunity to share intriguing cases derived from inpatient and outpatient experiences, ideas, or research interests. Mock Oral Interview These conferences provide residents with an opportunity to observe and practice structured interviews and formulate presentations in preparation for oral boards examination. Faculty and peer feedback assists in skill development. Scholarship Retreat This annual retreat, a component of the scholarship requirement, provides residents with a broad exposure to research principles. Residents hear from invited speakers about research methodology and are invited to discuss their own research ideas. All residents are then matched with faculty with on-going studies to begin a course of research design, development, implementation and eventual completion by the end of training. Somatoform and Factitious Disorders and Malingering These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of somatoform and factitious disorders. Residents learn methods to accurately diagnose and distinguish between factitious disorders and malingering. The significance of a biopsychosocial approach is emphasized as a model of treatment. Psychotherapeutic modalities and medications in several classes are discussed with regard to dose, adverse effects, appropriate labs to follow, and expected outcomes. Recent research is covered. Personality Disorders These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of personality disorders from clusters A, B, and C for example, schizoid, borderline, and avoidant. Residents learn methods to accurately diagnose and to apply a biopsychosocial model to treatment. The appropriate psychotherapeutic means to manage these disorders is emphasized (including issues of transference and countertransference) while evidence-based support for medications in several classes are also discussed. Recent research is covered. Dissociative, Impulse Control and Adjustment Disorders These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of three distinct disorder categories: dissociative, impulse control and adjustment disorders. Residents learn methods to accurately diagnose and clarify these disorders. They learn to apply a biopsychosocial model to treatment. Medications used to manage these disorders are discussed with regard to dose, adverse effects, appropriate labs to follow, and expected outcomes. Social and safety factors are also reviewed. Recent research is covered. Eating Disorders These seminars provide an in-depth study of the DSM-IV diagnostic symptoms and management of anorexia nervosa, bulimia nervosa, and other eating disorders. Case examples illustrate the clinical presentation of these disorders. Particular emphasis is placed on the assessment and management of physical complications associated with eating disorders especially anorexia nervosa. The basics of a cognitive behavioral perspective on these disorders are reviewed. The course also covers what mental health providers need to know about obesity, and how they may integrate their services with other providers. Attention is given to psychiatric presurgical evaluations of candidates for bariatric surgery. Sexual and Gender Identity Disorders These seminars provide an overview of the DSM-IV criteria for sexual and gender identify disorders, including sexual dysfunction and paraphilias. Residents learn to develop a differential diagnosis, then to apply an empirically supported treatment plan. The changing historical, social and cultural concepts of normal and abnormal human sexual behavior and attitudes are discussed. Sleep Disorders (part of Neuroscience series) These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of sleep disorders including sleep apnea and parasomnias. Residents learn methods to accurately diagnose and learn to use sleep and other diagnostic studies. Appropriate medications are also reviewed as are the psychosocial and environmental principles of sleep management. Recent research is covered. Advanced Psychopharmacology These seminars provide residents a forum for group-based learning in the integration of conceptual materials derived from the principle Diagnostic and Management series and Introduction to Psychopharmacology seminars. Investigational research, advanced neurochemistry principles, adherence to treatment, the role of the Federal Drug Administration, and the use of medication algorithms supported by evidence-based literature are covered. Electroconvulsive Therapy and Somatic Therapies This didactic offers a complete understanding of electroconvulsive therapy, including history, theory, technique and patient management. Other somatic treatments such as light therapy are also covered. Cultural Diversity These seminars provide residents an overview of the major cultural aspects of psychiatric care and role of mental health in society. The rich spiritual traditions are reviewed as are gender, sexual, and minority subcultures. Emphasis is placed on the regional Appalachian subculture that residents may encounter in clinical care. Residents learn to take a cultural, sexual and spiritual history. Child, Adolescent and Adult Development These seminars introduce residents to a broad range of developmental theories along the life-continuum. Theories discussed include those associated with Piaget, Freud, and Erickson. Residents learn to discern normal from abnormal development and incorporate this understanding into the psychosocial case formulation and patient care. Principles of Psychotherapy These extensive seminars introduce residents to the fundamentals of psychotherapy that lay the groundwork for different schools including psychodynamic, cognitive behavioral, brief, supportive, combined, crisis, family, couples and group therapies. The series is taught through consecutive modules that include interviewing skills, verbal response modes, working alliance, indexing patterns, change, resistance, transference and countertransference. Residents learn to integrate knowledge of the mental status examination, case formulation, and appreciation of cultural concerns as a part of this course. Residents build skills through interactive methods, work assignments, and observation while they begin to understand self-assessment and personal attitudes that effect patient care. Geropsychiatry and Bereavement These seminars offer a review of the important social aspects of managing older patients. The role of families and other care-givers within complex social systems that include in-home services and residential and nursing home facilities are discussed. Topics also include common psychiatric and comorbid illnesses, abuse and neglect of adults, and dignity and end-of-life concerns. Issues of bereavement and stages of grief are also covered. Research Methods These seminars provide an overview of research methodologies including the development of hypotheses, study design, application of review board approval, literature review, statistical analysis, and result interpretation. Residents learn to critically appraise the quality and value of scientific literature. Neuropsychological and Psychological Testing These seminars review the use of common objective and subjective neuropsychological and psychological instruments such as the MMPI-2 and Wechsler scales. The neuropsychological assessment, psychometric methodology, and research issues are discussed. Residents learn to administer and appropriately interpret common tests through demonstration and practice. Residents discover how and when to refer for advanced studies and integrate the reported results into clinical care. Principles of Neuroimaging (part of Neuroscience series) These seminars focus on the physical basis, indication and evaluation of neuroimaging including CT, MRI, SPECT and PET. Residents learn about the scientific basis and clinical application of evolving treatment modalities such as deep brain stimulation, transcranial magnetic stimulation, and vagal nerve stimulation. Legal Psychiatry These seminars discuss the fundamental areas of forensic psychiatry. Topics include competency to stand trial, criminal responsibility, sex offenders, malingering, involuntary hospitalization, professional misconduct, disability, child custody, termination of parental rights, confidentiality, informed consent, right to treatment, right to refuse treatment, and others. A special focus is on the assessment and management of suicide and violence. Administrative Psychiatry and Practice Management In these seminars residents learn the fundamentals of career development in various practice formats such as private practice and academics. Financial issues, malpractice, time-management, utilization review, quality assurance and performance improvement are among the topics discussed. History of Psychiatry Residents receive a full study of the rich history and traditions of the field of psychiatry. The seminar includes a survey of psychotherapeutic theories and their founders including Freud, Sullivan and Klein, among others. The chronological progression of the field in medicine and society is presented so residents may appreciate past struggles and accomplishments and be prepared to lead the discipline into the future. Board and PRITE Review This conference series prepares residents for standardized examinations via extensive review of the subjects assessed on national tests. The American Psychiatric Association’s Practice Guidelines are an important resource in the conferences. The peer-group forum also offers an opportunity for teaching experience and learning to provide constructive feedback. Neuroscience These seminars review the assessment, differential diagnoses, and appropriate management of common neurological disorders. The seminars highlight the psychiatric manifestations of neurological conditions. Topics include encephalopathies, dementias, epilepsy, headaches, cerebrovascular events, and movement disorders. Cognitive and Behavior Therapy These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in cognitive and behavioral therapies. Residents are introduced to learning theory, information processing theory, and behavioral therapy and cognitive therapy principles. Residents learn to set goals, structure sessions and apply advanced cognitive behavioral techniques to specific disorders. Techniques taught include evaluating automatic thoughts, management of anxiety, relaxation and exposure techniques and patient self-study, among others. Brief Therapy These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in solution-oriented and brief therapies. Residents learn about eliciting patient requests, negotiating goals, and setting time-sensitive objectives. Specific issues such as bereavement, loss, and acculturation problems are addressed. Supportive Therapy These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in supportive and crisis-oriented therapies. Residents learn how to identify patient strength and weaknesses, to assist in the safe confrontation of social and interpersonal problems, and to buttress a patient’s psychosocial network of support. Risk assessment is addressed. Other Therapies (Couples, Family, Group, Interpersonal, Gestalt, Dialectical) These advanced seminars, a broad collection of didactics, focus on the conceptual material and skill development necessary to achieve competency in a variety of therapies that include: couples, family, group, interpersonal, gestalt, and dialectical therapies. Hypnosis and biofeedback are also discussed. Presentations are offered by several faculty who implement a range of teaching techniques to enhance resident understanding. Select readings reduce this seminars’ extensive scope to highlight specific areas of focus (for example communication skills in couples therapy or exploration of repetitive patterns in interpersonal therapy) to facilitate the application of acquired knowledge and attitudes in clinical practice. Combined Psychotherapy and Psychopharmacotherapy These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in the integration of therapy with medication management. Residents learn about the outcome advantages of combined approaches, effective documentation, communication skills with other providers in dual therapy, issues of compliance, and begin to appreciate the social nuances of restricted formularies, third-party payers and managed care. Psychodynamic Therapy These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in therapeutic relationships and dynamic psychotherapies. Residents learn to identify appropriate candidates for success. Topics of discussion include defense mechanisms, transference, countertransference, resistance, and interpretation. Readings include integration of theory, neurosciences, development and pathology. Experiential assignments foster explicit and implicit learning. Video Conference This series offers an audiovideo medium for learning about various topics pertaining to psychiatry. Research Update This series allows a forum for residents to present updates regarding their research endeavors and will allow for faculty support of their work. The group setting will foster research interest while promoting translational cooperation of ongoing and new research initiatives. - Typical Didactic Schedule
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