Electives: Didactic

RESIDENT’S JOURNAL CLUB

Contact: Jordan Smoller, M.D.

724-0835; [email protected]

Duration: Twelve months, once/month. In the past, the journal club has been held during Wednesday (seminar day) lunch and lunch has been provided.

Educational Goals: Residents will learn how to evaluate critically the psychiatric research literature through a discussion of resident-selected original research articles. Residents will learn and discuss:

1. Critical skills that are useful in evaluating the medical and psychiatric literature.

2. Basic principles of study design and analysis.

3. New findings in psychiatric research as reflected in the articles selected for discussion.

4. Issues involved in translating research findings into clinical practice.

Course Description: The journal club meets as a monthly one-hour meeting. An initial didactic session covering principles of interpreting studies in psychiatry is presented by Dr. Smoller. Thereafter, a pair of residents will be responsible for selecting and distributing an article of their choosing in advance of the monthly journal club.

Expectations: Residents will volunteer to present an article in pairs. The presenting pair will be responsible for distributing the article. Dr. Smoller will assist in identifying suitable discussants. Residents’ participation in discussion is important to the success (and fun) of the journal club. One or more PGY II residents may volunteer to serve as the Journal Club Resident Coordinator, to assist Dr. Smoller in overseeing the scheduling and functioning of the journal club.

DIAGNOSTIC INTERVIEWING SEMINAR

Contact: Jacqueline Olds

547-5920

Duration: July to June.

Educational Goals: By the end of the seminar, the resident will have:

1. Learned how to give and get feedback on interviewing technique from group.

2. Learned how to do an evaluation interview of a family coming in for a child psychiatry evaluation.

3. Seen about 15-20 “garden variety” clinic (child psychiatry) cases with a group and gotten long-term follow-up on them.

Course Description: We will meet as a teacher and group of residents once a week for 1 ¼ hours to evaluate a new case every two weeks. There will be two sessions for each new evaluation and residents will be assigned to do the write-up in rotation. First semester, the teacher will do the majority of the interviews while the residents will do them 2^nd semester.

Expectations: Each resident will do approximately 3-4 evaluations.

DIALECTICAL BEHAVIOR THERAPY

Contact: Nancy Lundy Ed.D

726-2641

Duration: Anywhere between three months to 3 years (individually negotiated).

Educational Goals: Interested clinicians-in-training will gain familiarity with DBT in this individually designed rotation.

Course Description: Participants can choose from a variety of options ranging from a didactic seminar, to attending the staff weekly consultation group, co-leading or observing a skills training group, supervised experience in individual DBT therapy or any combination of the a

Expectations: A commitment to regular attendance.

SCIENTIFIC WRITING SEMINAR *

Contact: Theodore A. Stern, MD

726-2984; [email protected]

Barbara Burns

[email protected]

Duration: The seminar meets every other week for one hour, however additional time for reading, writing, and editing is necessary. September through June.

Educational Goals: This seminar seeks to encourage participants to write; to enhance writing, reviewing, and editing skills; to encourage submission of articles to refereed journals; and to gain an understanding of the peer-review process.

Course Description: Participants (residents, fellows, and staff) will learn practical strategies regarding preparation, organization, and submission of articles. Each participant submits works in progress (e.g., case reports, clinical studies, literature reviews, grant applications, book reviews, book chapters) at the seminar; manuscripts are critiqued by all participants and feedback is offered on style, content, and scientific merit. In addition, suggestions will be provided as to the best audience for the manuscript. General writing strategies and specific pointers are provided.

Expectations: Each participant will submit one or more manuscripts (over the course of the year) for review by seminar participants; each participant will review the manuscript written by the presenting participant in advance of the meeting at which the manuscript will be presented.

*Ellie Hackett and Ted Stern will also be running a separate Scientific Writing Seminar for the Hospital's Clinical Research Center on Wednesdays during October, 1999, from 4-5 PM in the O'Keefe Auditorium. All are welcome.

BEGINNING FAMILY THERAPY

Contact: Lois Slovik, M.D.

726-2724; [email protected]

Duration: Weekly from September to June.

Educational Goals: Residents, child psychiatry fellows, adult and child psychology interns and social workers will learn how to think systematically whether working with individuals, couples, families or larger systems. At the conclusion of the course, residents will have gained confidence and flexible expertise (the ability, in other words, to operate from multiple perspectives) in working with families and other systems. To accomplish this, they will have learned how to:

1. Evaluate whether or not couple or family therapy is therapeutically necessary.

2. Introduce couple or family therapy as an option to an individual patient.

3. Do a couple or family evaluation.

4. Conduct a couple or family therapy in all three stages: creating an alliance with each family member, implementing successful therapeutic interventions and gracefully terminating the therapy.

5. Broaden the thinking to include the larger systems, i.e. extended family, schools, agencies, etc.

6. Intervene therapeutically with larger system(s).

7. Develop an understanding of the effect of ethnicity on family therapy.

8. Become knowledgeable about specific issues and how they affect the family, i.e. alcohol abuse, adoption, domestic violence, homosexuality, the (family) life cycle, etc.

Course Description: Residents will spend three hours per week as part of a Beginning Family Therapy elective.

1. Residents will spend one and half hours per week participating in a multidisciplinary, didactic, experiential seminar which explores multiple systemic theoretical perspectives and their resultant strategies and techniques. These include psychodynamic, narrative, structural, strategic, solution-focused and psychophysiological (the use of medication within a family treatment).

2. There will be an hour a week spent in group (not to exceed 3 persons per group) supervision. This will alternate with an hour and a half observed (live) family interview or ongoing family treatment.

3. Every other or every third week the group will operate as a “reflecting team” behind the one-way mirror and observe while a supervisor does a (live) family evaluation or consultation. This will necessitate an hour and a half session.

4. If the group desires, a supervisor will do an ongoing family therapy using the one way mirror.

5. The resident will be expected to do at least one family treatment. This is not an additional hour. It can be accrued as part of the resident’s required number of hours.

Expectations: The resident will attend the Friday morning lecture and the group supervision/live interview every week. Residents will see at least one couple or family in the ongoing therapy.

PSCYHOTHERAPY/ADVANCED EVALUATION SEMINAR

Contact: Joseph Schwartz, MD 965-2779/F:244-8149 [email protected]

Duration: One hour per week for the entire year. A commitment of several months is expected of each participant. A maximum of 5 residents may attend at one time.

Educational Goals: Residents will study psychotherapy process in the context of outpatient practice. They will learn to:

1. Perform in-depth psychodynamic evaluations and learn the components thereof.

2. Learn the value and limitation of the above in the therapy process.

3. Study the paradigms of how therapy helps and learn which paradigms apply to which of cases

Course Description: Residents will attend one hour per week. They will present cases to a small group and will do appropriate readings as they apply.

LAYERS OF PSYCHOANALYTIC THEORY

Contact: Max Day, M.D.; 332-8907

Educational Goals: We invite you to participate in a workshop on the many layers of psycho-analytic theory, examined archaeologically, as it were, layer by layer, as they developed. We will examine some of the original writings and current versions of the same theories. This will attempt to show how one layer developed gradually into another and how they are probably complementary rather than exclusive. We shall also look at some of the main techniques common to all layers of theory and the personalities of the theorists involved to see how they influenced the development of various layers of theory.

ANATOMY OF THE HUMAN BRAIN (2000-2001)

Contact: Tim Wheelock

Educational Goals: This seminar series, designed primarily for resident staff and basic researchers of the McLean community, is comprised of a series of lecture-demonstrations devoted to the detailed structure of the human brain. A wide variety of fixed human brain specimens drawn from McLean’s Harvard Brain Tissue Resource Center will be made available as well as folders given to each participant with pictures, diagrams, charts, digital camera images, and a bibliography to augment the physical specimens. The emphasis of this seminar series will be on relating structures to each other anatomically, histologically, and phylogenetically. For example, we will see how the striatum and amygdala are not separated structures but have a common phylogenetic origin. We will see how portions of the amygdala have the same two cell types of the basal ganglia. We will look for the elusive cell columns perhaps common to the striatum, thalamus and the cerebellum’s granule cell layer. We also will experiment with expanding our definition of motor behavior to include not just sensory motor, but also cognitive-, linguistic-, limbic-, and visceral motor. If this conception is valid, can the cerebellum be said to be coordinating thinking, feeling, and even the sense of self? Thus the series will have a connectionist, somewhat philosophical flavor to it, but it will always be grounded, first and foremost, in as much anatomical detail as possible. Such interpretation and an appreciation of the modular nature of what on the surface seems to be holistic experience.

ELECTIVES - CLINICAL

Electives-Clinical

BIPOLAR DISORDERS UNIT

Contact: Carol Castro

726-6188; [email protected]

Duration: 4 months for a minimum of 5 hours/week. This can be done during the consultation or community portion of the PGY III year. The clinic can accommodate 2 residents/rotation. Also, residents may opt to pursue this rotation during their PGY IV year with duration being negotiable.

Educational Goals: Residents will learn to provide specialty outpatient consultation in the

bipolar spectrum disorders (e.g., bipolar depression, mania, mixed, rapid cycling, schizoaffective disorder – bipolar type). Residents will learn how to:

1. Evaluate and treat outpatients with both medical and psychiatric illnesses.

2. Psychoeducate patients and others in the “circle of confidentiality” (e.g. spouse, friend) about a very complicated illness.

3. Use a treatment contract to help patients and others involved in their treatment cope with the illness.

4. Use rating instruments critical to the systematic, iterative approach to making the diagnosis and evaluating severity of illness. (eg. Clinical Monitoring form, Structured Clinical Interview for Diagnosis – SCID-P, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, etc).

5. Be part of a research team and, if interested, develop research skills (e.g., learn hypothesis driven study design methods, statistical analysis and manuscript writing).

6. Acquire cognitive – behavioral therapy skills specific to managing bipolar patients.

Course Description: Residents will spend 5-10 hours a week in the bipolar clinic organized as a minimum of:

1 hour evaluation once a week

1 hour per week in didactics

1 hour per week learning various rating instruments

1 hour supervision with a staff member

1 hour a week to see follow-up patients

Expectation: Residents will evaluate a minimum of one patient every week and follow those they see if appropriate. Residents can choose to refer the patients to a provider within the bipolar research group at the end of the rotation or to continue to see the patients.

TWO-BRATTLE CENTER

Contact: John Wheelis M.D.

(617) 441-7500x229; [email protected]

Duration: 12 months, 10 hours/week. PGY IV residents may apply with consideration for a PGY III year under certain circumstances. This clinic can accommodate two residents per year.

Educational Goals: Residents will have the opportunity to pursue advanced training in Dynamic psychotherapy, psychopharmacology, Dialectical Behavior Therapy and Group Therapy in milieu treatment modalities. Residents will learn how to:

1. Evaluate and treat outpatients with major psychiatric disorders.

2. Evaluate and treat patients with character disorders

3. Evaluate and treat patients with substance abuse disorders.

4. Conduct group therapy within dialectical Behavior Therapy, Eating Disorders or long-term dynamic milieu Intensive Day Treatment settings.

5. Opportunity to join Dialectical Behavioral Treatment consultation teams

6. Work with adolescents, adults, children, families, and couples

7. Participate in outcome research

8. Communicate and create alliances with outside treatment teams

9. Attend rounds once or twice weekly depending on the particular program requirements

10. Attend case conference once monthly

11. Attend seminar series with guest speakers once monthly

12. Attend staff meetings once monthly

13. Participate in individual and group supervision

14. Attend didactic seminars in advanced psychotherapy

Course Description: Residents will spend 10 hours per week at Two Brattle Center organized around involvement in the Eating Disorders, Substance abuse, DBT, or long-term dynamic Intensive Day Treatment programs organized as:

1. One to Two individual psychotherapy patients

2. One hour of individual supervision

3. One hour of group supervision

4. One to two one hours in groups as co-leader

5. One to two cases for clinical administration in one of the four day treatment programs

6. Participation in didactic seminars and case conferences

Additional hours may be spent by taking on psychotherapy or psychopharmacology patients and/or initial evaluation assessments and/or conducting family and couples psychotherapy.

Expectations: Residents are expected to maintain and document appropriately a mix of group work, individual, and psychopharmacology patients in the context of daily treatment programs offered at Two Brattle Center, as well as participating in didactic seminars and supervision. IF the resident is a PGY IV, there are opportunities for increasing a case load with the expectation that upon termination where clinically and administratively appropriate the resident may take his or her patients into their private practice.

BEGINNING FAMILY THERAPY

Contact: Lois Slovik M.D.

6-2724; [email protected]

Duration: Every week from September to June

Educational Goals: Residents, child psychiatry fellows, adult and child psychology interns and social workers will learn how to think systematically whether working with an individual patient, a couple, a family or a larger system. AT the conclusion of the course residents will have gained confidence and flexible (able to operate from multiple perspectives) expertise in working with families and other systems. To accomplish this they will learn how to:

1. Evaluate whether or not couple or family therapy is therapeutically necessary.

2. How to introduce couple or family therapy as an option to an individual patient.

3. Do a couple or family evaluation

4. Conduct a couple or family therapy in all three stages: creating an alliance with each family member, implementing successful therapeutic interventions and gracefully terminating the therapy.

5. Broaden the thinking to include the larger systems, i.e. extended family, schools, agencies, etc

6. Intervene therapeutically with larger system(s)

7. Develop an understanding of the effect of ethnicity on family therapy

8. Become knowledgeable about specific issues and how they affect the family, i.e. alcohol, adoption, domestic violence, homosexuality, the (family) life cycle, etc.

Course Description: Residents will spend three hours per week as part of Beginning Family Therapy elective.

1. Residents will spend one and half hours per week participating in a multidisciplinary didactic, experiential seminar which explores multiple systemic theoretical perspectives and their resultant strategies and techniques. These include psychodynamic, narrative, structural, strategic, solution focused and psychophysiological (the use of medication within a family treatment).

2. There will be an hour a week spent in-group (not to exceed 3 persons per group) supervision. This will alternate with an hour and a half observed (live) family interview or ongoing family treatment.

3. Every other or every third week the group with operate as a “reflecting team” behind the one-way mirror and observe while a supervisor does a (live) family evaluation or consultation. This will necessitate an hour and a half session.

4. If the group desires a supervisor with do an ongoing family therapy using the one way mirror.

5. The resident with be expected to do at least one family treatment. This is not an additional hour. It can be accrued as part of the resident’s required number of hours.

Expectations: The resident will attend the Friday morning lecture and the group supervision/live interview every week. Residents will see at least one couple or family in the ongoing therapy.

ADDICTION PSYCHIATRY ELECTIVE ROTATION

Contact: Nancy Nitenson M.D.

573-2705

Duration: Minimum of one month, at least one to two mornings per week.

Educational Goals: 1. Evaluate and treat patients with substance abuse or dependence.

2. To evaluate and treat dual diagnosis patients.

3. To become familiar with the detoxification protocols for alcohol and opioid dependencies.

4. To learn biopsychosocial treatment strategies for patients with addictive disorders.

Course Description: Residents will spend a minimum of four hours per week on the Inpatient Addiction Service organized as:

1. One hour for patient evaluation

2. One hour to see follow up patients.

3. One hour of supervision by an addiction fellow or an attending supervisor.

4. One hour to attend daily Morning Report.

5. Additional time may be scheduled to see additional patients or attend scheduled didactic addiction conferences, Spaulding Rehabilitation Addiction staff Meetings, and/or Patient Care Conferences.

Expectations: Residents will evaluate a minimum of one-two patients per week and follow those patients during their hospital course(average length of stay, 12 days).

MEDICAL EDUCATION ELECTIVE ROTATION

Contact: Dennis P. Girard Ed.D

738-1116; [email protected]

Duration: The class meets weekly during the academic year from 3:00-5:00pm at the Mt. Auburn Hospital in addition preceptors are expected to be available for shadowing. There are also faculty development and administrative meetings.

Educational Goals: Residents will co-teach with three-experienced faculty, Patient/Doctor I, a full year clinical course for first year medical students. Objectives include learning to prepare tutorial didactic material, supervising students, clinical interviews, and learning to teach and mentor in the tutorial system.

Course Description: Under the direction of a senior tutor, the resident will participate as an instructor/tutor in the Patient/Doctor I course. This “new pathways” course introduces first year medical students to clinical work by teaching, interviewing and addressing multiple didactic area e.g. substance abuse, domestic violence, multiculturalism, HIV and Occupational medicine. There is a strong empathsis on medical ethics and helping students develop a professional identity.

Expectations: Faculty is expected to attend all sessions and be available to meet with students as needed. An additional hour of supervision will be provided by senior tutor.

OCCUPATIONAL PSYCHIATRY ELECTIVE ROTATION

Contact: John Herman

726-2972; [email protected]

Duration: Four months, every other week. This can be done during the consultation or community portion of the PGYIII year. The service can accommodate 6 psychiatry residents and/or psychology interns.

Educational Goals: Residents will learn to provide a wide range of clinical intervention, consultative and other services to corporate partnership, family business and individual clientele with work-place related problems. Residents will learn:

1. Specialty in Psychiatric services in occupational medicine settings.

2. Corporate and workplace stress management and wellness programs.

3. Mediating small family business and partnership conflicts (dissolution, succession planning)

4. Mediation and arbitration in Healthcare disputes

5. Executive coaching and career transitions, dual career, life work balance counseling.

6. Team building and management consultation

7. Crisis management, critical incident debriefing, assessing violence in workplace

8. Expert witnesses in litigation and employer consultation

9. Sexual harassment

10. Age and sex discrimination

11. “reasonable accommodations” for physical and mental disabilities (Americans with Disabilities act and EEOC/MCAD)

12. fitness for duty, wrongful termination

13. Environmental health problems (“sick building” indoor air, toxins) and OSHA consults.

Course Description: Residents will spend three hours/week in the Occupational Psychiatry Service, organized as:

One hour for service delivery

One hour to follow-up clients

One hour of supervision with occupational staff

Additional hours may be spent attending staff meetings and clinical case conferences, if residents with to do so.

Expectations: Residents and interns will: a) evaluate a maximum of four individual patients or couples/families and follow those they see if appropriate during the rotation (up to 16 weeks), then refer or continue to treat; b) conduct or participate in three outside consultations from among areas of mediation, executive or work team facilitation, and/or workplace litigation support.

CENTER FOR PSYCHOANALYTIC STUDIES

Contact: Anne Alonso

724-0808; [email protected]

Duration: This rotation is a two-year commitment.

Educational Goals: The objective of this program is to provide in-depth, sophisticated training in:

· Psychodynamic psychotherapy

· Psychodynamic supervision

Course Description: Each year of study includes weekly seminars in:

1. theory, one hour

2. technique, one hour

3. supervision, one hour

4. case conference, one and one-half hours

Expectations: This elective is designed to be started in the fourth year of residency, and completed the following year. Tuition is waived for the first year for PGY IV residents and second year psychology intern/post docs. The second year tuition is $6,000. Some limited scholarship aide is available.

ELECTIVE ROTATION IN SUBSTANCE ABUSE

Contact: Shelly Greenfield

855-2241

Duration: Ten hours per week for two months. The rotation can accommodate one resident per two-month block. During September and October, the service will not be able to accommodate residents.

Educational Goals: Residents will learn to provide consultation to physicians on the inpatient units for their patients who have co-occurring substance abuse and other psychiatric disorders. Residents will also learn about group treatment for patients with substance use disorders by attending and co-leading a group in the Alcohol and Drug Abuse Treatment Programs (ADATP) Partial Hospital Program. By the end of the rotation, residents will have gained knowledge and experience in the following areas:

1. How to take a substance abuse history

2. The evaluation and diagnosis of co-occurring substance use disorders in patients with other psychiatric disorders

3. The principles of detoxification for different substances of abuse

4. The resources available in the community for patient’s who require ongoing substance abuse treatment after hospitalization

5. Overall treatment approach for the achievement and maintenance of abstinence.

Course Description: Resident’s will spend approximately 10 hours per week on the service, organized as:

1. Four hours per week performing consults(including writing the consults)

2. One hour per week receiving consult supervisio from Shelly Greenfield, MD, MPH – Monday, 9:00 am

3. Three one hour per week in the Partial Hospital Program observing groups. If residents are available on Wednesdays, they may run a Dual Diagnosis Group

4. One hour of supervision with Roger Weiss, MD every other week

5. One hour per week meeting with different members of the ADATP staff or following a patient in the Partial Hospital Program

6. Residents receive a binder at the beginning of the rotation with selected readings on substance use disorders to supplement didactics and supervision.

Expectations: Residents will evaluate a minimum of two consults per week. Residents will be expected to attend the Partial Hospital Program one morning per week (preferably Wednesdays) from 8:45 a.m.- 12:00 noon. Residents will meet with Dr. Greenfield Monday at 9:00am for supervision. Other times will need to be negotiated.

RESIDENTIAL TREATMENT OF CHILDREN ELECTIVE

Contact: Christoper Bellonci

(781)292-2108

Duration: Minimum requirements of 4 hours per week for at least one month, preferably 3-12months.

Educational Goals: Residents will learn the principles of psychiatric consultation in a residential treatment setting for children ages 3-13. Models of care include acute, long-term, and emotional disorders. The training opportunities will include psychopharmacology, psychological and neuropsychological testing.

Course Description: Residents can develop an elective rotation to fit individual training needs and time constraints.

Expectations: Specific expectations will be developed with each resident depending on the training opportunities selected.

INPATIENT ELECTIVE ROTATION IN SUBSTANCE ABUSE

Contact: Roger Weiss, M.D.

855-2242

Duration: Twenty-two hours per week for six weeks. The rotation can accommodate two residents per six-week block.

Educational Goals: Residents will learn to provide care to patients admitted to an inpatient unit specializing in the treatment of substance use disorders, most of whom have comorbid psychiatric disorders. By the end of the rotation, residents will have gained knowledge and experience in the following areas:

1. The diagnosis of substance use disorders.

2. The principles of detoxification for different substances of abuse.

3. The evaluation, diagnosis and treatment of co-occurring psychiatric disorders in-patients with substance use disorders.

4. The resources available in the community for patients who require ongoing substance abuse treatment after hospitalization

5. An overall treatment approach for the achievement and maintenance of abstinence

6. A working understanding of different self help groups(AA, SMART, Recovery, NA, etc)

Course Description: Resident’s will spend approximately 22 hours per week on the service organized as:

1. Seven and one-half hours attending patient rounds(1.5 hours per day)

2. Ten hours meeting with patients outside of rounds(2 hours per day)

3. Two hours attending inpatient groups and/or day treatment groups

4. One hour supervision with attending psychiatrist

5. One hour supervision with attending psychiatrist

6. One hour supervision with Roger Weiss, MD every other week

7. Residents receive a binder at the beginning of the rotation with selected readings on substance use disorders to supplement didactics and supervision

Expectations: Residents will carry a maximum of three patients and follow them through their inpatient stay.

HIV/AIDS PSYCHIATRY

Contact: Jonathon Worth

726-2772

Duration: One year

Educational Goals: In this seminar, residents will learn how to:

1. Diagnose and treat the most frequent complications of the HIV disease.

2. Learn the psychosocial stressors unique to HIV risk groups.

3. Learn collaborative HIV care.

Course Description: Residents evaluate and treat patients under the supervision of the director Jonathon Worth, MD. A new patient is seen every two to four weeks, with follow-up care provided as indicated. Residents are given articles to read, which are relevant to the elective goals and specific patient cases. Supervision with Dr. Worth is every other week. Staff meetings are weekly including monthly combined rounds with the Infectious Disease Unit.

Expectations: The resident achieves all three goals.

OBSESSIVE-COMPULSIVE DISORDER INSTITUTE ROTATION

Contact: Darin Dougherty

724-6143; [email protected]

Duration: 6 week selective

Educational Goals: Residents will work closely with patients with OCD on an inpatient unit and learn to:

1. Evaluate and diagnose patients with OCD

2. Behavioral therapy techniques for OCD

3. Psychopharmacology for OCD

Course Description: Residents will spend most of the week at the OCDI interviewing patients, learning and participating in behavioral therapy. There will also be didactics in etiology, phenomenolos, neurobiology and types of OCD.

Expectations: Residents will participate directly in patient care on a daily basis.

GERIATRICS

Contact: S. Verma

855-2304; [email protected]

Duration: One month

Educational Goals: Residents will understand the complexity of caring for older patients. They will become familiar with the psychopharmacology in older persons. They will gain experience in working with the psychopathology of old age in a late life psychosis, depression, and dementia.

Course Description: One-month inpatient at Mclean Hospital. The resident will attend interdisciplinary rounds Monday, Wednesday, and Friday and follow 1-2 patients under the supervision of a PIC. Arrangement can be made for nursing home, assisted living care.

Expectations: To participate in the care of 1-2 patients.

BORDERLINE PERSONALITY DISORDER

Contact: John Gunderson

Duration: One year with the possibility for fellowships in the year after graduation.

Educational Goals: Residents will:

1. To develop skills in case management, psychotherapy, group therapy and psychopharmacology with borderline patients.

2. To learn basic clinical research methods and to participate in ongoing research.

3. To learn clinical teaching, supervising skills.

Course Description: Residents will spend 10 hours/week in the Mclean Outpatient Personality Disorder Service and in the Psychosocial and Personality Research Program.

Expectations: Co-lead group therapies; Organize and chair weekly care conference, attend administrative or research meetings, write paper(s) reflecting learning experience.

THE CHILDREN AND THE LAW PROGRAM

Contact: Mary Corbett

726-8217

Duration: Seminars occur every week September 14 to July 1. Child seminar is 9:00 to 10:00 a.m. Tuesdays. Adult seminar is 10:00 to 11:00 a.m. Tuesdays. Seminars are open to any resident.

Educational Goals: Residents will attend seminars which provide the legal, clinical, and research basis for the evaluation of children and families involved in the legal system in the context of divorce/custody disputes, allegations of abuse, neglect and domestic violence, termination of parental rights, adoption, and delinquency. Opportunities for a clinical rotation are available.

1. To identify laws and statutes, which apply to evaluations of children, adults and families, involved in the legal system.

2. To become familiar with and apply research in child development to issues facing children and families involved in the legal system.

3. To learn to conduct evaluations including divorce custody, care and protection, sexual abuse, and juvenile competency.

Course Description: Child seminars provide information about legal, theoretical and clinical underpinnings of issues facing clinicians that provide evaluations of children and families involved in the legal system. Adult seminars for clinical rotation contact Robin M. Deutsch, Ph.D 726-8970

Expectations: Clinical rotation requires application and interview.

COGNITIVE – BEHAVIORAL PSYCHOLOGY

Contact: Ross W. Greene Ph.D.

726-2724

Duration: Nine months (September to June), with weekly meetings on Thursdays 1:15 – 2:00 pm.

Educational Goals: The goal is to provide a basic orientation to cognitive – behavioral intervention for childhood internalizing and externalizing disorders.

TRANSPLANTATION PSYCHIATRY

Contact: Owen Surman M.D.

Duration: Six months or One year

Educational Goals: By the end of the seminar, residents will have:

1. Learned the ethical basis for transplant candidate and donor selection.

2. Learned psychiatric evaluation and the approaches to informed consent.

3. Identified peritransplant psychiatric syndromes and conflict.

4. Observed Medical and Surgical Team approach to care

5. Learned strategies for psychiatric intervention.

Course Description: The course consists of the following:

1. Attend weekly transplant rounds – Treatment OR

2. Attend weekly family meetings – Selection

3. Meet weekly with Dr. Surman – Supervised Treatment

4. Read selective articles – Independent Teaching

5. See selective cases (in or outpatient) with Dr. Surman

Expectations: Service Expectations – None

Reading – 1 paper per week

Meetings – 1.5 hours per week

Teaching – 1.5 hours per week

Writing – Optional

THE CENTER FOR PSYCHOANALYTIC STUDIES

Contact: Elizabeth Shapiro, Ph.D.

724-5600/(781)863-8997

Duration: A two-year program that may be begun during the PGY-4 year and must be completed during the following year after residency graduation.

Educational Goals: Residents will receive an in-depth training experience in psychodynamic psychotherapy. Components of the program include:

1. Learning how to evaluate and treat patients using psychodynamic framework.

2. Presentation and discussion of psychodynamic theories from Freud to present.

3. Presentation and discussion of the technical underpinnings of psychodynamic treatment.

4. Learning how to supervise psychotherapists within the psychodynamic model.

Course Description: The course is:

1. Three Monday morning seminars (10:00 a.m. to 1:00 p.m.)

2. Theory Seminar

3. Technique Seminar

4. Supervision Seminar

5. Monday afternoon case conference (2:00 to 3:20 p.m.)

6. Twice-monthly Thursday evening after dinner seminars (7:45 to 9:45 p.m.)

7. Provision of one hour weekly supervision

8. Two hours of weekly individual psychotherapy supervision (may be provided through the residency in the first year of the program)

Expectations: Regular attendance at all seminars and supervision meetings. Continuation of training into 2^nd year of program post-residency. Deposit much be made during the PGY-4 year toward tuition for the second year of the program.

SEXUAL DISORDERS

Contact: Linda Shafer, M.D.

724-0812

Duration: Short term therapy 8 – 12 weeks.

Educational Goals: Evaluate and treat patients presenting with a clear case of sexual disorder (DSM-IV) using a combination of techniques – medical/dynamic/behavioral. Individuals and couples are treated.

Course Description: Supervision of ongoing cases is possible or arrangement of cases and supervision of treatment.

Expectations: To learn to take sexual history and be able to evaluate and diagnose sexual dysfunction.

MAINTENANCE STRATEGY FOR SCHIZOPHRENIA

Contact: William M. Glazer, M.D.

(508) 645-9635; [email protected]

Duration: One month ( 1 x 1 week for 4 weeks, or once a month x 4 months)

Educational Goals: Residents will review principles of maintenance strategies for schizophrenia, focus on long – term side effects of typical and atypical antipsychotics, and discuss care examples presented by participants.

Course Description: Schizophrenia is a long-term illness. While a great deal is known about acute treatment; relatively little is known about long-term maintenance treatment. This course will review maintenance principles through the use of lectures, case presentations and videotaped material.

Expectations: This course is for the advanced resident who is currently treating outpatient suffering for schizophrenia.

ANXIETY DISORDERS

Contact: Mark Pollack

724-0846; [email protected]

Duration: Two months during PGY-III. Advanced clinical research electives are available (PGY III – IV)

Educational Goals: To learn about the etiology presentation and treatment of the anxiety disorders including panic disorder, social anxiety disorder, generalized anxiety disorder and post-traumatic stress disorder (PTSD)

Course Description: Residents will spend 5 hours/week receiving lectures, individual and group supervision, performing evaluations(both alone and supervised) and treating patients.

Expectations: Residents will attend didactics and supervision and perform evaluations and ongoing treatment.

ECT

Contact: Charles Welch M.D.

726-2990

Duration: To become clinically proficient usually requires 3-4 months doing ECT 1 morning per week. Less ambitious goals require less time commitment.

Educational Goals: To be set by the resident. Ranges from developing the expertise to practice ECT independently, to simply getting better familiarity with the central clinical or scientific issues.

Course Description: Residents will

1. Perform ECT

2. Read the pertinent literature

3. Evaluate candidates for ECT

Expectations: To be set by the resident.

TRAINING GROUP EXPERIENCE (T-GROUP)

Contact: Jerome Gans M.D.

(781) 235-1546; [email protected]

Duration: Starting in the PGY –II year and ending with the PGY-III year, the T-Group meets weekly.

Educational Goals: Residents who participate in the T-group experience will have the opportunity to:

1. Give and receive support during very stressful years of training;

2. Develop cohesion as a class;

3. Gain empathy for what is involved in asking for help;

4. Learn experimentally and cognitively about group dynamics, including but not limited to:

·Boundaries

·Roles

·Group norms

·Group culture

·Feelings about reactions to authorities

·Competition

·Scapegoating and how to work with it in a positive way

·Group as a whole and sub-group phenoma

·Projective identification

·The meanings of being late and being on time

·Transference

·Countertransference reactions to unique group leadership

·Leadership styles and qualities

·Phases of group development

·Termination

·The differences between here-and-now and there-and then work

·Support and various forms that it can come in

·Experience the complexity and multiple levels of psychological reality;

·Discuss in safety their thoughts and feelings about their evolving identities as psychiatrists.

Course Description: Residents meet for one hour per week in an unstructured format designed to promote emotional and cognitive learning. While participants frequently find the experience personally helpful, it is not designed or intended to be therapy. Periodic didactic sessions complement experimental learning. The T-Group leader is a person recognized to have expertise in group dynamics.

Expectations: Except for illness or vacation, residents are expected to come to all meetings on time and stay for the entire meeting. This included attending T-Group meetings that occur the morning after having been on call. (The T-Group has traditionally met at 11 a.m.). Participants in the T-Group experience are encouraged to keep its proceedings confidential.

LABORATORY FOR THE STUDY OF ADULT DEVELOPMENT

Contact: Mary Zanarini, Ed.D

Educational Goals: The main focus of this NIMH-funded lab is the study of the

longitudinal course of borderline personality disorder. Another important focus is to study the children of this patient cohort as they are at high risk for developing BPD. We are also beginning an MRI challenge study of the self-harm behaviors of borderline patients and continuing a number of medication studies aimed at alleviating some of the key symptoms of BPD.

Expectations: PGY-3 or 4 residents are welcome to work with our group on a subtopic of their choosing. A one year commitment is required. Typically, a minimum of 4 hours a week is necessary to develop and complete an independent project. One hour of individual supervision per week is provided. Participation in team meetings is also encouraged.

LAW AND PSYCHIATRY SERVICE

Service Director: Ronald Schouten, MD

Training Director: Julia Reade, MD

Duration: 12 weeks or negotiable

Educational Goals: To introduce residents to the fundamentals of forensic evaluation. Clinical experience to include one or more of the following cases:

1. Competency to stand trial

2. Criminal responsibility

3. Aid in sentencing

4. Personal Injury

5. Disability

6. Fitness for duty

7. Custody and visitation

8. Emphasis is placed on the differences between performing forensic evaluations and clinical evaluations, and on forensic ethics.

Expectations: Residents will be expected to attend LPS seminars, journal club and case conferences. Opportunities will be available for individual reading/research projects.

MANAGED CARE PHYSICIAN REVIEW COMMITTEE

Contact: Jeff Weilburg, M.D.

Duration: The committee will have a 1 hr/month meeting.

Course Description: The “Psychiatry Medical Management Committee” is a multidisciplinary group of clinicians who meet to review the medical necessity and appropriateness of in and outpatient psychiatric treatment for patients in the at-risk managed care plans (Tufts, Secure Horizons, and Fallon). Residents are welcome to attend, they will hear practical discussions about managed care in psychiatry.

MCLEAN PARTIAL HOSPITALIZATION PROGRAM

Course Description: Mclean’s Partial Hospitalization Program meets the needs of patients, providers and payers for flexible care options and cost-effective treatments. Partial Hospitalization is defined as an intensive, psychotherapeutic-based treatment experience for patients who do not need the security of a locked unit or 24-hour care, but who require more than conventional outpatient treatment. A partial hospitalization allows for a flexible combination of individual and group psychotherapy, psychopharmacology and activity programs to meet the needs of individuals in many stages of recovery. The program’s foundation is a commitment to understanding and responding to the person behind the creating a collaborative therapeutic contact between clinician and client.

In the Partial Hospitalization Programs, an extensive range of individual and group psychotherapy services is available, including the following:

1. Cognitive-Behavioral Therapy Skills

2. Eating Disorders

3. Grief, Loss and Transition

4. Impulse Control/Symptom Management

5. Interpersonal Problems and Solutions

6. Life-Management Skills

7. Prevocational Counseling

8. Relapse Prevention

9. Social Skills

10. Stress Management

11. Substance Abuse/Abstinence

MOOD DISORDERS PROGRAM

Contact: Maurizio Fava, MD

Duration: The average length of time for a research fellowship ranges between one to two years.

Educational Goals: This seminar will:

1. To provide the opportunity to learn about clinical research in the area of unipolar depression

2. To develop experience in long-term psychopharmacological treatment of depression

3. To improve diagnostic skills (particularly in the area of mood disorders)

4. To work with a highly successful team of psychiatric researchers in the area of depression

Course Description: The research fellowship is for people who have already received their Ph.D. and/or M.D., and have completed their necessary residencies and certifications. Fellows are trained to perform diagnostic procedures, including the Structured Clinical Interview for the DSM-IV (SCID), the main diagnostic tool used in the program. Also of importance is training on the use of clinical efficacy scales such as the Hamilton Depression Scale (Ham-D), the most commonly used scale in the program’s studies. Fellows typically dedicate four days a week to research activities, and the fifth day is often used to see patients referred through the hospital. The research work is typically characterized by seeing patients for assessment visits, during which the fellows are responsible for the diagnosis and determination of eligibility of the patients according to the study’s guidelines, and for their follow-up visits over the course of their treatment. Fellows with M.D. degrees are expected to perform physical examinations and to monitor the patients’ response to the medications during the study. Fellows work closely with a team of 8 research coordinators who work on approximately 20 ongoing studies. Each Research Fellow is assigned a mentor from the senior research staff to help foster the research career of the fellow. All Fellows, Staff Physicians and Psychologists, and Research Coordinators meet twice/week and each fellow is encouraged to develop independent projects and to write research papers.

Expectations: The fellows are expected to learn about the course of depressive illness and to have a more in depth understanding of unipolar depressive disorders. In addition, it is the expectation that the fellows will also learn the scope of research within the field of psychiatry. Specifically, research fellows in this program are expected to form a deep understanding of the symptoms, diagnosis, and pharmacological treatment of unipolar depression.

PSYCHIATRIC ASPECTS OF BURNS ROTATION

Contact: Frederick Stoddard, M.D.

371-4762, [email protected]

Note on Location: This is either a clinical, or clinical research, rotation in Burn Psychiatry at MGH, an inpatient consultation service which has been at MGH since the Coconut Grove Fire in 1942, or at Shriners Burns Hospital, which has treated burned children since 1968. Residents may rotate in the Burn Clinic, at the Sumner Redstone Burn Unit on Bigelow 13. Residents with interest in or training in child psychiatry or pediatrics are eligible for a rotation at the new Shriners Hospital, dedicated on May 1, 1999.

Duration: 4-6 months, continuously. Preference for the Bigelow 13 rotations will go to those who have previously consulted there on the consultation service. Preference for the Shriners Hospital rotations will go to those who are child psychiatry residents, those who plan to enter child psychiatric residency, or those with pediatric training. Research rotations are one year.

Educational Goals: Residents on the outpatient rotation on Bigelow 13 will provide triage, consultation, assessment and treatment to patients with psychiatric disorders seen as outpatients in Burn Clinic, following acute care. Residents will learn how to:

1. Evaluate and treat patients who have mental disorders, such as PTSD or substance abuse.

2. Evaluate and treat pain syndromes associated with burns

3. Differentiate pre-existing mental disorders from those due to the burns and their treatment

4. Assess the emotional effects of bodily disfigurement, and surgical reconstruction,

5. on self-esteem, body image and adult development.

6. Provide continuity of care for patients seen as inpatients by the Psychiatry Consult Service

7. Communicate with, collaborate with, and educate surgical staff

Residents on the research rotation on Bigelow 13 will design and complete a psychiatric research project with inpatients or with outpatients on the Burn Unit. Residents will learn how to:

1. Design focussed biological, diagnostic, psychopharmacological, psychosocial, or outcomes research

2. Utilize the database on burn patients

3. Conduct a psychiatric research study with burn patients

4. Present the findings

5. Prepare a manuscript for publication

6. Prepare a grant application based on the results (optional)

Residents on the clinical or research rotation at the Shriners Burns Hospital will have experiences similar to those described above, but exclusively with infants, children and adolescents, primarily inpatients. In addition to the objectives described above, the resident on a clinical rotation will learn developmental assessment.

Course Description: Residents on the clinical rotation will spend three hours per week in the Burn Clinic organized as:

1. one hour for psychiatric assessments

2. one hour to see follow up patients

3. one hour of supervision.

4. Residents on the research rotation will spend five hours per week on their project organized as:

5. one hour for research design

6. three hours for chart reviews, clinical assessments, data analysis, and write-up of results, and

7. one hour of supervision. These times will vary depending on the stage and design of the project.

8. Residents on the Shriners Burns Hospital clinical rotation will spend 9 hours per week at the hospital, organized as:

9. two hours for child psychiatric assessments

10. four hours to see follow up patients

11. two hours of conferences, rounds, and team meetings, and

12. one hour of supervision.

Expectations: Residents on the adult Burn Clinic rotation will evaluate a maximum of one patient every two weeks for 4 months and follow those they see if appropriate during and after the rotation, or referring them to a staff psychiatrist at the conclusion of the rotation. Residents on the Shriners Hospital rotation will evaluate a maximum of two patients per week for four months and follow those they see if appropriate during but not after the rotation; they will be referred to a child psychiatrist at Shriners or to an outpatient clinic at the end of the rotation.

PSYCHOLOGY ASSESSMENT CENTER ROTATION

Contact: Dennis Norman, Chief of Psychology, Co-Director of the Psychology Assessment Center

726-2977, [email protected]

Duration: 12 months-entire internship

This is a core site and rotation for all MGH clinical psychology interns. While psychological assessment has always been part of psychology training at MGH, the Psychology Assessment Center was in 1997 to unify all psychological assessment in neurology, psychiatry and pediatrics at the MGH.

Educational Goals: Psychology trainees will learn to identify the role, administration and interpretation of psychological tests in assessing personality, cognitive, academic attentional and neuropsychological disorders. Psychology trainees will learn to:

1. Clarify referral questions so that the appropriate tests can be used to answer the diagnostic or functional questions. When the questions are ill formed the trainee will learn to work with referral sources in clarifying what would be the appropriate tests for their questions.

2. Learn to competently assess intellectual functioning is a wide variety of patients.

3. Learn to competently assess personality functioning is a wide variety of patients

4. Learn to competently assess neuropsychological functioning is a wide variety of patients.

5. Be able to communicate these findings to a diverse referral audience which includes lay person and professionals of diverse training backgrounds.

Course Description: 1. Psychology interns have a didactic course 1 ½ hours weekly that covers theoretical and practical issues in all testing instruments, scoring and interpretation.

2. All adult interns perform psychological testing and consultation regarding previous testing on the Blake in-patient unit for the entire year they are placed on the unit. The number of focal or full assessments ranges from 15-30 during the year, with most of the assessments being focal and not full evaluations.

3. All child interns conduct out-patient psychological assessments on both children and adults for the entire year of internship. The average number of testing range from 8-16.

4. All interns receive supervision x2 month for OPD assessments and as needed for in-patient referrals.

Expectations: Interns will accept all referrals assigned not to exceed two full evaluations per month.

COGNITIVE NEUROSCIENCE ROTATION

Contact: Cary Savage, Ph.D.

[email protected]

Duration: Flexible

Educational Goals: Expose participants to cognitive neuroscience approaches in psychiatry (cognitive neuropsychiatry). Methods used in this group include neuropsychological and cognitive testing, and cognitive activation approaches using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI).

Course Description: This program provides research-oriented experiences in cognitive neuropsychiatry. Participants gain knowledge and experience in cognitive neuroscience approaches to studying normal cognitive processes and psychiatric problems, including obsessive-compulsive disorder (OCD) and schizophrenia. We have collaborative relationships with several groups and investigators in the Department of Psychiatry, including the Psychiatric Neuroimaging Group (Dr. Rauch), Obsessive-Compulsive Disorders Clinic and Research Unit (Drs. Jenike and Baer), and the Psychotic Disorders Program (Dr. Goff). We also have ongoing collaborations with investigators in the Department of Psychology at Harvard University.

Expectations: At least 1 day/week or two half days. Participate in ongoing studies and lab meetings.

GERIATRIC NEUROBEHAVIORAL CLINIC ROTATION

Contact: Bill Falk, M.D.

724-0843; [email protected]

Duration: The elective may best fit with the schedule of PGY- IV residents and number of sessions attended is negotiated with the co-directors. In the past residents have attended clinic (which typically is held 3 weeks out of 4 during month) for periods ranging form 2 months to 1 year. The clinic can accommodate no more than one resident at a time to create an optimal learning experience, but occasional participation of one additional resident (i.e. if rotations overlap) is possible.

Educational Goals: Residents will become familiar with all aspects of dementia assessment and will develop competent evaluation skills:

1. Comprehensive cognitive history

2. Various neuropsychological history and examination with particular focus on cognitive domains

3. Extensive neurological history and examination with particular focus on cognitive domains

4. Psychiatric evaluation

5. Laboratory data

6. Psychosocial assessment with emphasis on functional status, family issues and caregiver coping

7. Working with a team to establish a consensus diagnosis, differential diagnosis, further recommended diagnostic tests, and treatment recommendations. Attention is paid to comorbid disorders which may be exacerbating a primary dementing illness

8. Relating information to patients and their families in a comprehensible and caring manner

Course Description: Residents will spend 3-4 hours participating in each clinic, initially observing but with greater direct involvement as skills develop, spending:

1. one hour for history and observation of neuropsychological testing

2. one hour for neurological assessment

3. one hour to two hours for psychiatric assessment, family evaluation, formulation and treatment planning

4. additional reading and writing projects are available

Expectations: Residents will participate in the evaluation process of patients in a progressively autonomous manner such that by the end of the elective, residents will perform neurological and psychiatric examinations, assist in the interpretation of other testing and be able to dictate a comprehensive evaluation note.

NEUROPSYCHIATRY/BEHAVIORAL NEUROLOGY ELECTIVE AT MCLEAN

Contact: Bruce Price, MD

855-2353/2466; [email protected]

Duration: Four to six weeks, full time preferred but can be split

Educational Goals: By the end of this seminar,

1. Introduction to the interface between neurology, psychiatry, and

2. neuropsychology.

3. Further refinement of the mental state examination and elemental neurological examination.

4. Improved understanding regarding the neurologic differential diagnosis of psychiatric signs and symptoms.

5. Review of brain MRI scans and EEG results in the context of neuropsychiatric diseases.

Course Description: Residents will do four inpatient consultations per week salient to

1. They will spend approximately two hours for each evaluation, then one hour to present the patients to an interdisciplinary team consisting of neurology staff and residents, neuropsychology fellows and other rotators.

2. They will spend one to two hours per case reviewing the pertinent literature

3. Additional hours may be spent participating in Tuesday and Thursday afternoon neuropsychiatry/behavioral neurology outpatient clinics at McLean, Wednesday mornings at MGH with other neurology and psychiatry residents, and twice monthly afternoon visits to Tewksbury Hospital

4. MRI scans are reviewed as a group one to two hours/week

5. Two hours per week are given to observation of formal neuropsychological assessments.

6. Ten core-videotaped lectures in behavioral neurology are available for review and discussion.

Expectations: Residents will evaluate four inpatient consults and approximately two outpatient consults per week with direct supervision.

CONSULTATION IN PRIMARY CARE

Contact: B. J. Beck, MD

(617) 568-4608/beeper #23829.

Duration: Can be 6, 9, or 12 months; at least weekly is optimal for patient follow-up. Days: Tuesday, Wednesday, or Thursday. Hours are negotiable.

Educational Goals: In this seminar,

1. Learn the strengths and limitations of Primary Care Providers' (PCPs')

2. abilities to provide psychiatric care and pharmacological management for

3. their patients.

4. Be able to identify patients not appropriate for PCP management.

5. Learn what PCPs expect from a psychiatric consultant.

6. Learn to write and communicate pragmatically with PCPs, and develop the skill of curbside consultation.

7. Understand the differences in the primary care population, versus the referral psychiatric practice population.

8. Become familiar with different models of primary care psychiatry and the setting in which each model is most appropriate.

9. Understand the economic pressures, considerations, and/or implications of managed care, capitated care, carve out care, risk sharing, cost-shifting, and global capitation in the provision of quality, cost effective psychiatric care in the primary care setting.

Course Description: The resident in this rotation will develop their skills as an expert in psychiatric medicine in a large, urban, immigrant community primary care clinic. The resident will work closely with the Medical Director of Mental Health/Social Services (MH/SS), who will give an introduction to the community, the clinic, and the primary care-driven model of psychiatry as practiced at the East Boston Neighborhood Health Center (EBNHC). The resident will provide formal and informal consultation to the PCPs who refer their patients. Evaluations can be dictated, and will be reviewed by the Medical Director, who has a penchant for editorial comment. Immediate supervision will be available at the time of consultation, as needed, and will also be scheduled for one hour later in the day. The resident will participate in the decision to triage a patient to PCP management or outside services (although the resident will generally not be responsible for making the outside referral arrangements). The resident will start and stabilize patients on psychopharmacologic treatment, and refer the patient back to the PCP with recommendations for on-going management. Recommendations should include whatever other treatment modalities are appropriate (and available). There is a great deal of flexibility in the rotation, which can be tailored to meet the resident's needs. The interdisciplinary clinical meeting is another opportunity for the resident expert to teach their non-psychiatric colleagues. No language (other than English) is required, because of the large interpreter staff, but Spanish, Portuguese, or Arabic speakers will have ample opportunity to practice their language skills. There will be relevant readings about primary care psychiatry

and other topics that arise in the course of the rotation. For the research-minded, the development, implementation, and publication of studies are definitely possible and encouraged (though not required). For residents interested in the administrative issues of running a small department in a big (-ish) institution, this topic can be easily inserted.

Expectations: Be on time, be responsible, be enthusiastic and creative, have a sense of humor, and have fun. Residents are strongly encouraged to give an inservice on any relevant topic of their choosing to the Mental Health (and/or Adult Medicine, Pediatric, or OB/GYN) staff at EBNHC.

GEROPSYCHIATRIC CONSULTATION AT THE ELDER SERVICE PLAN

Contact: B. J. Beck, M.D.

(617) 568-4608/beeper #23829.

Duration: Negotiable; recommended 3 or more months. One, midmorning per week (actual hours negotiable); could be less frequent (e.g., every other week for 6 months or more).

Educational Goals: By the end of the seminar,

1. Become familiar with the presentation of common psychiatric problems in the elderly.

2. Learn to evaluate the frail elderly patient for possible organic causes of psychiatric symptoms.

3. Learn to manage psychiatric illness in the medically complicated, elderly patient.

4. Learn to assist caregivers in the development of consistent behavioral plans for multi-problem elders.

5. Learn about competency evals in the community.

Course Description: The resident on this rotation will visit the 3 Elder Service Plan (ESP) sites and learn about PACE programs for the elderly. They will consult at the Addison Day Health site (in EB), initially with the EBNHC MH/SS Medical Director, and then more independently. The Medical Director will be available by phone for any questions that arise during the consultation. Consults can be dictated, and will be reviewed with the Medical Director, in a non-threatening, constructive manner. Readings on appropriate topics will be provided. There may be some nursing home visits, or home visits, accompanied by ESP staff.

Expectations: No more than one eval per session. There are often less formal, brief consultations. It is important for the resident to attend as they agree to be scheduled, as patients are sometimes brought to Day Health specifically to see the psychiatrist.

PSYCHODYNAMIC PSYCHOTHERAPY RESEARCH PROGRAM

Contact: J. Stuart Ablon, Ph.D.

724-5055; [email protected]

Ray Levy, Psy.D.

724-0806; [email protected]

Duration: A five-year naturalistic study of long-tem psychotherapy for depression in clinical practice is also being planned.

Educational Goals: Patients are currently being enrolled in a study of Brief Psychodynamic Psychotherapy for Panic Disorder. The study aims to determine the effectiveness of psychotherapy for panic disorder using naturalistic design. The process of the therapies is being studied quantitatively and process correlates of outcome are being identified. Patients are also currently being enrolled in a study of Interpersonal Psychotherapy (IPT) for Perinatal Depression in collaboration with Perinatal Psychiatry Clinical Research Program directed by Lee S. Cohen, MD.

Course Description: The Psychodynamic Psychotherapy Research Program conducts programmatic research examining the process and outcome of psychotherapy for a range of psychiatric disorders. A particular focus of the program is naturalistic studies of the mechanisms of change in psychotherapy.

Expectations: There is no minimum commitment for those interested in participating.

PERINATAL PSYCHIATRIC CLINICAL RESEARCH PROGRAM

Contact: Lee S. Cohen, MD

[email protected]

Duration: 6 months to 1 year, 10-20 hours per week

Educational Goals: This rotation is a clinical research rotation in which each resident masters the evaluation and treatment of psychiatric disorders associated with reproductive function: pms, psychiatric illness during pregnancy and the postpartum period, perimenopausal and postmenopausal mood disturbance.

Course Description: The elective is typically for 6 months to 1 year duration and may also be pursued as a senior residency. Minimum time commitment is 10 hours per week with the senior residency involving 15 to 20 hours per week. This involves 1-2 hours of clinical consultation (perinatal psychopharamacology, postpartum illness and pms) and 6-8 hours of direct research training and clinical research.

Expectations: The resident functions as a full-fledged member of the perinatal psychiatry team.

BEHAVIORAL MEDICINE UNIT

Contact: David Ahern

724-0436; [email protected]

Duration: 4 months, every other week.

Educational Goals: Residents will learn CBT-based skills in the evaluation and treatment of medical out-patients. Specific skills include:

1. Behavioral analysis and treatment of chronic pain syndrome

2. Roles and responsibilities as part of an interdisciplinary team

3. Behavioral consultation skills and

4. Relaxation and biofeedback techniques for medical patients

Course Description: Residents will spend three hours per week in the behavioral medicine unit, organized as:

1. One hour for evaluation

2. One hour to see follow up patients

3. One hour in group supervisions

Expectations: Residents will evaluate along with a staff member 2 patients per month and follow selected patients based upon interest and appropriateness

PSYCHOPHARMACOLOGY RESEARCH AT MAILMAN RESEARCH CENTER- MCLEAN HOSPITAL

Contact: Ross J. Baldessarini, M.D.

855-3203

Duration: The intensity and duration of the experience is tailored to the needs and the schedule of individual trainees, but typically at least a part-time commitment for full academic year is expected.

Educational Goals: To gain practical experience in research in either clinical or preclinical pscyhopharmarcology pertinent to major mental disorders through individually designed, closely supervised, experiences within the McLean Hospital Bipolar & Psychotic Disorders Program and Mailman Research Center’s Laboratories for Psychiatric Research, directed by Ross J. Baldessarini, M.D.

Course Description: Elective experiences are offered to PGY III, IV and post residency Fellows to provide training and in the design conduct, analysis, interpretation, and reporting of clinical or laboratory research in neuropsychopharmacology, as well as familiarity with relevant research literature. Experiences are designed to fit the level of prior scientific experience, interests, career needs and postgraduate level of individual trainees, as well as the time available to them. Individualized experiences are negotiated and designed to fit the needs of individual trainees and the availability of an interested, primary preceptor within the McLean Hospital Bipolar & Psychotic Disorders Program or Laboratories for Psychiatric Research of the Mailman Research Center. Preceptors include established clinical and laboratory investigators interested in the pharmacology and treatment of psychotic and major affective disorders and in the design and actions of drugs used to treat such disorders.

Expectations: Trainees participate in an ongoing project, or develop one of their own, depending on their level of prior experience and time available, and available resources. They work with a primary research supervisor to gain familiarity with the relevant research literature, pertinent methods and research design, and participate in acquisition, analysis and reporting or publication of research data. Trainees are encouraged to attend weekly Research Seminars and Psychopharmacology Service Grand Rounds. Assistance is also provided in seeking fellowship support and in initiating an academic career for those in later years of training (PGY IV or V), when appropriate.

MGH PSYCHIATRIC NEUROSCIENCE PROGRAM

Contact: Scott Rauch, M.D.

724-9533; [email protected]

Duration: Flexible. Some Residents may choose this as a 4 month rotation as outlined above, or for up to a full year commitment during the PGY –IV year, in preparation for independent research during a subsequent fellowship. In some instances, Residents will be able to assist with ongoing projects and earn authorship on peer-reviewed publications.

Educational Goals: Residents will learn about psychiatric neuroscience by attending laboratory meetings, interacting with investigators and observing experiments. Residents will:

1. Develop understanding of specific neuroscience strategies for investigating the basis of psychiatric diseases and their treatments.

2. Become aware of opportunities for career development and future participation in research as investigators.

Course Description*: Residents will:

1. meet 1:1 with selected principal investigators form the progam(~1hr/wk)

2. attend weekly laboratory meetings(~1-2hrs./wk)

3. observe experiments (~1-4hrs./wk)

4. complete directed readings(~1hr./wk)

Expectations: Regular attendance at scheduled meetings and laboratories.

*The content of this offering can be tailored to the interests of the Residents.

MGH PSYCHIATRIC NEUROIMAGING RESEARCH PROGRAM

Contact: Scott Rauch, M.D.

724-9553; [email protected]

Duration: Flexible. Some Residents may choose this as a 4 month rotation as outlined above , or for up to a full year commitment during the PGY –IV year, in preparation for independent research during a subsequent fellowship. In some instances, Residents will be able to assist with ongoing projects and earn authorship on peer-reviewed publications.

Educational Goals: Residents will learn about psychiatric neuroimaging research by attending laboratory meetings, interacting with investigators, and observing experiments. Residents will:

1. develop understanding of specific neuroimaging tools and their applications for investigating the basis of psychiatric diseases and their treatments

2. improve their knowledge of neuroanatomy

3. become aware of opportunities for career development and future participation in neuroimaging research as investigators

Course Description*: Residents will:

1. meet 1:1 with selected principal investigators from the program (~1 hr/wk)

2. attend weekly laboratory meetings (~1-2hrs./wk)

3. observe imaging experiments and data analytic techniques (~1-4 hrs./wk)

4. complete directed readings (~1hr./wk)

Expectations: Regular attendance at scheduled meetings and laboratories.

*The content of this offering can be tailored to the interests of the Residents.

EATING DISORDERS

Contact: Paul Hamburg, MD 724-0815; [email protected]

Duration: 6 months (shorter periods can be negotiated), PGY III, IV residents, 2^nd year psychology fellows

Educational Goals: Upon completion of this elective, students will gain competence in the initial assessment of patients with bulimia nervosa, anorexia nervosa, and binge eating disorder. They will be able to design competent treatment plans, and learn how to provide care for complex patients within coordinated treatment teams. They will be familiar with the medical complications of eating disorders, and with the range of available treatments, including individual psychotherapy, psychopharmacologic interventions, group therapy, and other psychosocial modalities.

Course Description: To meet these goals, students in Eating Disorders will:

1. Participate in the evaluation of new patients in the MGH eating disorders clinic,

2. Attend a weekly clinical conference (Fridays at noon in the MGH Child Psychiatry conference room),

3. Receive an hour of weekly supervision

4. And may arrange to participate in ongoing research projects.

BEHAVIORAL MEDICINE UNIT OF CARDIOVASCULAR HEALTH CENTER

Contact: Andrew Littman 726-3475; [email protected]

Duration: months, every other week. This can be done during the community or consultation portion of the PGYIII year. The clinic can accommodate 1 resident/rotation.

This elective is a clinical rotation in the Behavioral Medicine Division of Preventive Cardiology at MGH, an outpatient psychiatric service that has been located in the Preventive Cardiology and Cardiac Rehabilitation Service for over 15 years.

Educational Goals: Residents will learn to provide a comprehensive psychiatric and behavioral patient evaluation to the Preventive Cardiology team and Cardiology medical staff through the evaluation and treatment of patients who are referred to the Behavioral Medicine Division. Residents will learn how to:

1. Evaluate and treat patients with both cardiac and psychiatric disorders.

2. Evaluate and treat patients who are having difficulties modifying the risk factors for coronary artery disease.

3. Evaluate the presence of subtle emotional and behavioral states in cardiac patients and differentiate the patient’s response to the current stress of medical illness and from

4. exacerbation of preexisting or the new onset of psychiatric disorders.

5. Evaluate the contribution of behavioral and emotional states, such as denial, irritability, and stress reactions as a primary or secondary risk factor for cardiac disease.

6. Learn how to engage and evaluate patients who are seen in specialty medical clinics who are not comfortable or familiar with psychiatric evaluation or treatment.

7. Learn how to communicate effectively with cardiologists and cardiac rehabilitation team members.

8. Participate in interdisciplinary team meetings.

Course Description: Residents will spend three to four hours/week in the Behavioral Medicine Division, organized as:

1. one hour for patient evaluation

2. one hour to follow up patients

3. one hour for supervision with psychiatry staff on patients care and other

4. areas of resident interest, such as smoking cessation, weight control,

5. treatment of anger.

6. one hour for interdisciplinary team meeting

Expectations: Resident will evaluate a maximum of one patient every two weeks for 4 months, and follow those they see if appropriate during the rotation. Most patients are seen for two or three visits, others may be followed on a longer term basis. Resident can continue to follow their patient after the rotation ends.

BIOSTATISTICS UNIT

Director: Cary Savage, Ph.D.

The Biostatistics Unit provides statistical consultation to members of the Department of Psychiatry. These services are available at all stages of research -- from early issues of research design and power analysis to data analysis and interpretation. For instance, we have worked with people submitting grants to provide advice about study design before they are submitted. Biostatistics also has a very capable statistical consultant, who is available to discuss issues pertaining directly to data analysis. We have the full SAS implementation on our workstation

and we are capable of performing all types of statistical analyses.

We welcome referrals from any member of the Department. The policy of Biostatistics is to charge an hourly rate for consultation to anyone who has funding to cover such expenses. While Biostatistics receives support from the Department, our goal is to be a self-sufficient as possible.

However, a primary reason for the existence of Biostatistics is to ensure that all members of the Department have access to quality statistical consultation. Our policy, therefore, is to provide consultation free from charge to Department members -- especially Fellow and Instructor

level individuals - who are not funded. Residents are especially encouraged to seek statistical consultation through Biostatistics.

To initiate a referral to Biostatistics, contact Dr. Savage directly, either by E-mail or phone. He will talk to you and get a sense of what your needs are. He is available to discuss any issues pertaining to research design -- before, during or after a study. Dr. Savage is also available to speak to Resident groups about any topic on statistics and research design. Individuals just starting research programs might find it helpful to learn more about research design issues before they initiate new projects.

CHARLESTOWN NEUROSCIENCE RESEARCH CENTER

Contact: Scott Rauch, MD; [email protected]

Duration: Flexible. Some Residents may choose this as a 4 month rotation as outlined above, or for up to a full year commitment during the PGY-IV year, in preparation for independent research during a subsequent fellowship. In some instances, Residents will be able to assist with ongoing projects and earn authorship on peer-reviewed publications.

The MGH Psychiatric Neuroscience Program represents a resource for Residents to learn about psychiatric neuroscience research and related career opportunities. The Program is located on the 9th floor of MGH-East in the Charlestown Navy Yard.

Educational Goals: Residents will learn about psychiatric neuroscience by attending laboratory meetings, interacting with investigators, and observing experiments. Residents will:

1. develop understanding of specific neuroscience strategies for

2. investigating the basis of psychiatric diseases and their treatments.

3. become aware of opportunities for career development and future

4. participation in research as investigators.

Course Description*: Residents will:

1. meet 1:1 with selected principal investigators from the program (~1hr/wk)

2. attend weekly laboratory meetings (~1-2 hrs./wk)

3. observe experiments (~1-4hrs./wk)

4. complete directed readings (~1hr./wk)

Expectations: Regular attendance at scheduled meetings and laboratories.

Contact:` Scott Rauch, Associate Chief for Neuroscience Research, 724-9553; [email protected]

*Note that the content of this offering can be tailored to the interests of the Residents.

COGNITIVE BEHAVIORAL THERAPY RESEARCH PROGRAM

Contact: Lisa Najavits, M.D. [email protected]

Duration: One year

Educational Goals: By the end of this seminar,

1. Learn methods for conducting outcome research for psychotherapies.

2. Evaluate patients using structured clinical interviews for research.

3. Help analyze data/write papers for publication (optional)

Course Description: Residents will spend 4 hours/week as follows:

1. hours evaluating patients for research.

2. hour lab mtg/group supervision on research methods.

Expectations: Interest in research, diagnosis, and assessment.

DISSOCIATIVE DISORDERS AND TRAUMA PROGRAMS

Contact: James Chu

Course Description: The Dissociative Disorders and Trauma Program at Mclean Hospital provides a comprehensive range of services for adults who suffer from the effects of childhood abuse or other painful traumatic memories. With regards to treatment, emphasis is placed on the overall psychological health and functioning of the individual and not simply on identifying and working on trauma. The Program emphasizes the need to develop solid relational skills and control of symptoms prior to embarking on exploration and abreaction of traumatic experiences. The following principles are emphasized:

1. Respect and Collaboration

2. Interpersonal Relationships

3. Psychological Education

4. Healing the wounds of early trauma

PSYCHIATRIC EPIDEMIOLOGY

Contact: Jane Murphy, M.D.

617-726-1822; [email protected]

Duration: Flexible.

Educational Goals: This program seeks to familiarize residents with the history of psychiatric epidemiology with emphasis on North American studies (the Stirling County Study, the Epidemiologic Catchment Area Program, the National Comorbidity Survey, etc., ) but with exposure to the World Health Organization's recent work on “The Global Burden of Disease.” Residents will learn the diagnostic principles employed in several different schedules used for gathering information in epidemiologic studies such as the DIS, CIDI, SCID, SCAN, etc. To review the definitions of prevalence, incidence, mortality ratios, etc. To achieve a grounding in what has been accomplished in the field and the major questions that remain unanswered.

Course Description: A two hour lecture in the Research Seminar directed by Dr. Michael Jenike. A tutorial of one hour a week for several weeks for those who have a special interest in this field.

Expectations: Demonstration through discussion that the educational objectives have been met.