R-1 curriculum

Departmental Grand Rounds:

Invited speakers through Northwell Health; chaired by J. Kane, M.D.

Formal presentations of recent research, or scholarly reviews of important issues affecting clinical practice and/or our understanding of the nature of mind and brain in health and illness. Most speakers are nationally and internationally recognized experts in their field of study. Grand Rounds are viewed through teleconferencing capability and occur at the hospital's North campus, which will also be the location for residents' educational activities on Wednesdays.

Weekly, each Wednesday, except summer and holidays

Journal Club:

Weekly review and critical discussion of journal articles of note. Articles will be disseminated in advance of the meeting, and faculty and residents will be assigned to lead the discussion. Articles will most often be from the current literature, though articles of historical interest may be included as well. Emphasis will be placed on importance and relevance of content; teaching skills necessary for critical reading, such as assessment of methodology, statistical analysis, and strength of findings; and questions or future directions suggested by the article's content. Residents will be required to fill out a form in advance of the meeting, in which they convey their assessment of the article with respect to these several measures. Their assessments will be reviewed with the faculty at the Journal Club and used to assist the residents in developing lifelong learning skills.

Bi-weekly, on Thursdays, over lunch

Research Seminar:

Weekly seminar with Dr Russell Joffe, Chair of the Department of Psychiatry and Behavioral Sciences, which will begin each academic year with an introduction for residents. Attendance in the R-1 and R-2 years is encouraged, though no formal expectation of research practice is required until the R-3 year. The seminar will set forth the expectations for research to be conducted in the R-3 and R-4 year - though research can be initiated at an earlier point in the residency. Dr Joffe, an internationally recognized and accomplished researcher, will guide residents in choosing topics with which they can work effectively, with the goal of producing a publishable article or study by the end of their residency. Residents will be made aware of research in progress or planned at SIUH, as well as at Northwell Health, including research activities at Zucker Hillside Hospital and the Feinstein Institute for Medical Research, which are part of the Northwell Health. Residents will also present their research projects as they are in development, and through each stage of the research activity. In addition, residents will be assigned a mentor for their research project, who will assist them individually, and who will attend the research seminar when indicated.

Weekly, Friday mornings

Literature, Narrative, and the Self:

Following the format and general outline of Robert Coles' successful seminar  series at Harvard Medical School - described in his book, Handing One Another  Along - we will read narratives, both literary and autobiographical, in order to explore the varieties of human experience, including but not limited to the 

experience of mental and physical illness. A selection of other readings, in psychology, the natural sciences and philosophy, and related fields, will also be provided.  The goals of the course will be to understand the importance of narrative and its utility in the practice of psychiatry, as well as medicine, generally; to  increase empathy; and to generate discussion of cultural, psychological and ontological issues that may arise in the course of our practice as physicians. A selection of films will also be assigned for viewing at home, and then be  discussed in class. A summer reading and viewing list and writing project will be  assigned and presented in the seminar in the autumn when classes resume. 

Residents on rotations at off-sites will be able to participate in discussions  through teleconferencing.

Weekly, Mondays, over lunch

Learning Practice:

Informal discussion group and seminar that will provide residents with an opportunity to discuss/review their current learning, to receive additional assistance or instruction where necessary; to direct residents to current, important literature or news affecting the field; to review performance on exams (PRITE, etc.); to provide feedback on their individual and group educational experience and identify gaps, or areas that require attention within the curriculum and/or supervision schedules; and to practice and review Board Exam-type questions and clinical vignettes. Residents will periodically be provided with exam or assignment materials that they will be expected to prepare before the course, so that answers may be reviewed there, and learning opportunities maximized. 

Bi-weekly, on Thursdays, over lunch, alternating with Journal Club

Crash Course in Psychopharmacology:

Structured using the outline of the ASCP (American Society of Clinical Psychopharmacology) Model Psychopharmacology Curriculum (6th Edition), and utilizing educational materials provided by ASCP, which have been updated and supplemented where necessary. PGY-1 residents will be provided with a basic knowledge of psychopharmacology to guide them as they begin their clinical work.

Weekly, 8 sessions

Orientation to Neurobiology:

Introduction to critical concepts in Neurobiology: interaction between the brain and other body systems, including the gut and the immune system; homeostatic mechanisms in the brain and their relation to illness states; introduction to cellular physiology, neurotransmitter and receptor interactions; gene regulation; oxidative metabolism and its relationship to illness states. The course will make liberal use of audiovisual materials to augment learning. Presented by Dr Russell Joffe.

Weekly during Psychiatry Rotation in R-1 year

Anthropology, Philosophy and Sociology in Psychiatry:

Introduction to the importance of understanding other perspectives on symptoms, illness, and healing, informed by other disciplines. Topics will include the influence of race, ethnicity, and cultural background on illness presentation and treatment; philosophical views on the nature of the illness experience, communication, and subjectivity; and the complex way in which language influences the process of assessment and treatment.

Weekly during Psychiatry Rotation in R-1 year

The Clinical Interview:

Intensive training in conducting an effective psychiatric interview. The course will necessarily encompass an introduction to Nosology, but also address: the relationship of diagnostic assessment to the clinical interview and mental status exam; how to establish a treatment alliance; ethics, boundaries and cultural sensitivities of which to be mindful in the conduct of an interview. As we examine the structure of the clinical interview over the course of treatment, we will discuss integrating clinical scales and measures such as sleep diaries and activity schedules; assessing progress in treatment; and examining different session structures tailored to the task, and the treatment contract/understanding.

R-2 curriculum

Courses in concert with R-1, R-3 and R-4 residents:

  • Departmental Grand Rounds
  • Journal Club
  • Research Seminar
  • Literature, Narrative and the Self
  • Learning Practice

Other courses:

Syndromes and Disorders in Psychiatry:

A series of courses which will examine the major syndromes in psychiatric practice, reviewing the etiology, nosology, principles of assessment and treatment, and current research related to these conditions. We will also discuss patient-centered perspectives on diagnosis and treatment, as well as principles of recovery models as they relate to the syndrome being discussed. Residents should acquire expertise in understanding and managing conditions covered by this course. The course will make use of videos as well as live interviews. Topics will include Mood Disorders presented by Dr Joffe; Schizophrenia Spectrum Disorders presented by Dr Sullivan; Child and Adolescent Disorders; Anxiety Disorders; Personality Disorders; Addiction Psychiatry; and more throughout the academic year.

Basics of Neurobiology:

Introduction to basic knowledge necessary for understanding brain functioning, in illness and in health, as well as the actions of therapeutic agents, and treatments generally. We will review the gross anatomy of the brain; the brain's organization and the neural networks, in particular, that underlie mood regulation and cognitive processes relevant to psychiatry; cellular physiology; the neurobiology of affect; learning, the mechanisms underlying long-term potentiation (LTP) and neural plasticity, and the role of mirror neurons; and principles of genomics.  

Psychological Theories of Behavior:

This course will present the major psychological schools, and areas of inquiry, that represent the scientific effort to understand the mind. Behaviorism, from Pavlov, Thorndike and Watson, to Skinner, and post-Skinnerians, as well as more recent developments, including Acceptance and Commitment Therapy theory and practice; the Cognitive Sciences; the contributions of Learning Theory; and exciting new areas of inquiry such as Perceptual Control Theory. We will examine the insights of these theories as they relate to our understanding of the mind, and to the practice of psychiatry. 

The Psychotherapies:

The major schools of psychotherapy will be presented, including the history of their development, their fundamental principles and underlying theories and the essentials of their practice, with attention to what distinguishes each school from the other. Research on effectiveness and outcomes will be reviewed. We will discuss the psychoanalytic schools; group and family therapies; the cognitive therapies; the "Third Wave" cognitive therapies; and others.

Anthropology, Philosophy and Social Medicine in Psychiatry:

We will read, review and discuss the work of contributors both within and outside the discipline of psychiatry who examine the influences of human social structures and behaviors, evolutionary forces, and the evolution of our own cognitive frameworks on the way we think about the mind and mental illness. The writings of Arthur Kleinman, Allan Young, Roy Porter, Byron Good, Michel Foucault, and others will be discussed. We will explore the practice of psychiatry in other cultures; the role of race and culture in society in the USA and New York in particular; the ways in which cultural assumptions influence the interpretation of illness; and the challenge and role of dissenting views. 

Professionalism and Ethics:

Residents will study and discuss scholarly work, and professional guidelines, which address the doctor-patient Relationship, proper boundaries and boundary violations including social and/or sexual contact with patients. Ethics in Medicine and Psychiatry will also be addressed with respect to such topics as patient's rights, confidentiality, professional behavior and competency. Case studies will be presented to facilitate discussion and learning.

R-3 curriculum

Courses in concert with R-1, R-2 and R-4 residents:

  • Departmental Grand Rounds
  • Journal Club
  • Research Seminar
  • Literature, Narrative and the Self
  • Learning Practice

Other courses:

Research, Evidence-Based Practice and Critical Appraisal: 

Overview of research methodology and study design. Formulating an answerable question, searching for the best evidence to answer the question(s), critical appraisal of the literature regardless of whether the issue is etiology, diagnosis, treatment or outcome and prognosis and application of the appropriate evidence to individuals' care.

Advanced Psychopharmacology:

The course will follow the structure of the ASCP Model Psychopharmacology Curriculum (6th Edition), and utilizing educational materials provided by ASCP, which have been updated and supplemented where necessary. Topics will include pharmacological management of Anxiety Disorder Syndromes, PTSD, OCD, Eating Disorders, Personality Disorders, Psychopharmacology of Sexual Dysfunction, Cross-Cultural Psychopharmacology, Mental Retardation, Child and Adolescent Disorders, and many others. Case studies will be utilized.

Addiction Disorders:

This course will increase the participants' understanding of the neurobiologicalunderpinnings of addictive thinking and behaviors. We will examine the distinctions between "abuse" and "dependence" clinically, physiologically, and with respect to both the unique and common factors that predispose to these patterns of behavior. The physiological and behavioral effects of various  substances of abuse will also be examined, together with the social and cultural contexts that characterize the use of different agents. The public health dimension of substance abuse will be outlined. In addition, the relapsing nature of addictive disorders has lead to a variety of treatment modalities, and, in particular, innovative means of engaging patients in treatment, such as motivational interviewing. Case studies and video demonstrations of techniques will be presented.

Psychopharmacology and Treatment of Addiction Disorders:

We will study integrative forms of treatment, and examine the risks and benefits of both abstinence-based and harm-reduction models. Residents will be exposed to the range of treatment settings available, and the scientific evidence of efficacy associated with different models. Pharmacologic treatment of withdrawal, as well as relapse prevention therapies, will be reviewed. The role of behavior therapies, and contingency management in different treatment settings, will also be studied, with clinical examples and exercises for residents to complete and discuss. The principles involved with treating patients with co-morbidities will receive special focus, especially the challenges of co-morbid substance use and serious mental illness (Quadrant IV patients).

Molecular Psychiatry and Genomics II:

This course will examine current pre-clinical and clinical research elucidating mechanisms underlying mental illness, dysfunction and human behavior. Residents will be helped to understand the basic principles, concepts, and vocabulary necessary to read this burgeoning literature, including the developing field of genomics. In order to both broaden and deepen understanding, we will invite speakers who are conducting research in this area, including scientists in our healthcare system (NSLIJ), at Zucker Hillside Hospital. We will also organize at least two field trips to visit sites where research is being conducted. 

Developing Assessment Skills:

In this seminar series, residents will be helped to perfect their skills in performing assessments and in drafting clinical summaries for purposes of case conferences, referral for consultation, or publication, as well as learning to concisely and effectively record pertinent history to enter into the clinical record. Residents will be expected to prepare write-ups (the nature of the which will be assigned), related to patients they see in their clinical rotations, and bring them to class to discuss and receive critical feedback from faculty. Patients will, at intervals, be interviewed in front of the class, so that residents can record their impressions, complete a draft psychiatric history and mental status exam, and bring their work to present, contrast and review with other participants. Specific training will be provided in the use of clinical tools (HAM-D, YMRS, BSDS, Beck Anxiety, YBOCS, BPRS, PANSS, QLES-Q, AIMS and others) and how to integrate them in the assessment process.

Psychological Testing and Assessment:

This course will increase the participants' understanding of the role of the psychologist in the interdisciplinary team. The range of psychological and neuropsychological testing will be presented, together with indications for referring patients for this testing, and guidance in interpreting the psychologist's findings. The use of psychological testing in research will also be reviewed, together with an introduction to the methods of statistical analysis commonly used in psychiatric an social science research.

Psychotherapy - Advanced Topics:

We will utilize video demonstrations of different psychotherapeutic techniques, as well as live interviews, to deepen residents' understanding of specific psychotherapies, with emphasis on supportive, psychodynamically-informed, and cognitive therapies. Residents will be taught how to create records of therapy sessions for use in supervision, and exposed to scales used to measure competency in the practice of psychotherapy, as well as fidelity to given models. Residents will be prepared to begin the process of certification in CBT with the Academy of Cognitive Therapy during their PGY-4 year.

Community Psychiatry:

This seminar will provide an opportunity for residents to become familiar with community services on Staten Island, and to be involved first-hand in observing and contributing to such activities by participation in board-level functions. Residents will be assigned a mentor who will assist them in identifying a community agency with which to become engaged, and then to approach the agency and determine a means for the resident to learn about the entity's administrative functions and operations. Residents will be required to develop a systems-based "change project," which they will identify with the help of staff at the agency with whom they have chosen to work. Residents will report on their experiences, and on their progress toward completing their "change project", in subsequent seminars, and receive feedback from peers and faculty. 

Gender, Sexuality, and Sexual Psychopathology:

In this course, we will survey issues related to sexuality, sexual identity, and sexual behavior in illness and in health. In addition to didactic presentations, we will invite spokespersons from communities of interest, such as the LGBT community, to speak about their experiences and concerns, as well as clinicians who work in specialized programs addressing the needs of these individuals, including the LGBT clinic where residents may elect a rotation in their PGY-4 year. 

The course will address the range of sexual roles in healthy sexual relationships; the importance of therapists' awareness of their own sexuality and biases; issues relevant to the LGBT and related communities; the role of sexuality in persons suffering from depression and other mental illnesses, and how to address these issues in treatment; sexual psychopathology, its phenomenology and evidence-based treatments; and the importance of identifying attitudes toward gender and sexuality in psychiatric/psychological theory, practice and research.

Advanced Course in Child &Adolescent Psychiatry/Psychopharmacology:

This course will build on the foundations of normal observed Child development to diagnosis and treatment of Childhood disorders with a focus on Integration of Psychopharmacological as well as psychotherapy techniques relevant to the Outpatient treatment setting. The residents will develop a detailed understanding of major childhood disorders and treatments and treatment guidelines .This course will promote an evidence based curriculum including DSM based diagnosis and evidence based medicine with a background of clinical observations. These will include case discussions as well as review of relevant and current literature as necessary. The resident should gain an adequate level of comfort in assessing, treating and developing collaboration with other care providers.

Clinical Case Conference in Child Psychiatry:

The clinical case conference will be a monthly discussion of a case identified by the resident that will be presented formally and discussed with the faculty as well as the residents. The goal of the presentation is three fold: a)The resident will learn to obtain and present a detailed yet concise history to other professionals)Allow feedback on narrative as well as diagnostic and treatment related dilemmas faced by the patient and clinician c) Foster a learning environment by case discussion as well as literature review to help understand unique situations that pose a challenge to outpatient psychiatry practices especially in the realm of child psychiatry.

R-4 curriculum

Courses in concert with R-1, R-2 and R-3 residents:

  • Departmental Grand Rounds
  • Journal Club
  • Research Seminar
  • Literature, Narrative and the Self
  • Learning Practice

Other courses:

Training to be a Teacher: 

Residents will be helped to acquire skills and confidence that will allow them to become effective teachers. We will make use of institutional resources designed to help faculty improve their teaching skills. We will also present material related to learning theory, including adult learning styles and needs. Residents will be helped to prepare classes that they will present to different groups in different settings: classes for PGY-1 residents and visiting medical students that are part of the regular curriculum; classes for professional staff at the institution that are part of the Department's ongoing continuing education programs; and classes to consumer and community groups on requested topics. Emphasis will be placed on using different teaching modalities, tailored to the audience and setting. Residents will research topics and prepare lesson plans, and present lessons in class to receive critical feedback from faculty, before the actual class. Residents should expect to teach at least one class monthly.

Scientific Reading Seminar:

Residents will be guided in pursuing advanced independent study of selected topics. Residents will be expected to lead seminar discussions on the works they have read, in which seminar participants will relate the topic of discussion to the works they are reviewing. Emphasis will be placed on works related to translational research (e.g.,Translational Neuroscience: Applications in Neurology, Psychiatry and Neurodevelopmental Disorders); studies in the cognitive sciences (e.g., The Invisible GorillaPerceptual Control Theory: Science and Applications - A Book of Readings; Consciousness Explained; Mirroring People: The Science of Empathy and How We Connect With Others); the history of psychiatry including critiques and perspectives from within the social sciences (e.g., History of Psychiatry and Medical Psychology: With an Epilogue on Psychiatry and the Mind-Body RelationFlesh in the Age of Reason: The Modern Foundations of Body and SoulMadness: A Brief History); related disciplines, such as anthropology, especially those presenting insights gleaned from recent research (e.g., Our Inner Ape: A Leading Primatologist Explains Why We Are Who We Are); and different schools of psychotherapy and psychological theory (e.g., Mindfulness and Acceptance: Expanding the Cognitive-Behavioral TraditionWhen Theories Touch: A Historical and Theoretical Integration of Psychoanalytic ThoughtJung contra Freud: The 1912 New York Lectures on the Theory of Psychoanalysis). Residents will also be expected use this seminar to prepare a scholarly discussion paper in publishable form on one of the subject areas they study over the course of the year. 

Advanced Study of Psychotherapy: Theory and Practice

This course will have two components: Residents will study in greater detail the theories underlying the principal modalities of psychotherapy for which there is evidence-based research support, including Cognitive-Behavioral Therapy (CBT); Interpersonal Psychotherapy (IPT); Dialectical Behavior Therapy and Mindfulness-Based Cognitive Therapy (DBT and MBCT); and Mentalization Based Therapy (MBT); as well as Best Practices with respect to Psychodynamic Psychotherapy and Supportive Psychotherapy for which there is less robust scientific support.

In addition, residents will present session records, including their use of clinical scales where relevant, from active psychotherapy cases using one of the modalities noted above. Each resident will have the opportunity to present and receive feedback from faculty and peers for 8-10 weeks over the course of the academic year. Where possible, cases will be followed episodically over several months, though brief therapy cases will also be selected for purposes of supervision.

Psychopharmacology Consult Service - Case Presentation:

Residents will present challenging psychopharmacology cases from the Consultation Service or from the Outpatient Department. Residents will be expected to review the case, perform an independent examination and write up their findings, including a literature review. Cases will be presented to senior consultants and a treatment plan recommended. Follow-up presentations will also be scheduled to  examine the outcomes of recommended interventions.

Neurology Board Review:

Kaufman Review Course: preparation for the Neurology portion of the American Board of Psychiatry and Neurology Examination. SIUH's Residency Program will underwrite attendance for all PGY-4 residents. Attendance includes preparation for the general psychiatric portion of the Board Examination.

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