Clinical Rotations

3 months of inpatient psychiatry at the VA
Interns are exposed to patients with such diagnoses as chronic schizophrenia, mood disorders, and PTSD. There is ample opportunity to gain experience treating the increasingly important and rapidly expanding geriatric population, as well as growing numbers of women and younger veterans. Interns are supervised by attending staff as they work in an interdisciplinary setting to diagnose and treat acute and chronic psychiatric disorders. During weekday short call and weekend 24-hour call, interns are supported at all times by an in-house senior resident or attending.

1 month of inpatient psychiatry at the University of Michigan
This rotation provides interns with the opportunity to manage acutely ill patients with a wide variety of disorders. The patient population is highly diverse with regard to ethnicity, socioeconomics, legal status, and treatment needs. Inpatient services include in-depth clinical assessment, crisis intervention, medication management, ECT, and coordination of care with outpatient providers. Interns work side-by-side with hospital specialist attending faculty and other members of interdisciplinary treatment teams.

1 month of addiction psychiatry at the VA
The Ann Arbor VA provides a range of outpatient addiction services. Interns provide supervised care for both addiction and co-morbid psychiatric disorders through the SUD-IOP (Substance Use Disorder Intensive Outpatient) Program, gaining experience managing withdrawals and learning about a variety of maintenance treatment. Interns work closely with the rest of the team, including a dedicated team of substance use therapists. There is also an opportunity to learn about the nuances of prescribing buprenorphine.

1 month of consultation/liaison psychiatry at the VA
Interns are introduced to consultation/liaison psychiatry, providing psychiatric assessment and collaborative treatment to medical and surgical patients at the VA Hospital. Interns are taught how to assess clinical decision-making capacity, manage delirium, and the variety of options for psychiatric disposition.

Medicine Rotations

There are several rotation options to fulfill the 4 months of medicine that each intern is expected to complete. Interns interested in a child fellowship may find it useful to rotate through inpatient pediatrics and can discuss substituting a month of inpatient pediatrics for a month of inpatient internal medicine at the VA.

Inpatient Internal Medicine at the VA (2-3 months)

The Ann Arbor VA Medical Center is a major veteran tertiary care center. The psychiatry intern works as an additional intern to the internal medicine interns. Teams rotate call responsibilities, taking call every other day. Interns receive one day off per week; the schedule is determined by the senior medical resident. There are weekly didactics and resident case seminars. Interns gain experience in efficient management of common medical conditions, as well as in evaluation and treatment of more complex medical pathology.

Inpatient Family Medicine at U of M (1 month)
Residents work with a senior Family Medicine resident and rotating faculty to care for patients with a wide spectrum of medical and psychiatric co-morbidities who are admitted on a daily basis. Residents are involved in basic inpatient management of common medical complaints. This rotation provides residents with a degree of independence in formulating treatment plans and managing day to day care of patients.

Inpatient Pediatrics at U of M (up to 1 month)
The psych intern is part of a 3-intern team. Teams can include general pediatrics with one of the additional pediatric subspecialty teams—gastroenterology, pulmonary, or neurology. There are case seminars and daily didactics.

VA Urgent Care (1 month)
The urgent care rotation at the Ann Arbor VA is a particularly rewarding rotation. The clinic is staffed by Internal Medicine faculty and residents from various specialties. Residents see patients with a wide variety of complaints, from chest pain to a skin rash. Many of the VA population are very sick, with multiple medical problems, creating an opportunity for residents to learn to treat and triage a large variety of diagnoses, preparing them to manage just about anything that their patients may present, including a significant number of psychiatric cases. The Urgent Care rotation allows for a high degree of autonomy, with attending faculty available at all times.

Neurology Rotations

Neurology is divided into 1 month at the Ann Arbor VA Medical Center and 1 month at the University of Michigan Medical Center.

1 month of neurology at the VA
Working side-by-side with senior neurology residents and faculty, interns spend mornings seeing patients in the outpatient neurology clinic, and afternoons rounding on the inpatient service. In addition, interns gain valuable experience treating a wide variety of neurological complaints in the emergency room and by consultation. Weekend responsibilities for the neurology service are from home by pager only.

1 month of neurology consults at the University of Michigan

Psychiatry interns work with senior neurology residents and faculty on the neurology consult service. Psych interns will care for patients with seizures, strokes, neuro-oncologic disease, and myriad other neurologic issues.

Didactics

Protected time for didactics for the first-year psychiatry resident includes lectures on Thursday mornings. These occur weekly while on psychiatry rotations; while on medicine/neurology rotations, interns attend these lectures every other week. Topics focus on the needs of early independent clinicians, including the mental status exam, suicide assessment, delirium, psychopharmacology, consultation psychiatry, emergency psychiatry, mood disorders, psychotic disorders, and PTSD. 

Additionally, for the first 6 weeks on the psychiatry service, interns meet with more senior residents for "Intern Bootcamp" and receive additional didactics. 

University of Michigan Department of Psychiatry Grand Rounds are held Wednesdays in the auditorium at the Rachel Upjohn Building, with teleconference connections to University and VA Hospitals. These Grand Rounds bring in national and international speakers to present cutting edge clinical care and research in psychiatry and mental health.

VA Clinical Grand Rounds are held on Tuesdays and focus on clinical and educational topics. They are subdivided to include monthly resident journal club, clinical research, interdisciplinary topics, and case presentations. Each intern will present at VA Clinical Grand Rounds once during the year.

PGY-2 residents spend 5-6 months on inpatient units at University Hospital and the VA. Reasonable case loads, intensive supervision and teaching, and many on-going research projects create an academic atmosphere that facilitates both excellent patient care and education. Time is protected for weekly core seminars focusing on a working knowledge of psychiatric diagnoses, psychodynamic principles and practice, basic principles of pharmacological treatment, emergency psychiatry, consultation/liaison, ethics, and forensics. Residents also acquire technical skills in the administration of electroconvulsive therapy (ECT).

We have extensive night float coverage that takes the place of most over-night call at both University Hospital and the VA. This system allows residents to have infrequent call nights throughout the rest of residency. Faculty members staff the Psychiatric Emergency Service from 8 am – 2 am weekdays and 10 hours a day on weekends, and a senior resident or fellow is available to assist with in-house back-up when needed. When no attending is present, residents staff most patients with an attending over the phone. Additional emergency psychiatry training takes place during the Psychiatric Emergency Service Day Float month, when PGY-2 residents work afternoon and evening shifts with attending faculty, nursing, social work, and junior residents.

The third year is devoted entirely to outpatient and community psychiatry. In the Adult Outpatient Clinic, residents become part of interdisciplinary clinics supervised by full-time faculty. The clinic experience includes intensive mentorships in family therapy, cognitive-behavioral therapy (for both anxiety and depression), dialectic/behavioral therapy, interpersonal therapy, and psychodynamic psychotherapy. All residents participate in the Geropsychiatry Clinic, Child/Adolescent Clinic, and Addiction Treatment Service. Residents select from additional specialty clinics focusing on depression, anxiety disorders, bipolar disorders, personality disorders, and others. Residents follow patients throughout the year at a local Community Mental Health Center with on-site faculty supervision. Time is protected for participation in each of the psychotherapy mentorships and the core didactic series on Friday afternoons covering topics pertinent to outpatient psychiatry.

In PGY-3, each resident will begin supervised, long-term psychodynamic psychotherapy cases that will continue throughout the residency. Supervision of psychotherapy cases in individual and group settings is intensified during PGY-III. Flexibility in the number of psychodynamic and other psychotherapy cases allows residents to develop unique interests in the field.

Clinical supervision and seminars are provided to give residents experience in civil forensic cases. PGY-3 residents also spend 2 weeks at the Center for Forensic Psychiatry, a highly respected facility with a high level of inpatient and outpatient clinical activity. The Forensic Center focuses on the interface between the criminal justice system and community psychiatry. Residents participate in outpatient evaluations of patients' competence to stand trial, degree of criminal responsibility, and other legal issues. Fifteen full-time psychiatrists with special qualifications in forensic psychiatry, as well as a large number of psychologists, social workers, and others, contribute to the experience.

The final year of training provides residents with an opportunity to explore additional areas and develop unique interests. Protected core curriculum time on Thursday afternoons is used for advanced topics and preparation for independent practice.

PGY-4 residents return to the university and VA Consultation/Liaison Service for 2 months of supervised clinical work. They have the opportunity to provide teaching and guidance to junior residents on the service, under the direction of faculty. While at the VA, there may be opportunity to crossover to a teaching and supervisory role on the VA Inpatient Service, where they interact with PGY-1 and PGY-2 residents on the service but are not responsible for direct patient care.

Ample time is provided during the year for elective rotations. Many residents choose to return to rotations in which they developed interest earlier in the residency, while others pursue training in new settings. Popular experiences include a homeless outreach program through CMH, work with students and families on the main university campus, community outreach clinics, sexual disorders clinic, corrections-based services, early psychosis clinic, TMS, ketamine and ECT, and many others. Residents are encouraged to develop new experiences that will enrich their own training and contribute new ideas to the residency program. In fact, many of the established electives were resident initiatives.