The first year of the four-year training program consists of a categorical psychiatry internship (PGY1 residency) at Meharry Medical College Department of Psychiatry. The Department of Psychiatry is responsible for curriculum, oversight, and support for the psychiatry residents. Since a number of the rotations take place within the VA Murfreesboro, VA Nashville, Parthenon Pavilion at Centennial, Nashville General Hospital, Elam Mental Health Center (EMHC), the Residency Program Director collaborates closely with the administrators of these sites to design and implement a well-integrated experience.
During the PGY1, the resident develops his/her identity as a physician and gains familiarity with Meharry Medical College and the communities it serves. Residents are given considerable responsibility for patient care to foster competence in psychiatric medicine. PGY1s rotate on the general medical and psychiatry teaching service, with a protected five-hour didactic block on Tuesday afternoons. This didactic seminar further prepares residents for fluency in psychiatric practice.
Half of the internship year focuses on primary care in a community hospital setting. Rotations include medical wards, the ICU, ambulatory care, and/or Pediatrics. The remainder is devoted to psychiatric rotations. These include one month each of general neurology, behavioral neurology, addictions medicine, child psychiatry, geriatric psychiatry, and rehabilitation community psychiatry. In child psychiatry, residents work alongside an attending on an inpatient unit and have the opportunity to serve in a variety of roles. In their geriatric rotation, PGY1 residents work in an inpatient setting; in neurology rotations, they provide inpatient and outpatient assessment and treatment under the supervision of attending neurologists and behavioral neurologists. In their addiction rotation, PGY1 residents consult medicine for acute detoxification, and observe and participate in outpatient group therapy and residential treatment. Residents contribute to the intensive care of chronically and severely mentally ill patients and see patients in the EMHC Transition programs designed to treat patients recently discharged from various care facilities for stabilization, detoxification and treatment. PGY1 residents work with senior residents and faculty to care for psychotic patients living in the community who access shelters and come to the EMHC.
Training during the PGY-1 year covers learning to recognize and describe various forms of psychopathology. Residents also develop their solid interviewing skills through rotations on the various inpatient psychiatry units. In the second half of the PGY-1 year, residents in psychiatry begin "on call" for psychiatric emergency services. This allows continued learning of basic and advanced emergency psychiatry skills for after hours care. PGY- 4 residents work as "back-up" consults for the PGY-1's in teaching and monitoring the work to prepare PGY-1 residents for solo call at the beginning of the PGY-2 year. Faculty attending serve as "back up" for PGY-4 residents.
During PGY2, the resident builds upon the fundamentals of psychiatry learned during PGY1. The resident receives broad exposure to most of the specialty areas within psychiatry. The second year's emphasis is on strengthening interview techniques and the skills necessary to diagnose and treat patients with a variety of medical and psychiatric disorders. During the PGY-2 year, medical skills are refined and strengthened through specialty rotations.
PGY2 residents in psychiatry perform "on call" services for psychiatric emergency services. This allows continued learning of basic and advanced emergency psychiatry skills for after hours care. PGY-4 residents work as "back-up" consults for the PGY-2s in teaching and monitoring their work. Faculty attending serve as "back up" for residents.
The PGY-3 year is dedicated to the development of outpatient skills, which includes proficiency to perform a comprehensive assessment of the outpatient presenting for the first time as well as more complex patients who seek a second opinion. PGY3 residents perfect broad practical skills in the evaluation and treatment of a variety of disorders. Depending on the individual patient needs, some treatments are intensive and psychodynamically based care, while others are brief or applied in conjunction with psychopharmacologic agents.
PGY3 resident are provided the opportunity to concentrate on the specific issues involved in managing patients with psychiatric symptomatology in an outpatient setting. Learning experiences include exposure to patients with disorders that require periodic hospitalization and other patients with symptoms that can be successfully managed as outpatients. Residents treat patients in settings that include traditional hospital care, outpatient clinics, psychiatric facilities, and specialty clinics.
PGY3 residents in psychiatry perform "on call" services for psychiatric emergency services. This allows continued learning of basic and advanced emergency psychiatry skills for after hours care. PGY-4 residents work as "back-up" consults for the PGY-3's in teaching and monitoring their work. Faculty attending serve as "back up" for residents.
The PGY4 resident obtains a dynamic balance between elective flexibility and the vital opportunity to integrate all that he or she has learned in the preceding years. PGY4 residents return to the inpatient and consultation services but do so with an expanded responsibility for the leadership and teaching of their team members. PGY4 residents are allowed to focus on a particular area of interest such as research, chemical dependency, or geriatric psychiatry, or to address further areas in preparation for fellowship or life after residency. Throughout the residency, PGY4s continue to gain the skills necessary to aid patients and colleagues in other fields who suspect that their patients' illnesses are influenced or caused by psychiatric disorders. These specific skills require experience coupled with close supervision. The PGY4 resident has increased responsibilities in providing education and supervision to other residents and medical students on the team.
PGY4 residents in psychiatry perform "on call" services for psychiatric emergency services. This allows continued learning of basic and advanced emergency psychiatry skills for after hours care. Faculty attending serve as "back up" for residents.