GENERAL PSYCHIATRY RESIDENCY PROGRAM
Click here for PDF file of Goals and Objectives
The overall goal of the Johns Hopkins Psychiatric Residency is to produce a well-educated, broadly experienced psychiatrist who can prosper in any subsequent career. This goal is approached systematically by combining closely supervised intensive clinical experience in multiple settings with a comprehensive didactic program. These experiences broaden in comprehensiveness over the four years of the residency. The experiences are also aligned with the health-care reform demands of the contemporary era in giving residents clinical responsibilities within an integrated continuum of progressive complexity on the wards and in the clinics. In addition to a didactic lecture series specific to each residency year, an ongoing across-the-years department-wide educational program runs concurrently and consists of weekly meetings of Departmental Grand Rounds, Research Conference and Visiting Lecture Program, Journal Club, Psychodynamic Psychotherapy Conference, and Chairman’s Service Rounds. All residents, juniors and seniors, participate in considering principles of psychiatry during these weekly didactic meetings. The more informal interactions of residents and faculty at ward rounds and outpatient meetings facilitate the integration of didactic elements with daily clinical experience. The discourse of the departmental “community” is a vital element of the educational experience of everyone - resident and faculty alike. Its place in resident education can be identified in the specific goals and objectives of each residency year described below.
Our residency program is organized according to the general and specific goals detailed below. Amplifications and modifications have occurred over time in response to the growth of knowledge in psychiatry and in response to the demands of a changing health-care system. Our ultimate goals are to open the field of psychiatry to our residents and to help them become both broad- and tough-minded.
Year I of Residency
The goals of the first year of residency are integrative and introductory - specifically to provide a foundation in internal medicine and neurology and also to provide an initiation to the essentials of psychiatric practice through supervised responsibility for assessing and treating a diverse population of psychiatric inpatients on a general psychiatry service.
Thus we expect that by the end of this year, residents will have an initiatory knowledge of:
- internal medicine and neurology
- methods of patient assessment and formulation
- different categories of psychiatric patients and the categorical implications for treatment and prognosis
- the milieu concept of inpatient psychiatric service
- the responsibilities of the other mental health practitioners integrated in team treatment of patients: the nurse, social worker, psychologist, occupational therapist, case manager, addiction counselor, and others
- the several treatment modalities - psychological, pharmacological, physical, and rehabilitative - employed with psychiatric patients
Year II of Residency
The goals of the second year are to build on the developed capacities of the first year and to introduce more advanced knowledge and methods of care. These goals are achieved by close supervision of residents on a variety of inpatient units and also by introducing residents to the vertically integrated continuum of care through closely supervised experiences in specially designed day programs and an office-based outpatient practice. Their broad experiences with patients are amplified by a didactic program of lectures in psychiatric assessment, treatment and research.
We expect by the end of this year that a resident will have acquired:
- a thorough competence in the assessment and formulation of psychiatric disorders along with a clear appreciation of the corroborative methods tied to psychological testing and laboratory measurement
- competence in treating the most seriously mentally ill patients, their frequent complicating medical and surgical problems, and the forensic issues that may affect their treatment
- a comprehensive understanding of the psychological, pharmacological, and physical treatments involved in the care of the seriously mentally ill
- a capacity to assume a leadership role on the treatment team in an inpatient milieu
- experience with targeted behaviorally oriented treatment plans for treatment of such behavioral conditions as eating disorders and addictions
- an introductory knowledge of subspecialty psychiatry gained through experience on specialty services such as geriatric psychiatry, affective disorders (adult and adolescent), neuropsychiatry, schizophrenia, chronic pain, motivated behaviors (including substance abuse), and eating disorders
- an introduction to both time-limited symptom-focused and long-term insight-oriented psychological treatments by delivering psychotherapy, under close supervision, to selected patients followed in an ambulatory setting
- an initiatory experience of the vertical integration of clinical practice incorporating day programs and office outpatient services in the continuum of care
Year III of Residency
The goal of this year is to enhance the resident’s acquired competencies in outpatient care by supervised experience in more complex arenas of psychiatric service. A whole variety of new competencies are derived from this emphasis on mastering the problems of psychiatric assessment and treatment in unique domains within the health-care system. The resident continues to treat patients in an office-based practice but through a comprehensive outpatient service, also has closely supervised experience in the assessment and treatment of chronic schizophrenia, affective disorders, anxiety disorders, drug and alcohol disorders, forensic issues, and sexual disorders. Special treatment experiences - psychopharmacology for chronic disorders, couples therapy, and family therapy - are provided under close supervision along with an extended series of psychodynamically oriented lecture demonstrations. A significant exposure to community-based psychiatry is provided, including rehabilitative and outreach services.
Emergency psychiatric consultation both in the emergency department and general hospital inpatient wards enhances the residents’ confidence in methods of assessment and develops their capacity to provide crisis management and behavioral stabilization. An HIV psychiatry clinic and emergency consultations for general medical outpatients provide experiences in ambulatory consultation to primary-care physicians. Such experiences help residents learn how psychiatrists function in a large system of health care.
We expect that by the end of this year a resident will have acquired:
- mastery of skills of psychiatric assessments and treatments in complex outpatient settings
- diagnostic skills in recognizing the psychiatric disorders that complicate medical/surgical conditions and the capacity to provide this information in consultation to primary-care physicians in general hospital inpatient and outpatient services
- mastery of the role of liaison in the general hospital setting
- a firm grasp on the theoretical underpinnings and the practice pitfalls of outpatient psychotherapy both in time-limited symptom-focused and long-term insight-oriented treatment
- competence in the assessment and management of psychiatric issues seen most commonly in outpatient settings - in particular affective, anxiety, family, marital, sexual and addictive disorders
- a knowledge of community psychiatry that rests on supervised experience in outpatient community clinics with an outreach program
- A capacity to function as an effective member of a primary-care team in assessing and treating ambulatory medical patients
Year IV of Residency
The goals of this year are those of completion and depth. The resident will add child psychiatry skills and enhance mastery of providing a continuum of care by rotating in an intensive outpatient program. Additionally, residents rotate to advanced specialty areas including Huntington’s Disease, Geriatric and Neuropsychiatry, Chronic Pain, and University Mental Health clinics. The resident, through a freely chosen elective, develops advanced experience in a psychiatric subspecialty - a ‘field of concentration’ with one or more of the faculty members to demonstrate how advancing knowledge accrues through research and close study. Finally, an appreciation of psychiatric administration is provided to residents through a weekly meeting with the Chairman of the Department where discussions review the rationales behind past and present responses of the department to the demands of heath care reform, managed care and hospital/medical school needs.
We expect that by the end of this year the resident will:
- acquire the skills of child and family assessment and gain an appreciation of the specialty of child and adolescent psychiatry
- have an understanding of the changing health-care environment and of the competencies necessary for success in clinical practice and in other professional leadership roles
- acquire confidence in office psychiatric practice and long-term psychotherapy given an experience with some patients extending out for years
- have an advanced understanding of a subspecialty of psychiatry through close mentoring from a faculty member in an elective
- have an appreciation of the rational approaches to administrative decisions within a system of psychiatric services in the contemporary challenging era for health care
Research Opportunities
The Department of Psychiatry and Behavioral Sciences has extensive clinical and basic science research programs that provide multiple opportunities for elective rotations. Our department ranks #3 among all Johns Hopkins departments in federally-funded research, with only the departments of Medicine and Oncology receiving more research funding.
Areas of emphasis in clinical research include: psychiatric genetics, geriatric and neuropsychiatry, psychiatric epidemiology, neuroimaging, psychopharmacology, outcomes research, neuropsychology, behavioral medicine, eating disorders, chronic pain, and substance abuse. Basic research programs focus on neurobiology, behavioral neuroscience, behavioral biology, genetics, substance abuse and molecular psychiatry. Residents may select from our diverse faculty to initiate research projects at any time during their residency training.
Click here to view a directory of current research programs, projects, and laboratories.
