Clinical Experience

What Training at Emory Looks Like – Sehar Jessani, MD, and Ashley Subler, MD

The goals of the PGY-1 year are to provide a foundation in internal medicine/ pediatrics and neurology, and also to provide an introduction to the evaluation and care of both acute and chronically ill psychiatric patients. Residents are allowed to choose from a variety of experiences on internal medicine and/or pediatrics including inpatient rotations, outpatient consultation services and emergency room medicine. Residents choose these rotations based on their individual goals with residents interested in child psychiatry often electing to spend more time on pediatric rotations and residents interested in emergency psychiatry opting for the emergency services rotations. 

During the two 3-month blocks of psychiatry rotations, the residents are based on the Thirteenth Floor and in the Emergency Department of Grady Memorial Hospital. The Thirteenth Floor has the full complement of psychiatric training resources including the psychiatric emergency room (Crisis Intervention Services - CIS), and an inpatient psychiatric unit. The strength of the program for these beginning residents is that they can be closely supervised by the faculty and followed on each of the rotations across these units. Overall goals can be monitored closely, remediation plans put into place for residents who are not achieving the goals and residents who are doing well can be given more appropriate autonomy based on feedback from supervisors.

Seminar lectures focus on basic emergency psychiatric skills such as suicide assessment and commitment law, diagnostic and treatment criteria for the major psychiatric disorders with a focus on the psychotic disorders and substance abuse and psychopharmacology related to management of patients with severe, acute and chronic psychiatric disorders.

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. The residents continue rotations on inpatient psychiatry at the Atlanta VA Medical Center and the Emory University Hospital at Wesley Woods where they extend their psychiatric knowledge in different patient populations. In the PGY-2 year, residents provide care in different treatment settings with patient populations that have different challenges and learning opportunities than those they worked with as PGY-1 residents. The residents are also on call at Wesley Woods and the VA emergency room and again this adds to their emergency psychiatry training by exposing them to different patient populations and a range of community resources. 

Seminar lectures topics are expanded to include more lectures on the mood and anxiety disorders including diagnostic criteria and psychopharmacology and somatic treatments (e.g. electroconvulsive therapy and transcranial magnetic stimulation) for these disorders, lectures on child and adolescent development and introductory lectures on psychotherapy.

In addition to the inpatient goals cited above for the PGY-1 year, the residents assume increasing autonomy in the care of the psychiatric inpatients and develop the capacity to take a leadership role on the inpatient treatment team.

The goal of the third year is to develop and extend the resident’s capacity to manage psychiatric outpatients. The residents are based at Executive Park 12 for their outpatient psychotherapy and psychopharmacology clinics as well as their outpatient child experience. Residents have additional experiences in an outpatient setting near the Grady campus (Park Place), VA Medical Center, or Emory University Student Health & Counseling Services.

Seminar lectures are on increasingly advanced topics in the diagnosis and care of psychiatric disorders including additional topics in depression and anxiety with an emphasis on treatment resistant patients. Seminar lectures also focus on advanced topics in child and adolescent psychiatry and in family and group therapy.

The goals of the PGY-4 year are to prepare the resident for post residency and to ensure that they use the final year effectively as part of developing their career plan. By the fourth year the goals for their career plan are well developed through the mentoring process with the faculty and the biannual resident reviews that have been conducted since their PGY-1 year. The specific goals for each resident vary considerably.

In general, residents interested in academic careers, or refining their teaching or inpatient psychiatry skills will apply for the chief resident positions. Each of the positions offers unique opportunities and challenges. The newly created outpatient chief resident position has added an innovative opportunity for a resident who wants to pursue a career in private psychiatry. This position offers a resident the opportunity to develop skills in managing a large clinic. This Chief Resident will learn everything about the clinic from the budgetary issues to the issues related to clinical care. The Grady Chief Resident has significant clinical responsibilities for both the emergency room and the inpatient wards. The VA Chief Resident is largely responsible for administration and preparing the seminars for the residents and medical students and is particularly suited to a resident considering a VA based career. The Emory Chief Resident has administrative, teaching and clinical responsibilities. 

Often the Chief Resident at each of the sites is considering a post residency career at that hospital and this position allows them to try working with the faculty at that hospital in a leadership position.

Some residents will use the time to complete requirements and all will continue with outpatient psychotherapy and psychopharmacology cases. Most residents will have ample time to try a number of electives including electives in research and clinical areas.

The seminars for the final year include a majority of the lectures which have been left unassigned and the residents chose special topics. Popular topics include private practitioners discussing how to manage a private practice, advanced research topics and a return of the most popular lecturers from the previous years.