Child Fellowship and Triple Board
Residents enter the child and adolescent psychiatry program in much the same way as they enter the general psychiatry program (i.e. there is NOT a separate ERAS code). In this Combined Five-Year Adult and Child/Adolescent Training Program (aka “Child Track”), the final two years are dedicated to fellowship training in child and adolescent psychiatry. WPIC trainees who enter our general psychiatry residency program and later decide to pursue subspecialty training in child/adolescent psychiatry are able to do so at WPIC if there are positions available. Anyone wishing to switch must decide by the beginning of their third year of adult training and are required to be in good standing with the program.
The WPIC Child Track, begun in 1970, was one of the first such integrated programs nationally. Trainees may enter the 5-year combined program following graduation from medical school, as a PGY1, or after completion of a separate one-year internship, as a PGY2. This integrated approach to training allows the trainee to build, in stepwise fashion, on their basic adult psychiatry training, and gain more exposure and experience with child and adolescent psychiatry. The first three years is very similar to that of the categorical psychiatry residency program, with the exception that the Child Track Resident has exposure to pediatric medicine and neurology in their PGY-1 year. The Child Track Resident also has the ability to begin their longitudinal outpatient clinic through the Center for Children and Families in their PGY-3 year, so that they may opt to have continuity within this clinic for up to two and a half years.
The first year, the internship, is designed to provide a foundation for subsequent training in psychiatry. The clinical rotations and didactic curriculum are integrated to prepare residents to competently manage a broad variety of medical and psychiatric disorders and emergencies. This is the first step in acquiring mastery over a wide variety of skills that are required by a modern-day psychiatrist.
|4 WEEK BLOCKS||ROTATION|
|3 blocks||Family Medicine and/or Pediatrics|
|1 block||2 weeks Adult Neurology and 2 weeks night float at WPIC|
|1 block||Pediatric Neurology|
|1 block||Medical Care Of the Psychiatric Patient (MCPP)|
|1 block||2 weeks Adult Neurology and 2 weeks night float at WPIC|
|3 blocks||Psychiatric Emergency Services|
|3 blocks||Substance-related & Anxiety Disorders|
While identical to the PGY1 in the 4-year general program in goals and objectives, as well as most clinical experiences, residents in the combined 5-year program can elect to complete some or all of their medicine requirements through pediatrics at Children's Hospital of Pittsburgh, as opposed to inpatient family medicine through the UPMC St. Margaret’s family medicine program. Also, the Child Track Residents split their neurology months with one month of pediatric neurology and one month of adult neurology.
In order to accommodate the ACGME intern year duty hours requirements from July 1 2011, we have split the PGY1 year into 13 blocks of 4 weeks each, rather than 12 month long blocks. Residents in the Child-Track spend 3 blocks in medicine (pediatrics and/or family medicine), 1 full block in Pediatric Neurology, 2 separate blocks comprising 2 weeks each of Neurology and night float floor coverage at WPIC and 1 month in Medical Care of the Psychiatric Patient, (MCPP), though some choose to spend more time in these rotations during electives later in training.
Residents rotate through the Psychiatric ER, (The DEC), for 3 blocks and continue to take overnight call in the ER throughout their 2nd year. The free standing Psychiatric Emergency Room, separate from the medical Emergency Department at UPMC, provides psychiatric evaluation, brief counseling and crisis intervention, routine pharmacologic management, and referrals for acute inpatient hospitalization, partial day programs, and outpatient clinics. During the evenings, the residents are the primary medical doctors in the emergency room, working with a directly supervising attending, "in house", with child attending supervision by phone as needed.
A 3 block rotation in substance-related disorders and anxiety disorders is divided into a 1-block rotation at the Center for the Treatment of Addictive Disorders (CTAD) and Post Traumatic Stress Disorder Clinic, VA Pittsburgh Healthcare System - Highland Drive, and a total of 2 blocks rotating at WPIC on an inpatient service specializing in acute treatment of patients with comorbid psychiatric and addictive disorders.
The formal didactic curriculum during PGY1 focuses on fundamental psychiatric knowledge base upon which subsequent training and education will build. The curriculum includes lectures, seminars, case conference, grand rounds and workshops. These programs are directed and taught by faculty, many of whom are renowned experts in their areas.
The second year of residency training is an exciting year that provides a core set of experiences that essentially define the scope of psychiatry. Residents undergo clinical rotations in adult, child, geriatric and Consultation and Liaison psychiatry services. The didactic curriculum is closely integrated with these clinical experiences. Residents begin psychotherapy training with patient assignments and individual supervision towards the middle of PGY2. At the end of the second year, residents will be able to competently diagnose and treat a wide variety of common psychiatric disorders.
|2.4 Months||2.4 Months||2.4 Months||2.4 Months||2.4 Months|
|Mood Disorders Unit||Psychotic Disorders Unit||Geriatric Psychiatry Unit||Child & Adolescent Unit||Consultation/Liaison Service|
|Interpersonal Therapy & Long-term Psychotherapy|
During the PGY2 in the combined program, Child Track residents join their general training colleagues in all clinical and didactic experiences. In addition, combined residents begin to see child and adolescent outpatients along with their adult outpatients. This allows for a more longitudinal experience in the treatment of children and adolescents than would otherwise be possible in the two year fellowship.
Residents in the General program spend 10 to 11 weeks in four specialty inpatient services, reflecting four broad areas in clinical psychiatry. Each inpatient service has "teaching teams" with one resident supervised by one attending. Residents carry no more than 8 patients at any given time. On each service, residents work closely with the supervising attending and the treatment team, comprising nurses, social worker and other clinicians. Residents are given increasing and graduated independence in managing the assigned patients. There is onsite medical coverage and specialty consultations are available through Presbyterian Hospital, which is physically connected to WPIC.
The Consultation and Liaison (C/L) Psychiatry service provides psychiatric consultation to all units (medical, surgical, transplant, intensive care units, oncology, obstetrics, gynecologic, etc.) at Presbyterian Hospital, and on occasion, the UPMC Emergency Department. Presbyterian Hospital is connected to WPIC by an indoor tunnel. Residents are assigned patients for consultation and, under supervision, provide a set of management recommendations and follow these patients for the duration of the patients' hospital stay. There are daily lectures and seminars on C/L topics while on this service. Residents on this service are exempt from call at WPIC. Instead, they provide evening and weekend coverage to the C/L service from home, coming in as needed.
Residents continue to take overnight call at WPIC throughout their 2nd year, except while on C/L rotation.
The formal didactic curriculum during PGY2 expands on acquiring fundamental psychiatric knowledge that began during PGY1, and is closely linked to the clinical experiences during this year. The curriculum includes lectures, seminars, case conference, grand rounds and workshops. These programs are directed and taught by faculty, many of whom are renowned experts in their areas.The formal didactic curriculum during PGY2 expands on acquiring fundamental psychiatric knowledge that began during PGY1, and is closely linked to the clinical experiences during this year. The curriculum includes lectures, seminars, case conferences, journal clubs, grand rounds and workshops. These programs are directed and taught by faculty, many of whom are renowned experts in their areas.
The third year of residency training is focused on extending the skills and knowledge acquired during the first and second years of residency. During PGY3 residents work in several general and specialty clinics that provide an opportunity to learn about different models of care utilized today. These models include following patients independently, seeing patients with counselors, and working closely with treatment teams. Residents are required to complete two year-long clinics as well as the six-month requirements of Geriatric and Child psychiatry. In addition to these requirements, residents are required to choose at a minimum of 3 six month electives. An elective typically occurs once per week for a half-day per week. Each clinic is directed by faculty who are experts in their fields. Residents continue psychotherapy training with additional patient assignments and individual supervision. At the end of the third year, residents will be able to competently diagnose and treat patients, and provide longitudinal care in a variety of outpatient settings. They will achieve increasing levels of competency in psychotherapy.
|6 Months||6 Months|
|Geriatric Psychiatry||Child & Adolescent Psychiatry|
|Bellefield Clinic |
(primarily mood, anxiety and personality disorders)
Comprehensive Recovery Services
(primarily chronic psychoses)
The formal didactic curriculum during PGY3 provides a series of advanced topics, including the psychiatric literature. These programs are directed and taught by faculty, many of whom are renowned experts in their areas.
PGY4 (First Year Child/Adolescent Fellowship)
This first year of full-time child and adolescent psychiatry training is designed to provide a broad clinical and didactic exposure to the field, building on adult training and past experiences in child and adolescent psychiatry. The resident works with patients of all ages, infancy through adolescence, in a variety of treatment settings, using a variety of treatment modalities, both within the main hospital and out in the community. By the completion of this year, the resident should have an appreciation of the particular needs of children and adolescents and their families in the mental health system, and how these needs differ from those of adults. They should have developed the basic skills needed to assess and treat their child and adolescent patients, with particular appreciation of the impact of developmental variables.
Clinical rotations include experiences each on these services: Child inpatient unit, John Merck inpatient unit, Acute Adolescent Partial Program, Mathilde Theiss Child Development Center, the Center for Overcoming Problem Eating (COPE), and the psychiatric Consult/Liaison service at Children's Hospital of Pittsburgh (CHP).
|2.4 Months||2.4 Months||2.4 Months||2.4 Months||2.4 Months|
|Child & Adolescent Inpatient Unit||John Merck Inpatient Unit||Mathilde Theiss Child Development Center / Center for Overcoming Problem Eating (COPE)||Acute Adolescent Partial Program||Consultation-Liaison Service at Children's Hospital|
Child Inpatient Program
This service treats mostly school aged and younger patients. The child fellow works with a seasoned attending, managing all aspects of the care of a team of 7 – 9 patients, including psychopharmacology, individual and milieu needs (e.g. collaborative problem solving), educational and larger systems needs (e.g., child welfare) and family treatment. The resident also has the opportunity to interact with managed care entities, depending on individual patient needs.
John Merck Program
The Merck Child and Adolescent Inpatient Unit specializes in assessing and treating children and adolescents who have autism spectrum disorder. The unit also works with children who have developmental disabilities and co-occurring psychiatric or behavioral disorders. This unique program offers a wide selection of treatment contexts and modalities within which the resident will have the opportunity to train. The child fellow will, similar to the experience on the general child inpatient unit, manage all aspects of care of a team of 7 – 9 patients, under the supervision of an attending experienced with this special population.
Mathilda Theiss Child Development Center
This is a unique clinical setting within a local community which allows the child fellow to observe typically developing infants, toddlers, and preschoolers along side of children with developmental and other behavioral disorders. The Center’s Behavioral Health service offers a parent/infant assessment and treatment program (e.g. Parent Child Interactional Training, Parent-Child Psychotherapy, etc.) as well as a toddler day treatment program.
Residents will evaluate and treat patients and families within both settings, working with psychiatrists and psychologists with expertise in these age groups.
Acute Adolescent Partial Program
The program is situated in a local community and provides intensive day treatment to adolescents not in need of an inpatient setting but whose clinical acuity is nonetheless quite high. Fellows manage a team of ~9 patients under the supervision of an experienced child psychiatrist, and have the opportunity to provide individual treatment, participate in group interventions and family work, as well as manage medication treatment.
Center for Overcoming Problems of Eating (COPE)
The COPE Service Line offers a variety of levels of care from inpatient hospitalization to Partial Hospitalization and Intensive Outpatient Program in a highly structured environment for the treatment of severe eating disorders. The program specializes in cognitive-behavioral treatment for anorexia and bulimia. Patients participate in meals and group therapy, as well as work independently on specific psychoeducational materials related to eating disorders, coping skills, depression, emotion skills, and many other topics. COPE is staffed by an interdisciplinary team of psychiatrists, physicians, social workers, therapists, dietitians, nurses, and other mental health specialists to provide an intensive but rewarding treatment program. Inpatient treatment for children occurs at Children’s Hospital of Pittsburgh (CHP), and is typically for those who are severely malnourished, requiring nutritional stabilization or weight gain. All other levels of care are provided at WPIC and/or in satellite offices.
Consult/Liaison Service at CHP
The CHP Consult-Liaison Psychiatry service provides inpatient and outpatient consultation to a wide variety of general and specialty services within this large, academic children’s hospital. Fellows evaluate patients and present them to one of a team of child psychiatrists who work in this setting. 24-hour on-call services are provided by the fellows during the first year of fellowship to the C/L service and the emergency department at CHP.
The half-day/week continuity clinic continues throughout the 2 years of child and adolescent fellowship training, and is designed to provide the fellows broad experiences in the outpatient assessment and treatment of youth.
Formal didactics during the first year of full time child/adolescent training are focused on developing a fundamental knowledge base in child and adolescent psychiatry, both in assessment and treatment.
This second and final year of full-time child and adolescent training is designed to build on the skills and knowledge base gained in the first training year, with the opportunity for the fellow to electively focus on particular areas of interest. Experiences over the year are designed with an eye on the future career of an individual resident. There are no call responsibilities during this year. Forensics, school consultation, community psychiatry, neurology (if not previously done) are all required experiences during this year, as well as senior resident teaching activities and a scholarly project, continuity clinic and longitudinal psychotherapy cases. Electives, which provide the remaining experiences during this year, are as numerous as the clinical, administrative and research activities ongoing within this large UPMC system of behavioral health care. There are a number of already existing elective opportunities and new ones are regularly proposed by residents and faculty.
Formal didactics build on the knowledge base attained in the first year of child/adolescent training, and address more advanced and specialized topics designed to add depth to knowledge and skills. There is also a classroom focus on career transitioning and decision-making in anticipation of the completion of residency training.
APPLICATION PROCEDURE & ADDITIONAL INFORMATION
Applications are accepted for:
- 5-year General/Child and Adolescent Combined Residency Training Program
- 2-year Child and Adolescent Residency Fellowship Program
5-year General/Child and Adolescent Combined Residency Training Program
Residents enter the child and adolescent psychiatry program in much the same way as they enter the general psychiatry program (i.e. there is NOT a separate ERAS code). The applicant must be a senior in an approved medical school or hold an MD degree. We encourage applications from minority students. Applicants with specialty training in in other areas of medicine are also welcome.
Applications are accepted through ERAS (Electronic Residency Application Service). We require a complete application form, personal statement (including a statement regarding areas of interest), medical school transcript and three letters of reference. Applications will be accepted until mid-December. After completion of the review process by the Selection Committee, applicants will be notified by email or mail. Dates for the interview will be determined at the time of the invitation. We generally interview on Mondays, November through early January.
2-year Child and Adolescent Fellowship Program
Application for the 2-year Child/Adolescent Residency Program is through ERAS, however, we do not participate in the NRMP match during years when our fellowship is filled through the Child Track Combined Residency Training Program. The application includes:
Applicants requiring ECFMG certification must ensure that USMLE transcripts are available for review on the ERAS application.
Further information may be obtained by contacting:
Sansea Jacobson, M.D.
Director, Child & Adolescent Psychiatry Residency Training
Western Psychiatric Institute & Clinic
University of Pittsburgh
3811 O'Hara Street
Pittsburgh, PA 15213