- Is the residency program accredited by ACGME?
We are a fully accredited program. Our last site visit was in August 2008 and we were granted 5 years of accreditation, the maximum possible.
- Is WPIC a “biological” program?
WPIC is on the cutting edge of combining psychotherapy and psychopharmacology in the treatment of major psychiatric disorders, and thus ascribes to no one school of thought. There is as much research conducted at WPIC in psychotherapy as pharmacotherapy. Research and Clinical Programs at WPIC are part of a balanced portfolio spanning basic and clinical neuroscience, pharmacology, social psychiatry and psychotherapy.
In accord with this the training program takes a balanced (not just eclectic) approach to patient care, on a continuum between the largely biological approaches at one end and purely psychosocial approaches at the other, responsive to the individual patient’s needs on that continuum. The needs of patients are continually assessed and evidence based treatments and management strategies utilized to optimize outcome for the patient.
- Do residents get enough exposure to psychotherapy?
There is a strong commitment in the program to the development of sound psychotherapeutic skills, across all modalities of therapy, even in an era of diminished coverage for such services. We believe that psychotherapy is a powerful educational experience and aids significantly in general psychiatric competence.
Dr. Karen Katunich, PhD, is the Director of Psychotherapy Training at WPIC.
Training exists for brief psychotherapies [Interpersonal Psychotherapy (IPT) & Cognitive Behavioral Therapy (CBT)], family and group therapy, Dialectical Behavioral Therapy (DBT), Motivational Interviewing and Supportive Psychotherapy.
Longitudinal Psychotherapy training is overseen by the Clinical Training Committee which is devoted solely to resident education. Residents first begin with lectures on psychotherapeutic principles during PGY1 and PGY2, followed by case assignments commencing in the middle of PGY2.
Longer term psychodynamic therapy remains an excellent training experience. At least one long term case can be assigned through the Clinic without Walls (a collaboration between WPIC and Pittsburgh Psychoanalytic Institute).
Residents often have the opportunity to choose supervisors, and there is a wealth of full time & voluntary faculty available for supervision, including analysts associated with the Pittsburgh Psychoanalytic Institute.
The Resident and Psychology Intern "Psychotherapy Training Clinic" commenced on July 1 2006. This is a flat fee training clinic which is supported by WPIC and greatly simplifies access to suitable patients for all therapy modalities.
The PIT, (Psychotherapy in Training), program is a mechanism by which residents, as part of their training, can obtain their own psychotherapy at a greatly reduced cost with some of the City's best providers.
- What is the balance between service needs and education?
WPIC and Residency Training are uniquely devoted to ensuring that residents’ education is their primary goal: by providing protected educational time, caps on patient load, and continuous evaluations of clinical teaching sites.
- Is there an opportunity for residents to get involved with research?
There are multiple opportunities to become involved in research, although this is by no means a graduation requirement. For interested applicants, a research track program provides significant time during residency devoted to research. Residents can apply for research track any time prior to their 3rd year. All residents have the opportunity to involve themselves in ongoing research, and apply for post residency research training fellowships, (T32s), as early as the PGY4.
- What if I don't want to make research my career but want to get some experience?
Many of the current and graduated residents have done just this. There are opportunities to do discrete small projects often focused on quality improvement and other facets of clinical care. Others have simply identified a question that they really want to answer and then sought guidance about appropriate mentorship.
- I see myself as pursuing a career as a Clinician Educator, can I do that at WPIC?
Very much so. Both UPMC and WPIC are dedicated to training and promoting Clinician-Educators as leaders in medicine. At WPIC we have a Residents as Teachers course for all trainees, starting in PGY1. We have close links with U. Pitt's Center for Instructional Development and Distance Education who give seminars and educational support. In addition we have an Academic Administrator Clinician Educator (AACE) Track within the residency to support and help to develop future clinician educators and academic administrators who want to go that extra mile during residency. Further details are available elsewhere on the website.
- Do residents stay at WPIC to eventually join the faculty?
Up to one quarter to a half of graduating residents join WPIC as faculty. Some residents stay on as clinical or research fellows, subsequently joining the faculty. Many others remain in the area, affiliated through voluntary faculty status. WPIC is eager to hire WPIC Residency Graduates as faculty.
- Women in the program?
Diversity is always our priority and for the past 5 years at least 45% of our entering Residents have been female. WPIC is in the forefront of established and developing programs in the area of women’s issues in psychiatry. There are many prominent women faculty in clinical, research, and administrative arenas. They are always available for mentorship or informal discussions.
- What is the balance between inpatient and outpatient training?
There is a good balance between the two. The curriculum combines concurrent inpatient and outpatient experiences beginning in the PGY1 (one month outpatient at a local VA hospital), and C/L psychiatry rotation is now during PGY2. Thus, all of PGY3 is an outpatient experience, including long-term psychotherapy.
- What is call like?
Currently, in-house call is limited to PGY1 and 2 in the General Program.
During the first two years at WPIC, there are two basic types of call that occur. One is known as DEC (diagnostic emergency center) call, and the other is known as floor call. The DEC call occurs in our free-standing psychiatric emergency facility. Overnight and during weekends, first and second year residents see and evaluate patients in the DEC during call. Second year residents take call in the DEC about every two weeks. First year residents take call on a rotating night-float system during their 3 month emergency psychiatry rotation (5 nights in a row, every few weeks).
Inpatient psychiatric and medical issues in the psychiatric hospital are covered overnight by the floor call resident. Second year residents have floor call, on average, about every two weeks. First year residents have do floor call, primarily, as two separated two week blocks of night float during their seven blocks of medicine and neurology. In addition, PGY1 residents will do a weekend floor call shift about every two to three weeks during their psychiatry rotations outside the emergency psychiatry service.
During their Consult and Liaison (C/L) Psychiatry rotation, second year residents rotate duties for C&L phone call over the weekends. During the C&L rotation, they are excused from floor and DEC call. During a rotation at the Magee Hospital (for OB/Gyn outpatient psychiatry), third year residents rotate phone call for the Magee C&L service on a weekly basis (available by phone about every 5-6 weeks). Other than this, third year and fourth year residents are free from call.
- What is medical back up like?
We have our own medical and laboratory service led by family medicine physicians. In addition, sub-specialty consultation is available through UPMC. Physicians are also available at night for phone consultation, or patients can be transferred to UPMC Presbyterian, next door, for urgent/emergent evaluation. Medical emergencies are managed by the psychiatric housestaff, with assistance from the code teams from UPMC Presbyterian, who also respond to these.
- What is medicine/pediatrics like?
Medicine is 7 blocks of rotations comprising 3 blocks of Family Medicine at St. Margaret's Hospital 1 block of MCPP, (Medical Care of the Psychiatric Patient, Medical Director, Dr. Marcos Habib, Director), and 2 blocks, in total, of Consult Neurology. One of the Neurology blocks is now split in two. Thus each PGY1 does two blocks of two weeks of Neurology and two weeks of night float covering medical and psychiatric issues on the floors at WPIC. Call is approximately every 4 nights in at St. Margaret's. Most residents regard the internship as an excellent and collegial experience, where WPIC interns are integral and respected members of the medical team.
For combined child/adult program interns who wish to do pediatrics rather than family medicine, Pediatrics is a 3-month rotation at Children’s Hospital, and call is every 4th night. Residents also do 1 month of MCPP and 2 months Consult Neurology, (1 month in child neurology and 1 Month in adult neurology) As for the general track residents the adult Neurology block is split in two. Thus each PGY1 does two blocks of two weeks of Neurology and two weeks of night float covering medical and psychiatric issues on the floors at WPIC. This is likewise considered an excellent and collegial experience.
- Do residents have to opportunity to formulate treatment plans for their patients or do they carry out plans dictated by attendings?
Attendings will allow as much autonomy as residents feel comfortable with, and commensurate with the resident’s level of skill. Developing leadership skills and the concept of graduated responsibility and individualization of training is integral to the training program.
- What are the core lectures like? Are they a good preparation for the boards? Do residents have the opportunity to attend lectures?
Lectures cover all the basics, in addition to special areas of expertise* given by leaders in the field. These are also designed to be preparatory for the Boards (WPIC has very high pass rate, over 90% in the last 2 years). The curriculum allows weekly protected time of 4 hours for regular classes, (Thursdays 1-5pm), 1 hour for a Facility Wide Journal Club, 1-2 hours of case conferences, and 1 ½ hours for Grand Rounds.
*Short-term therapies, psychopharmacology, neurosciences, imaging, etc.
- Accessibility to the Chairman? Training Directors?
The Chairman attends monthly meetings with residents and is involved in case conferences and lectures, and is available at all times for individual discussions regarding developing academic careers.
The Training Director and Co-Directors meet regularly with Residents individually to assess training needs and goals. There is active collaboration between Training Directors and Residents in all facets of the training program coordinated through regular business meetings with the Resident elected house staff leadership and the program appointed Chief Residents. The Training Director and Co-Directors also have a strong advisory role and are always available for help and advice.
- Are resident concerns and opinions taken seriously by administration?
Yes. Residents meet weekly for housestaff meetings to discuss issues among themselves, and the housestaff officers represent these views in appropriate faculty forums. Housestaff officers and class representatives meet with training directors monthly. In addition, resident representatives meet regularly with the chairman and service chiefs to informally address issues. Finally, the annual Resident Retreat generates suggestions for change that are rapidly incorporated into the program, emphasizing the responsiveness of the institution. Residents serve on all major academic & administrative committees.
- How is the Institution developing?
Like all medical centers, health care reform is a key area in the developing mission of WPIC. We are at the forefront of defining and developing viable mental health care systems for today’s climate of managed cost. WPIC programs are expanding and include many new sites in communities and affiliated hospitals. The residents are integrally involved in problem-solving new challenges with faculty and administration.
WPIC's commitment to improving the quality of care in the clinical services and the opportunity for Resident to be involved is illustrated by Residents taking the lead in Quality Improvement projects. Some of these lead to articles or national presentations. Recent examples include projects about the connectivity across levels of care between MD’s and various poly-pharmacy reduction projects. In this way Residents have the opportunity to be architects of ever improving systems of care to our patients.
The influx of new faculty, and particularly the presence of many former residents, speaks to the vigor of the Institution.
- What do graduating residents do?
In the last few years, approximately a fourth to a half of the graduating class joined WPIC as Faculty. Some joined clinical or research fellowships (geriatrics, research, etc.) and the rest went into practice. No one experienced difficulty in finding jobs.
- Are residents happy? Do they do things as a group?
Yes, the level of enthusiasm for learning and education is infectious. Please feel free to ask our Residents or watch and hear them on video.
There are an increasing number of happy hours, holiday parties and casual get-togethers with faculty.
- What is Pittsburgh like? (Activities, climate, cost of living etc)
Pittsburgh has a very high quality of life, and was recently voted, "America's most livable city", by "Places Rated Almanac". Pittsburgh is a town of education, home to 17 Colleges and Universities. It is a very manageable city with a rich cultural life, some of the nation's best museums, first class ballet, theater and symphony, and a burgeoning Restaurant scene.
Have a look for yourself A New Vision. A New Tomorrow a great video about Pittsburgh and UPMC
Located just an afternoon drive away from Washington DC, New York City and Toronto, we think of ourselves as an East Coast City with Mid-Western Hospitality. In addition to all of this, the airport provides excellent transport links with the rest of the US and is only about 30 minutes drive away from WPIC.
- Where do residents live?
Rental apartments are plentiful in Shadyside and Squirrel Hill within the city (5-10 minutes away). Housing is very affordable in Pittsburgh, and residents frequently buy homes/condos.
- Where do residents park?
University of Pittsburgh provides a variety of parking lots. All are 5-10 minutes away. Residents park at WPIC free of charge while on call. We do not subsidize parking but have, instead, increased the annual educational stipend available to each resident.
- Does WPIC support and train residents who are interested in teaching?
Absolutely. Residents have a significant educational role at the University of Pittsburgh, and WPIC values this mission, which is also an ACGME requirement. The most important teaching role for residents has been teaching third-year medical students during their clinical clerkship on psychiatry; residents are also involved in other clinical and elective experiences with medical students, and many serve as small group facilitators in preclinical courses or as mentors for students interested in psychiatry as a possible specialty. Some lecture to medical student audiences on a variety of topics, or created educational materials (quizzes, websites) to further the teaching mission of the department. Residents receive much formal and informal feedback on their teaching efforts, and this information is reviewed in annual meetings with the training director.
Residents teach other trainees and students in a variety of settings, most prominently during WPIC-wide journal clubs and clinical grand rounds, where they work with faculty advisors on how best to teach. We plan on expanding the formal feedback given to residents following their teaching, in the hopes of helping residents improve quality over time.
The department supports the teaching mission in other ways. In previous years, we have run a series of workshops on a variety of topics related to education: learning styles, giving feedback, teacher/learner roles, the five “microskills,” and the “challenging” learner. We have incorporated this material into required curricular offerings for PGYI and higher residents as part of the "Residents as Teachers" program with additional topics (e.g., “How to give a lecture”) for interested residents.
This is now complimented by the AACE Track.
- What are the strengths of the program?
Enormous resources (clinical, research, library, medical center, etc.). Perhaps the largest array of clinical services for a University based psychiatry program in the Country.
Wonderful collegial atmosphere.
Proactive stance with regard to changing health care models.
Good balance between clinical and research training.
Specialized inpatient and outpatient services most within a few blocks of WPIC.
Highly proficient resident peers.
One year, flexible, elective time.
- New developments/changes in the Program over the last year?
Summer 2010 – WPIC Summer Seminar Series – new format, focused on the neurobiology of, and evidenced-based management within, a specific disease area. The first of these began July 2010 with a focus on addiction. The eight seminars are open to all WPIC, UPMC and University of Pittsburgh staff and students and have CME credits.
July 2010 – New “Chief Resident for Family Medicine and Psychiatry” role initiated. To enhance integration and continuity between the two family medicine programs and psychiatry
October 2010 – Hosted the American Board of Psychiatry and Neurology Oral Board exams
January 2011 – RRC site visits for Child and Adolescent Psychiatry and Addiction Psychiatry fellowships
February 2011 – first phase of technological enhancement of Thursday afternoon teaching. Using Camtasia to create permanent but revisable on line archive of didactic content – pilot phase
June 2011 – Revised new resident orientation including an experiential OSCE style training and assessment to train and demonstrate the incoming residents’ ability to manage call, request supervision and use it effectively
July 2011 – Implementation of new ACGME duty hours regulations. Switch of PGY1 from twelve one month blocks to thirteen four week blocks. Implementation of night float for floor call.
September 2011 – second phase of technological enhancement of Thursday afternoon teaching – first class of PGY2 schizophrenia course switched to 1 hour video didactic and 1 hour participatory in class. Feedback good.
- New developments/changes in the Program over the next year?
New Courses for 2010-2011
Discussions in Psychiatry - M Travis
Family Systems Theory - A Towers
Advanced Phenomenology - A.Dombrvoski;
Providing Treatment for The Deaf Community - K Mathos
Mental Health Care in the Secular & Nonsecular Community- J Kettel
New Courses for 2011-2012
Formal Suboxone Training for PGY4s
Advanced Clinical Neuroscience course for PGY4s – Pierre Azzam
Business Course for Graduating Classes – Jack Rozel and Ken Nash
- What is your cut off score in USMLE Steps 1&2 for accepting applications?
We have no absolute requirements but our average score is in the upper 80’s centile scores.
- Do you require US clinical experience (research, externship or observership)?
No, but it is obviously an advantage as is research and academic experience
- Does your program participate through ERAS?
Yes, the application deadline is mid-December
- How many IMGs are there on your program?
WPIC is an equal opportunities employer and operates an open policy in regard to resident recruitment. All residents are taken onto the program based on achievement, excellence and "goodness of fit". Numbers of IMGs vary from year to year.
- Do you consider year of graduation in accepting applications?
Not generally, though the amount of time since you last practiced medicine may be a factor. Each application is treated on merit and suitability for the program.
- How many letters of recommendation do you require with each application?
- Would having passed USMLE Step 3 benefit me in any way?
Yes, passing STEP 3 is required to transition from PGY2 to PGY3, and for an H1B Visa application, therefore having passed the exam already would be an advantage.
- Do you sponsor visas for IMG's?
Yes we do. Sponsorship and type of visa is decided on a case by case basis. We have previously sponsored both J1 and H1B visas.
- Does Psychiatry experience in another country help me in any way?
Previous experience or training in psychiatry shows a commitment to the specialty which can only help a candidate. It is unlikely, however, that training outside of the US will reduce the psychiatry residency training requirements.
- Does WPIC force you to do research?
Definitely not. There are certainly many opportunities to do research at WPIC if this is your interest, but there are several residents at WPIC who do not desire to partake in an intense research experience. This is completely fine. There is certainly no pressure. The cool thing is that if for some reason you ever do desire to do research during your time here or you run across an interesting case report, attending physicians would be more than willing to sponsor and teach you. Plus, you do have the benefit of being in an institution where cutting edge research is always taking place and where the attendings are the best in their field so they can keep you up to date even if you have no plans to do the research yourself.
- Does the size of the program or the size of the hospital really matter?
Initially when I started looking at different residency programs, location and reputation were my top two criteria. However, as I began to look at different programs I began to realize that the number of inpatient beds is very important. Think about it. If you are going to be at a hospital that has only 14 or 30 inpatient beds, how much pathology do you really think you are going to see? Also if you're in a place where there are so many competing hospitals, unless you are at the top hospital, are you going to get to see the most variety of psychopathology? Not necessarily. WPIC has 289 inpatient beds and is one of the four largest free standing psychiatric hospitals in the country. So if it exists, you will see it here. Here at WPIC we have entire floors dedicated to children, adolescents, eating disorders, psychotic disorders, mental retardation and pervasive developmental disorder, adults, dual diagnosis (drug and alcohol), and geriatrics.
Also, if you are interested in a particular branch of psychiatry such as child psychiatry or geriatric psychiatry, it would behoove you to be at a place where they have a fellowship in that particular field. That way you know that their inpatient and outpatient programs are very well developed.
- Does the number of the residents at a residency program matter?
YES! It can mean the difference of being on call q4 to q3x a month! Also here at WPIC, there is currently no call for residents in their 3rd and 4th years! In smaller programs, you tend to be on call more. Also since there are only about 2-3 residents on a particular rotation at one time, you are still getting individualized attention.
- I heard that on call you are by yourself and you have to run codes? What is this all about?
While you are on FLOOR call, it is true that you are the only one who will be called. However, typically, call consists of giving verbal orders from the call room for things such a Tylenol. At times, you are also called to when there are questions about blood sugars and blood pressure. However, there are guidelines for both of these so you do not have to think too much! If you would ever find yourself in a "sticky" situation, there is always the family medicine Doc on call who is MORE than willing to answer calls at anytime of day or night, no matter how "stupid" you think the question is. Also do not forget that the nurses at WPIC have tons of experience so they will often give suggestions as to what needs to be done. There are also attendings and senior residents in the emergency room at all times so you can always call them with any questions.
We do run codes. Let me first clarify what the majority of our codes concern. 1. loss of consciousness 2 seizure 3 chest pain. However, everyone is sent for training for the codes (NOT just ACLS) but training on actually running a code. Also again remember the nurses have been here longer than you and know how to run them.
- What does being on the “Child Track” mean?
Being on the Child Tract means that you will have the opportunity to do your preliminary work in pediatrics at Children's Hospital of Pittsburgh (one of the top 10 peds hospitals in the country). I had a great time working there and I still keep in touch with my friends there. EVERYONE appreciates you there because you are an extra helping hand on any team. By working at Children's, you get to work and see the interface of pediatrics and psychiatry which is very invaluable to your psychiatric training. After all, on the floors and in the clinics, many children and adolescents who come through have medical issues as well including overdoses.
Being on child track also give you the opportunity early on to be paired up with various mentors in the field. You are also targeted for various opportunities and grants early on which include the plethora of clinics that are here (STAR - center for at risk youth, TORDIA - treatment resistant depression in adolescents, OCD clinic, Mathilda Theiss clinic for children ages 0-5, COPE - center for overcoming problem eating, bipolar disorder clinic, mental retardation & pervasive developmental disorders, and the list goes on!).
One of the biggest benefits of being on the child track is the seamless transition it gives you from general psychiatry residency to fellowship. If you indicate that you would like to be on the child track, a spot is reserved for you in WPIC's Child and Adolescent Psychiatry program (did I mention it is one of the top five in the country?).
We asked our Triple Board (TB) residents some of the most frequently asked questions and compiled their answers here in bullet notes.
- What is Triple Board (TB)?
- Combined, integrated, and comprehensive residency program in pediatrics, psychiatry, and child psychiatry that prepares you to be board-eligible in all three areas.
- Upholds the spirit of the biopsychosocial model of care, stresses the importance of studying body and mind, as well as the interactions between the two
- TB emphasizes the importance of providing the most holistic of care
- TB has brought together the 3 disciplines as well as social medicine,
public health, human behavior and development in one cohesive residency training program here in Pittsburgh
- Why did you decide to do Triple Board?
- Interest in all 3 subject areas
- Fell in love with the philosophy
- Desire for integrated clinical learning experience
- Career goals for utilizing child psych in primary care setting
- Too little psychiatry in pediatrics training and too little pediatrics in child psychiatry training
- Children & adolescents with psych problems were the most challenging & pediatrics alone didn’t offer specific psych training
- Plan to be a pediatrician for kids with behavioral problems due to psychiatric illnesses & address primary care mental health
- Integrate care between peds and child psych. There is so much overlap, esp in the outpatient setting. Provide holistic care.
- I wanted the background in normal development and family centered care that pediatrics offers to enhance my understanding of children and adolescents
- TB allowed pediatrics and child psych fellowship in a shorter period of time
- What did you like about Pittsburgh's Triple Board program?
- Integration of psych and peds throughout training
- the schedule
- The people!
- The BEST residents – friendly & supportive, fun group, TBers see each other weekly in pediatrics continuity clinic with monthly social events. 3rd, 4th & 5th years share a child/adolescent psychiatry continuity clinic as well.
- Pittsburgh draws interesting, well rounded people from all over, who are great to have as colleagues and friends
- the sensibility of TB residents. They are very smart and very wise about medical and psychosocial issues. They are as comfortable with complex medical illness as they are with behavioral and emotional problems
- The strengths of each program clinically and in research
- Support of psych and peds faculty for TB – valued on both sides
- Strong psych & peds
- Free standing peds and psych hospitals
- the new children’s hospital
- How are peds and psych integrated?
- Great working relationships among the leadership
- TB chief residents who serve as liaisons to both programs
- 5 years of pediatrics continuity clinic
- 2 years of child/adolescent psychiatry outpatient clinic that focuses on children/adolescents with medically complex histories
- Weekly psych lectures while on pediatrics rotations, starting intern year till graduation
- A natural part of training as you go through rotations on both sides, esp. in GI, palliative care, child development, transplant, consults, oncology, endocrine, hematology, oncology, neurology, and child/adolescent psych where both skill sets are heavily utilized
- Kids are becoming more and more medically complex as breakthroughs are made. As a result, there are more and more children with severe health issues that have far reaching psychiatric implications for the children and families. The TB program allows residents to obtain training in both disciplines.
- What are TBers doing while in residency (ex. special opportunities)?
- Helping to design their schedules and choose/create electives
- CORE (Community Oriented Research Education) program
- Research projects (posters, publications)
- International health/travel abroad
- Volunteer (ex. Salud Para Ninos free health clinic)
- Utilizing excellent faculty resources
- Conducting workshops
- AACE (Administrative, Academic, Clinician Educator) track
- APA fellowship in public psychiatry
- UPMC Leadership and Management Certificate Course
- Grief Group Facilitator
- What have TB graduates done?
- Anything they want
- Pediatrics psychiatry consultation & liaisons at different children’s hospitals across the country
- Child/adolescent psychiatry in pediatrics clinics
- Private practice
- Specialty clinics
- Do you have to take all 3 boards?
- It is expected, though not an absolute requirement
- You also need to pass the adult psychiatry boards before you can take the child psych boards
- Our TB graduates are uniquely prepared and well trained at highly respected residency programs. Triple “Boarding” is the reward for that achievement.
- Are there research opportunities?
- Absolutely, but it is easier to do later in training (years 3-5)
- Available in all 3 fields, as well as integrated
- Opportunities both during and after residency.
- WPIC & CHP have T32’s designed for MDs interested in research
- As a TBer, what do you like about Pittsburgh?
- Affordable, bought a house
- Very livable city, very easy place to live
- Nice, friendly, down to earth people
- 4 seasons
- Overall lovely weather
- Lots of cultural opportunities – museums/galleries
- The parks are amazing spring through fall & sports keep us occupied in the winter
- Good restaurants
- Local music scene
- Love neighborhoods with unique personalities
- Hospitals are convenient
- Public transportation
Thanks to Sheryl Fleisch, PGY2 Class Rep for her help with revising these FAQs and to the Triple Board Residents