Clinical Rotations

Consistent with our drive to be innovative and creative, UCSF residents and faculty strive to continually improve our Adult Psychiatry Residency Training Program.  Thus, change in the structure and organization of the residency during your potential tenure with us is always a possibility.  Should you be invited for an interview, please feel free to ask us about exciting details of potential changes in the program, and please know that planning for change routinely includes active involvement of both residents and faculty.  The current configuration of the training program is described below:


PGY-1 Year

The PGY-1 Year consists of four 3 month blocks.  Residents have a total of six months combined experience in the UCSF Departments of Medicine, Emergency Medicine and Neurology and six months of psychiatry training at San Francisco General Hospital (SFGH). The order of the rotations is split evenly as in the table below:

 

6/21-9/21

9/22-12/21

12/22-3/21

3/22-6/21

6/20-6/30

Half of the class (n=8)

3 mo of med-neuro

3 mo of psych

3 mo of med-neuro

3 mo of psych

All interns are off each year from 6/21-6/30 prior to starting PGY-2 year on 7/1.

Half of the class (n=8)

3 mo of psych

3 mo of med-neuro

3 mo of psych

3 mo of med-neuro

The Med/Neuro rotations include a total of four months of Primary Care (Ward Medicine, Emergency Medicine, and Outpatient Medicine) and two months of Neurology.  For most interns, one month of the Neurology experience emphasizes the behavioral and neuropsychiatric aspects of neurology and is based in the UCSF Memory & Aging Center and the other is an inpatient neurology rotation.  For those residents interested in a Child Psychiatry career, one of the Primary Care months can be Pediatrics, and one of the neuro months can be Pediatric Neurology.

The other six months of the first year are spent learning principles of psychiatric evaluation and treatment planning on the psychiatric inpatient units and psychiatric emergency services at San Francisco General Hospital (SFGH) in two separate 3 month blocks.  The SFGH inpatient units treat patients with acute psychiatric emergencies in a multi-disciplinary, short-term inpatient setting.  At SFGH, residents are introduced to the principles of care for the chronically mentally ill in the public psychiatric sector.  Uniquely, SFGH has Ethnic/Minority focused inpatient treatment teams. These teams serve Asian, Black, Latino, women, HIV positive/AIDS, lesbian, gay, bisexual and transgender, and forensic patients and provide training in cultural, ethnic minority, sexual orientation and gender-related issues.  During their months at SFGH, interns rotate between several different treatment teams. 

Residents also have a three-week Emergency Psychiatry rotation at some point during their 6 months of psychiatry.  The Psychiatric Emergency Service (PES) at SFGH is a 24-hour, 7 day-a-week, acute psychiatric emergency service which provides almost all of San Francisco’s psychiatric emergency care.  In addition, residents are introduced to principles of Assertive Case Management for severely mentally ill by participating in “hotel rounds” and visiting the Community Focus Program.

Every Wednesday afternoon, interns are not on their Med/Neuro and inpatient psychiatry rotations, and instead, they all come together for psychiatry residency core didactics, including "Intern Clinic" which is a seminar series organized by Psychiatry Chief Residents that addresses the experiential aspects of internship, with particular attention paid to the intern’s developing medical and psychiatric identity.  In addition to didactics, the PGY-1 Resident Group, facilitated by 1 or 2 volunteer faculty members, also meets on Wednesdays.



PGY-2 Year

The PGY-2 year includes three months of inpatient consultation/liaison at either SFGH or the UCSF Medical Center, three months of inpatient psychiatry at Langley Porter Hospital and Clinics (LPPH&C), and six months of full-time outpatient psychiatry at the San Francisco VA Medical Center (SFVAMC) as outlined in the chart below:

 

7/1-9/30

10/1-12/31

1/1-3/31

4/1-6/30

4 residents

3 mo of inpatient psych

3 mo of C/L at either SFGH or UCSF Med Ctr

Outpatient psychiatry at the San Francisco VA Medical Center

4 residents

3 mo of C/L at either SFGH or UCSF Med Ctr

3 mo of inpatient psych

4 residents

Outpatient psychiatry at the San Francisco VA Medical Center

3 mo of inpatient psych

3 mo of C/L at either SFGH or UCSF Med Ctr

4 residents

3 mo of C/L at either SFGH or UCSF Med Ctr

3 mo of inpatient psych

Consultation/Liaison – During this 3-month rotation, residents learn how to provide psychiatric consultation in the acute inpatient medical settings at either the UCSF Medical Center & UCSF Medical Center/Mt. Zion or San Francisco General Hospital.  On both C/L services, second year residents work very closely with faculty and learn how to complete thorough evaluations and manage psychiatric presentations in the medical hospital and, at UCSFMC, in the emergency department.  Residents also learn how to work successfully as a consultant to the primary team caring for the patient.

Langley Porter Adult Inpatient Program (AIP) – This service offers comprehensive inpatient treatment on an acute locked psychiatric inpatient unit. Residents learn how to conceptualize inpatient treatment within a large and complex system of mental health care.  The patient population is extremely broad, with ages ranging from late teens to over ninety and all socio-economic classes.  Patients are referred primarily from the UCSF Emergency Department and C/L Service, the Psychiatric Emergency Service (PES) based at San Francisco General Hospital, and other emergency departments and general hospitals in the region.  The vast majority of patients have either managed care insurance or Medicare.  Residents assess and treat a wide range of clinical presentations on the AIP including major depression, psychotic disorders, bipolar disorder, personality disorders, substance-induced disorders and comorbidities, dementia, and delirium.  The AIP also has an active electroconvulsive therapy (ECT) service, and residents gain direct experience working directly with patients receiving this treatment.

SFVAMC – Psychiatry Outpatient Service – This six-month full-time rotation has been designed to give residents exposure to the principles of outpatient psychiatry evaluation and treatment at an early point in their training.  With close supervision in several settings, residents learn a variety of treatment modalities including comprehensive diagnostic evaluations, pharmacotherapy, individual and group psychotherapy. PGY-2 residents focus simultaneously on a number of major outpatient treatment components:

  • Behavioral Health Access Center
  • Substance Abuse Treatment Clinics
  • Psychopharmacology Clinics
  • Post Traumatic Stress Disorders Treatment Clinic

Psychotherapy training includes:

  • Substance Abuse Group
  • Long Term Process Group
  • Family Therapy
  • Time Limited Psychodynamic Psychotherapy
  • Cognitive Behavioral Therapy

Residents also have the option to focus in one specialty outpatient area including: Community Mental Health, Mood Disorders, Women's Mental Health, Geropsychiatry, HIV Psychiatry, Telepsychiatry, Addictions, Primary Care, Consultation, or Research.

If interested in the research track (described in more detail in the PGY-3 year section below), residents have the option to designate 4 hours/week while at the VA during their PGY-2 year to be involved in the research home clinic. Residents may also choose to take an additional 4 hours by deferring their famiy/couples therapy rotation, which is then made up during the PGY-4 year if the resident selects this option. This time may be used to take courses in research methodology and/or begin meeting with potential PIs and begin developing a research project.



PGY-3 Year

The PGY-3 Year is an exclusively outpatient experience located primarily at Langley Porter Hospitals and Clinics (LPPH&C) on the Parnassus Campus of UCSF. It is comprised of teaching modules within the Adult Psychiatry Clinic (APC) that include: Specialty Clinics, psychotherapy clinics, brief group psychotherapy, and the Medication Management Clinic.  Special attention has been given to the educational experience of residents in the APC to provide comprehensive training, supervision and support in the application of diverse treatment models.  Third year residents also learn about the evaluation and treatment of children, adolescents, and families in the Child and Adolescent Services (CAS) one half-day/week throughout the year.  To promote professional development, all third year residents present a critical appraisal of a journal article at the Department’s monthly journal club.

Adult Psychiatry Clinic (APC) Overview – Residents in the APC are assigned to one of three outpatient teams, each of which has 3-5 PGY-3 and 3-5 PGY-4 members plus 3 faculty.  In weekly team meetings, residents present cases and learn how to integrate a variety of different treatment modalities. Residents receive expert training in long-term psychodynamic individual psychotherapy, brief cognitive behavioral group psychotherapies, individual cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT) and pharmacotherapy.  Intensive weekly individual and small group supervision is provided for all of these activities; supervision includes extensive use of videos.  All residents have cameras as part of their individual office computer work stations to facilitate teaching using video recording of sessions.  Video recordings are stored on a secure server for review during supervision sessions.

Specialty Clinics (SC) – These half-day clinics are organized either by diagnostic category or patient population and are designed to provide comprehensive teaching and “real time” supervision in diagnostic evaluation, outpatient consultation-liaison and brief psychiatric interventions. Most PGY-3s participate in two clinics weekly.  The different clinics include

  • Depression including the following specific foci:
    • Depression in Asian-Americans
    • Peri-partum depression (in collaboration with the Women's Mood and Hormone Clinic)
    • Psychosomatic medicine (i.e. depression in the medically-ill)
  • Bipolar Affective Disorder
  • Anxiety Disorders including the following specific foci:
    • OCD
    • Deep Brain Stimulation for OCD
    • Gen'l anxiety d/o such as GAD, Panic, and individuals with Co-morbid anxiety
  • Women's, Mood and Hormone Clinic which includes the following specific foci:
    • Mood and and anxiety d/o during and after pregnancy
    • Menstrual-related mood and anxiety d/o
    • Perimenopausal mood and anxiety d/o
    • Libido/sexual function d/o
  • Early Psychosis
  • Geriatrics
  • LGBT Mental Health

New patients being evaluated in a Specialty Clinic are seen for a 90 minute intake appointment with both a PGY-3 and a faculty member in the room together.  The half-day clinics also include a treatment component for acute follow up of newly evaluated patients and ongoing medication management of patients from that treatment clinic.  If not followed in that particular Specialty Clinic, patients may be referred back to their clinician (if a consultation) or will be seen by the same resident who evaluated them for continued treatment in formal brief therapy (individual or group), long-term individual psychotherapy, and/or medication management.  They will be referred within the APC for treatment if their evaluating PGY-3 does not have availability in their caseload.

Medication Management Clinics Each PGY-3 manages a caseload of patients receiving pharmacotherapy in a half-day medication management clinic.  During clinic, residents have real-time supervision from faculty members, and each clinic uses evidence-based medicine techniques routinely to answer clinical questions (a computer with web access and large monitor are in the clinic’s meeting room). In addition, each third year resident participates in a regular pharmacotherapy supervision small group. These groups use case material brought by residents to master the skills of evidence-based clinical practice, including question formulation, information acquisition, critical appraisal, and application to the individual patient. Finally, all third years attend a series of workshops that focus on the essential skills of pharmacotherapy.

Psychotherapy Clinics– Each PGY-3 manages a caseload of patients receiving psychotherapy in several half-day psychotherapy clinics. Residents provide time-limited and open-ended psychotherapy, learning a variety of supportive and insight-oriented techniques. Specific modalities include psychodynamic psychotherapy, cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, and problem-solving therapy. A portion of each psychotherapy visit is directly observed by an attending, allowing for immediate, formative feedback on psychotherapeutic techniques. As part of each half-day clinic, there is a small group case conference, co-facilitated by a paid faculty member and a community advisor. Case conferences and small group supervisions emphasize a variety of modalties, including psychodynamic, interpersonal therapy, and cognitive behavioral therapy.


Child & Adolescent Psychiatry – This training module includes didactics and clinical experience observing and conducting supervised comprehensive psychiatric evaluations of children, adolescents and their families. In addition, residents do weekly outpatient therapy with a child or adolescent and participate in weekly individual supervision about their case.  Seminars teach residents about normal child development, therapy, and childhood psychopathology. Electives in the Tourette’s and Pervasive Development Disorders (Autism) Clinic are also available. A limited number of residents interested in obtaining experience working with children and families in a community mental health/public setting may elect an alternative year-long Child Psychiatry rotation at SFGH (see below for more information). 


Alternative tracks and opportunities within the PGY-3 year:

Research Track – The research resident training program is for trainees clear in their goal to pursue a research career post-residency, including a research fellowship. Additional information is available at http://psychrrtp.net/Residents in this track have their PGY-3 year tailored to accommodate their research interest. Thirty percent of their time is allocated for research training, and the remaining 70% is the core outpatient training experience.  In the PGY-4 year, significantly more time is allotted for research.

Community Psychiatry Track – At SFGH, a part-time community psychiatry elective is offered to those residents wishing to develop additional expertise working with multicultural public sector patients. Residents treat high-risk pregnant and postpartum women within an integrated multidisciplinary Women’s High Risk OB Clinic located at SFGH one day a week for 6 months.

PGY-3 residents can also choose to complete a one year child psychiatry rotation at SFGH treating children and adolescents (rather than doing the child experience at Langley Porter described above). The Child and Adolescent Service at SFGH is the recipient of a grant to establish a Multicultural Clinical Training Program to serve ethnic minority, disadvantaged children and families with multiple traumas. Residents also have opportunities to learn about consultation, co-management and treatment of Community Health Network patients (the S.F. public health provider clinics).

Leadership Pilot – At SFVAMC, a pilot leadership elective is available for a PGY-3 resident with a strong interest in leadership in health systems. The goal of the leadership pilot, starting in the PGY-3 year and ending in the PGY-4 year, is to thelp residents develop skills necessary to lead large systems of care. Residents partner with faculty mentors within the Department as well as participate in the UCSF Health and Society Pathway to Discovery. Additionally, residents work on an in-depth quality improvement project based at the SFVAMC.

 



PGY-4 Year - Senior Residency

The PGY-4 year is primarily elective in nature and is designed to ensure that the experiences residents select have a coherent theme. These experiences aim to advance professional development by promoting growth as a leader, an educator, an expert in a specific area, and an outstanding clinician. During the second half of their PGY-3 year, residents (with support from advisors and mentors) develop personalized learning goals for their fourth year and then construct an individualized set of elective experiences to meet those goals. During the fourth year, each resident presents a Grand Rounds talk on an area of special interest. This Senior Talk experience promotes leadership, scholarly inquiry, and professional development.

In addition to providing continuity of care to a portion of their outpatients from the PGY-3 year, residents choose from a variety of Senior Resident rotations drawing from several broad areas of concentration, e.g., Community and Public Psychiatry; Outpatient Psychotherapies; Pharmacotherapy; Inpatient Care; Consultation/Liaison; and Partial Hospitalization. Elective options exist across all three of UCSF’s training sites. Senior residents assume leadership roles in the administrative and educational processes of the elective rotations, functioning, for example, as team leaders. Within these broad areas, senior residents may participate in a variety of clinical endeavors, while also meeting their overall professional development objectives.  As an example, a schedule for a senior resident focusing on outpatient psychiatry may include a caseload of diverse patients receiving a variety of different psychotherapeutic treatments, work in the UCSF Student Health Clinic, co-leading supervision groups for third year residents, &/or co-leading a CBT group with a PGY-3, and receiving specialized training with their long-term psychodynamic psychotherapy cases.  In contrast, a resident in the clinical research track may continue psychotherapy with 6 patients, attend supervision, team meetings, and didactics and then spend the rest of their time working on their research project.

The community psychiatry focus at SFGH recognizes the general psychiatrist’s need for advanced knowledge of psychopharmacology, consultation skills, a thorough understanding of the interface of clinical medicine and clinical psychiatry, and familiarity with the major modes of contemporary psychotherapy. The Department of Psychiatry at SFGH offers a wide array of innovative services to pubic sector patients. A PGY-4 could select, for example, a part-time senior resident experience on a particular service (inpatient, outpatient, or consult/liaison), during which time he/she would further develop administrative and teaching skills. Emphasis on the appreciation of social and cultural factors relevant to psychiatric illness, and on the understanding of how systems impact care for the public, multicultural mentally ill, are important educational objectives of senior resident electives at SFGH.

Numerous options exist for PGY-4 elective experiences at the SFVAMC including working in specialized PTSD, substance abuse, and women’s mental health clinics, joining the active consult service or working as a junior attending on the inpatient service. In addition, the VA is an active hub for clinical research, and residents can potentially gain valuable research experience if they so choose.  Research opportunities exist at the VA for all residents, including both research and non-research track trainees.

Numerous other specialized electives also exist for fourth year residents, including electives that focus on medical education, quality improvement, or mental health policy, and some electives in the community.

Fourth year residents also supervise 3rd year medical students and teach in a medical student course and in annual workshops for junior residents. These experiences are viewed as important components of each resident’s professional development.

Chief Residents – In the Spring of each academic year, a total of four rising PGY-4s are selected to be Chief Residents for the upcoming academic year across all sites, two at LPPI, one at SFGH, and one at the SFVAMC. (In addition, some years, the Department also has a 5th Chief Resident who focuses on Program Development.) These residents receive a special opportunity to develop teaching, leadership and administrative skills and play crucial roles in all aspects of the training program.  Chiefs are selected by the Program Director and the Residency Training Program (RTP) faculty, with input from service chiefs.  They meet weekly with the Program Director as a group and also individually with the Site Director at their site. Chiefs also meet regularly with the junior residents at their assigned site.  The four positions are:
  

  • SFGH (meets with PGY-1s on psychiatry & PGY-2s on C/L)
  • SFVAMC (meets with PGY-2s at the VA)
  • LPPH&C Intensive Services (meets with PGY-2s on C/L and AIP)
  • LPPH&C Ambulatory Services (meets with PGY-3s).


Women's Mental Health Focus Clinical Opportunities:

Across all four years of the training program and all three sites, residents can participate in a wide variety of clinical services that focus on women's mental health. In brief, the opportunities are:

PGY-1:

  • Women's Focus Team on the inpatient units at SFGH


PGY-2:

  • Women's Mental Health outpatient psychiatry clinic at the VA


PGY-3:

  • Women's Mood and Hormone specialty clinic in the Adult Psychiatry Clinic at Langley Porter Hospital and Clinics
  • Perinatal psychiatry specialty clinic in the Adult Psychiatry Clinic at Langley Porter Hospital and Clinics
  • Integrated Psychiatry and High Risk OB clinic at SFGH


PGY-4:

Multiple different elective experiences including, for example:

  • Junior attending in any of the clinical rotations above
  • UCSF Fertility Practice working 1:1 with a psychologist on our faculty who specialized in the mental health consequences of Assisted Reproductive Technology

 

Leadership in research, education, psychiatric care and public service