The first year of training is designed to give the resident a sense of medical identity. It has elements of a rotating or flexible internship. The year begins for all new residents with at least one month on Psychiatry. This affords them an introduction to the service and to their psychiatric colleagues, and it also serves as a period of learning skills basic to psychiatry. The inpatient psychiatry experience is shared between the geriatric psychiatry unit at MMC with a significant population of med-psych patients and two month at Spring Harbor Hospital.
Second-year residents complete their inpatient experience at Spring Harbor Hospital, our 100-bed affiliate in Westbrook. There they work with general psychiatry patients, as well as spending a month on the Developmental Disorders Unit. The patients are extremely diverse in psychopathology and socioeconomic class. Residents learn to work as members of the treatment team, utilizing the principles of focal therapy. Each resident carries approximately six patients with on-site supervision from inpatient staff psychiatrists. The second year also includes two months of neurology, one month of addiction psychiatry, and two months of Consultation-Liaison Psychiatry.
Toward the middle of the second postgraduate year, residents may elect to acquire a small outpatient case load, moving toward a major outpatient focus in the third year. In the third year, brief and extended outpatient treatment becomes the focus of training. Third year residents spend a half-day per week seeing patients in Portland's community-based outpatient VA Clinic. The third year resident also has further training in outpatient child psychiatry and begins the supervised long term follow-up of at least two children and their families. During the third and fourth years of training, the resident is exposed to a broad array of special treatments including:
- Cognitive-behavioral therapy
- Mentalization-based treatment
- Group therapy
- Couples therapy
- Family therapy
- Good psychiatric management for borderline personality disorder
- Assertive community treatment
- Family psychoeducation
- Dialectical behavior therapy
- Traditional insight-oriented psychodynamic approaches continue to be valued and taught
Finally, before graduation the resident should understand the important ethical issues in psychiatry, and his or her conduct should reflect adherence to high ethical standards.
We believe it is the goal of the psychiatrist to understand not only the patient's illness but the much larger context of the patient's life. This necessitates an appreciation of biological, psychological, and social factors and an interest in the patient's life story. We embrace and teach current advances in neuroscience, and we assert that learning psychotherapy is vital to residency training. We are committed to teaching residents to thrive in the evolving medical climate, and to respond to community needs. At the same time we are dedicated to maintaining our identity as medicine's most humanistic specialty.
Daniel Grant Price, M.D.