The main thrust of the PG2 year is to expand on the basic skills and knowledge learned in the first year by exposing the trainee to a much broader set of psychiatric disorders, severity of illness, and treatment modalities and settings. In addition, residents are introduced to the practice of psychiatry in non-inpatient settings. The year is typically broken into 11 blocks.
Chemical Dependency – Bridgeway (1 block)
Service Director: Dr. Marcie Garland
The resident spends his/her time at Bridgeway Counseling Services learning to evaluate and treat patients with substance use disorders in an acute inpatient and intensive outpatient setting. In addition to learning the use of pharmacotherapeutics, the resident learns individual and group psychotherapies as applied to these disorders.
Chemical Dependency – VA (1 block)
Service Director: Dr. Dragan Svrakic
The resident works as part of a team with supervising psychiatrists, psychologists, nurses, and addiction counselors to treat outpatients with substance use disorders (mainly opiate and alcohol) through various services available at the VA Medical Center. In addition to learning evidence-based group and individual psychotherapies for substance use disorders, residents also learn pharmacologic treatments such as agonist (methadone), partial agonist (buprenorphine), and antagonist (naltrexone) therapy for opiate dependence.
Consultation Psychiatry (2 blocks)
Service Director: Dr. Monica Bishop
On this rotation, residents learn to evaluate and treat patients with psychiatric illness that is occurring comorbidly with other medical illnesses by providing consultation services to the non-psychiatric floors of Barnes-Jewish Hospital.
Eating Disorders (1 block)
Service Director: Dr. Kim McCallum
Residents learn how to evaluate and treat patients with severe eating disorders by rotating at McCallum Place, a specialized eating disorder treatment setting providing both residential and outpatient services. Residents become adept at using a broad array of psychotherapies and medications in addition to learning how to handle non-psychiatric complications associated with these disorders.
Emergency Psychiatry (1 block)
Service Director: Dr. Don Bohnenkamp
Residents perform psychiatric consultations on patients that present to the level one emergency department at Barnes-Jewish Hospital. Residents learn how to do an emergency psychiatric assessment and risk assessment in order to determine the appropriate level of care for the patient. Residents learn use of both pharmacotherapies and psychotherapies for the emergency setting.
Geriatric Psychiatry (1 block)
Service Director: Dr. Eric Lenze
This rotation is designed to teach residents how to assess and manage psychiatric dysfunction in older adults by rotating through several different sites each week. They become adept at evaluating and treating neurocognitive disorders in the Memory Diagnostic Center at Washington University, which is associated with one of the top Alzheimer’s Disease Research Centers in the country. They are instructed how to diagnose and treat a variety of different movement disorders by working at Washington University’s Movement Disorders Clinic. The residents also work at BJC Extended Care, a skilled nursing facility, providing psychiatric care to elderly patients. Residents in Dr. Lenze’s outpatient clinic will assess and treat older adults with psychiatric illness. A one-time observation visit at Memory Care Home Services and a home visit with Susie Berger, RN, MSN, psychiatric nurse specialist, round out the rotation’s itinerary.
Interventional Psychiatry (1 block)
Service Director: Dr. Chuck Conway
On this rotation, residents learn the basic use of and principles underlying ECT by providing both inpatient and outpatient ECT services to not only the St. Louis area but also the greater bi-state region. In addition, residents become familiar with newer treatments (e.g., TMS, DBS, VNS) by working with faculty who are developing these treatments for general psychiatric use.
BJH – PSQI (1 block)
Service Directors: Drs. Michael Jarvis and Nuri Farber
The main goals of this rotation are to learn Patient Safety and Quality Improvement (PSQI) principles as well as administrative skills and to provide clinical coverage as needed. The psychiatric inpatient unit utilizes a multidisciplinary approach with hospital administration, nursing, social workers, activity therapists, psychiatrists, residents in psychiatry, and medical students on psychiatry clerkships. The resident on this rotation learns principles of PSQI and monitors the quality of the PGY1s’ compliance with hospital/JCAHO policies and their involvement in PSQI exercises. The resident also is available as backup in the case of illness and provides teaching to PGY1 residents and medical students.
Electives (2 blocks)
Service Director: Diverse faculty
In addition to the 9 blocks described above, residents expand their horizons by choosing two additional rotations. Residents will typically use this time to explore areas that are of potential long-term interest to them (e.g., child psychiatry, forensic psychiatry, sleep medicine). Residents may also choose to focus on research or even design their own elective to meet their personal needs.