Clinical Rotations
Year 1
4 |
2 |
3 |
1 |
1 |
1 |
Internal Medicine |
Neurology |
Inpatient |
ER |
Addiction |
Night |
Year 2
4 |
2 |
2 |
2 |
1 |
1 |
Inpatient |
Geriatric |
Consult-Liaison |
Scholarly |
Selective |
Night |
0.5 day per week Outpatient Psychiatry (long-term Psychtherapy cases) |
|||||
Year 3
12 Months |
Full-time Outpatient Psychiatry |
0.5 day per week Scholarly Concentration for 6 months |
Year 4
6 Months |
6 Months |
Selective 50% |
Selectives |
0.5 day per week Outpatient Psychiatry (long-term psychodynamic cases) |
|
Clinical Rotations Summary
First Year
The PGY-1 year consists of three blocks of inpatient psychiatry, divided between the Palo Alto VA Hospital and Stanford Hospital; one block of addiction psychiatry at the Palo Alto VA Hospital; one block of emergency psychiatry at the Santa Clara Valley Medical Center (County Hospital); four blocks of internal medicine divided among inpatient medicine, consult medicine, and ambulatory medicine at the Palo Alto VA Hospital; and two blocks of neurology at Stanford Hospital. In addition, we complete two two-week periods of night float at the Palo Alto VA Hospital, typically coupled with two two-week vacation blocks.
PGY-1 Rotations
- Psychiatry: As PGY 1 residents, we spend three blocks on inpatient psychiatry, one block on addiction psychiatry, one block on emergency psychiatry, and one block on night float.
- Inpatient Psychiatry: We spend two blocks at the Palo Alto VA inpatient unit 2B1, a locked, acute-care unit for the treatment of male veteran patients. We also spend one block at Stanford Hospital inpatient unit G2P, an unlocked unit. While on the inpatient services, we spend 1-3 hours weekly in multidisciplinary rounds, and participate in formal didactics and journal clubs.
- Addiction Psychiatry: We complete one block at the Palo Alto VA short-term addiction and psychiatric inpatient unit 5B3. During this rotation, we learn to conduct a thorough diagnostic assessment, evaluate the need for psychiatric treatment, initiate and complete medically supervised withdrawal protocols for opiate dependence, alcohol dependence, and sedative/hypnotic dependence, and develop a plan of care including psychotherapeutic and pharmacologic interventions for alcohol dependence, nicotine dependence, opiate dependence, and other major psychiatric disorders. We initiate a course of evidence-based psychotherapy or psychoeducation for at least two patients and co-lead an evidence-based group psychotherapy weekly during the rotation under supervision.
- Emergency Psychiatry: We spend one block at the Santa Clara Valley Hospital Psychiatry Emergency Room, a facility that provides care to the majority of the county’s uninsured and underinsured residents. On this rotation, we learn how to triage and assess patients in the emergency room, admit patients in acute situations, evaluate/admit transfers from outside hospitals, manage any emergent clinical needs, and work effectively with other services.
- Night Float: We do two two-week periods of night float at the Palo Alto VA Hospital, during which they assess patients in the emergency room and address any urgent inpatient issues that may arise. This is a Sunday night – Friday night rotation (9pm – 8am), with Saturday evenings off. The two weeks of night float are typically coupled with two weeks of vacation.
- Internal Medicine: We complete four blocks of internal medicine, comprising at least one month of inpatient medicine, one month of consult medicine, and one month of ambulatory medicine at the Palo Alto VA. Call on inpatient medicine is on a five day admitting cycle.
- Neurology: We rotate on two blocks of neurology at Stanford Hospital – one inpatient and one outpatient.
- Inpatient Neurology is a six-day a week rotation (M-F and Sunday; Saturday off) with no call duties. We are typically exposed to cases of multiple sclerosis, myasthenia gravis, Guillain-Barre syndrome, paraneoplastic syndromes involving the nervous system, etc. We also treat a range of stroke syndromes.
- Outpatient Neurology: We rotate through a number of specialty clinics during this block, including Epilepsy Clinic, Multiple Sclerosis Clinic, Parkinson's Disease Clinic, Stroke Clinic, Dementia Clinic and the Movement Disorders Clinic.
- Inpatient Neurology is a six-day a week rotation (M-F and Sunday; Saturday off) with no call duties. We are typically exposed to cases of multiple sclerosis, myasthenia gravis, Guillain-Barre syndrome, paraneoplastic syndromes involving the nervous system, etc. We also treat a range of stroke syndromes.
Second Year
In the PGY-2 year, we rotate through four blocks of inpatient psychiatry, two blocks of geriatric psychiatry, two blocks of consultation–liaison psychiatry, and one block of night-float. We have two blocks of scholarly concentration time, in which we choose an area of clinical or research interest to pursue with appropriate supervision and mentorship. Lastly, a selective block is dedicated to either an additional block of inpatient psychiatry, or a block of addiction psychiatry in a residential setting.
Additionally, we begin long-term psychotherapy training in the Individual Psychotherapy Clinic during the PGY-2 year.
- Inpatient Psychiatry: As PGY-2 residents we spend two blocks on Stanford Hospital H2, a locked inpatient unit with 16 beds. The typical H2 patient has an acute and severe psychiatric illness (i.e. primary affective disorder or psychotic disorder). Patients are commonly on involuntary legal holds for danger to self, danger to others, or are gravely disabled. We also spend one block on G2P, and the final block on either H2, G2P, or Palo Alto VA 2B1. (See First Year rotation descriptions for details about G2P and 2B1.)
- Geriatric Psychiatry: The geriatric psychiatry service at Stanford Hospital is an 8-10-bed program located on wards G2 or H2, depending on clinical need. On this service we care for patients over 60 years of age and patients referred for ECT.
- Consultation-Liaison Psychiatry: The Stanford consult service provides psychiatric care for all inpatient medical and surgical wards, the emergency department, and selected outpatient medical and surgical clinics.
- Night Float: We do two two-week periods of night float at Stanford Hospital, during which we assess patients in the emergency room and address any urgent inpatient issues that may arise. This is a Sunday night – Friday night rotation (9pm – 8am), with Saturday evenings off. The two weeks of night float are typically coupled with two weeks of vacation.
- Individual Psychotherapy Clinic: The Individual Psychotherapy Clinic at Stanford provides us with clinical experience in outpatient, open-ended, preferably long-term individual psychotherapy where we meet with patients at least once per week. Additionally, we gain experience in the utilization of outpatient psychotherapy supervision and case consultation groups.
- Scholarly Concentration:
- PGY 2 – Full time, 2 4-week blocks, during which residents are on back-up to clinical services
- PGY3 – 25% time for 6 months
- PGY 4 – 50% time for 6 months
We choose an area of clinical interest, ranging broadly by demographics (e.g., child and adolescent, immigrants and refugees, international), diagnosis (e.g., sleep disorders, PTSD, psychotic disorders), and treatment modality (e.g., medications, various psychotherapeutic techniques). Alternatively, we may select a research area of interest with an appropriate mentor for close supervision and educational support. All concentrations require the development of clear goals and objectives with appropriate supervision by a mentor, to be approved by the Program Director. We have individual supervision weekly with their mentor(s). Group supervision for project development occurs within Thursday afternoon course time in the PGY 1, 2, and 4 years.
A proposal including topic, faculty sponsor, and goals and objectives for each block of scholarly concentration time is due to the Office of Residency Training Director four weeks prior to the start of the rotation.
Coming soon: Sample proposal
Coming soon: Non-comprehensive list of mentors (i.e., people who have expressed interest in sponsoring a scholarly concentration
Third Year
The third year is devoted to outpatient work, and we assume a higher level of responsibility for all aspects of the clinical service. The outpatient experience is split between Stanford Psychiatry Clinics and the Menlo Park Veterans' Administration (VA) Mental Health Clinic. Residents develop skills cognitive behavioral psychotherapy as well as second-generation CBTs such as Prolonged Exposure Therapy for PTSD under the guidance of supervisors in the Psychosocial treatment Clinic at Stanford and the psychology training program at the Menlo Park VA. We participate in psychopharmacology clinics focusing on mood disorders, community mental health, clozapine and severe mental illness, and addiction. In addition, during the six months at the VA, we have the opportunity to choose from a number of specialty clinics, including: Bipolar Disorders Clinic, Psychosomatic Medicine Clinic, Geriatric Psychiatry Clinic, Women's Wellness Clinic, Obsessive-Compulsive Disorders Clinic, Neuropsychiatry Clinic. Furthermore, during this year, we participate in one of a number of child and adolescent clinics under the auspices of the child psychiatry training program. Finally, we continue to treat our long-term psychotherapy patients in the Individual Psychotherapy Clinic, and have some dedicated time to continue our scholarly concentration pursuits.
Fourth Year
During the fourth year every effort is made to provide us with a schedule tailored to our individual interests and with our career goals in mind. There are a variety of clinical and basic research opportunities. We have 50% time for six months to devote more heavily to our scholarly concentration interests. We can also apply for various fellowships to obtain funding for clinical or basic research.
PGY 4 Selective Rotations
Stanford Psychopharmacology Clinics Advanced Rotation
Bipolar Disorders Clinic
Geriatrics Clinic
Psychosomatic Medicine Clinic
Neuropsychiatry Clinic
Obsessive-Compulsive Disorder Clinic
Women's Wellness Clinic
Kaiser Permanente Medical Center, Redwood City Rotation
Adult outpatient clinic with a focus on brief individual psychotherapy and psychotherapy groups.
Palo Alto VA, Menlo Park Division, National Center for PTSD Rotation
Residential program for the treatment of veterans with PTSD. Residents participate in medication management and group psychotherapy including Cognitive Processing Therapy.
Stanford Hospital & Clinics Electroconvulsive Therapy Rotation
Active ECT service providing acute and maintenance treatment, as well as consultation service to the inpatient units.
San Mateo County Community Clinic
Vaden Student Health Center: Counseling & Psychiatric Services
Outpatient clinic with a focus on student mental health, psychopharmacology, and brief individual psychotherapy.
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