General Adult Psychiatry Residency

Internal Medicine/Pediatrics. Generally our interns will be rotating with a hospitalist service, covering one of Thomas Jefferson University Hospital's general medical floors. The intern will be working closely with another internal medicine intern on the team, along with a senior resident (PGY-2 or 3) and an attending. Our interns can elect to spend a portion of this time to rotating at the Nemours/Alfred I. duPont Hospital for Children, Jefferson's primary pediatric affiliate. Residents may wish to consider this option if they are interested in a Child and Adolescent Psychiatry fellowship in their future. This time is usually spent at a general pediatric medical floor.

Neurology. Our interns will be rotating with Jefferson’s Department of Neurology for two months. Time with neurology is divided between experiences on the general neurology service, the eight-bed epilepsy monitoring unit (EMU), and the neurology consultation service. These experiences allow the intern to master the neurologic examination and provide exposure to both common and uncommon neurologic disorders, including those with a psychiatric component. Jefferson, which is consistently ranked among the best in the nation for neurology and neurosurgery by US News & World Report, is a regional transfer center for the area's most complicated cases. This rotation provides the intern with unparalleled exposure to the field of neurology.

General Adult Inpatient Unit. Our 14 Thompson is a 16-bed secure psychiatric acute care unit dedicated to the treatment of severe mental illness. Inpatients treated on 14 Thompson suffer from a wide range of major psychiatric illnesses, including schizophrenia spectrum or affective psychoses, major depressive disorders, substance use disorders, adjustment disorders, and personality disorders. The patient mix is drawn from both the inner city and suburban populations of the tri-state area. Residents have first-line responsibility for managing a caseload of inpatients. Residents participate in interdisciplinary treatment teams, including nurses, social workers, and activities therapists. The unit provides the most secure setting for treatment of ill patients, regardless of their degree of psychiatric pathology. The unit often admits patients seen through the Trauma Program, especially where injuries have been self-inflicted, following an initial period of medical stabilization. Our 14 Thompson regularly accepts patients from the medical and surgical services, who develop psychotic reactions or major affective disorders and require psychiatric care. Additionally, we are a citywide referral service for medically ill or pregnant patients in need of acute inpatient psychiatric care.

Division of Geriatric Psychiatry. The Geriatric Psychiatry Program treats elderly patients primarily and a small number of younger patients with neuropsychiatric disorders. Most of the elderly patients suffer from chronic age-related psychiatric, medical, and neurological conditions such as depression, dementia, Parkinson’s disease, stroke, and accompanying medical disorders. The unit is composed of 12 inpatient beds in a specially designed environment for an elderly disabled population. Somatic therapies include psychopharmacology, electroconvulsive therapy, and management of concurrent medical and neurological comorbidities. The treatment program is multidisciplinary and includes psychiatry, neurology, family medicine, nursing, social work, and occupational and creative art therapies. Each discipline contributes its own specific expertise to create a comprehensive treatment program. Residents have first-line responsibility for managing a caseload of geriatric inpatients. Active training and research establish the academic program.

Jefferson Emergency Medicine. This rotation consists of 12 to 18 shifts in Jefferson's emergency department, home to a Level I trauma center that sees more than 90,000 patients per year. During this rotation, residents will learn how to rapidly assess patients with urgent medical complaints and the basics of managing common physical emergencies.

Albert Einstein Medical Center. The Albert Einstein Medical Center (AEMC) is a medical facility with 506 beds, serving the Philadelphia area, and one of the principal clinical components of the Jefferson Health System. It is located in Philadelphia approximately six miles from the Jefferson campus. The Crisis Response Center serves more than 5,000 adults and more than 1,000 children yearly, who present with acute psychiatric symptoms. At the AEMC Crisis Response Center, residents are trained to manage the following: 1) assessment and triage of agitated patients while maintaining patient and staff safety; 2) assessment and management of delirium, emergency substance abuse disorders, and involuntary commitments; 3) identification and assessment of risk factors for suicide; and 4) assessment of medical conditions presenting as psychiatric emergencies.

General Adult Inpatient Unit. Our 14 Thompson is a 16-bed secure psychiatric acute care unit dedicated to the treatment of severe mental illness. Inpatients treated on 14 Thompson suffer from a wide range of major psychiatric illnesses, including schizophrenia spectrum or affective psychoses, major depressive disorders, substance use disorders, adjustment disorders, and personality disorders. The patient mix is drawn from both the inner city and suburban populations of the tri-state area. Residents have first-line responsibility for managing a caseload of inpatients. Residents participate in interdisciplinary treatment teams, including nurses, social workers, and activities therapists.

The unit provides the most secure setting for treatment of ill patients, regardless of their degree of psychiatric pathology. The unit often admits patients seen through the Trauma Program, especially where injuries have been self-inflicted, following an initial period of medical stabilization. Our 14 Thompson regularly accepts patients from the medical and surgical services, who develop psychotic reactions or major affective disorders and require psychiatric care. Additionally, we are a citywide referral service for medically ill or pregnant patients in need of acute inpatient psychiatric care.

Consultation-Liaison Psychiatry. The Consultation-Liaison Psychiatry division is a nationally recognized academic division that is active in educational, clinical, and research activities. The consultation service sees about 1,000 patients per year who have medical, surgical, and obstetrical diagnoses, complicated by psychiatric symptoms. The faculty teaches residents about competency evaluations: the use of psychotropic medications in the medically ill; identification and management of delirium tremens and/or withdrawal/intoxication states; and a variety of other psychiatric conditions. The consultation liaison psychiatry faculty has specific expertise in cancer, complementary medicine, transplant, bariatrics, stress management, AIDS, women’s health, pain, and medically ill children.

Bryn Mawr Hospital. Bryn Mawr Hospital is located just outside of Philadelphia. The hospital, part of Main Line Health, has a 20-bed general inpatient unit. The hospital is located on Philadelphia's Main Line, one of the nation's most affluent suburban communities. As such, the patient population poses a different set of challenges. While the underlying psychiatric disorders are the same, there are different psychosocial circumstances that change the management of the patient. Bryn Mawr also provides the resident with experience working in a community hospital.

Substance Abuse Programs. The resident spends a considerable amount of time learning to evaluate and treat patients presenting with substance abuse disorders in their PGY-II year. Rotations include: 

• Narcotic Addict Rehabilitation Program (NARP): This is an outpatient methadone maintenance treatment program serving about 400 opiate dependent patients. Residents serve as treatment team leaders and consultants to the treatment team. In these roles, residents are involved in admitting patients to the program and performing psychiatric evaluations and follow-up visits. Residents spend about two thirds of their time at this program.
• Family Center Program (FCP): FCP is a program for addicted pregnant and parenting women. Within FCP, there are three programs including an outpatient component, a methadone maintenance treatment program and a residential program. Residents rotate here one half day per week and serve as psychiatric consultants to the staff-seeing patients for their initial evaluations and follow up visits. Residents spend about one eighth of their time at this program.
• My Sister’s Place (MSP): MSP, part of Jefferson’s Maternal Addiction Treatment Education and Research program, is a residential treatment program for mothers recovering from opioid addiction. The residential program helps patients who are currently pregnant and mothers with children aged 6 and under. The program provides mothers with the tools to become successful parents through individual and group therapy, mindfulness-based parenting education, career and professionalism counseling, resume-writing sessions, and assistance with community job placement.

Belmont Center for Comprehensive Treatment. Belmont's Adolescent Unit is a 28-bed secure psychiatric acute care unit dedicated to the treatment of mental illness in adolescents. The patients' ages range from 13 to 18 years. Residents are involved in all stages of inpatient care, including admissions evaluations, individual/group/family psychotherapy, medication management, and disposition planning. Resident educational objectives include interviewing techniques as applied to adolescents, diagnosis of psychiatric disorders and emotional difficulties in adolescents, and use of psychiatric medications for inpatient children and adolescents.

Adult Outpatient Clinic. The adult outpatient clinic is staffed by two fulltime faculty psychiatrists and psychiatric residents in their third and fourth year of training. The clinic treats adult patients between the ages of 18 and 65 with diverse clinical psychiatric diagnoses. In a typical year, the clinic records upwards of 4,000 patients visits. A majority of these patients have affective disorders, which may often be accompanied by an Axis II diagnosis. In addition, the clinic treats patients with psychotic disorders. Each new case is discussed in detail during an intake meeting with faculty, where a sophisticated approach to diagnostic formulation and differential therapeutics prevail. Some patients are deemed suitable for intensive psychotherapy, others for a combination of medication and psychotherapy, and still others for group interventions. An attempt is made to tailor the treatment to the patient's needs. Each resident is expected to undertake the care of a representative mix of patients and learn to use various treatment modalities. A climate of therapeutic devotion and academic dedication is fostered on the service.

Outpatient Subspeciality Clinics. The resident begins to staff the department's outpatient subspeciality clinic in their PGY-III year. Subspecialty clinics include: 

• Psychopharmacology: This clinic provides medication management services to patients with medical comorbidities and/or complex psychiatric medication regimens. 
• Women's Health: The Women's Health Clinic provides residents exposure to patients suffering from disorders specific to females, including postpartum disorders and mood disorders due to menopause. This rotation will also give the residents a better understanding of concerns involving breastfeeding and hormone replacement therapy.
• Geropsychiatry: In this clinic, the resident sees patients aged 65 and older. The patients are suffering from a variety of psychiatric illnesses, along with comorbid geriatric illness such as Parkinson's disease and Alzheimer's disease. This clinic also provides the opportunity for residents to work with patients requiring outpatient electroconvulsive therapy.
• Psycho-Oncology: The Psycho-Oncology Clinic cares for people living with cancer. Services include psychiatric care from the time of diagnosis, to patients undergoing chemotherapy and radiation, to patients living in remission.

Community Mental Health/Mental Retardation (COMHAR). COMHAR, Inc. is a private, nonprofit, full-service Community Health Center that primarily serves the Kensington, Port Richmond, Fishtown, Juniata Park, and Northeast Philadelphia areas. COMHAR’s Mental Health Division provides a variety of services, including outpatient, partial hospitalization, targeted case management, residential, clubhouse, and outreach programs to a diverse population of adults and children. It is the only community mental health center in the city of Philadelphia that has dedicated mental health services for individuals with HIV/AIDS. COMHAR also specializes in services to the Latinx population. Residents perform intake evaluations and manage medications in collaboration with nonmedical staff. Residents also rotate through the partial hospital or HIV service.

Electives. The PGY-IV resident has 40% of their time, or 1.5 days per week, allocated to a wide variety of electives, depending on his or her specific interests. Residents meet with the program director to discuss plans and interests at the end of the third year to plan out the electives. Popular electives include:

• Student Personal Counseling Center (SPCC): The Student Personal Counseling Center (SPCC) offers a variety of counseling and support services to Jefferson University Center City students. Many of the encounters involve graduate students and healthcare trainees (including medical students, nursing students, and residents) dealing with stress related to their new roles. 
• Child Psychopharmacology: This clinic, staffed by the program director for the Child and Adolescent fellowship, provides care to children and adolescents in the outpatient setting. Common disorders encountered include ADHD, oppositional defiant disorder, autism spectrum disorder, and mood disorders. 
• International: One to two residents usually elect to undergo a month-long rotation at the Tavistock and Portland Clinic, located in London. The clinic, operated by the NHS, provides psychotherapy, including psychoanalysis.  

The rest of the PGY-IV year is spent in the outpatient clinic and the outpatient subspeciality clinics.