General Residency Program
Clinical Rotations
PGY-I
The first year psychiatry rotations are divided into six months of psychiatry, four-months of general medicine and two-months of neurology, alternating in two-month blocks.
PGY-1 Rotation Schedule
| Group A | Group B | |
| July-Aug | Med/Neuro | Psych |
| Sept-Oct | Psych | Med/Neuro |
| Nov-Dec | Med/Neuro | Psych |
| Jan-Feb | Psych | Med/Neuro |
| Mar-Apr | Med/Neuro | Psych |
| May-June | Psych | Med/Neuro |
PGY-1 Rotations
| 3 Months |
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| 1 Month |
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| 3 Months |
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| 1 Month |
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| 2 Months |
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| 2 Months |
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Psychiatry Rotations
As a first year psychiatry resident at the University of Michigan, you are will complete four months of inpatient psychiatry and two months of substance abuse treatment. The four months of inpatient psychiatry include three months at the Ann Arbor VA Medical Center and one month at the University of Michigan Medical Center. You will also have the opportunity to be involved in the Mental Health Clinic, working on new patient evaluations.
Inpatient Psychiatry at the Ann Arbor VA:
First year residents will be exposed to patients with such diagnoses as chronic schizophrenia, depression and PTSD. Residents gain independence in diagnosing and treating psychiatric disorders. In-house calls provide the resident the opportunity to triage emergency psychiatric phone calls, see inpatient consults from both the general medical floors and the emergency room and round on psychiatric inpatients during the weekend. Residents will gain experience treating the increasingly important and rapidly expanding geriatric population. There is also the opportunity to work with the attending physician in providing patients with ECT. Attending physicians are available to residents at all times. The majority of weekends are free of clinical responsibilities.
Inpatient Psychiatry at the University of Michigan Medical Center:
This rotation provides first-year residents with the opportunity to manage patients that are generally more severely ill, with a wider variety of disorders. The patient population tends to have greater variety, in terms of age, gender, and socioeconomic status. Residents will gain familiarity with the newest psychotropic medications. Residents get some exposure during the first year, but the majority of the University Inpatient Psych experience comes in the second year.
Substance Abuse Rotations
The two month substance abuse rotation can be either at the High Intensity Outpatient Therapy/Substance Abuse Clinic (HIOT/SAC for short) at the Ann Arbor VA or the University of Michigan Addiction Treatment Services (UMATS) at the new Depression Center. The AAVA rotation deals with older patients with other medical and psychiatric co-morbidities, while UMATS serves a younger crowd consisting of many university students. Weekends are free of clinical responsibilities unless you’re on call at the VA.
Outpatient Psychiatry:
Once a week, residents will get a chance to complete an outpatient psychiatric evaluation at the Ann Arbor VA Mental Health Clinic under direct supervision by experienced Attending Psychiatrists. This gives the residents a unique opportunity to work with the outpatient patient population during internship. The goals of this educational activity include improving: clinical interviewing skills, biopsychosocial formulation, treatment planning, and documentation. This activity is also geared toward preparation for the oral portion of the Psychiatric Boards.
Didactics:
Protected time for didactics for the first year psychiatry resident include core lectures on Thursdays with topics by clinical faculty including Mental Status Exam, Suicide Assessment, Delirium, Psychopharmacology, Consultation Psych, Emergency Psych, Mood Disorders, Psychotic Disorders, and PTSD.
University of Michigan, Department of Psychiatry Grand Rounds are held Wednesdays in the new auditorium at the outpatient, Rachel Upjohn Building. They are also teleconferenced to the U of M Hospitals as well as the VA. These Grand Rounds bring in national and international speakers to present cutting edge research in psychiatry and mental health.
VA Clinical Grand Rounds are held on Tuesdays and focus on clinical and educational topics. They are subdivided to include monthly Resident (supervised by Attending) Journal Club, Clinical Research, Interdisciplinary topics, and Case Presentations.
Medicine and Neurology Rotations
Neurology is divided into one month at the Ann Arbor VA Medical Center and one month at the University of Michigan Medical Center, the neurology rotation is our residents’ first exposure to inpatient, outpatient, and consult liaison neurology.
Neurology
At the Ann Arbor VA Medical Center, you will work side by side with senior neurology residents and staff. Your responsibilities include seeing patients at the neurology clinic, rounding on the inpatient service and consult requests from the other services and the emergency room. Residents will gain valuable experience treating a wide variety of neurological complaints. The weekend is free of all clinical duties.
At the University of Michigan Medical Center, the psychiatry resident cares for patients on the general Neurology service, as well as the Stroke Unit, neuro-oncology, and Long-Term Monitoring for epilepsy. Residents also have the opportunity to care for more medically ill patients in the Neuro Intensive Care Unit. You are expected to take in-hospital call every 4 days. Like the medicine inpatient service, there will be an average of one day off every seven days.
There are several rotation options that fulfill the 4 general medicine months that each first-year resident are expected to complete. These options include inpatient medicine, inpatient pediatrics, inpatient Family Medicine, Urgent Care, ER and the Pediatric ER.
Internal Medicine
The University of Michigan Medical Center and the Ann Arbor VA Medical Center are tertiary care centers, incorporating residents and faculty from the University of Michigan Medical School. The psychiatry resident works as the third intern at both locations, with a cap of four admits during call days. Call is every four days. There are weekly didactics, resident case seminars, and patient presentations with the departmental chair. Residents gain experience in efficient management of common medical conditions, as well as in evaluation and treatment of more complex medical pathology.
Inpatient Pediatrics:
Residents have the opportunity to spend a month on a Pediatrics rotation at Mott Children’s Hospital. The resident is part of a three-intern team, with call every four nights. Teams can include interns from pediatrics, med-peds, family medicine and emergency medicine. Residents learn about evaluation and management of general pediatric patients. They also gain experience with two pediatric subspecialities. Most residents choose to work with the Pediatric Neurology team, which allows increased exposure to some aspects of Child/Adolescent Psychiatry as well. There are case seminars and daily didactics. Residents have found this to be a satisfying and enjoyable experience.
Inpatient Family Medicine:
The first year psychiatry resident may choose to do a month of inpatient family medicine at the University of Michigan Hospital. You will work with a senior family medicine resident to care for patients with a wide spectrum of medical and psychiatric co-morbidities, who are admitted on a daily basis. Residents will be exposed to basic inpatient management of common medical complaints. This rotation provides residents with a greater degree of independence in formulating treatment plans and managing day to day care of patients.
Pediatic Emergency Room:
The Children’s Emergency Service (CES) is a Level I Trauma Center, covering most of South-Central Michigan and caring for a high percentage of complicated pediatric illness and injury cases. It is staffed by Department of Emergency Medicine Faculty with specialized training in pediatrics or pediatric emergency medicine. During the month, you will gain experience dealing with acutely ill children and common pediatric emergencies. Your colleagues will consist of residents from family medicine, pediatrics and emergency medicine in addition to pediatric emergency medicine fellows. Trauma cases are generally followed by more junior and senior level residents. You will generally work approximately 20-23 shifts in the month. This rotation provides an excellent opportunity to see pediatric patients with a wide range of medical complaints.
Urgent Care Clinic at the Ann Arbor VA
The urgent care rotation, at the Ann Arbor VA, is a very rewarding rotation. This clinic is staffed with internal medicine faculty and residents from various specialties. Residents see patients with a wide variety of complaints, anything from chest pain to a skin rash. Many of the VA population are very sick, with multiple medical problems, creating an opportunity for you to learn to treat and triage a large variety of diagnoses, preparing you to manage just about anything that your patients may present with. There are also a good number of psychiatric cases that will come your way. The Urgent Care rotation allows for a good amount of autonomy though attendings are available at all times.
PGY-II
Option A
6 months |
4 months |
2 months |
Adult Inpatient |
Consultation/Liaison |
Emergency Psychiatry |
Option B
5-6 months |
3-4 months |
1-2 months |
2 months |
Adult Inpatient |
Consultation/Liaison |
Child and Adolescent |
Emergency Psychiatry |
PGY-II rotations include five to six months on the University Hospital adult psychiatry inpatient unit. Supervised case loads, intensive supervision and teaching, and many ongoing research projects create an academic atmosphere that facilitates both excellent patient care and education. Core seminars focus on a working knowledge of psychiatric diagnoses, psychodynamic principles and practice, basic principles of pharmacological treatment, emergency psychiatry, consultation/liaison, ethics, and forensics. Residents also acquire technical skills in the administration of electroconvulsive therapy (ECT).
We have an innovative two-month rotation in the Psychiatry Emergency Service (PES). Residents work one month of 10 hour evening shifts, five days a week and one month of 10 hour night shifts, five days a week. This system allows residents to have infrequent call nights throughout the rest of the year. Clinical supervision is provided by a faculty member, and a senior resident or fellow is available to assist with in-house back-up when needed. Each morning there is a teaching and patient care coordinating meeting to discuss cases seen the night before.
Later in PGY-II, each resident begins supervised, long-term psychodynamic psychotherapy cases that will continue throughout the residency. A special clinical seminar and individual supervision allow rapid development of psychotherapeutic skills.
PGY-III
Option A
Adult Outpatient 80% time x 12 months |
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Adult Outpatient Team 20% time x 12 months |
Clinical Mentorship 10% time x 12 months |
Geriatric Psychiatry 10% time x 3 months, then 5% time x 3 months |
Community Mental Health 10% time x 12 months |
Long-Term Psycho-therapy (1-5 cases) |
Civil Forensics (1 case) |
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| Child and Adolescent Outpatient 20% time x 12 months | ||||||
Option B
Adult Outpatient 100% time x 12 months |
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Adult Outpatient Team 20% time x 12 months |
Clinical Mentorship 10% time x 12 months |
Geriatric Psychiatry 10% time x 3 months, then 5% time x 3 months |
Community Mental Health 10% time x 12 months |
Long-Term Psycho-therapy (1-5 cases) |
Civil Forensics (1 case) |
The third year is devoted entirely to outpatient and community psychiatry. Treatment of ongoing psychotherapy cases started during PGY-II is continued throughout the year. Supervision of psychotherapy cases in individual and group settings is intensified during PGY-III. Flexibility in the number of psychodynamic cases allows residents to develop unique interests in the field.
In the Adult Outpatient Clinic, residents become part of interdisciplinary clinics supervised by full-time faculty. The clinic experience includes intensive mentorships in marital and family therapy, cognitive-behavioral therapy, dialectic/behavioral therapy, interpersonal therapy, and psychodynamic psychotherapy. A special workshop in advanced clinical skills focuses on interviewing techniques and interpersonal style. Residents participate in the specialty Geropsychiatry Clinic, and have optional clinical experiences in additional specialty clinics, including Depression, Anxiety Disorders, Bipolar Disorders, Personality Disorders, and others. Residents follow patients throughout the year at a local Community Mental Health Center with on-site faculty supervision. Clinical supervision and seminars are provided to give residents experience in civil forensic cases. Residents spend 20% time throughout the year working at the university’s Child/Adolescent Clinic, seeing patients and families with the full range of diagnoses and providing a broad spectrum of treatments (Option A).
PGY-IV
80% time x 1 month |
80% time x 1 month |
80% time x 2 months |
80% time x 8 months |
Managed Care |
Forensic Psychiatry |
Consultation/Liaison |
Senior Electives |
Adult Outpatient 20% time x 12 months (includes Long-Term Psychotherapy, Clinical Mentorship, Outpatient Team) |
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Senior residents spend one month at the Center for Forensic Psychiatry, a well-respected facility with a high level of inpatient and outpatient clinical activity. The Forensic Center focuses on the interface between the criminal justice system and community psychiatry. Residents participate in outpatient evaluations of patients’ competence to stand trial, degree of criminal responsibility, and other legal issues. Fifteen full-time psychiatrists with special qualifications in forensic psychiatry, as well as a large number of psychologists, social workers, and others, contribute to the experience.
Residents have the opportunity to participate in the University Health System’s Managed Care program, evaluating systems of care, participating in peer review of treatment, and providing direct patient care. This novel experience promises to create a unique and vital perspective among young psychiatrists.
Senior residents return to the university’s Consultation/Liaison Service for two required months of supervised clinical work. They have the opportunity to provide teaching and guidance to junior residents on the service, under the direction of faculty.
Ample time is provided during the year for elective rotations. Although many residents choose to return to rotations in which they developed interest earlier in the residency, many pursue training in new settings. Popular experiences include psychiatry in the primary care clinic (PRIME), work with students and families on the main university campus, community outreach clinics, clinical research, Ypsilanti Family Practice, and many others.