Didactics Overview
The Department offers a wide variety of academic activities specifically designed for residents that complement the seminars, tutorials and supervisory activities. The didactic seminars occur during one protected afternoon each week. Residents are expected to participate in core seminars and are given the opportunity to take part in other more specialized forums. A review of the didactics are presented below.
PGY-1
During the first two months of training at Brown, the PGY-1 residents join the PGY-2 residents for a series of lectures designed to teach them a practical and systematic approach to the evaluation and treatment of acute presentations of psychiatric illnesses. These seminars provide a foundation essential to functioning as a resident on an adult inpatient unit and as doctor-on-call. Content is geared to the fundamentals of psychiatric interviewing and mental status examination, beginning neuropsychiatry and basics in psychopharmacology. Incorporated into these seminars are clinical presentations on topics such as suicidality, violence, agitation, confusion and intoxication with a focus on teaching assessment skills, differential diagnosis and treatment strategies.
For the remainder of the PGY-1 residents, when they are not on medicine or neurology, the didactic afternoon has two components. PGY-1 residents join the PGY-2 residents for the lectures series on psychopathology and psychopharmacology. They also meet as a cohort weekly with one of the psychotherapy teaching faculty to explore basic concepts, terminology and experiences in psychotherapy. This seminar serves as a foundation for the subsequent psychotherapy curriculum.
PGY-2
The didactic component of the PG-2 year is concentrated in one afternoon per week, consisting of seminars in each of four basic tracks: Psychopathology Psychotherapy Psychopharmacology Research.
The track devoted to psychopathology addresses the DSM-IV-TR Major Clinical Syndromes including mood disorders, psychotic disorders, alcohol and substance abuse, dementia, personality disorders, anxiety, somatoform and eating disorders, and psychiatric disorders in childhood. These seminars are designed to cover the descriptive phenomenology of DSM-IV-TR disorders as well as current theories on etiology, diagnosis and treatment.
The Individual Psychotherapy track is centered on the curriculum developed by Bernard Beitman, MD, Chair of Psychiatry at University of Missouri-Columbia. This year long course that meets weekly, is led by one of the psychotherapy teaching faculty. The faculty guides residents through a case-based, experiential seminar that teaches residents the basic tools of all talking therapies. At the end of the course, residents are able to evaluate the nature and intentions of their communications, understand the task of setting therapeutic goals, appreciate the common resistances they encounter in therapy, and begin to appreciate the complex area of transference and countertransference. Early in the course of this psychotherapy track, the residents also receive a series of lectures on developmental concepts central to psychotherapy.
Group Psychotherapy training at Brown has as its goal the development of basic competence in group psychotherapy as a technique and form of psychodynamic psychotherapy. Residents become co-leaders of an ongoing psychotherapy group at the beginning of their PG-3 year. During the last month of the PG-2 year, seminars provide a theoretical overview of the dynamics and process of group psychotherapy and focus on the following specifics: curative factors in group psychotherapy, characteristics of the therapist, techniques for patient selection and starting a therapy group, the process of group psychotherapy, and particular problems and approaches in treatment.
The Psychopharmacology track focuses on building a core fund of both basic and clinical knowledge of the different classes of psychotropic medications. In addition, seminars cover topics such as drug interactions, effect of non-psychiatric medications on mood and behavior, toxicity, treatment of overdoses, and augmentation strategies.
The PGY-2 Research seminars are designed to enable residents to begin to define research questions in psychiatry. Residents learn how to pose a research question, the strengths and limitations of the methodology proposed to answer the research question, the applicability of the research findings to clinical practice, how to explore the scientific literature and the ethics of human research. The goal of these seminars is to train Brown Psychiatry Residents to become competent consumers of the rapidly expanding body of psychiatric knowledge. The Research Track, described below, offers a more substantial opportunity to become engaged in clinical research.
PGY-3
PGY-3 seminars are organized along three tracks: Neuropsychiatry Psychotherapy Advanced Integrative Topics
The Neuropsychiatry track exposes residents to current concepts of neuroscience and the behavioral sciences. The seminar series begins with a review of neuroanatomy and the principles of brain imaging. The clinical EEG and its correlation to major clinical abnormalities is reviewed. Subsequently, the series addresses concepts of neurotransmitter biochemistry of the brain and neuropharmacology. Neuroendocrinology is discussed in relation to mood disorders. Sleep and chronobiology are examined as important factors in mood and psychotic disorders. The seminar series covers the use of animal models in understanding disorders of human behavior, clinical and research methods in neuropsychological assessment, the scientific basis of ECT, biofeedback and self-regulation.
The PGY-3 psychotherapy track advances the general skills and knowledge begun in the PG-1 and PG-2 years to focus on a specific psychotherapeutic modality - cognitive/behavior psychotherapy (CBT). This year long course is led by a team of psychotherapy faculty. It introduces the techniques of CBT as applied to depression, suicidal behavior, anxiety disorders, addictive disorders, traumatic stress disorders and personality disorders. The weekly seminar is complemented by group supervision of on-going CBT cases, so that residents can gain proficiency in this treatment modality as applied to depression and anxiety disorders. The goal of this curriculum is to enable residents to achieve a working knowledge of the principles and application of cognitive/behavior therapy in commonly encountered clinical conditions so that they can incorporate cognitive/behavior approaches in the assessment and treatment of their patients.
The Family Therapy segment of the psychotherapy seminar series begins at the end of the year. This series introduces the residents to the McMaster Model of Family Functioning and Problem-Centered Systems Therapy of the family.
The Advanced Integrative Topics seminars include advanced psychopharmacology, ethics, cultural psychiatry, community psychiatry and epidemiology. The cultural and social psychiatry seminars address basic principles of anthropology and sociology, as well as social psychology applied to clinical issues in the United States and other countries. The aim of the community psychiatry segment is to enable residents to understand basic theoretical issues of community structure and function, community care of the mentally ill, national and regional pressures and trends in the financing of community mental health care. Residents also gain an appreciation of the particular challenges of the community-based treatment of the chronically and severely mentally ill. The epidemiology seminars address issues of prevalence and incidence of major psychiatric disorders throughout the life cycle, their untreated morbidity, treatment approaches and the cost effectiveness of treatment within hospital and community settings.
PGY-4
The specific topics for most of the PGY-4 seminars are determined each year as a result of a discussion among the PGY-4 residents, the Chief Residents, and the Director and Associate Director. Topic outlines for each seminar, as developed by the residents, are presented to faculty who have identified expertise in the subjects the residents want to address. A final schedule for the seminars is developed jointly by residents and faculty, and approved by the Director and Associate Director.
In the past, topics have included specialized seminars in advanced psychopharmacology, psychopathology and neuropsychiatry, the history of psychiatry, forensic psychiatry, the economics of psychiatric practice, and women's issues such as psychiatric symptoms and medications in pregnancy.
The psychotherapy track focuses on advanced topics such as object relations theory, self psychology, psychoanalysis, short term psychotherapy, and hypnotherapy. Specific content focused seminars are enhanced by a continuining case psychodynamic supervision, that occurs weekly with a beloved psychotherapy supervisor. This continuing case conference serves to integrate the residents' prior experiences with advanced theory and practice, allowing them to graduate the residency as skilled psychotherapists well on the road to continue their life-long learning in this challenging and rewarding treatment modality.