Curriculum

Formal didactic instruction occurs on Tuesday afternoons from 1-5 pm. Grand Rounds features presenters from local, regional, and national pools as well as senior residents' presentations which are part of the graduation requirement. Residents meet weekly for Resident Council. Every fall residents take the PRITE (Psychiatry Resident in Training Examination) to identify strengths as well as areas for improvement. Clinical Skills Exams occur each year to assess resident progress and provide regular feedback.

PGY 1 and 2 years have a one hour weekly case conference. PGY 3 and 4 years have didactic time available for their Grand Rounds, for scholarly preparation, or board review. All Residents participate in a PRITE review session on alternating weeks throughout the year.

PGY 1

Orientation curriculum starts a week before July 1 to prepare incoming interns for their year of rotations. The PGY 1 year emphasizes interviewing, diagnostic, and treatment skills, which expand as the residents move through their rotations in emergency psychiatry, inpatient psychiatry, and inpatient internal medicine. There is additional experience with outpatient neurology and primary care. Residents are expected to pass their Step 3 during the PGY 1 year. 

Sample PGY I Rotation Schedule:

First Column	Second Column	Third Column	Fourth Column
July Inpatient Psychiatry	Aug. Inpatient Neurology	Sept. Inpatient Psychiatry	Oct. JCMC Inpatient Internal  Medicine
Nov. VAMC Emergency Psychiatry	Dec. Outpatient Neurology	Jan. Inpatient Psychiatry	Feb. JCMC Inpatient JC Family  Medicine
Mar. Outpatient Primary Care	Apr. VAMC Emergency Psychiatry	May Outpatient  Primary Care	June Inpatient Psychiatry

PGY 2

This year builds on fundamentals with introduction to supportive psychotherapy as well as child psychiatry, consultation- liaison psychiatry, inpatient psychiatry, and geriatric inpatient psychiatry which correlate with the primary rotations in this year. Residents develop more complex inpatient care plans and informally mentor first year residents on these units, as well as doing night float call coverage.

Sample PGY II Rotation Schedule:

First Column	Second Column	Third Column	Fourth Column
July Inpatient Psychiatry	Aug. 2 weeks Consult/Liaison  Psychiatry 2 weeks Night Float	Sept. Inpatient Psychiatry	Oct. Child Inpatient Psychiatry
Nov. Inpatient Psychiatry	Dec. 2 weeks Night Float 2 weeks Consult/Liaison Psychiatry	Jan. Child Inpatient Psychiatry	Feb. 2 weeks Night Float 2 weeks Consult/Liaison Psychiatry
Mar. 2 weeks Night Float 2 weeks Consult/Liaison Psychiatry	Apr. Inpatient Psychiatry	May Consult/Liaison Psychiatry	June Inpatient Psychiatry

PGY 3

The 3rd year of residency has a strong  emphasis on more advanced psychotherapy learning and individual therapy supervision utilizing direct viewing (camera, one-way mirror, or in the room) interview sessions, review of videotaped sessions, and discussion of the resident's cases with experiences in supportive, cognitive-behavioral, and psychodynamic therapies. Advanced psychopathology and psychopharmacology, including substance abuse, are also presented this year. Rotations in a number of outpatient clinics give the residents opportunity for a more independent role in diverse patient exposure and supervision. Also, didactic time is available to work on grand rounds or a scholarly project.

Sample PGY III Rotation Schedule> July-June Outpatient Clinics:

First Column	Second Column	Third Column	Fourth Column	Fifth Column
Monday a.m. Psychotherapy Clinic	Tuesday a.m. VAMC Mental Health Clinic	Wednesday a.m. Adult Outpatient  University Psychiatry Clinic	Thursday a.m. ETSU Clinics: Psychology Clinic, University Health Clinic;	Friday a.m. VAMC Adult Outpatient Tele-Psychiatry Clinic
Monday p.m. VAMC Mental Health Clinic	Tuesday p.m. Didactics	Wednesday p.m. VAMC Substance Use Clinic	Thursday p.m. Sleep Medicine or Pain Medicine	Friday p.m. VAMC Psychopharmacology  Clinic

 

Note: All residents will do Adult Outpatient Psychiatry (University and Veterans Affairs Medical Center), Substance Use Disorder, and Psychotherapy clinics as well as one, or more, of the outpatient specialty clinics.

PGY 4

The final year curriculum focuses more on resident consolidation of prior learning with more senior roles in inpatient and C/L helping to mentor junior residents as well as a half day of Medication/Therapy Continuity Clinic. Six months of electives round out the curriculum with the residents' particular interests helping direct sub-specialization or work choices. Recent past electives have included Hospital Psychopharmacology, Veterans Community Living Center Consultation, Mental Health Intensive Case Management program for Veterans, Home Based Primary Care for Veterans, Tele-psychiatry, Emergency Psychiatry, Consultation-Liaison Psychiatry, ECT, Substance Abuse, Pain Management, Palliative Care, Sleep Medicine, Junior Attending on an inpatient unit, and a one month research elective. Residents are encouraged to develop new electives that suit their interests. Residents complete their scholarly project this year and are strongly encouraged to present this at a national meeting. Senior residents also teach a basic psychopharmacology course to PGY1s throughout the year, as well as each presenting a relevant psychiatry topic to Internal Medicine Residents. Transition to Practice and continuation of clinical psychotherapy supervision in a group format prepares the resident for future board certification and employment.

Sample PGY IV Rotation Schedule:

First Column	Second Column	Third Column	Fourth Column
July ER or Inpatient Unit with interns, weekly half-day Medication/Therapy Continuity Clinic	Aug. ER or Inpatient Unit with interns, weekly half-day Medication/Therapy Continuity Clinic	Sept. ER or Inpatient Unit with interns, weekly half-day Medication/Therapy Continuity Clinic	Oct. ER or Inpatient Unit with interns, weekly half-day Medication/Therapy Continuity Clinic
Nov. ER or Inpatient Unit with interns, weekly half-day Medication/Therapy Continuity Clinic	Dec. ER or Inpatient Unit with interns, weekly half-day Medication/Therapy Continuity Clinic	Jan. Elective, and weekly half day Medication/Therapy Continuity Clinic	Feb. Elective, and weekly half day Medication/Therapy Continuity Clinic
Mar. Elective, and weekly half day Medication/Therapy Continuity Clinic	Apr. Elective, and weekly half day Medication/Therapy Continuity Clinic	May Elective, and weekly half day Medication/Therapy Continuity Clinic	June Elective, and weekly half day Medication/Therapy Continuity Clinic

 

DIDACTICS

PGY I COURSES

Crash Courses at the start of the year
Interview Skills
Basic Psychopharmacology


DSM-V-TR
Case Conference

PGY II COURSES

Child Psychiatry and Child Psychopharmacology
Introduction to Psychotherapy: Supportive, CBT, and Psychodynamic Psychotherapy
Case Discussion

PGY III COURSES

Advanced Psychopharmacology
Advanced Psychopathology
Advanced Psychodynamic Therapy
Continuing Psychotherapy Case Conference
Transition to Practice
Grand Rounds Preparation/Scholarly Project Development Time

PGY IV COURSES

Continuing Psychotherapy Case Conference


NNCI Brain course

Transition to Practice
Scholarly Project Development Time/Psychiatry Board Review Time
Teaching Basic Psychopharmacology for PGY1's

COMBINED COURSES/TOPICS

Journal Club
Quality Improvement
Chair Rounds
M&Ms
Internal Medicine Topics
Neurology
Forensics
Research Lectures

TRAINING SITES

We offer residents a diversity of experiences with our various sites in a university town that services a large patient catchment area including rural areas of Tennessee, as well as veterans through the VAMC.

1) East Tennessee State University & Quillen College of Medicine

ETSU Psychiatry Building - Residents have outpatient general adult medication management and psychotherapy clinics as well as didactics at this site, which is housed off campus across State of Franklin Rd. from Johnson City Medical Center and close to Woodridge Hospital and the Veterans Administration Medical Center (VAMC). Residents also have the opportunity to be involved with Child and Adolescent patients at this site.

ETSU Psychology Clinic - The ETSU Psychology clinic treats patients from Johnson City and surrounding counties ranging in age from early childhood through late adulthood. PGY3 Residents provide medication consultation.

University Health Center - This is a general medical clinic through the Nursing department for university students where faculty and psychiatry residents provide medication management.

Family Medicine Clinics - Residents have outpatient primary care experience in one or more of the three nearby family medicine clinics as part of a team with family medicine residents and medical students.

2) Veterans Administration Medical Center (VAMC)

The James H. Quillen Mountain Home VA Medical Center services the 41 county area of Tennessee, Virginia, and Kentucky. Psychiatry training experiences here include adult inpatient, outpatient, substance use, Consultation-Liaison, PTSD, ER, Tele-psychiatry, CBT psychotherapy, MHICM, and ECT, as well as inpatient Internal Medicine. Residents work in interdisciplinary teams including consultive roles. The VAMC is a comprehensive care hospital offering medical, psychiatric, and surgical services for residents.

3) Woodridge Hospital

A free standing 84 bed psychiatric private hospital affiliated with and across the street from Johnson City Medical Center that offers child and adult inpatient, geriatric inpatient, and crisis services. Residents do several inpatient adult, geriatric, and child psychiatry ward months at this location.

4) Johnson City Medical Center (JCMC)

This is a large regional tertiary referral center that has medical, surgical, women's, and pediatric services. JCMC is an acute-care teaching hospital where psychiatry residents receive one month of inpatient general internal medicine as part of their primary care training as well as 1 month of inpatient Neurology.

5) Frontier Health 

This is an outpatient clinical experience in an underserved area in a community mental health center that serves seriously mentally ill patients with board certified psychiatrist supervision. These CMHCs also have 24 hour walk-in, provide medication assisted treatment and residential care. Residents are involved in assessment and treatment with medications, but also work with inter-professional staff in the care of these patients.

 

Other Program Highlights:

Tennessee has offered stipends that residents can apply for to augment their yearly residency salary in return for similar years of service in areas of high need.

Mentors: Each resident meets with a mentor throughout residency.

Resident regional or national conference presentations: Funds are typically  available to help cover  some of travel and registration for one presentation during the residency.

Other Education Funds: Yearly funds are available for books or other education materials.

Education Day: Residents are able to join faculty off site for a half-day intensive review of the program to address areas of improvement and recognize areas of strength

Call: 

PGY I - No overnight call until spring when PGY1s take a few Saturday Night Float rotations each to prepare for PGY2 year Night Float. Weekend day call approximately one weekend in every four or five weekends at VAMC or Woodridge Hospital.

PGY 2 - Approximately eight weeks total of Night Float in two week intervals and occasional overnight call during the rest of the year at VAMC.

PGY 3 - Weekend day call at VAMC and Woodridge--approximately one weekend in every five or six weeks.

PGY 4 - Weekend day call at VAMC and Woodridge--approximately one weekend per quarter.

Moonlighting: If desired may start in PGY 3 year or later after obtaining a full Tennessee State License (with the permission of the Residency Program Director).

ETSU Center for Physical Activity (CPA): Residents have free access to ETSU Center of Physical Activity that includes weight room, track area, volleyball and basketball courts, pool, fitness classes, including yoga, ballroom dancing,  and martial arts as well as indoor and outdoor climbing wall and a three level ropes course outside.

Leisure: Hiking, biking, spelunking, kayaking, canoeing, white water rafting, camping, etc. East Tennessee has beautiful Appalachian Mountains and forests with four seasons of fun. Johnson City is a university town that has easy access to work, no state income tax, wonderful restaurants, concerts, festivals, ETSU sports team games, and more.