Clinical rotations make up the majority of a trainee's time in residency. In the General Psychiatry Residency Program at Northwestern University Feinberg School of Medicine, each internship year focuses on a more advanced or specialized aspect of clinical practice. To allow residents to personalize their training based on their individual career goals, a diverse range of elective rotations are also available through the program.
The primary clinical focus of psychiatric training during the PGY-1 year is on learning to diagnose and treat acute and severe psychiatric illness in hospital settings. PGY-1s rotate on the NMH Norman and Ida Stone Institute of Psychiatry inpatient psychiatry unit, Jesse Brown VA Medical Center inpatient psychiatry unit, consult-liaison psychiatry service at NMH and emergency psychiatry at NMH. Interns also complete one week of night float training at NMH.
Our residents spend the first month of intern year together with a one-week orientation followed by three weeks on our inpatient psychiatric unit at Northwestern Memorial Hospital (NMH). This gives the class time to bond and familiarize themselves with NMH. During this block, the interns have smaller caseloads and more dedicated class time to gain skills in acute psychiatric care.
After the first month, the cohort is split into two groups for three-month blocks. While one group is on psychiatric rotations, the other group is on non-psychiatric or off-service rotations. Each intern completes two three-month psychiatry rotation blocks and two three-month non-psychiatric rotation blocks. During the off-service blocks, all interns complete three months of inpatient internal medicine, one month of emergency medicine and two months of inpatient neurology. Residents may elect to substitute two months of pediatrics for two of their internal medicine months. While on these rotations, our interns are core members of the team and participate in the didactic curriculum of the host program.
In the second year, residents solidify skills managing acute, severe psychiatric illness on inpatient psychiatry at the VA and NMH as well as consultation-liaison psychiatry at NMH. Residents also complete night float at NMH, a one-month geriatric psychiatry rotation, a two-month child and adolescent psychiatry rotation and neuromodulation training.
During the geriatric rotation, residents rotate in outpatient clinics at NMH and the VA to learn the principles of treating older adults and to gain exposure to neuropsychological testing and subspecialty neuropsychiatry clinics. At Ann & Robert H. Lurie Children’s Hospital of Chicago, residents rotate on the pediatric inpatient psychiatric unit and may choose to rotate at the partial hospitalization program or on the consult-liaison service. During the neuromodulation block, residents conduct assessments for electroconvulsive therapy (ECT), participate in inpatient and outpatient ECT and rotate through our outpatient ketamine and transcranial magnetic stimulation (TMS) clinics.
Outpatient psychotherapy training and supervision start in the second half of this year during Immersion Clinic. PGY-2s have one month of dedicated elective time to explore individual career interests. Current elective options include:
This elective at Shirley Ryan AbilityLab allows trainees to gain experience in consultation-liaison psychiatry, with a focus on managing psychiatric conditions in rehabilitation settings, particularly for patients with spinal cord injury, traumatic brain injury, stroke and amputation. Residents are able to develop strong relationships with patients due to fixed-schedule appointments and the opportunity to spend more time with patients. Residents have both the autonomy to make treatment plans and interview and the supervision to feel confident in their medical decision making.
CCJCC is a forensic clinic that is a non-judicial office under the authority of the Circuit Court of Cook County, which is operated by Northwestern University. CCJCC provides a variety of services responding to requests from juvenile court judges for mental health information in the context of court proceedings, including court-ordered forensic evaluations for fitness to stand trial and mental state at the time of the alleged offense, identification of community-based mental health resources, and referrals to court-related entities and agencies. This elective offers an excellent opportunity for residents to become acquainted with the relationship between psychiatry and the legal system and learn the fundamentals of forensic psychiatry.
A medical education project elective can be considered for residents who have a specific medical education scholarly project that they would like to work on under faculty mentorship during their elective time. Residents who have completed this elective in the past have used this time to explore career paths in medical education, work on designing and developing lecture or curriculum materials, participate in direct observed teaching and/or work on medical education research and literature review.
The rotation at Positive Sobriety Institute (PSI) provides psychiatry trainees with a unique opportunity to enhance their clinical skills in substance use disorder treatment for professionals. PSI focuses on advancing psychiatry trainees' skills in diagnosing substance use disorders, using pharmacotherapy and psychotherapy for individual and group sessions, providing psychoeducation on substance abuse, as well as exposure to a variety of substances and behavioral addictions.
Lurie Children's multidisciplinary consult team provides services to children and adolescents with primary psychiatric diagnoses, including autism spectrum disorder, depression, anxiety, psychosis, catatonia and eating disorders as well as medical diagnoses such as delirium and coping due to primary medical conditions.
Lurie Children's Partial Hospital Program (PHP) in the Lincoln Park neighborhood takes 14 children and adolescents and primarily serves a population with ADHD, anxiety, depression and school refusal or avoidance. The typical length of stay in the PHP is at least two weeks and consists of family therapy, group therapy, individual therapy and work with a school liaison.
This elective at Northwestern Medicine provides trainees with the opportunity to observe and participate in neuropsychological and psychological testing, review results with clinical neuropsychologists, and formulate case conceptualizations and write reports for psychological testing. The elective gives trainees valuable experience in understanding the role of clinical neuropsychologists in psychiatric treatment and exposure to a range of cases.
The outpatient neurology and neuropsychiatry rotation is a two-to-four-week elective that allows the resident to work with some of our talented neurologists who also love to teach. It is customizable to certain interests but can include exposure to electroencephalogram (EEG) reading, first seizure clinic, genetic epilepsy clinic, multiple sclerosis (MS) and neuroimmunology (autoimmune encephalitis, CNS vasculitis) clinic, Huntington's disease clinic, Wilson's disease clinic, general movement disorders, behavioral neurology and neuropsychiatry clinic and the general neurology clinic.
The sleep medicine elective is a two-to-four-week outpatient rotation that provides the resident with exposure to sleep medicine clinic and reading and interpreting sleep studies.
The primary clinical focus of the third year is learning to treat psychiatric illness in outpatient settings. In Resident Continuity Clinic (RCC) at NMH, trainees have their own caseload of patients with direct supervision in real time from faculty (two half-day clinics per week). Residents continue with the same caseload of patients in their fourth year. Residents see patients for individual psychotherapy and meet with an individual psychotherapy supervisor as well as participate in group CBT supervision (two half-day clinics per week).
Each resident rotates in four subspecialty clinics over the course of the year to develop greater subspecialty expertise with direct supervision from faculty experts (two half-day clinics per week for six months at a time). Current PGY-3 specialty clinics include:
The geriatric clinic is led by Danielle Anderson, MD, who is also the director of our Geriatric Psychiatry Fellowship. This clinic treats adults over the age of 65 with a range of psychiatric problems and medical comorbidities. The clinic provides skilled and comprehensive psychiatric medical care of older adults suffering from psychiatric and neuropsychiatric disorders. It emphasizes expert diagnosis, treatment planning and continuity of care.
The First Contact Program is led by Will Cronenwett, MD, who is director of the General Division of Psychiatry. The program serves young adults who are in the earliest phases of what threatens to be a serious mental illness.
Symptoms of mental disorders can be frightening, all the more so when they are present for the first time. Symptoms can be varied and may include mood disturbances, changes in thinking or perception or suicidal thoughts; what they all have in common is that they can upset the trajectory of a young person’s life.
The First Contact Program aims to prevent disability by offering treatment to help people manage symptoms and to support the individual so they can have the best chance of staying in school or at work and of maintaining the relationships that are important to them.
The LGBTQ psychiatry clinic is led by Kaitlyn Kunstman, MD, assistant residency program director. The clinic provides mental health services, including psychiatric evaluation, diagnosis, treatment recommendations and referral to additional behavioral health supports for LGBTQ patients. Resident psychiatrists in training learn how to conduct affirming mental health evaluations that address the social determinants of health that disproportionately impact this patient population and take into account issues unique to this patient population, including the coming out process, issues around homophobia/biphobia/transphobia, ways in which this population experiences minority stress and resiliency and understanding the ways in which intersectional identities contribute to mental health.
The Northwestern Medicine Recovery from Early Psychosis Program (REPP) is led by Morris Goldman MD, an expert in schizophrenia. REPP treats 18- to 26-year-olds who have experienced a recent onset of a psychotic illness. REPP is a time-limited treatment program (two to three years) directed specifically to young adults whose psychotic experience has disrupted their progress to becoming self-reliant adults.
The program partners a team of professionals with the young adult and their social support network to promote skills that empower the young adult to define, revise and travel along a life path of their own making. The program utilizes treatment plans informed by diverse outcome measures, which the young adult increasingly oversees as he or she moves from first healing and understanding, to managing and preventing psychosis, and then to developing and engaging opportunities that help foster a sense of mastery of life’s challenges.
The practice of behavioral neurology and neuropsychiatry requires knowledge of the brain-behavior relationships specific to complex neuropsychiatric and neurobehavioral conditions. This clinic is led by Amy Corcoran, MD, associate residency program director. This subspecialty is committed to better understanding the links between neuroscience and behavior and to the care of individuals with cognitive, emotional and behavioral disturbances as a result from illnesses that are traditionally also cared for by neurologists. Examples of such conditions include strokes, epilepsies, dementias (such as Alzheimer’s disease) and movement disorders (such as Parkinson’s disease or Huntington’s disease).
The Northwestern Medicine anxiety disorders clinic is led by Michael Ziffra, MD, who is also the outpatient medical director at NMH. The program specializes in the diagnosis and treatment of anxiety disorders and related illnesses. The program focuses on adults with diagnoses such as generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. The program has particular expertise in working with patients whose anxiety symptoms have been more treatment-resistant, or whose anxiety disorders have been complicated by other coexisting psychiatric and medical conditions.
The women’s mental health clinic is led by Dorothy Sit, MD, who is also the director of the Perinatal & Women's Mental Health Fellowship. At the Asher Center for the Study and Treatment of Depressive Disorders, residents learn about the special behavioral health needs of women during their reproductive years. Residents advance their clinical skills in the management of patients with general anxiety, major depression and bipolar disorders during the perinatal period and in preconception planning. They will gain experience the treatment of co-presenting mood and anxiety disorders in women with epilepsy, cancer and inflammatory disorders.
Third-year residents also spend one day a week at the VA gaining experience in the treatment of substance use disorders (six months) and community psychiatry (six months). During addiction training at the VA, residents have the opportunity to rotate in a methadone-maintenance treatment clinic, an intensive outpatient treatment program, and short-term and long-term residential treatment programs.
During the community psychiatry rotation, residents are focused on learning home-based treatment modalities. The resident joins a full primary care team that goes into the home for integrated care of homebound veterans. The resident visits patients and their families in the patient’s home with a psychologist, staffing the case and treatment recommendations with an attending psychiatrist.
The major aim of the fourth year is for residents to further solidify their skills in psychiatry, develop an area of scholarly and clinical concentration, and grow in their role as a teacher. PGY-4 residents continue with their Resident Continuity Clinics and psychotherapy clinics. Residents choose an acute care service at Northwestern Medicine (Consult-Liaison, Emergency or Inpatient Psychiatry) for their senior acute care elective, serving in a teaching and supervisory role for junior residents and medical students. Residents also spend one evening a week for six months at The Family Institute, learning family and couple's therapy.
Residents also design electives to meet their career objectives and round out their training experience. Residents may elect to spend half a day per week on a scholarly project or to participate in the PGY-1 Teaching Elective. They may also choose to participate in our forensic consultation training clinic with Vice Chair for Education Cara Angelotta, MD. Residents complete electives at NMH in specialty clinics, for example: the gender clinic, designed to support the mental health of gender-diverse adults seeking further evaluation for gender-affirming treatment and ongoing psychiatric management, and the Focused Forward Clinic, a program to help young adults with serious mental health conditions focus on a future that is worth pursuing, specifically by participating in work or educational opportunities.
Formal psychotherapy training starts in the fall semester of the second year with a psychodynamic psychotherapy course. Clinical training in psychotherapy then begins in the second semester with the Immersion Clinic, a two-hour clinic every week where residents learn the principles of psychodynamic and supportive psychotherapy. As the semester progresses, each resident is assigned a case to be discussed in group supervision.
During the third year, residents transition to working with an individual supervisor for psychodynamic and supportive therapy cases. They take a course in cognitive behavioral therapy (CBT) in the fall semester and start with group CBT supervision. PGY-3 and PGY-4 residents maintain two half-day psychotherapy clinics. During these clinics, they see patients and have group and individual supervision. This is complemented by advanced interviewing and case conferences in the didactic curriculum.
PGY-4 residents spend one evening a week for six months at The Family Institute, where they will have family and couple's therapy cases with weekly supervision. PGY-4 residents may also elect to co-facilitate group therapy with a psychologist in our Intensive Outpatient Program. Fourth-year residents may also elect to participate in graduate-level psychology courses in advanced psychotherapy modalities and to take on an additional half-day of psychotherapy clinic.