Clinical Rotations

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.

PGY-1

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. PGY1s complete one week of night float at the VA.

Watch: Discover the inpatient unit at NMH

Our residents spend the first month of intern year together with a one-week orientation followed by time together 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 one month of pediatrics for one 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.

PGY-2

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 complete child and adolescent psychiatry training at Ann & Robert H. Lurie Children’s Hospital of Chicago, where residents rotate on the inpatient psychiatric unit, consult-liaison service, and emergency psychiatry service. All PGY2s spend one month on the interventional psychiatry rotation, learning about electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine treatment. PGY2s also complete approximately five to six weeks of night float at NMH. On this rotation, residents learn to manage a busy emergency psychiatric service and cover emergencies for the consult-liaison service and inpatient unit.

Uniquely, our PGY2 rotation schedule is three weeks of acute care services followed by one week of elective and outpatient rotations throughout the duration of the academic year. During each of 13 outpatient weeks, residents start outpatient psychiatric training with two half-day resident continuity clinics (RCCs), spend one day a week in the pediatric emergency room, and have two and half days of elective time for career exploration, subspecialty psychiatry experiences, medical education projects, and scholarly work. In RCC, residents learn basic principles of psychiatric assessment and management in the outpatient setting. Trainees have their own longitudinal caseload of patients with direct supervision in real time from faculty. Outpatient psychotherapy training and supervision start in the second half of the year during Immersion Clinic.

PGY-3

The primary clinical focus of the third year is learning to treat psychiatric illness in outpatient settings. PGY3s have two half-day RCC clinics per week, gaining skills in longitudinal outpatient psychiatric assessment and management. Residents continue with the same caseload of patients in their fourth year.

Residents see patients for individual psychotherapy and meet with an individual psychodynamic psychotherapy supervisor as well as participate in group CBT supervision (two half-day clinics per week).

PGY3s spend one half day a week rotating in the geriatric psychiatry outpatient clinic. The geriatric clinic provides comprehensive psychiatric medical care of older adults suffering from psychiatric and neuropsychiatric disorders. Residents also spend one half day a week rotating in the neuropsychiatry outpatient clinic. In the neuropsychiatry clinic, residents learn about the practice of behavioral neurology and neuropsychiatry, which requires knowledge of the brain-behavior relationships specific to complex neuropsychiatric and neurobehavioral conditions. Residents participate in 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).

PGY3s have one half day of elective time throughout the year. Elective time may be used for additional clinical elective rotations, independent scholarly projects, or medical education projects. Each resident also rotates in two selective subspecialty clinics over the course of the year to develop greater subspecialty expertise with direct supervision from faculty experts (one half-day clinic per week for six months at a time). Current PGY-3 selective specialty clinics include:

First Contact Program

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. 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.

Pride Clinic

The Pride 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. Residents 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.

Recovery From Early Psychosis Program (REPP)

Recovery from Early Psychosis Program (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.

Anxiety Disorders Clinic

The 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.

Women’s Mental Health Clinic

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 spend one day a week at the Jesse Brown VA Medical Center 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 for substance use disorders.

During the community psychiatry rotation, residents help care for persistently and chronically ill Veterans. Residents learn 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. Residents also rotate on an ACT team and learn about psychosocial rehabilitation on a long-term residential unit.

PGY-4

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. PGY4 residents continue with their RCCs and psychotherapy clinics. Residents may choose an acute care service at Northwestern Medicine (Consult-Liaison, Emergency or Inpatient Psychiatry) for a 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.

PGY4s have approximately 50% of their time dedicated to clinical electives to develop further subspecialty expertise and round out their training experience. There is a wide range of clinical elective options, including:

Addiction Clinic
Addiction Consult Service
Antepartum Service
Clinical Trials
Collaborative Care
Compass Reproductive Psychiatry Collaborative Care
Cook County Juvenile Court Clinic
Dementia Clinic
ECT
Forensic Consultation Clinic
Gender Pathways Clinic
Huntington's Disease Clinic
Ketamine Clinic
Movement Disorders
Neurology Subspecialty Clinics
Psychology Testing
Reproductive Psychiatry
Sleep Medicine
Tic Clinic
Transitional Care Free Clinic
TMS Clinic
Trauma Clinic
Wilson's Disease Clinic

Residents may elect to spend half a day per week on a scholarly project or QI project. Residents may also use elective time to participate in the PGY-1 Teaching Elective or conduct medical education projects. Residents may enroll in psychology graduate school coursework to learn science-based psychotherapy modalities as well as participate in neuropsychology fellowship didactics.

Psychotherapy Training

Formal psychotherapy training starts in the fall semester of the second year with a psychodynamic psychotherapy course. Clinical training in psychotherapy starts 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. PGY3 residents have two half days dedicated to psychotherapy cases and supervision. PGY4 residents have one half day for psychotherapy cases and 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. PGY4 residents may also elect to co-facilitate group therapy in our outpatient department. Fourth-year residents may also elect to participate in graduate-level psychology courses in advanced psychotherapy modalities and use elective time for additional psychotherapy cases and supervision.