Child psychiatry fellowship: what mattered most to you?

[Psychiater]

Hi everyone.

As I’m starting to make my rank list for child psychiatry fellowship, I’m struck by the variety of approaches to CAP fellowship curricula. I’m fortunate to be interviewing at several wonderful programs this cycle, and I don’t doubt I’d be well-trained leaving any of them.

That said, I’m hoping to leave training as a well-rounded clinical C+A psychiatrist. I’m wondering what you found particularly useful or important in your education as a child psychiatrist. For instance, was it working in tons of subspecialty clinics, a huge CL service, lots of elective time, a robust bench of research faculty, or something else? Were there aspects of your fellowship that you feel made you a particularly good child and adolescent psychiatrist?

Looking back at your training, are there things you wished you’d been exposed to or experiences your fellowship had offered?

Thanks for your thoughts!

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[hamstergang]

I found it very valuable to train in the state I wanted to work in after. Good for networking, good for knowing the local resources, and good for understanding some state-specific laws that impact our work.

 

[Celexa]

I am consults, not child, but I think things are not too different when picking a fellowship.

Remember though that at the end of the day it's your life and your priorities. Everyone has different ones.

I think the single most important part of training is how close a program gets to the ideal volume balance--high enough that you get the right amount of stress (and there should be at least some stress!) and see a volume that builds your skills, but not so high that learning gets sacrificed to the grind. This is particularly important with outpatient, since it's the majority of psychiatry yet training often has a skew to inpatient.

I liken it to going to the gym. If you want to put on muscle, you have to work hard enough it doesn't always feel good in the moment but you also need to attend to form. If you try to lift too much too fast with bad form, you end up hurt.

Other things to think about specifically in the residency to fellowship transition:

-are there any gaps in my residency exposure I need to fill? Patient populations I want to make sure I get experience with?
-there is an educational benefit to seeing a new system, at the cost of it being more exhausting to move and get up to speed
-if you are considering an academic career, specific mentors or types of services offeres may be relevant
-amount of psychotherapy training
-whether you think you might want to stay in the area or at the instition for your first job. Child is in demand everywhere, but having trained in a place gives you a leg up in networking and evaluating jobs. Also, given the differences in mental health law, local training can be very helpful in that aspect too

The nice thing about fellowship compared to residency is that it's much more in favor of the applicant. You should feel pretty relaxed in assessing your options.

 

[TexasPhysician]

In the city I planned to practice in that was near family.

A significant percentage of fellows stay where they train. You’ll know the state laws, network, and have a leg up on where the best jobs are.

 

[clozareal]

I wanted to graduate competent in child & adolescent psychiatry. I wanted to be a CAP that can evaluate and treat almost anything that comes through the door. That means:

1. Having a real inpatient psych experience for children and adolescents. You'll definitely believe in pediatric bipolar disorder when you see a manic teen on the unit wrecking havoc and not sleeping all night. Having a residential/IOP/PHP program you rotate through is also extremely helpful to learn different levels of care.
2. Learning how to diagnose and treat eating disorders in an outpatient, inpatient, residential, IOP, PHP setting. This is a gap in many CAP fellowships.
3. Defined curriculum and clinical experience in diagnosing autism spectrum disorder. You'd be shocked how many child psychiatrists graduate not feeling comfortable diagnosing autism. This is also another gap in many CAP fellowships. If you can learn the ADOS-2 or ADI-R, even better.
4. Having an early psychosis clinic and managing these patients. Seeing childhood onset schizophrenia would be nice (although rare).
5. Having a robust consult-liaison experience where you get to see FND, pain crises, catatonia, psycho-onc, delirium in kids, autoimmune encephalitis, etc. Bonus if you have can rotate with the child abuse team.
6. Lots of ADHD evaluations and treatment. You need to know this extremely well.
7. Community mental health center where you treat extremely vulnerable children and their families.
8. School based rotation where you are integrated into the mental health team at schools, such as sitting in IEP meetings and such.
9. Adolescent addiction experience. Lots of kids will be addicted to weed, vaping, alcohol, and many others. Ideally you have an addiction trained faculty who can help you here and bonus if there's a clinic that treats it exclusively, especially if there are different level of care (IOP, PHP, 12 step group, residential, etc).
10. Psychotherapy:
    1. Good individual CBT
    2. Learning DBT since this is so helpful for teens
    3. Doing therapy with young children below age 7, particularly play therapy
    4. Doing parent therapy. PMT and PCIT.
    5. Family therapy, such as structural, EFFT, etc.
    6. Group therapy with kiddos, multifamily therapy

Depends on your career goals afterwards, but being in a location close to friends/family or where you want to live afterwards is great. It's been extremely helpful for me to build my private practice.

 

[Psychiater]

I wanted to graduate competent in child & adolescent psychiatry. I wanted to be a CAP that can evaluate and treat almost anything that comes through the door. That means:

1. Having a real inpatient psych experience for children and adolescents. You'll definitely believe in pediatric bipolar disorder when you see a manic teen on the unit wrecking havoc and not sleeping all night. Having a residential/IOP/PHP program you rotate through is also extremely helpful to learn different levels of care.
2. Learning how to diagnose and treat eating disorders in an outpatient, inpatient, residential, IOP, PHP setting. This is a gap in many CAP fellowships.
3. Defined curriculum and education to learn how to diagnose autism spectrum disorder. You'd be shocked how many child psychiatrists graduate not feeling comfortable diagnosing autism. This is also another gap in many CAP fellowships. If you can learn the ADOS-2 or ADI-R, even better.
4. Having an early psychosis clinic and managing these patients. Seeing childhood onset schizophrenia.
5. Having a robust consult-liaison experience where you get to see FND, catatonia, psycho-onc, delirium in kids, autoimmune encephalitis, etc. Bonus if you have can rotate with the child abuse team.
6. Lots of ADHD evaluations and treatment. You need to know this extremely well.
7. Community mental health center where you treat extremely vulnerable children and their families.
8. School based rotation where you are integrated into the mental health team at schools, such as sitting in IEP meetings and such.
9. Adolescent addiction experience. Lots of kids will be addicted to weed, vaping, alcohol, and many others. Ideally you have an addiction trained faculty who can help you here and bonus if there's a clinic that treats it exclusively.
10. Psychotherapy:
    1. Good individual CBT
    2. Learning DBT since this is so helpful for teens
    3. Doing therapy with young children below age 7
    4. Doing parent therapy
    5. Family therapy
    6. Group therapy with kiddos, multifamily therapy

Depends on your career goals afterwards, but being in a location close to friends/family or where you want to live afterwards is great. It's been extremely helpful for me to build my private practice.

Thanks, all, and particularly to you, clozareal, for some excellent food for thought. This is an extremely helpful list.

Any additional perspectives are welcome, too!

 

[Merovinge]

I know it's cliche and hard to assess as an applicant, but just how much time you actually spend with clinically adept to excellent attendings made a big difference for me. If you know a program is known for having really strong clinicians (rather than say researchers, although certainly some people are both) I think it makes a huge difference. Clozareal's list is ideal for good CAP training but what actually made me learn/be good was just raw time seeing great doctors work/teach. If I was going to ask about one thing, it might be about journal club and/or docs that have encyclopedic knowledge of the literature base.

 

[milesed]

I learned a lot from the usual inpt/outpt training the program required, but most of my learning was from moonlighting. My program allowed 1/2 day per week moonlighting in any state CMHC (without taking any PTO) and it was covered by the program's malpractice insurance. I would work from 12-7 pm one day a week, then also drive 3 hrs to a different clinic to work lots of Saturdays and any holidays. I saw mostly kids in both settings and if I added up the hours spent during PGY-3 through 5, it was about equal to 1 year of full-time work. I started it because I was poor, but it REALLY prepared me for the real world. In each setting, I had great attendings, I studied what I'd see daily and asked lots of questions.

 

[peterpeternickeleater]

Hypothetically, would it be better to go to a very strong fellowship program that is not in the area you want to ultimately end up, or a program that in the city where you would ultimately like to live that is not as reputable and missing a few learning opportunities that seem important (i.e., no inpatient consult rotation, limited opportunities for research, inpatient rotations are not within the academic institution?) This is for someone who might be interested in an academic career (although doesn't need to be a research-heavy career).

 

[clozareal]

Hypothetically, would it be better to go to a very strong fellowship program that is not in the area you want to ultimately end up, or a program that in the city where you would ultimately like to live that is not as reputable and missing a few learning opportunities that seem important (i.e., no inpatient consult rotation, limited opportunities for research, inpatient rotations are not within the academic institution?) This is for someone who might be interested in an academic career (although doesn't need to be a research-heavy career).

Location where you want to end up. Local networking is really key. Anyone can get an academic job in CAP because they pay so little.

 

[TexasPhysician]

Hypothetically, would it be better to go to a very strong fellowship program that is not in the area you want to ultimately end up, or a program that in the city where you would ultimately like to live that is not as reputable and missing a few learning opportunities that seem important (i.e., no inpatient consult rotation, limited opportunities for research, inpatient rotations are not within the academic institution?) This is for someone who might be interested in an academic career (although doesn't need to be a research-heavy career).

Do you want a career focusing on inpatient consults or research? If not, I’d go local. It doesn’t matter where inpatient is.