"Orientations" of residency programs

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charlotte7

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Hey everyone - any thoughts on the different "orientations" of the various programs? How much does this affect the day-to-day training?

People keep saying that programs have reputations for certain philosophies: UCLA (biological), UCSF (psychodynamic), Stanford (biological), MGH (biological), Columbia and Cornell (psychodynamic), Yale (biological), etc.

This seems oversimplified, but where do these reputations come from? Isn't residency training like med school, where national committees decide what's important to teach, and make sure those things are being taught?

If I end up at a non-biological program, will I not know how to use a prescription pad?
 
Those are 7 of the biggest programs, and so I agree: it's reductionistic and inaccurate to summarize a program with one word. Further, UCSF may be psychodynamic but there isn't a single analyst on their full-time faculty. Cornell and Columbia may also be dynamic, but Cornell's long-time chair is a neurobiologist who has never seen patients, and Columbia's is a big-time clinical researcher, and their residencies have more MD-PhD's than just about anywhere else. And yes, there are lots of teaching rules out there, but there are resource issues (some faculties are much deeper than others in regards to certain psych subspecialties) and philosophical issues (some programs just don't see dynamics as very important).
 
I agree that it's reductionistic - e.g., MGH might have a reputation for being biological, but all the major players are very well versed in psychodynamics and the residency program mirrors this. If you're looking for balanced training, I'd say that almost all of the programs will teach you how to use your prescription pad but a relatively small minority will give you significant exposure to psychodynamic psychotherapy.
 
They all (supposedly) meet the RRC requirements for all these orientations. If your interested in a particular type of training, you might ask the PD's how much training (didactics, specific clinics, specified inpt wards, etc) they provide above/beyond the RRC requirements.

For instance, some programs might have a specific eating disorders clinic that all residents rotate through, or it might be an elective, or not at all available. Does the residency have a specific psychodynamic clinic (as opposed to general individual psychotherapy), and if so, how long are residents in it (6 months? 1 year? 4 years?)? Is there an elective for "advanced" psychopharm clinic (for pts who have had multiple treatment failures), or a specific anxiety or depression clinic, run by 1 or more renowned faculty members? All these things are above/beyond the usu. RRC requirements (as I know them). ASK about what they have available, beyond the requirements, in your area of interest. BTW, my experience was that current residents think their training in all areas is above average - despite the fact that most don't know what is/isn't available elsewhere, i.e. residents (pgy1-4) were a poor source of info about comparative quality of training. But that's just me.

When I was interviewing, I asked specifically about the emergency psych training, is there a separate PES or do psych residents do evals in the main ED, if there was a medical director of the PES (as opposed to simply being manned by a rotation of attendings - many of whom don't like it or really know much about it), electives available in PES, research going on specific to PES, etc. I found alarmingly little. The program that had the most in this regard (and, therefore, my first ranked) completely dismantled the emerg psych program and "re-assigned" the primary attending from emergency psych to general clinic - and this happened between the time of my ranking of programs and their ranking of residents. (Obviously, horrific politics going on!) The weeks until match day were real nail biters for me. The PD and Dept Chair refused to answer/return my calls and emails. I matched at my second choice (thankfully), rather than match at my first choice where they no longer had any of the things I liked. WHEW!
 
Doc Samson,

Your new avatar looks like the gamma irradiation has burned out his thyroid. What exactly are the super powers of the new hypothyroid super hero?
Indestructible apathy?
Stubborn indecision?
A mysterious ability to recognize, even at long distances, that EVERYONE is choosing the wrong direction and therefore nothing will ever go right?
Skin so thick (myxedema) that even super evil insults simply bounce off?
 
kugel said:
Doc Samson,

Your new avatar looks like the gamma irradiation has burned out his thyroid. What exactly are the super powers of the new hypothyroid super hero?
Indestructible apathy?
Stubborn indecision?
A mysterious ability to recognize, even at long distances, that EVERYONE is choosing the wrong direction and therefore nothing will ever go right?
Skin so thick (myxedema) that even super evil insults simply bounce off?
Click to expand...

The second 2 are actually pretty accurate (and important attributes for CL work). While I'm stubborn and indestructible, I'm neither apathetic or indecisive.

I couldn't resist the "make your own Mad Men avatar" feature on the AMC website - I'm sure I'll get bored with it sooner or later and the muscularity/flowing green hair of the real DS will return to my avatar space soon.
 
Ah, the classic "I'm caught in deep thought" look we psychiatrists can sometimes give that makes the patient think we know the meaning of life.

If they only knew the truth....
 
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