Psychiatry Residency Curriculum

In line with our mission of service, residents starting in their intern year will provide mental health care directly in the community through Meritus’ Mobile Clinic program. This clinic is designed to be a 4-year longitudinal outpatient experience for residents where they will see their patients ½-1 day a month for therapy and psychopharmacological treatment. Residents will travel directly to areas of need throughout the city of Hagerstown, visiting patients who experience barriers such as homelessness, unemployment, and lack of insurance or transportation which prevents participation in traditional mental health care. With this experience, residents not only obtain psychiatric knowledge from a multi-year longitudinal clinic but also develop a special understanding of the structural and social barriers our patient population faces and unique ways to provide quality, barrier-breaking mental health care.

Interns will have 6 total blocks of inpatient psychiatry. This experience is designed to be the initial clinical experience of residency to acclimate interns to a new level of practicing medicine in a comfortable setting. In their first year on the inpatient psychiatric unit, residents will become competent in the basics of psychiatric interviewing, evaluation, and treatment with emphasis on acute decompensated illness. Residents will rotate through adult inpatient psychiatry units at both Meritus Medical Center and Brook Lane. Each facility and unit treat acutely decompensated patients with a variety of psychopathology including depressive disorders, bipolar spectrum disorders with mania, acute psychosis, substance use disorders, neurocognitive disorders, and personality disorders.

Community psychiatry at the PGY-1 level is a 1 block rotation designed to ignite the passion of service and to instill a richer understanding of the barriers our patients face. Residents will provide outpatient psychiatric care through our community-based downtown clinics. They will also work with a community mobile crisis unit, exploring how empathetic first-response in the community can lead to better care. In addition, residents will provide education and advocacy through providing lectures outside the hospital and in the community and attending regional meetings of community-based leaders and volunteers. Residents will also participate directly in advocacy efforts with designed curriculum for government interaction and conflict resolution.

Residents will have 2 blocks of neurology, rotating with the inpatient neurology team, participating in the direct care of patients on consultation services and as a primary team for stroke patients. Residents will also spend time in the neurology outpatient clinic with our neurology attendings. This neurology experience is designed to help residents develop connections between neurologic and psychiatric symptoms and conditions.

Interns will have 2 blocks of inpatient medicine rotating alongside our family medicine residents on our family medicine inpatient service. They will also rotate with family medicine residents in the Meritus Family Medicine Outpatient Clinic seeing a variety of acute and chronic conditions seen in the primary care setting. These rotations are designed for residents to obtain knowledge of the pathology, evaluation, diagnosis, and treatment of medical illnesses to assist in the understanding of the interplay of medicine and psychiatry and promote excellence in psychiatric practice.

PGY-2 residents continue honing their psychiatric education with a 4 week rotation on the inpatient unit at Meritus Medical Center where they will continue to develop medical/psychiatric knowledge as well as interview, diagnostic, evaluation, collaborative, and professional skills in the inpatient psychiatric setting. The inpatient psychiatry rotation at the PGY-2 level is also designed as an introduction into team leadership with PGY-2 residents acting as senior residents to medical students and interns with increased responsibility for leading the treatment team.

Residents rotate through the Geriatric psychiatry consult-liaison service at Meritus Medical Center seeing patients with psychiatric and cognitive illness with significant medical co-morbidity. Residents will learn to delineate and consider each of these illness domains to provide accurate and safe treatment. In addition, residents will develop forensic knowledge regarding capacity assessments, guardianship and competency, and involuntary commitments and will learn various resources and levels of care available for the geriatric population including palliative and end of life care.

Residents will spend 2 blocks rotating through various treatment settings at Brook Lane, receiving experience in the full spectrum of child and adolescent psychiatric care. Services which residents will spend time include a 17 bed inpatient psychiatric adolescent unit serving ages 13-17 and a 14 bed “Tween” unit serving ages up to 14. Residents will also have the opportunity to participate in PHP programming and outpatient treatment with possible experiences within the adolescent residential unit, family counseling program, and special-needs school. This rotation is designed to guide residents to become proficient in evaluation and treatment of psychiatric illnesses within the child and adolescent patient population. Residents will also engage in specific child and adolescent-focused psychosocial interventions and learn about the importance of the family dynamic in illness course and management.

Residents rotate through 3 blocks of addiction psychiatry with experiences at Meritus Medical Center and Brook Lane. At Meritus, residents will be providing care with CL addiction psychiatry services on the medical units and in our 6 bed Crisis Center which provides care for individuals with moderate substance withdrawal for medication management and linkage to rehabilitative programing. They will also rotate at Brook Lane through the addiction IOP program to treat patients seeking programming for prolonged cessation and recovery. They will have experience in our family medicine Suboxone clinic as well. During these experiences, residents will participate in group and individual therapy sessions, full diagnostic evaluations and psychiatric/addiction treatment planning and will provide acute and chronic treatment of substance intoxication, withdrawal, and use disorders.

Residents will rotation for 3 blocks with the CL psychiatry service at Meritus Medical Center. During these blocks, residents will perform psychiatric consultation to patients with a wide variety of medical decompensation and mental health illness in observation, med-surg, and ICU settings. Psychiatric diagnoses seen include delirium, adjustment disorders, functional neurologic and other somatic-spectrum disorders, mood, anxiety, and psychotic spectrum disorders, and substance use disorders. Residents will also see psychiatric pathology due to general medical conditions/organic causes. Residents will perform full diagnostic evaluations, order diagnostic laboratory, imaging, and procedural studies, provide neuropsychological testing when applicable, develop treatment plans, provide liaison services to care services outside of the hospital setting, and provide consultation services including documenting recommendations to and participating in meetings with primary service and full interdisciplinary team.  During this rotation, residents will also see patients through the Meritus Medical Center Emergency Department in our specialized psychiatric ED space. Residents will perform diagnostic and risk assessments, order needed testing and consultations to rule out organic etiologies, and create management plans including recommendations for higher level of care and/or recommendations for safe discharge planning.

Residents will rotate throughout their PGY-3 year in various outpatient settings with the goal of receiving supervised clinical experience in the comprehensive, biopsychosocial-focused, integrated care of psychiatric patients in the outpatient setting. Residents will provide longitudinal patient care both at Meritus Medical Center and Brook Lane Outpatient Behavioral Health Clinics. Residents will also spend time in our Mental Health Walk-in Clinic and providing consultative services to our primary care providers. Rotations will also include experience within community mental health. Residents will take ownership of their patients as longitudinal and primary providers of psychiatric care and maneuver the various short and long-term social needs of the psychiatric patient population.

The PGY-4 inpatient psychiatric experience is meant to be a capstone to resident inpatient psychiatric education with senior residents leading the multi-level and multidisciplinary treatment team at a junior attending level. While rotating 2 blocks at Brook Lane and 1 block at Meritus Medical Center, residents not only elevate their skills in evaluation, case formulation, and treatment planning to an independent level but actively manage patients, junior residents, medical students, and allied health professionals at the attending level.

This 1 block rotation is designed to expose residents to the administrative background of supporting a hospital and outpatient psychiatric practice. Residents will take part in leadership committees and meetings as well as safety practices such as Root Cause Analyses, peer reviews, and event response. They will also meet with the leadership team at Meritus Health and Brook Lane to discuss topics and see “a day in the life” of an administrator.

Neuromodulation is a 1 block rotation at Brook Lane where inpatient and outpatient ECT as well as outpatient TMS are performed. This rotation allows for a supervised experience to gain procedural competency in ECT and TMS treatment modalities including patient evaluation and selection, treatment planning, procedural understanding and skills, and education to patient and family.

The Psychotherapy rotation is a 1 block rotation where residents will have a chance to further develop and refine their therapy skills with more intensive supervision. Residents will provide psychotherapy in individual and group settings as well as in inpatient and outpatient settings with daily individual supervision.

PHP/IOP is a 1 block rotation designed to bring together all areas of psychiatric education and practice into one rotation in an acute outpatient treatment setting. Residents will be the team leaders of the Partial Hospitalization Program at Brook Lane and the Intensive Outpatient Program at Meritus Medical Center where they will see patients individually and in groups, providing psychiatric and psychotherapeutic care in an acute treatment setting.

The PGY-4 community psychiatry is a 1 block rotation to allow residents to refine their skills as advocates and leaders with continued experiences in the community providing care, advocacy, and education. This continued community experience provides a nuanced understanding of what social and structural issues lead to deterioration of our patient population’s health. Residents will interface with our outpatient community-based clinic, a community mobile crisis unit, government officials, and meetings of community service leaders with the goal of taking an active role in developing programs to break barriers to patient care and quality of life.

Elective rotations within the Meritus Health Psychiatry Residency currently include opportunities in addiction inpatient/outpatient psychiatry, consult-liaison psychiatry, ED psychiatry, inpatient psychiatry, various medical specialties, child and adolescent inpatient and outpatient psychiatry, PHP/IOP-based psychotherapy, outpatient sleep medicine, inpatient palliative care, inpatient/outpatient neurology, community psychiatry, neuromodulation, and research. We also have the capacity for the development of additional and individualized electives as requested.