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Residents and faculty in inpatient workroom

Excellent clinical skills are essential for each resident no matter whether he or she aspires towards private practice, public psychiatry, or academic positions involving clinical education or basic/clinical research.

A major emphasis of our program is intensive clinical training underscoring diagnostic skills, somatic treatments including psychopharmacology, ECT, rTMS, ketamine/s-ketamine, experimental procedures such as VNS, and a wide range of psychotherapeutic techniques including supportive therapy, cognitive therapy, behavioral therapy, interpersonal therapy, and pragmatic psychodynamics.

Practice sites

Our psychiatrists and house staff treat patients in a world-class complex that includes Washington University School of MedicineBarnes-Jewish HospitalSt. Louis Children’s Hospital, and the Alvin J. Siteman Cancer Center.

Barnes-Jewish Hospital and St. Louis Children’s Hospital are both members of the BJC Health System. With ties to 24 hospitals in Missouri, southern Illinois, and eastern Kansas, BJC is the largest academically linked health system in the country. Washington University has over 1,800 faculty physicians across 77 specialties and subspecialties. One out of every three top doctors in the St. Louis region is a Washington University Physician.

Learn more about our patient care services »

Patient diversity

The faculty at the medical school see more than 1.5 million patients per year. Our large patient volume means that our residents get to work with a very diverse patient population with wide-ranging mental health and other health needs.

Most of our patients come from the St. Louis region, which includes urban, suburban, and rural residents, as well as people from various socioeconomic and ethnic backgrounds.

Geography and ethnicity

While we predominately care for individuals from the local area of St. Louis, patients routinely come to us for our cutting-edge treatment from the broader state of Missouri as well as nationally. St. Louis also has a good mix of citizens who have immigrated here from different parts of the world (e.g. the Middle East, Bosnia, and Nepal). This mix provides the residents with a diverse cultural experience.

Insurance coverage

Our patients have varying insurance coverage–patient pay, Medicare/Medicaid, and private insurance–although it does not affect the way we deliver care.


On the inpatient service at Barnes-Jewish Hospital, all patients are at least 18 years old. There are general adult, acute, and geriatric units with varying populations due to age and acuity of illness.

Mental illness

The spectrum of mental illness seen is rather broad on the inpatient service (from a first depressive episode with suicidal ideation to rather severe manic episodes of bipolar disorder, new onset psychosis, or dementia with behavioral disturbance).

Due to our inpatient units having a total of 96 beds, there is ample opportunity for each resident to have sufficient exposure to a wide spectrum of illness.

Rotations in our program allow for a greater exposure to specific populations including people with eating disorders, addictions, or “bread and butter” topics where medical or neurological concerns overlap on consults (e.g. delirium and dementia).


The vast majority of residents’ rotations occur on the Washington University Medical Campus, specifically Barnes-Jewish Hospital.

The main inpatient psychiatry facility has 46 beds and is divided into three locked units: intensive care floor, step-down floor, and a geriatric psychiatry floor. The units are located on the 15th floor of the main Barnes-Jewish teaching hospital and are closely integrated into all of the specialty care inpatient units (e.g. surgery, internal medicine, neurology) of the hospital.

A second, lower acuity, inpatient facility–called the BJH Psychiatric Care – Delmar Campus (PCDC)–is located 2 miles from the medical center. It has 2 units and can accommodate an additional 50 inpatients. Residents rotate there for additional inpatient training.

First year

The PG1 year is aimed at providing the intern with basic knowledge and skills in medical, neurological, and psychiatric medicine.

Beginning in your first year, you will experience the autonomy of running your own team of health-care providers–including nurses, medical students, social workers and pharmacists–in a hospital setting.

Unlike some programs, you will not be paired with a second, third, or fourth-year resident; they are on other rotations. You are the team lead as an intern. You are not alone, though. An attending is on the floor daily and always available to provide support and guidance.

PGY1 Rotations

Inpatient Psychiatry

  • 6 months
  • Rotating weeks of night shift call

Internal Medicine

  • 4 months
  • No night shift call

Inpatient Neurology

  • 2 months
  • No night shift call

For 1 of the 4 months of medicine, residents may select to do emergency medicine or pediatrics.

Inpatient Psychiatry

Service Director: Dr. Matthew Chapman

On this rotation at Barnes-Jewish Hospital, the residents work one-on-one with renowned faculty from Washington University. They learn the basics of psychiatric care including obtaining good histories, doing mental status exams, and properly diagnosing and managing patients with severe psychiatric illness. Specialized services include an intensive care unit and a geriatric psychiatry unit. The setting utilizes a multidisciplinary approach with nurses, social workers, activity therapists, chaplains, psychiatrists, and medical students.

As a group, residents provide coverage 24/7 split into two call shifts during which they admit new patients and provide emergency consultation for issues that arise on the psychiatry units. Residents also are assigned medical students to supervise and educate.

Internal Medicine

This fourth-month rotation occurs on services supported by the Department of Internal Medicine, a world-renowned division that sees some of the brightest medical minds pass through its halls. With over 19 Nobel Laureates associated with Barnes-Jewish Hospital and Washington University School of Medicine, the Department of Internal Medicine accounts for approximately 30 percent of the university’s research enterprise and is currently ranked 6th in the nation among internal medicine departments receiving research funding.

Psychiatry residents take care of patients hospitalized on the inpatient medical units at Barnes-Jewish Hospital. Residents typically are assigned to a general medicine team consisting of an attending internist, internal medicine residents, and medical students.

Residents function as categorical internal medicine interns. Residents may be assigned to the hospitalist or medicine consultative services where they work one on one with the attending.

Residents are expected to attend didactic conferences of the internal medicine department during their rotations.

There is typically no required overnight call.

In place of one of the four months, residents may elect to do one month of emergency medicine in the emergency room or one month on the general inpatient pediatric floor at St. Louis Children’s Hospital, located next to Barnes-Jewish Hospital on the Washington University Medical Campus.

Inpatient Neurology

First-year residents will rotate for two months in the Department of Neurology, which has nearly 120 faculty members with international leaders in nearly every sub-specialty area. Residents are assigned to teams consisting of an attending neurologist, a supervising neurology resident, and medical students taking care of patients on the inpatient neurology, acute stroke, and consult services.

There is no required overnight call.

Residents are expected to attend didactic conferences occurring in the Department of Neurology during their rotations.

Second year

The main thrust of the PG2 year is to expand on the basic skills and knowledge learned in the first year by exposing the trainee to a much broader set of psychiatric disorders, severity of illness, and treatment modalities and settings. 

During the PG2 year, our residents spend approximately two months offsite in the St Louis area for Addiction Psychiatry at the Veterans Affairs Medical Center and Harris House.

PGY2 Rotations

  • Addiction Psychiatry (2)
  • Eating Disorders
  • Emergency Psychiatry
  • Inpatient Psychiatry
  • Pt Safety/Quality Improvement
  • Geriatric Psychiatry
  • Consult Service (2)
  • Interventional Psychiatry – Inpatient
  • Interventional Psychiatry – Outpatient
  • Perinatal Psychiatry
  • Selectives* (2)

Year is split into 14 blocks of equal length

On average, PGY2 residents do less than one ER night or weekend call per week.

*PGY2 selectives: autism, child psychiatry, forensic psychiatry, sleep medicine, toxicology, LGBTQ+, psychiatric oncology, psychotherapy, research

Addiction Psychiatry – Harris House

Service Director: Dr. Kevin Xu

The resident spends his or her time at Harris House learning to evaluate and treat patients with substance use disorders in the acute inpatient, intensive outpatient, and residential settings. In addition to learning the use of pharmacotherapeutics, the resident learns individual and group psychotherapies as applied to these disorders.

Addiction Psychiatry – Veteran’s Affairs Medical Center

Service Director: Dr. Naazia Azhar

The resident works as part of a team with supervising psychiatrists, psychologists, nurses, and addiction counselors to treat outpatients with substance use disorders (mainly opiate and alcohol) through various services available at the Veteran’s Affairs Medical Center. In addition to learning evidence-based group and individual psychotherapies for substance use disorders, residents also learn pharmacologic treatments such as agonist (methadone), partial agonist (buprenorphine), and antagonist (naltrexone) therapy for opiate dependence.

Consultation Psychiatry

Service Director: Dr. David Daniels

On this rotation, residents learn to evaluate and treat patients with co-morbid psychiatric and other medical illnesses by providing consultation services to the non-psychiatric floors of Barnes-Jewish Hospital.

Eating Disorders

Service Directors: Dr. Callie Bishop

Residents learn how to evaluate and treat patients with severe eating disorders. Residents on this rotation rotate through various psychiatric and medical clinics that specialize in the treatment of eating disorders.  Residents become adept at using a broad array of psychotherapies and medications in addition to learning how to handle non-psychiatric complications associated with these disorders.

Emergency Psychiatry

Service Director: Dr. Angela Lin

Residents provide psychiatric consultations in Barnes-Jewish Hospital’s Level 1 emergency and trauma center. Residents learn how to do an emergency psychiatric assessment and risk assessment in order to determine the appropriate level of care for the patient. Residents learn the use of both pharmacotherapies and psychotherapies in the emergency setting.

Geriatric Psychiatry

Service Director: Dr. Eric Lenze

This rotation is designed to teach residents how to assess and manage psychiatric dysfunction in older adults by rotating through several different sites each week. Residents become adept at evaluating and treating neurocognitive disorders in the Memory Diagnostic Center at Washington University, which is associated with one of the top Alzheimer’s Disease Research Centers in the country. The residents also work in a neuropsychiatry clinic, in a general geriatrics clinic, and in Dr. Lenze’s outpatient geropsychiatry clinic where they learn to assess and treat older adults with psychiatric illness. 

Inpatient Psychiatry

Service Director: Dr. Mina Charepoo

For this rotation, the residents return to the inpatient setting where they rotate to our BJH Psychiatric Care – Delmar Campus (PCDC) units. Similar to community based units, there are no MDs providing coverage at night. Patients who arrive during the evenings are worked up the next day. On this unit, the resident works closely with a PGY4 resident with the support of an attending. Ancillary services are similar to those provided on the PGY1 inpatient units. The rotation provides the opportunity to consolidate learning from the first year and to further enhance inpatient skills and knowledge. Day work is performed Monday through Friday. Similar to other PGY2 rotations, call work is done once a week in the ER.

Interventional Psychiatry – Inpatient

Service Director: Dr. Lauren Marks

On this rotation, residents learn the basic use of and principles underlying ECT by providing both inpatient and outpatient ECT services to individuals in the St. Louis area and the greater bi-state region. Barnes-Jewish hospital houses an ECT suite where approximately 2,000 treatments are done each year. In addition to the procedure room, the suite contains its own pre-treatment holding area and post-anesthesia recovery unit. Residents under the supervision of an attending psychiatrist also provide ketamine treatments to inpatients at Barnes-Jewish Hospital.

Interventional Psychiatry – Outpatient

Service Director: Dr. Pilar Cristancho

This rotation is designed to teach residents how to assess and manage outpatients who have a treatment resistant disorder like Major Depression that has not responded to routine treatments and who are referred for an interventional treatment (e.g. ECT, rTMS, esketamine, ketamine). In addition to conducting the initial evaluation and determining the most appropriate initial treatment residents will follow patients as they progress in treatment. Some patients will receive more than one interventional treatment. Residents on this rotation also provide the treatments (rTMS, esketamine, ketamine) that can be given in the outpatient setting.

Patient Safety and Quality Improvement (PSQI)

Service Director: Dr. Rita Haddad

The main goals of this rotation are to learn Patient Safety and Quality Improvement (PSQI) principles as well as administrative skills and to provide clinical coverage as needed. The resident on this rotation learns principles of PSQI and monitors the quality of other physicians’ compliance with hospital/JCAHO policies. In addition, PGY2 residents as a group develop their own PSQI project. The resident also is available as backup in the case of illness.

Perinatal Psychiatry

Service Director: Dr. Bridget Galati

This rotation is designed to focus resident learning on the unique psychiatric issues associated with pregnancy and the post-partum period. Residents provide consults to patients on the Ob/Gyn floors as well as the neonatal ICU. In addition, the residents work in several perinatal clinics. Residents are supervised not only by adult psychiatrists but also by CAP attendings and those from the Ob and toxicology services. Opportunities exist for residents to treat women with opiate use disorder as well as to treat patients suffering with post-partum depression with brexanolone.


Service Director: Various faculty 

In addition to the required rotations listed above, residents expand their horizons by choosing three additional rotation blocks. Residents will typically use this time to explore areas that are of potential long-term interest to them (e.g. child psychiatry, maternal-fetal psychiatry, sleep medicine).

Residents may also choose to focus 2 blocks on research.

Third year

The third year is devoted entirely to outpatient care. The residents rotate through two adult clinics and one child clinic.

PGY3: Outpatient Adult and Child Clinics

No weekend or overnight call

Adult Outpatient Psychiatry Clinics

Service Director: Dr. Akinkunle Owoso

The residents spend most of the 10-month rotation seeing outpatients at Barnes-Jewish Hospital. Patients in the psychiatry clinic often are seen at other Barnes-Jewish Hospital specialty clinics, making for a multi-practice specialty clinic. Residents also see patients at BJC Behavioral Health, which is a traditional community mental health center (CMHC) with case managers for patients, an on-site pharmacy, and in-house therapy resources.

The 10 months of training are spread out over the 12-month academic year.

The main goal of the adult clinic experience is to allow the resident to improve his or her psychiatric skills and to learn to manage patients long term in an outpatient setting.

Child & Adolescent Psychiatry Outpatient Clinic

Service Director: Dr. Eric Spiegel

In this clinic, residents learn the basics of child and adolescent psychiatry by working closely with the faculty in the Department’s Child and Adolescent division to provide care in a tertiary care outpatient setting that receives referrals from across the bi-state area.

The 2-month experience is spread out over the 12-month academic year, giving the resident a longitudinal perspective of these illnesses.

During this rotation, the resident learns the skills of assessing and working with families as well as with children and adolescents of all ages.

Fourth year

The thrust of the fourth year is to allow residents to round off their general education by exploring topics in more detail and to gain skills as a supervisor and educator. The PG4 year is divided into three parts — four months of required supervisory clinical work, four months of research, and four months of elective work.

PGY4 Rotations

BJH Supervision

  • 1-2 months

Consult Supervision

  • 2-3 months


  • 4 months


  • 4 months
BJH Inpatient Supervision

Service Directors: Dr. Matthew Chapman and Dr. Mina Charepoo

Residents work at both the main inpatient psychiatry unit as well as the PCDC site. While at the main unit the PGY4 resident administratively supervises PGY1 residents on their inpatient rotation. When assigned to the PCDC site, the resident directly supervises the care provided by the PGY2 resident with the support of an attending. The main focus is for the PGY4 resident to learn how to teach and supervise other clinicians and to become adept at administrative psychiatry. The PGY4 resident also monitors the quality of the documentation of the junior residents, their compliance with hospital/JCAHO policies, and their involvement in quality improvement exercises.


Service Director: Various faculty

The goal of the research block is for the trainee to develop an understanding of research questions and methods. Residents typically choose to join one of the large number of projects that are on-going inside and outside the department. Residents may also choose to develop their own projects. There is no expectation that residents obtain publishable data or write a manuscript. However, residents do present on their efforts at end-of-year department-wide conferences.

Learn more about research training opportunities »

Consult Supervision

Service Director: Dr. David Daniels

The emphasis of the rotation is learning how to supervise the work of other clinicians who are providing care. Residents gain valuable experience supervising physician assistants, junior residents, and medical students under the guidance of a consult attending. The supervising resident takes a lead role in the education of the medical students and junior residents on the rotation.


Service Director: Various faculty

Residents use these four months to focus on areas of particular interest to them. They may use the four months to do any of a large number of predefined electives, to do more research, or to do an individualized elective.

Call schedule

Overnight call is done by our PGY1 and PGY2 residents. We have two residents on-call at any one time – one in the ER and one on the inpatient unit.

PGY1 residents cover the inpatient psychiatry service at night using a night-float system in which residents rotate onto the night shift for either one or two weeks before rotating back to the day shift. There is usually no overnight call on internal medicine and neurology.

PGY2 residents cover the ER at night during the week and on the weekend.  Overnight call for the PGY2 residents occurs less than once a week on average.

There is no required call for PGY3s and PGY4s. During their evenings and weekends, residents may moonlight or pursue other interests.