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, experimental procedures such as rTMS and VNS, and a wide range of psychotherapeutic techniques including supportive therapy, cognitive therapy, behavioral therapy, interpersonal therapy, and pragmatic psychodynamics.
Our psychiatrists and house staff treat patients in a world-class complex that includes Washington University School of Medicine, Barnes-Jewish Hospital, St. 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 15 hospitals, BJC is the largest academically linked health system in the country. Washington University ranks fifth among the nation’s 125 medical schools in terms of the size of its clinical practice.
The faculty at the medical school see more than 1 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.
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.
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 unit having 46 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) or in an extended care facility.
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 Support Center–is located 2 miles from the medical center. It has 2 units and can accommodate an additional 50 inpatients. Residents may elect to rotate there for additional inpatient training.
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.
For 1 of the 4 months of medicine, residents may select to do emergency medicine or pediatrics.
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 service where they work individually with the hospitalist 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.
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 admitted to the inpatient neurology service at Barnes-Jewish Hospital. Residents also may be assigned to the neurology consultation service.
There is no required overnight call.
Residents are expected to attend didactic conferences occurring in the Department of Neurology during their rotations.
Service Director: Dr. Michael Jarvis
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.
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 three months offsite in the St Louis area at McCallum Place for eating disorders and the Veterans Affairs Medical Center and Harris House for chemical dependency.
The year is typically broken into 12 blocks.
* Patient Safety Quality Improvement
PGY2 selectives: autism, child psychiatry, forensic psychiatry, sleep medicine, community psychiatry, TMS, neurology consults, research
Chemical Dependency – Harris House
Service Director: Dr. Carrie Mintz
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.
Chemical Dependency – Veteran’s Affairs Medical Center
Service Director: Dr. Dragan Svrakic
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.
Patient Safety and Quality Improvement (PSQI)
Service Director: Dr. Emily Mukherji
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, residents develop their own PSQI projects. The resident also is available as backup in the case of illness and provides teaching to PGY1 residents and medical students.
Service Director: Dr. Ginger Nicol
Residents learn how to evaluate and treat patients with severe eating disorders by rotating at McCallum Place, a specialized eating disorder treatment setting providing both residential and outpatient services. 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.
McCallum Place is a free standing center that provides intensive outpatient and residential treatment to people afflicted with eating disorders. It is located about 8 miles from campus.
Service Director: Dr. Fay Womer
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.
Service Director: Dr. Don Bohnenkamp
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.
Service Director: Dr. Charles Conway
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 also become familiar with newer treatments (e.g. TMS, DBS, VNS) by working with faculty who are developing these treatments for general psychiatric use.
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 at BJC Extended Care, a skilled nursing facility, providing psychiatric care to elderly patients. Residents in Dr. Lenze’s outpatient clinic will assess and treat older adults with psychiatric illness. A one-time observation visit at Memory Care Home Services and a home visit with Susie Berger, RN, MSN, psychiatric nurse specialist, round out the rotation’s itinerary.
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.
The third year is devoted entirely to outpatient care. The residents rotate through two adult clinics and one child clinic.
Outpatient Psychiatry including Child Psychiatry
Adult Outpatient Psychiatry Clinic
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. Anne Glowinski
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.
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.
|Long-Term Patient Follow Up|
Inpatient Supervisory Rotation
Barnes Jewish Hospital
Barnes Jewish Hospital
Residents administratively supervise PGY1 residents on their inpatient rotation. The main focus of the PGY4 rotation is for the resident to learn how to teach other clinicians and to become adept at administrative psychiatry. In addition to teaching the interns and medical students, the PGY4 resident 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: Dr. Fay Womer
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. Additionally, residents also obtain unique experience in providing outpatient consultations in a primary care clinic setting.
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.
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.
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 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.