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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.

Age

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).


Rotations

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.

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
  • Outpatient TBD
  • Consult Service (2)
  • Interventional Psychiatry – Inpatient
  • Interventional Psychiatry – Outpatient
  • Perinatal Psychiatry
  • Selectives* (2)

Year is split into 15 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

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

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

Research

  • 4 months

Electives

  • 4 months

Call schedule

Overnight call is done by our PGY1 and PGY2 residents. We have two residents in house 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 during the week and on the weekend.  Overnight call for the PGY2 residents occurs less than once a week on average. For the 2023-2024 academic year we are trialing a night-float system for the ER.

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