Director: John Sargent, MD
Associate Director: Charles Moore, MD
ROTATION SCHEDULE
Rotation scheduled can vary from year to year and resident to resident. While the schedule may vary, all residents are ensured that they received training at all locations and for equal periods of time. An example of one resident's rotation schedule is below.
First Year
July - December
- Child Psychiatry Inpatient Unit - Tufts Medical Center (6 months)
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (6 months; Resident is assigned to one of the four clinics)
January - June
- Josiah Quincy Elementary School (6 months; 1/2 day per week)
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (6 months; Resident is assigned to two of the four clinics)
- Pediatric Gastrointestinal Clinic - the Floating Hospital for Children at Tufts Medical Center (6 months)
- Center for Children with Special Needs (CCSN) - Tufts Medical Center (3 months; 1/2 day per week)
Second Year
July - December
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (6 months; Resident is assigned to two of the four clinics)
- Child/Adolescent Psychiatry Consultation/Liaison Team - Tufts Medical Center and the Floating Hospital for Children (6 months)
- Court Clinic (6 months; 1/2 day per week)
January - June
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (6 months; Resident is assigned to two of the four clinics)
- Pediatric Neurology - the Floating Hospital for Children at Tufts Medical Center (6 weeks; three days per week)
- South Boston Behavioral Health Center (6 months; 1/2 day per week)
- Elective (1 month)
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DIDACTICS
July & August
Wednesday
- 10 a.m. - 12 p.m., Introduction to Psychiatry Seminar (various lecturers)
September – June
Monday
Wednesday
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10 a.m. - 12 p.m., Special Topics Series (various lecturers; topics include - but not limited to- group psychotherapy, psychopathology, cultural psychiatry, psychological testing, violence and abuse, physician wellness, and alternative treatments) additional details below
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12 p.m. - 1 p.m., Journal Club
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1 p.m. - 2 p.m., Child/Adolescent Psychiatry Lecture Series (various lecturers; topics include - but not limited to - in-depth look at various disorders, treatment modalities, psychopharmacology, forensics, child development, etc.) additional details below
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2 p.m. - 3 p.m., Psychodynamic Psychotherapy
Thursday
Friday
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12 p.m. - 1 p.m., Resident Lunch & Training Meeting (run by Joseph J. Jankowski, MD, Director of Residency Training)
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1 p.m. - 2 p.m., Mock Oral Boards
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MONDAY GRAND ROUNDS
Department of Psychiatry Grand Rounds
Psychiatry Grand Rounds are open to the entire department and take place on Mondays from 12-1pm. Guest speakers present special topics and current research in psychiatry, neuropsychology, neurology, medicine, and basic sciences such as molecular biology and genetics. Discussion is encouraged.
WEDNESDAY DIDACTIC TOPICS
Introduction to Child/Adolescent Psychiatry
Lecture, case presentation, and/or seminar
Topics include:
Interviewing children and adolescents
Genetic history
Diagnostic assessment
DSM IV categories
Strategies for treatment
Pediatric issues
Co-morbid illnesses
Family aspects
Education and social/legal aspects
Agencies and involvement
Emergency Services for Children & Adolescents
Description of emergency evaluations of children and adolescents.
Dispositions include:
Hospitalizations
Acute residential units
Day treatment
Outpatient programs
Detox
Management issues include:
Medications
Restraint - seclusion not permitted unless with attendant
1:1 sitters
Assessment of violence potential to self and others
Suicidality
Substance abuse
Medical/surgical problems
Utilization of environmental supports such as parents, school, DSS, DYS, probation officer, therapists, family support team, and community programs. Legal issues such as child abuse petitions, commitment, child custody, emergency care, care and protection petitioning, and foster placement in specialized foster home on an emergency basis.
Child Development
Normal Development: cognitive, motor, psychological, sexual, language, moral, and social. Emphasis is on integrative aspects. Factors impacting on Development: ethnic, cultural, risk factors, protective factors, temperament, familial, environmental, education, psychopathology of patient and/or parents, domestic violence, abuse, trauma, and medical illness.
Psychopathology
Generalized anxiety, adjustment disorders, PTSD, substance abuse, and medical problems relating to psychiatric issues (e.g. thyroid, rheumatic disorders, cystic fibrosis, and anorexia).
Other topics include:
PDD/Asperger’s
Autism
Affective disorders (unipolar and bipolar)
ADHD
Phobias
Bulimia
Tourette’s
OCD
Somatoform disorders
Mental retardation
Infancy I (feeding/elimination disorders)
Infancy II (attachment disorders and behavioral disorders)
Neuroscience
Topics include:
Neurobiology
Genetics
Neuropathology
Neurophysiology
Imaging
Neuropsychopharmacology
Med/Psych and C/L
Topics include:
Pediatric C/L and school consultations
Overview of consultation process
Interviewing children in the hospital and school
Effects of hospitalization on the child and family
Special needs of children with Cystic Fibrosis, Rheumatic Disorders, GI problems, HIV, Organ Transplantation, Oncology Problems, Physical Trauma and Amputation
Specific disorders presented and discussed include:
Somatoform disorders
Tourette’s
Depression/grief
Trichotillomania (OCD)
Pain disorders
Anxiety disorders (Phobias)
Eating disorders
Also presented are specific issues such as:
Medical ethics
Death and dying
Suicide
Substance abuse
Psychopharmacology in a pediatric setting
Intervention strategies/modalities include:
Behavioral treatment
Crisis intervention
Family therapy
Psychopharmacology
Restraint
Social network therapy
Hypnosis
Guided imagery
Treatments
Lecture and Readings
Treatment Modalities:
Psychodynamics
Play Therapy
Cognitive Behavioral Treatment
Other Behavioral Interventions (Relaxation, Conditioning, Desensitization, CBT, and Biofeedback)
Family
Group
Hypnosis
Psychopharmacology (Anxiolytics, Neuroleptics, Antidepressants, and Psychostimulants)
Other treatments include:
Crisis Intervention
Network Therapy
Acute hospitalization
Acute residential treatment
Day treatment (partial hospitalization)
Forensics
Lecture and Readings
Topics include:
Custody
Guardianship
Commitment
Child abuse petitions
Confidentiality statutes
Emancipated minor age of majority
Foster care
Adoption
Termination of parental rights
Malpractice issues
High Risk Children and Adolescents
Lectures on a variety of topics, such as:
Adoption
Foster care
Physical abuse and neglect
Sexual abuse and incest
Munchausen Syndrome by Proxy
Multi-problem families
High-risk children and adolescents
Children and divorce
Neuropsychiatric symptoms and syndromes
Violence in children
Acquired brain disorders
School Consultation
Lectures on the school consultation process, early childhood education, special education programs for inner-city youth, school avoidance/phobia, truancy, violence in the school, teen pregnancy, and teacher as first line mental health worker.
Psychology Testing
This lecture series provides a presentation of Psychological Tests including indications for use, strengths/weaknesses, and scoring. They include Intellectual/Developmental tests, Neuropsychological Testing, Memory Functioning, and Personality/Behavioral Testing.
Inpatient Psychiatry
This lecture includes a number of topics relevant to inpatient services, e.g. Psychosis, Bipolar Disorders, Major Depression, Eating Disorders, Suicide, PTSD, Assessment of Dangerousness, Fire-Setting, Crisis Intervention, Family Assessment and Intervention, Restraint and Seclusion, and Psychopharmacology on an Inpatient Unit.
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ROUNDS
Child/Adolescent Psychiatry Grand Rounds
Takes place weekly on Thursday mornings. Residents present cases that are then discussed by the staff.
Inpatient Child Psychiatry Rounds
Takes place daily. The resident(s) on rotation in the Inpatient Unit rounds with the on-site attending.
Pediatrics C/L Rounds
Takes place daily. The resident(s) on C/L rotation rounds with the attending covering C/L attending. Attendings rotate C/L coverage monthly.
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CLINICAL ASSIGNMENTS
Outpatient Child/Adolescent Psychiatry
The major task of this assignment is for the resident to gain proficiency in diagnosing and treating a variety of children and adolescents with a wide range of psychiatric disorders. There are four outpatient clinics: ADD and ADHD, Community Child/Adolescent Psychiatry including the follow-up of department and emergency room cases, Medical/Psychiatric and Genetics, and PDD Attention Disorders. Within these clinics, residents are expected to:
- Obtain a thorough psychiatric history including genetic, medical, and psychological data
- Utilize this data to formulate a differential diagnosis
- Obtain any further data (e.g. laboratory, neuroimaging, or psychological testing) to help narrow the choice of differential diagnoses and select the treatment modality which would treat the patient most effectively while keeping the patient, and others in the environment, safe.
- Become familiar with public health agencies which serve children (e.g. courts, schools, hospitals, speech and hearing programs, rehabilitation facilities, social services, forensics, courts and services for delinquent youths, day treatment units and acute residential treatment (ART) programs)
Pediatric Neurology
This six-week rotation gives residents a chance to learn about a variety of Pediatric Neurological syndromes and disorders.
Josiah Quincy Elementary School
The major objective is to learn the techniques for effective psychiatric consultation at the request of teachers, principles, guidance counselors, and special education personnel. Within the school, residents are able to gain experience in the following:
- Reviewing problems with the referring special education personnel, administration, and teachers who know the child
- Recognizing those disorders encountered in a school setting such as Learning and Language Disorders, PDD, Major Depressive Disorders, ADHD, Eating Disorders, Organic Brain Disorders, Mental Retardation, and Bipolar Disorders
- Becoming familiar with problems often encountered in the school-aged population (e.g. school absence, school phobia/avoidance, and disruptive behavior)
- Understanding the role of the family, teachers, principal, and special education staff within the school milieu
- Providing verbal and written reports to the school staff while maintaining appropriate confidentiality
South Boston Behavioral Health Clinic
This community based clinic allows the resident the following experiences:
- Evaluation of inner city children and families
- Family and crisis intervention
- Visits to homes, schools, Boys/Girls Clubs, and courts
- Work closely with state agencies
- Substance abuse, juvenile crime, and domestic violence
Pediatric C/L
The major objective of this assignment is to learn the techniques for undertaking effective psychiatric consultations at the request of non-psychiatric physicians. The resident should be able to:
- Review the problem with the referring physician and nursing personnel
- Obtain information from a review of the patient’s chart
- Learn to evaluate and diagnose children within a tertiary care pediatric setting
- Recognize those syndromes and disorders which are commonly seen during psychiatric consultation in a pediatric hospital including, but not limited to, delirium, head trauma, adjustment reactions to medical/surgical illness, somatoform disorders, medication side effects, effect of medical illness on central nervous system functioning, sexual/physical abuse, psychiatric morbidity associated with intensive care units and transplantation
- Understand the management of the above disorders
- Understand the management of the dying patient
- Understand the rights and obligations of physicians, the rights of patients, and the assessment of consent and competency
- Appreciate the ethics of medical/psychiatric care
- Report back to the requesting physician in jargon-free verbal and written reports
- Supervise and teach third and fourth year medical students in the above areas
Forensic Services/ Court Clinic
The major objective is to learn techniques for providing effective child/adolescent psychiatric consultation within a court clinic setting, including the provision of psychiatric testimony. This consultation is provided at the Court Clinic, serving adults, children, and adolescents. The resident is able to do the following:
- Review the problem with the hospital attorneys, referring judge, other attorneys, guardian Ad Litem, or probation officer
- Obtain pertinent information from legal documents, e.g. briefs, arrest warrants, prior court testimony, and police reports
- Learn to psychiatrically evaluate and diagnose children/adolescents who are adjudicated to the court
- Learn to provide interventions and treatment modalities for such children/adolescents
- Learn about the specific legal aspects regarding child/adolescent psychiatry, e.g. Child Abuse Petitions, Adjudicating a Child as an Adult, termination of Parental Rights, Commitment, Custody (physical and legal), Incarceration, Legal Rights, Tarasoff Issues, and Miranda Law
- Recognize symptoms and syndromes of a variety of disorders commonly seen in court clinic consultations including Conduct Disorder, Anti-Social Personality Disorder, Substance Abuse, Organic Brain Disorders, Psychosis, Borderline Personality Disorders, Bipolar Disorder, Major Depressive Disorders, Temporal Lobe Syndrome, Sequelae of Head Trauma, and ADHD
- Understand the court committed child/adolescent regarding involvement of family, community, and schools
- Understand the role, demands, expectations, and environment of the court and its staff
- Learn to provide accurate, concise, jargon-free psychiatric testimony
- Learn how a courtroom functions in terms of rules of order, hierarchy, type of legal proceedings and hearings, e.g. Civil, Probate, Criminal, and Federal
Elective – Clinical/Research
The goals and objectives of this elective are to allow the resident an opportunity to select a rotation which would be of special interest or help to fill a gap in their training. This rotation is selected by the Resident with the guidance of the Training Director. Three months prior to this elective, the resident meets with a Research Mentor with whom they will begin to plan a research endeavor. This endeavor may include a critical review of the research in a specific area, sampling a group of patients, and writing a scholarly paper on a selected topic. This work must at somepoint be presented to the Child/Adolescent faculty for review and comment. The resident is expected to learn how to do the following:
- Perform a literature search
- Critically analyze the literature in a specific topic
- Create a research design
- Gather data using a variety of techniques
- Designate and use appropriate statistical methods
- Interpret data
- Write a scholarly paper
- Present research data
- Present work for peer review
Child Psychiatry Inpatient Unit
The major objective of this rotation is to provide the resident with a training experience with children ages 2 through 12 years, who have serious psychiatric problems which require intensive treatment in an inpatient setting. The resident is expected to learn the following:
- Obtain a comprehensive psychiatric history and interpret historical data from patients, relatives, and medical and school records
- Perform a psychiatric assessment interview including a mental status evaluation
- Perform a pediatric examination to rule out medical problems which may affect the patient’s behavior and/or well-being
- Order supplemental tests, e.g. Psychological Testing, Neurological Evaluation, CT, MRI, SPECT Scans, Neuropsychological Assessments, and Medical and Laboratory Tests
- Understand the use of a variety of rating scales including Hamilton Depression Rating Scale, Beck Depression Inventory, Connors Scales, -SADS, and Achenbach
- Gain experience with psychiatric disorders seen in this population of children, e.g. DO, Eating Disorders, Bipolar Disorder, Schizophrenia, Other Psychoses, Major Depression, PTSD, Organic Brain Disorders, Oppositional Defiant Disorder, Mild Mental Retardation, and Genetic and Mitochondrial Disorders
- Manage these disorders within the milieu and in the community
- Assess and intervene with families, many of whom are dysfunctional nd/or manifest the same or similar diagnoses as their children
- Assess dangerousness regarding aggressivity, combativeness, running away, suicide, and homicide
- Treat these patients with psychosocial, behavioral, and psychopharmacologic techniques
- Utilize and understand psychotropic agents in terms of theory and mechanisms of action, their side effect profiles and efficacy with children who manifest severe problems requiring inpatient care
- Provide supportive psychotherapy to patients and families dealing with affect in the patient, their family, and in the resident
- Utilize a wide array of services in a step-down fashion as the needs of the patient shift with ongoing treatment, i.e. the patient may utilize one of all components of after care (Acute Residential or Day Treatment) and the resident can follow his or her patient throughout the patient’s care cycle, including outpatient care at T-NEMC and/or a family support team
- Work with referral agencies such as schools, courts, pediatricians, and other mental health providers
- Provide models of family intervention which are useful for these seriously disturbed patients and their families
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CHILD/ADOLESCENT PSYCHIATRY CALL SCHEDULE
First Year
On-call to the Child Psychiatry Inpatient Unit and Pediatric Consultation/Liaison service for an average of two weekend days (24 hrs.) every 5-6 weeks. No weeknight call. Call can be done in-house or from home.
For application information, please click here aszetela@tuftsmedicalcenter.org
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