Director: John Sargent, MD
ROTATION SCHEDULE
Rotation schedules can vary from year to year and resident to resident. While the schedule may vary, all residents are ensured that they will receive training at all locations and for equal periods of time. An example of one resident's rotation schedule is below.
First Year
July - December
- Inpatient Child/Adolescent Psychiatry (6 months; 3 1/2 days per week)
- The Walker School (3 months)
- MetroWest Medical Center (3 months)
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (6 months; 1/2 day per week. Resident is assigned to one of the four clinics)
- Child/Adolescent Psychiatry Didactics (6 months; 1 day per week)
January - June
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (4 months; 1 day per week. Resident is assigned to two of the four clinics)
- Pediatric Neurology- the Floating Hospital for Children at Tufts Medical Center (2 months; 4 days per week)
- Center for Children with Special Needs (CCSN) - Tufts Medical Center (3 months; 1/2 day per week)
- Josiah Quincy Elementary School (3 months; 1/2 day per week)
- Child/Adolescent Psychiatry Didactics (6 months; 1 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)
- Child/Adolescent Psychiatry Didactics (6 months; 1 day per week)
January - June
- Child/Adolescent Psychiatry Outpatient Clinics - Tufts Medical Center (6 months; 1 day per week. Resident is assigned to two of the four clinics)
- Josiah Quincy Elementary School (3 months; 1/2 day per week)
- Lowell Juvenile Court Clinic (3 months; 1/2 day per week)
- Elective (6 months, 1/2 -2 days per week)
- Child/Adolescent Psychiatry Didactics (6 months; 1 day per week)
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DIDACTICS
Mondays (September - June)
Wednesdays
- 9:00-10:00am: Journal Club (1st Wednesday of each month) and CAP Case Conference (all other Wednesdays)
- 10:00am-12:00pm: 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
- 12:00-2:00pm: Introduction to Child and Adolescent Psychiatry Seminar (July-August: various lecturers); Child/Adolescent Psychiatry Lecture Series (September-June: various lecturers; topics include - but not limited to - in-depth look at various disorders, treatment modalities, psychopharmacology, forensics, child development, etc.) additional details below
- 2:00-3:00pm (1st Wednesday of month only): CAP Residents' Meeting with Program Director
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TUESDAY GRAND ROUNDS
Department of Psychiatry Grand Rounds
Psychiatry Grand Rounds are open to the entire department and take place on Tuesdays 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 Case Conference
Takes place weekly on Wednesday mornings. Residents present cases that are then discussed by the staff.
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 Psychotherapy/Family Therapy Clinic. 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 2-month 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
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/ Lowell Juvenile 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
Inpatient Child & Adolescent Psychiatry
<ȉ>Metro West Medical Center
This 3 month rotation for 1st year Child and Adolescent Psychiatry Residents will include comprehensive care for children and adolescents in mental health crisis who have required psychiatric hospitalization at MWMC on their child and adolescent psychiatric inpatient unit. This is a 12 bed unit serving children and adolescents between the ages of 5 and 17. A wide variety of diagnoses are represented among those hospitalized including Mood Disorders, Psychotic Disorders, Autism Spectrum Disorders, Disruptive Disorders and Anxiety Disorders. Hospitalization is often precipitated by suicidal behavior or ideation, aggressive or homicidal behavior or failure to adequately care for oneself. Hospitalization stays are generally between 5 and 14 days with occasional patients requiring longer stays. The resident is responsible for patient admission, daily rounds, family conferences, treatment team meetings, medications, review of laboratory tests and discharge planning for 2 patients at a time and rounds, medication, laboratory test review, treatment team meetings and psychiatric discharge planning for 4 additional patients. Unit census is generally between 10 and 12 patients. Supervision is provided by 2 Board Certified or Board Eligible Child and Adolescent Psychiatry faculty who are employed by MWMC and are on the clinical faculty at Tufts University School of Medicine. MWMC is accredited by JCAHO. This rotation will meet the RRC requirement for training in a 24 hour Child and Adolescent Treatment facility. Competencies to be gained during this rotation include knowledge, skills and attitudes within Medical Knowledge, Patient Care, Interpersonal and Communication Skills, System Based Practice, Practice Based Learning and Professionalism. Each of the 4 first year residents will rotate in turn for 3 months of the year providing coverage throughout the year.
The Walker School
1st year Child and Adolescent Psychiatry Residents will spend 3 months at the Walker School in Needham, Ma. They will provide care on the short term residential treatment unit there. Children between the ages of 5 and 12 receive 24 hour care in this unit and are admitted there with significant emotional and behavioral problems which require continuous care but are not acutely at risk of suicide or dangerousness. Diagnoses are similar to those seen at Metro West but also include children with significant learning difficulties and academic problems in school. Children generally are in this program for 2-4 weeks. Residents will be responsible for admission, rounds, treatment team meetings, family meetings, discharge planning and collaboration with schools. Residents will also coordinate milieu treatment and organize team based collaboration. Residents will coordinate the care fully for 2 patients and manage psychopharmacology for 4 additional patients. They will be supervised by 2 Walker Board Certified Child and Adolescent Psychiatrists with at least 2 hours of supervision weekly. Competencies to be gained are similar to those gained at Metro West but also include organizing the milieu treatment and coordinating discharge planning.
The major objective of both rotations 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
On-call (from home) to the Psychiatric Emergency team and Pediatric Consultation/Liaison service for a period of 1 week every 6 weeks.
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INFORMATION FOR APPLICANTS
- Four 1st Year positions per year offered
- Must apply via Paper Application
- Use NRMP match only (No pre-match acceptance)
- Application Deadline is November 1st
Requirements
- Completed Application (click here to download)
- Curriculum Vitae
- Personal Statement
- 3 letters of recommendation (from Psychiatry or Child/Adolescent Psychiatry)
- Dean’s Letter and Transcript from Medical School
- Letter from Current Program Director of Completed Rotations
- For International Medical Graduates only:
- ECFMG certification is required
- Only sponsoring J-1 Visas
To request additional information, please click here amuir@tuftsmedicalcenter.org
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