Rotation Schedule Overview

Our Department is dedicated to a dynamic approach to education. The training experience for each resident is designed to meet ACGME specialty training requirements for psychiatry, while allowing residents to tailor their educational experience. Residents have 6-7.5 months of selective time in the PGY4 year. They may also chose to complete rotations not as full-time monthly blocks, but rather as less than full-time experiences over a greater number of months, thus combing them with a part-time experience on other services and allowing for longitudinal treatment experiences.

The following table depicts the core rotational content of the four-year program. The first or internship year includes 4 blocks of Internal Medicine or Pediatrics (or a mix thereof), blocks of Neurology, and 6 blocks of Psychiatry (4 blocks of Adult Inpatient Psychiatry and 2 blocks of Emergency Psychiatry), and an introduction to Quality Improvement/Research block. The medicine and psychiatric rotations alternate every two blocks to provide a diverse educational experience. Interns attend core lectures or seminars in psychiatry throughout the year. They also attend teaching conferences and rounds on Internal Medicine, Pediatrics, and Neurology when assigned to those services. Chief resident positions are an integral part of each of the 4 core services – Emergency, Inpatient, Outpatient, and Consultation-Liaison – and consist of 40% of time for those 4th year residents selected. Those 4th year residents not serving as chief residents complete 3 months of senior rotations on their choice of core services.

In the event that a resident enters the program after having completed an ACGME accredited internship year elsewhere (i.e., Pediatrics, Internal Medicine, Family Medicine or Psychiatry), the rotation schedule is similar to that of the four-year program but is tailored to ensure that all ACGME specialty requirements are met.

  • 4 Blocks – Medicine/Pediatrics
  • 2 Blocks – Neurology
  • 4 Blocks – Inpatient Psychiatry
  • 2 Blocks – Emergency Psychiatry
  • 1 Block – QI/Research
  • 4 Months – Inpatient Psychiatry
  • 1 Month – Emergency Psychiatry
  • 3 Months – Consultation-Liaison Psychiatry
  • 1 Month – Keck Consult Liaison
  • 1 Month – Adol Inpatient Psych
  • 1 Month – VA Geriatric Psych
  • 1 Month – VA Addiction Psych
  • 12 Months – LAC+USC Adult Outpatient Clinic (95%) and Keck Outpatient Clinic (5%)
  • 0.5 Month – Community Psychiatry
  • 1 Month – Child Consult Liaison*
  • 3 Months – Core Service Senior Rotation**
  • 7.5 Months – Electives
  • LAC+USC Adult Outpatient Clinic (10%) and Chief Residency (40%)

*1.0 month FTE
**3.0 month FTE for residents not serving as chief residents on ER, Inpatient, CL, or Child Services.

Possible Electives:
Emergency Psychiatry
Inpatient Psychiatry
Consultation-Liaison Psychiatry
Outpatient Psychiatry
Psychopharmacology
Psychodynamic Psychotherapy
Adolescent Inpatient Psychiatry
Reproductive Psychiatry
Forensic Psychiatry
Palliative Care
Geriatric Medicine
Neurology
Quality Improvement
Research
Teaching
Electroconvulsive Therapy
Pain Medicine
Memory Disorders
Neuroradiology
Addiction Psychiatry
Dialectical Behavior Therapy

*PGY – Post-Graduate Year

Residency Curriculum

Core Curriculum

All residents attend a half-day of core lectures each week. The core curriculum is separated by residency class year, although fourth-year residents are encouraged to provide several lectures to second- and third-year residents. Residents have protected time away from clinical services for core lectures. The curriculum for each year is designed to augment the training and teaching provided on individual clinical services and to ensure comprehensive instruction in psychopathology, evaluation and diagnosis, neuroscience and genetics, psychopharmacology, diverse psychotherapies, evidence-based medicine, sociocultural aspects of mental illness, and ethical and legal concerns. The program provides residents with required textbooks and facilitates online access to other educational materials.

Service-Specific Curricula

Each major clinical service — including adult inpatient services, psychiatric emergency services, consultation-liaison services and ambulatory services — sponsors a separate, service‐specific curriculum. These curricula occur on site and focus on content specific to the given service. In general, each service includes case conferences, journal club meetings and didactic lectures on clinical topics.

Residency Program Events and Opportunities

Board Review Courses

A review course is offered each July and August in preparation for the Psychiatry Resident In-Training Examination (PRITE) and American Board of Psychiatry and Neurology (ABPN) examination. This course uses a combination of textbook and question learning and is led by residents with faculty participation and consultation. Our goal is for all graduates to become board-certified.

Grand Rounds

Psychiatry Grand Rounds are held weekly for the entire department. Twice per month, Grand Rounds feature local and visiting professors from all areas of psychiatry presenting their research and selected topics of interest. Once per month, Grand Rounds consists of a clinical case conference, during which a resident presents an interesting case with a faculty discussant. During the remaining week per month, residents meet as a group with chief residents while faculty attend a business meeting focusing on administrative, medical center and county issues that affect the department and training program.

Journal Clubs/Scholarship

Evidence-based medicine and research methods are taught in journal clubs and as separate research courses each year. Third‐year residents are required to complete a small, independent research project. Projects are broad in range; recently, they have mostly consisted of literature reviews, case reports or case series, and chart reviews related to improving quality of care on our ambulatory services. Recent research topics have included:

  • use of ketamine for treatment-resistant depression
  • role of hormones in treatment of schizophrenia
  • impact of bullying on depressive and anxiety disorders among children and adolescents
  • treatment of delirium in children
  • stress and resilience during residency training
  • history of restraints in psychiatric practice
  • relationship between global economic indicators and mental health care

These projects were presented in poster sessions to all department members. Some residents submitted abstracts to the annual meeting of the American Psychiatric Association or wrote a manuscript; residents also have presented their work as posters or in oral presentations. Faculty advisers are readily available to assist residents with these projects. In addition, the department provides meeting registration and travel funds for residents who present posters or papers.

Teaching Opportunities

Residents receive didactic instruction in effective teaching methods and directly supervise and instruct medical students on most clinical rotations. When residents from more than one residency year are present on a service, including the inpatient or consultation services, senior residents also instruct junior residents. Fourth-year residents provide lectures to residents in earlier class years. Residents teach in journal clubs, and many present at case conferences as part of department Grand Rounds.

Research Opportunities

Several residents per year choose research electives. Recent examples and possibilities include working with:

  • James A. Knowles, MD, PhD — associate chair for research and Della Martin Chair in Psychiatry and Neuroscience — on the genetics of psychotic, mood and anxiety disorders
  • David Baron, DO, MSEd — vice chair, Department of Psychiatry and Behavioral Sciences and psychiatrist-in-chief, Keck Hospital and USC Norris Cancer Hospital — on psychiatric issues in sports medicine and traumatic brain injury
  • John Briere, PhD — associate professor of psychiatry and behavioral sciences and psychology — on post-traumatic stress disorder
  • Barbara Van Noppen, PhD — associate professor of clinical psychiatry and the behavioral sciences — on cognitive–behavioral treatment for obsessive compulsive disorder
  • Isabel T. Lagomasino, MD — assistant professor of psychiatry and residency program director for adult psychiatry — on evidence-based, primary-care interventions for depression among low-income Latinos

Clinical Service Descriptions

Ambulatory Psychiatry

Ambulatory psychiatric services are primarily provided in the Adult Outpatient Clinic located in the Clinic Tower at LAC+USC Medical Center. Services are available for patients of all ages. An additional outpatient experience is offered at the Healthcare Consultation Center on the USC Health Sciences Campus. Clinical rotations in ambulatory psychiatry provide intensive training in long‐term and short-term treatment for diverse psychiatric disorders. Residents typically evaluate one to two new patients weekly. Ongoing caseloads for mostly medication-management services include approximately 75 patients; residents also carry four to six ongoing psychotherapy cases. Residents are assigned faculty supervisors for each treatment modality (psychopharmacology, psychodynamic psychotherapy, cognitive–behavioral psychotherapy); additional consultation is always available. A specialized addiction psychiatry rotation is offered at the USC-affiliated Veterans Affairs Ambulatory Care Center in downtown Los Angeles, less than two miles from LAC+USC. Although training and didactic instruction in addiction psychiatry is provided across all services, this rotation allows residents to focus on outpatient care of patients with alcohol and drug dependency. Treatment modalities employed include methadone maintenance programs, buprenorphine treatment, pharmacotherapy to decrease withdrawal symptoms and 12‐step programs (e.g., Alcoholics Anonymous).

Community Psychiatry/Mental Health Systems

Community psychiatry is a core aspect of the training program. A specialized experience in administrative psychiatry and public policy is offered by the Los Angeles County Department of Mental Health, the largest county mental health system in the country. By visiting many types of facilities and through meetings with clinical program directors, residents gain appreciation for the administrative and organizational tasks associated with the operation and financing of a mental health system. Residents also gain experience in consulting with community agencies and leading interdisciplinary teams.

Consultation Psychiatry

The Psychiatry Consultation-Liaison Service is primarily located at LAC+USC Medical Center. Facilities include a 24‐bed behavioral medicine ward co‐managed by the Psychiatry and Internal Medicine departments. Residents evaluate new patients while monitoring the care of ongoing cases, with supervision from faculty psychiatrists. This clinical service provides comprehensive training in the principles of consultation-liaison psychiatry and crisis intervention. Residents become proficient in evaluation and treatment of psychiatric symptoms among medically and surgically ill patients. Residents also rotate through the Keck Hospital Consultation-Liaison Service, where they have opportunities to evaluate and treat patients on specialized medical/surgical services, including transplant, bariatric and oncology services. This rotation includes training in outpatient electroconvulsive therapy. Residents teach and supervise medical students on both services. A specialized geriatric psychiatry rotation is offered at the USC-affiliated West Los Angeles Veterans Affairs Medical Center, approximately 15 miles from LAC+USC. Residents consult on older medical and surgical inpatients as well as nursing home residents, and receive supervision from faculty specialists in geropsychiatry.

Electives

For electives, residents may select from a variety of clinical or research experiences based on their individual needs and interests. Residents frequently decide to rotate on specific clinical services or pursue new experiences in addiction, forensics, women’s mental health, specific psychotherapies or research, and may also design new elective experiences tailored to their interests.

Emergency Psychiatry

The Psychiatric Emergency Service is located on the main floor of LAC+USC Medical Center. Faculty psychiatrists see patients with residents and discuss diagnoses and treatment plans. Patients either walk in or are brought in by ambulance, police, social agencies, or concerned family and friends. Clinical issues are frequently related to suicidal potential, dangerous behavior and the capacity for self-care. Residents become skilled in emergency evaluations, acute treatment strategies, crisis intervention and community resource referrals. In addition to resident and faculty physicians, the emergency room staff includes psychiatric social workers, nurses and medical caseworkers. Residents also have an opportunity to evaluate and treat children and adolescents who present for emergency care.

Inpatient Psychiatry

Inpatient services are based at the Augustus Hawkins Mental Health Center, located approximately 18 miles south of LAC+USC Medical Center, which houses three adult teaching wards (33 beds) and one adolescent ward (10 beds). Residents assess and treat two to three new adult patients per week while carrying a typical caseload of five to seven patients. Faculty psychiatrists supervise residents in all new and ongoing cases. Adult inpatient services emphasize short-term, acute psychiatric care with the goal of discharge and continued treatment in less-restrictive outpatient settings. This rotation provides an intensive experience in diagnostic evaluation and treatment as well as introductions to major psychopathologies and the legal regulation of inpatient psychiatric practice (e.g., hospital- and court-based legal hearings). In addition to resident and faculty physicians, inpatient staff includes psychologists, clinical pharmacists, psychiatric social workers, occupational and recreational therapists, nursing personnel and medical caseworkers. Residents teach and supervise medical students, and senior residents supervise junior residents. Residents also have a night float experience during which they work with on‐site faculty members to admit patients overnight.