The Clinical Years:

PGYI

Interns who begin our program in the first year have a wonderful initial exposure to psychiatry at the New Mexico VA Medical Center, a regional flagship center that serves as a referral source for the VA system in the Southwest. This includes six months on a state-of-the art inpatient psychiatry unit working with a gifted interdisciplinary service. Residents learn about the acute management of psychiatric disorders and interact with behavioral health providers throughout the facility working in a highly sophisticated system in which veterans can receive appropriate care at multiple levels.

Complementing this inpatient experience is a year- long immersion in the outpatient treatment of psychiatric patients with serious mental illness in the psychiatry primary care clinic. Residents work in this clinic one half day a week and work concurrently with both medical and psychiatric leaders to provide both services to their patients.

Interns also work both at the VA and at the University of New Mexico to complete their requirements in other disciplines. This includes two months of neurology, one at UNM and the other at the VA. Interns also spend four months on internal medicine at either of the two facilities. One of these is spent on the inpatient medical wards, and the other three months can be spent through a combination of outpatient medicine clinics, emergency medicine, family practice clinic, or inpatient our outpatient pediatrics.

PGYII

Most of our residents in the second year have spent a year in the program as interns. Two new residents join the program in the second year, and their schedules are somewhat different.

Residents who have spent the initial year in our program spend six months rotating through three unique inpatient psychiatry experiences quite different from their training in the previous year at the VA. These inpatient units at the University of New Mexico represent acute treatment programs and serve as the referral source for much of the state of New Mexico. Two of the units treat adults in the context of a locked inpatient unit, and one is a specialized unit for geriatric psychiatry and patients with comorbid medical illnesses.

The inpatient years are complemented by three months on the psychiatry consultation liaison service, either at the VAMC or at UNM where residents work with a specialized psychiatric service consulting to the medical services in the hospital.

Psychiatry residents also spend one month in the psychiatric emergency service at the University Psychiatric Center learning critical skills in crisis stabilization, acute interventions, and determination of the appropriate levels of psychiatric care.

Residents spend one month in our Acute Substance Abuse Program during this year learning the principles and treatment of acute outpatient detoxification from multiple substances of abuse.

Residents also begin their exposure to child psychiatry during the second year, spending one month of their time on the inpatient child psychiatry units where they work with child fellows and faculty managing children in the acute residential setting.

Residents in our program who join in the second year spend the bulk of their training on the three inpatient units at the University of New Mexico Psychiatric Center.

Residents also begin their training in psychotherapy during the second year by beginning their work with at least one patient who they work with over the course of the year or longer. This clinical work is complemented by a beginning curriculum in psychodynamic psychotherapy early in the second year.

PGYIII

The third year of training is an immersion in the outpatient treatment of psychiatric patients. Residents learn the specific skills involved in the outpatient treatment of psychiatric patients in multiple settings. Residents work in general adult outpatient assessment clinics and treatment programs as well clinics with a more specialized focus. Residents are involved in all aspects of the biopsychosocial assessment and treatment wherever possible. This includes pharmacologic management, couples and family interventions, and multiple formats of individual and group psychotherapy. Residents are taught by enthusiastic faculty often with national and international expertise in the area in which they practice and teach. Residents work with providers from multiple disciplines in the capacity as a leader of the treatment team . At all times, residents are provided with administrative supports to manage contact with multiple clinics.

General Assessment Clinic:

Residents in their third year spend time during their outpatient training in the General Assessment Clinic in the outpatient services. This area involves the evaluation of new patients, development of treatment plans in conjunction with the attending faculty in the clinic, and treating the patient for acute psychiatric symptoms. Residents work with patients in this clinic for 1-6 sessions before making a triage decision into one of the continuation of care clinics, a primary care clinic, or another program in the medical school or community. The General Clinic has a didactic curriculum focused on specific issues of assessment, psychopharmacology, supportive psychotherapy, and referral. Residents meet weekly in their treatment teams to discuss clinic issues and particular patients. All patients are staffed by faculty members who teach residents and medical students throughout the clinic day.

Continuation of Care Clinics –Residents spend time in the continuation of care clinic working with psychiatric patients over the course of the year. This involves working with a group of patients refractory to initial interventions. Patients in this clinic generally carry chronic psychiatric diagnoses and are managed by an interdisciplinary team of providers. Trainees develop expertise in the management of psychotic disorders, affective disorders, and psychiatric presentations of traumatic events, among other diagnoses.

Dual Diagnosis Clinic :

Residents work with patients who carry a diagnosis of substance use as well as a second psychiatric diagnosis with nationally recognized leaders in the area of substance use treatment. Residents learn to manage both issues concurrently in conjunction with a treatment team and modalities that include psychopharmacology, case management, and specific individual and group psychotherapies.

Child Outpatient Clinic:

Residents evaluate and manage a panel of children throughout the year supervised by the faculty from our child psychiatry program. Residents develop skills in the assessment of children and adolescents, treatment planning, and sophisticated psychopharmacology as well as appropriate psychotherapies.

Brief Therapy Program

Residents meet weekly with faculty with an expertise in brief treatment modalities. These include cognitive behavioral therapy, motivational interviewing, dialectic behavior therapy, mindfulness stress reduction, and interpersonal therapy, among others. Residents are expected to work with three patients at any given time through this program.

Long Term Dynamic Psychotherapy Clinic -

During the third year of training, residents build on the exposure they receive in psychodynamic psychotherapy earlier in the residency. Residents are expected to work with three patients in long term dynamic psychotherapy during the third year. They receive both individual and group supervision by faculty well versed in the area of psychotherapy and psychodynamic formulation. Residents also participate in a sophisticated reading group around psychodynamic paradigms. Finally, they participate in a unique nationally recognized case presentation with their classmates presenting their cases to psychoanalysts throughout the country in a state of the art televideo conference room.

PGYIV

The fourth year of training is an individually tailored experience to allow for the personal development and specialization of the resident. Residents participate in a wide variety of elective experiences. Three residents each year are selected to serve as chief resident through the year. Some residents may also apply to a child fellowship program in their third year to begin this year.

During the fourth year, many residents participate in our nationally recognized rural psychiatry program Residents have the opportunity to work locally through telecommunications or in rural locations throughout New Mexico through the assistance and sponsorship of the rural program. This provides residents with the opportunity for an immersion in unique cultures throughout the state and an exposure to practicing psychiatry in remote regions while supported by an actively involved faculty.

Residents may also immerse themselves in a research experience during their fourth year of training. This is often initiated earlier in the program, but the fourth year affords the time for an in depth immersion in a program under the mentorship of faculty both at UNM and the New Mexico VA. Residents have been highly successful in this in the past and have worked in areas including PTSD, schizophrenia, and geropsychiatry, among many others.

Other popular electives during the fourth year include:

• Sleep medicine
• Interdisciplinary pain management
• Neuropsychologic assessment
• Seniors Clinic
• MIDD Clinic for the developmentally disabled
• HIV clinic
• Affective Disorders Clinic
• Health Care for the Homeless
• Las Vegas State Hospital