We prepare residents to be excellent psychiatrists while building upon foundational skills for life-long learning in medicine. We apply principles from multiple theories of adult learning to support curiosity, problem solving, understanding of the unknown, and application of experience to best serve patients and to transform the practice and study of psychiatry.
"I'm early in my training, but I can already tell that Brigham psychiatry features the best of academic psychiatry, while still allowing time and resources for your own individual pursuits."
-Todd Jones, MD, PGY1
Residents attend the Thursday morning didactic half-day from 8am to 1pm throughout the four years of residency, except during the 6-month block of medicine and neurology in the PGY1 year when residents attend didactics with the categorical internal medicine residents. Thursday didactic time is protected, with attendings covering clinical services during that time. The four-year didactic curriculum is dynamic, changing in response to resident feedback, advances in psychiatry, and the changing culture of medicine.
During the COVID-19 pandemic we shifted our didactics to a virtual model which still remains in a hybrid form. We recognize that each life circumstance and preferred learning and teaching environment is unique. As such, we will always have a virtual option for all didactics. For PGY classes that prefer to be in person as a group we will always have dedicated conference rooms on-site with breakfast provided. Once monthly we host an in-person all resident meeting with catered breakfast. We encourage residents and teaching faculty to be on-site, if possible, for didactics on these days. We strive to best meet the learning needs of our residents, the teaching needs of our faculty, to encourage community, comeraderie, rest and recovery, and well-being.
Clinical Practice is an introductory thread for PGY1s that introduces best practice models for interviewing, documentation, formulation, and differential diagnosis. Using a series of custom-designed simulations for PGY1s, our residents get to practice skills in the nurturing environment of the world-renowned STRATUS Center for Medical Simulation, which is located just across from the Hale Building for Transformative Medicine.
Psychopathology is a PGY1 and 2 thread that introduces residents to psychiatric semiology, historical perspectives of psychiatric illness, and classification according to DSM-5. This introductory thread forms the foundation for more advanced conceptual frameworks including the Research Domain Criteria (RDoC) and precision psychiatry.
Pharmacology (and other Therapeutics) is a four-year thread that builds upon each prior year. Residents will be able to describe mechanisms of action, receptor physiology, binding properties, clinical indications, dosing strategies, side effects, and monitoring parameters of psychotropic medications. Residents become adept at management of complex psychopharmacology in medically complex patients. Residents also learn interventional treatment paradigms including electroconvulsive therapy, transcranial magnetic stimulation, ketamine, and other emerging therapies with psychadelics.
Neuroscience is woven throughout the four-year didactic curriculum, beginning with a foundational course on the basic domains of human functioning relevant to psychiatry and the underlying brain networks, circuits, regions and neurotransmitter systems. In the PGY2-4 years, residents are exposed to increasingly complex clinical neuroscience and neuropsychiatry, working with faculty and other trainees from the Center for Brain Mind Medicine. Residents ultimately learn how to apply a multidisciplinary approach (functional circuitry, neuroradiology, neuropsychologic, epigenetic, behavioral, psychodynamic, among others) to the assessment and treatment of psychiatric illness.
Community Psychiatry and Justice System is a thread that spans the four years of training beginning with an overview of racism, social justice and mental health in PGY1. In PGY2 residents learn about the Recovery Model, cultural and structural competency, systems of care, impact of homelessness, and the criminalization of people with mental illness. PGY2 residents also learn core concepts in Forensic psychiatry, including committment, competence, correctional facility psychiatry, competency to stand trial, and insanity defense. The PGY3 and 4 curricula explore topics of social justice more deeply while also presenting more nuanced applications of psychiatry and the law, including malpractice, disability, regulation of impaired physicians, juvenile justice system, problematic sexual behaviors and bioethics. The PGY4 thread also includes a course on cultural psychiatry, religion and spirituality.
Psychotherapy training is emphasized from the first PGY year, when residents practice brief psychotherapy on the inpatient psychiatry unit at Brigham and Women's Faulkner Hospital. Residents receive early exposure to different modalities of psychotherapy in PGY1, followed by comprehensive didactic courses on motivational interviewing, CBT, and psychodynamic psychotherapy in PGY2. This coursework complements PGY2 residents' first experience of having their own outpatient therapy patients. PGY3 residents receive ongoing training in CBT and psychodynamic psychotherapy and practice DBT in an experiential skills course. PGY4 residents have the opportunity to learn other therapy modalities including acceptance and commitment therapy (ACT), sex therapy, group and couples therapy, concepts of hypnosis and eye movement desensitization and reprocessing (EMDR).
Evidence-based practice (EBP) is an essential physician competency required for lifelong learning in medicine. Our residents receive formal training in the core competencies of EBP including how to ask structured clinical questions, how to construct and carry out an appropriate search of the literature, how to perform a critical appraisal of different types of evidence, and how to apply the evidence to the individual patient while engaging the patient in shared decision-making. All residents are exposed to the core elements of research in a series led by our Research-Track Co-Directors, who serve as advisors for all residents interested in pursuing research.
Child Psychiatry and Development is taught by our Young Adult Mental Health faculty, Child Track Directors, and child and adolescent psychiatry faculty from Boston Children's Hospital. Residents are exposed to theories of attachment, trauma, first episode psychosis and mania in young adults, vulnerable populations, social determinants of health in children, neuro developmental disorders, neuropsychological testing, school-based psychiatry, childhood mood and anxiety disorders, autism spectrum disorders, and child CL topics.
Medical Psychiatry is a comprehensive thread that covers core concepts of consultation liaison psychiatry in addition to advanced sub-specialty medical psychiatry including psychosocial oncology, women's mental health, perinatal mental health, cardiovascular psychiatry, transplant, HIV, GI, burn and trauma psychiatry.
Career Development is a thread that starts in the PGY2 year with the exploration of career paths in psychiatry including academic psychiatry (clinician-educator, primary research), private practice, hospital employed practice, public sector psychiatry, industry, administration, advocacy and policy work, and non-traditional paths. Residents are exposed to the range of fellowship options and get to hear about the personal career paths of former residents, faculty and psychiatrists practicing in other settings. Residents are exposed to strategies for job searches, applying to fellowship, and negotiation skills. In the PGY4 year residents learn about essentials for the transition into practice including billing, liability, and other business aspects of medicine.
The curriculum is conceptualized as a series of concurrent content threads that are strategically and differentially placed according to the resident developmental continuum. Each year is created to build upon the year prior. Teaching methods vary across the four-years, with early years focused on delivery of high-yield content and development of skills in formulation and differential diagnosis. Later years become more nuanced and multidisciplinary, with focus on treatment of complex patients.
In addition to the weekly morning of protected didactics, all residents (except on medicine and neurology during PGY1) have a protected half-day for focus on scholarly work, which may include research, preparation of reviews or case reports, other scholarly writing, meeting with mentors, reading, program development, advocacy, or any other area of scholarship for which the individual is passionate. Residents are expected to present a product of their scholarly time by the end of training. Such products may take the form of a poster, manuscript, oral presentation at a regional or national meeting, and a formal talk for the grand rounds setting.