A Strong Foundation in Medicine
The role of psychiatry in population health is well recognized, and the specific responsibilities of the psychiatrist of the future differ from the psychiatrist of the past. Duke invests in training competent physicians who have expertise in psychiatry and behavioral health. Future leaders in psychiatry need to understand not only behavioral neuroscience, but also ways in which the brain and body interact for both mental and physical wellness and illness.
During the intern (PGY1) year, trainees work on general medical services at Duke Regional Hospital where they function as a medicine intern under the supervision of a medicine resident and attending hospitalist. Psychiatry interns also work in the acute care medicine clinic at the Durham VA Medical Center where they gain exposure to urgent and emergent medical concerns among adults who frequently have comorbid behavioral and mental health concerns. Finally, interns work on the combined medicine-psychiatry service at Duke University Hospital, where dual-trained (internal medicine-psychiatry) faculty members facilitate learning around the care of patients who are sick enough to be hospitalized medically but who have contributing or comorbid psychiatric issues warranting an integrated approach to their care. By the end of the PGY1 year, trainees are confident and competent in the management of routine and acute medical illnesses, and are critical thinkers with respect to the underlying medical illnesses facing patients.
Duke Psychiatry’s diverse group of therapy supervisors represent expertise in all types of psychotherapy. Seminars, experience with patients, and mentoring from supervisors offer a strong foundation of psychotherapy competency for all trainees, with rich opportunities to develop proficiency in one or more specific areas of psychotherapy. Training and supervision is provided by faculty (who may also conduct research) teaching empirically validated psychotherapies. Features of our psychotherapy training include:
- Early exposure to concepts and practice in psychotherapy through didactics in the PGY1 year.
- Weekly PGY1 process groups.
- Assignment of different psychotherapy supervisors during the PGY2, PGY3, and PGY4 years to facilitate basic competency in supportive, cognitive-behavioral, and psychodynamic therapies.
- Live supervision of therapy patients during the PGY2 year using one-way mirror observation for trainees to watch expert clinicians conduct psychotherapy.
- Participation during the PGY3 year in the Duke Family Studies Program, where expert family and couples therapists provide live supervision and feedback during therapy cases. Trainees not assigned to a case during a particular session participate as a member of the supervisory team behind the mirror and thus have the opportunity to learn from a variety of cases.
- An opportunity to take practicum electives during the PGY3 and PGY4 years in Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and/or Psychodynamic Psychotherapy.
Evidence-Based Medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM integrates individual clinical expertise with the best available external clinical evidence from systematic research. We believe that diverse types of education offers trainees a strong foundation for life-long learning.
Residents take an introductory EBM course during the PGY1 year, participate in weekly EBM conferences at the Durham VA Medical Center, and critically appraise methods in published literature during the weekly Chair’s Conference. Beyond the lecture hall, residents practice these skills on the ward and in the clinic. Duke attending psychiatrists and supervisors apply an evidence-based approach to resident supervision, whether medication or a psychosocial therapy.
Psychiatry trainees participate in meaningful quality improvement activities based on their own observations. During early efforts at quality improvement, trainees focus on improving the environment of care and safety for patients and staff in the Emergency Department, and continue to identify “low-hanging fruit” and engage in projects with the Duke Psychiatry Outpatient Clinic, transitions of care, and other arenas.
In academic medical centers, trainees observe systems in need of improvement. In an effort to help residents find a voice for effective advocacy, Duke places significant emphasis on quality improvement. Psychiatry trainees care for patients with stigmatizing illnesses who may encounter special vulnerability interacting with acute care services. By advocating for individual patients’ care, residents are able to observe opportunities where small changes may result in meaningful improvements in the delivery of behavioral health care.
Trainees obtain first-hand experience in identifying data, involving stakeholders, and leading small but measurable projects. Trainees who are interested in learning more about quality improvement may participate in Duke’s GME Patient Safety Quality Council and other institutional activities.
"The way this program has shifted to benefit residents in just the last 3-4 years is pretty incredible! We also have highly knowledgeable attendings and mentors who enjoy teaching. All in all, Duke Psychiatry is a great environment for training that more than prepares you for whatever post-residency life will bring!"
Raj Shah, MD (PGY3)