Duke Psychiatry residents receive broad-based training with an emphasis on the biopsychosocial model of mental illness. Our trainees are encouraged to pursue a balanced education, integrating theoretical and scientific understandings of psychiatry. Residents learn through clinical experiences in our many training sites and through lecture-format and interactive teachings offered during protected academic half-day sessions by leaders in the field of psychiatry.
The Duke Psychiatry Residency Program is a part of the Duke University Hospital System, a nationally ranked academic medical center and one of the most sophisticated centers in the world for medical education. Located in Durham, North Carolina, Duke has three hospitals, Duke University Hospital, Duke Regional Hospital and Duke Raleigh Hospital. The Psychiatry Residency Training Program is closely affiliated with the Durham Veterans Affairs Medical Center and Central Regional Hospital, a North Carolina state psychiatric hospital.
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 may differ from the psychiatrist of the past. At Duke, we are invested in training competent physicians who have expertise in behavioral health / psychiatry. Future leaders in psychiatry will 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 year Duke Psychiatry trainees work on general medical services at Duke Regional Hospital, where they function in the full role of a medicine intern under the supervision of a medicine resident and attending. 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, our interns work on the combined medicine-psychiatry service at Duke University Hospital, where dually-trained faculty members facilitate their learning about 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 intern year it is our goal that our trainees are confident and competent in the management of routine and acute medical illnesses and that they are critical thinkers with respect to the underlying medical illnesses that will face their future patients.
Duke Psychiatry and Behavioral Sciences has a tradition of training in psychotherapy, rooted in the work of Adolf Meyer, Fred Hine, and David Werman. Our large, diverse group of supervisors represents expertise in all types of psychotherapy. Seminars, experience with patients, and mentoring from therapy supervisors provides a strong foundation of psychotherapy competency for all residents, with rich opportunities to develop proficiency in one or more specific types of psychotherapy. Personal, individual psychotherapy is strongly encouraged, though not required.
Features of our psychotherapy training include:
- Interns enjoy early exposure to concepts and practice in psychotherapy through didactics in the PGY1 year.
- Interns also have a weekly intern process group.
- All trainees are assigned a psychotherapy supervisor during the PGY2 year, another psychotherapy supervisor during the PGY3 year, and another supervisor during the PGY4 year and will be able to achieve basic competency in supportive, cognitive-behavioral and psychodynamic therapies.
- Second-year trainees begin to see patients in the outpatient setting through a weekly continuity clinic; for the first half of the year trainees observe psychotherapy conducted by an expert clinician, with real-time feedback and commentary by a supervisor who sits behind the mirror with the trainees while the psychotherapy session proceeds.
- Live supervision of therapy patients from behind one-way mirror starts in the PGY-2 weekly outpatient clinic after a six-month period of time during which the one-way mirror observation takes place with trainees watching an expert clinician conduct psychotherapy with supervision by another expert clinician.
- PGY3 trainees at Duke spend a year in the Duke Family Studies Program, where expert family and couples therapists provide live supervision and feedback during therapy cases; trainees who are 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 diversity of cases.
- PGY3 and PGY4 trainees have the opportunity to take “practicum” electives in Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Psychodynamic Psychotherapy.
- All training and supervision is provided by faculty who teach (and often research) empirically-validated psychotherapies.
Evidence-Based Medicine in Psychiatry
Evidence-based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
Why do we emphasize Evidence-Based Medicine?
At Duke, we believe that the best education gives trainees the best foundation for life-long learning.
How do residents learn Evidence-Based Medicine skills at Duke?
Residents begin with an EBM Start-Up course during the PGY1 year. Trainees participate in a weekly EBM conference at the Durham VA Medical Center and have the opportunity to critically appraise methods in published literature during weekly Chair’s Conference at Duke.
Beyond the lecture hall, residents are challenged to practice these skills on the ward and in the clinic. Duke attendings and supervisors apply an evidence-based approach to resident supervision, whether the topic is a medication or a psychosocial therapy.
Quality Improvement in Psychiatry
Psychiatry trainees have participated in meaningful quality improvement activities based on their own observations. During early efforts at quality improvement, trainees focused on improving the environment of care and safety for patients and staff in the Emergency Department. Through focused projects trainees have successfully implemented a nurse-measured, evidence-based checklist to help predict violence risk. Through continued work, trainee suggestions for improvements in staffing have been gradually implemented. Trainees continue to identify “low hanging fruit” for their quality improvement efforts and are engaged in projects in the Duke Psychiatry Outpatient Clinic, in transitions of care, and in other arenas.
Why do we emphasize Quality Improvement?
In an academic medical center, learners are well positioned to observe systems in need of improvement. Psychiatry trainees are in a particularly noteworthy position as they care for patients with stigmatizing illnesses who encounter special vulnerability interacting with acute care services. In advocating for individual patients’ care, residents are in an ideal position to make observations about “what small changes could we make that might result in meaningful improvements in the delivery of behavioral health care.” In an effort to help residents find a voice for effective advocacy, an emphasis on Quality Improvement began in the 2013-2014 academic year.
How do residents learn Quality Improvement at Duke?
During large-group sessions encompassing all four years of training, trainees are exposed to the idea of continuous quality improvement regarding the training program.
Toward the end of the PGY2 year, trainees participate in a curricular series on “evidence-based medicine and quality improvement,” during which they learn about the IHI Model for Improvement and begin to brainstorm projects.
By December of the PGY3 year, every trainee is required to complete one PDSA (Plan, Do, Study, Act) cycle according to the Model for Improvement. Our residents thereby get first-hand experience in the importance of identifying data, “involving stakeholders” and selecting small but measurable projects.
For trainees in the latter portion of training who are interested in learning more about quality improvement, there are opportunities to participate in the institutional GME Patient Safety Quality Council as well as in the Duke GME Concentrations Program in Patient Safety and Quality Improvement.
What to expect during your residency at Duke
The Duke Psychiatry Residency Training Program is known as a “front-loaded” program in which trainees in the PGY1 and PGY2 years complete most of the acute care requirements before proceeding to the more ambulatory and elective PGY3 and PGY4 years. Elective opportunities available in the PGY3 and PGY4 years are abundant and varied and range from research electives to neuromodulation to psychotherapy practicums and experiences. A number of Duke Psychiatry residents also avail themselves of the opportunity to participate in one of the Duke GME Concentrations (which are available in Patient Safety and Quality Improvement; Resident as Teacher; Law, Ethics and Health Policy; and Leaders in Medicine).
Medicine (3 inpatient, 1 outpatient)
1 month Duke inpatient MedPsych
1 month Acute Care Clinic at Durham VA
2 months General Medicine at Durham Regional Hospital
2 months Duke inpatient
2 months Durham VA inpatient
2 months Durham VA Psychiatry Emergency Center
1 month Duke Emergency Department night float
Inpatient Psychiatry at Central Regional Hospital
3 months Adult Admissions Unit
1 month Geriatric Psychiatry
1 month child psychiatry
1 month night float
1 month Durham VA PEC
2 months Duke Emergency Department night fload, modified schedule
2 months Duke Hospital C/L
1 month Durham VA C/L
The transition from acute care psychiatry to outpatient psychiatry is eagerly anticipated by our trainees, who learn early in the PGY3 year that the responsibilities are different, but the learning opportunities continue to be plentiful and salient! A “typical” schedule is depicted below. Please note that all PGY3 trainees are required to do a full day in the Duke Psychiatry Outpatient Clinic (Monday or Friday), a full day in the VA Mental Health Clinic, and a half-day in the Duke Center for Child and Family Studies (Thursday afternoon), as well as participate in the didactics offered during Academic Half-Day (Tuesday afternoon). Trainees in the PGY3 year may opt to meet most of their remaining ABPN requirements by also doing a half-day per week of Neurology, a half-day per week of Community Psychiatry (which, if it includes an addictions component, can count toward the addictions requirement), an additional half-day per week at the Durham VA, and an additional half-day per week at the Duke Psychiatry Outpatient Clinic. Some trainees may pursue electives during the PGY3 year, punting Neurology, Community, and/or VA and Duke Psychiatry Outpatient responsibilities to the PGY4 year.
Full Day Duke Psychiatry Outpatient Clinic
Half-Day Duke Psychiatry Outpatient Clini
Full Day VA Mental Health Clinic
Half-Day VA PRIME/ Women’s Health Clinic
Half-Day Family Studies
Half-Day Community Psychiatry
Depending on the way the trainee has scheduled his/her PGY3 year, the PGY4 year is one that includes at least a half-day per week in the Duke Psychiatry Outpatient Clinic, a half-day per week in the Academic Half-Day, and the rest of the time devoted to completing any remaining requirements. A sample schedule follows:
Half-Day Duke Psychiatry Outpatient Clinic
How to Apply
- All applicants must apply through ERAS website https://www.aamc.org/students/medstudents/eras/
- We review applications received through ERAS when the PostOffice opens
- We will only consider candidates who will be eligible for a Residency Training License in the State of North Carolina (see eligibility requirements here)
- We require a minimum of THREE Letters of Recommendation
- If you are a Foreign Medical Graduate, we require ECFMG certification
- We sponsor the following visas: J1
- We do NOT accept COMLEX Scores in place of USMLE Scores
- Trainees must pass USMLE Step 1, Step 2CK, and Step 2CS prior to commencing their Duke postgraduate training
If you have any questions, please contact the residency office at (919) 684-2258.