UNC General Psychiatry Residency Program
Karon Dawkins, MD, Associate Professor
Director, General PsychiatryTraining Program

About the General Psychiatry Residency Program

» Four Year Rotation Diagram (View) » Three Year Rotation Diagram (View)

» Curriculum (View Diagram)

» First Year
» Second Year
» Third Year
» Fourth Year

» Night Call
» Research Training Program
» Medical Student Teaching
» Resident Participatory Management

Introduction

The University of North Carolina General Psychiatry Residency Program offers a complete and balanced opportunity for medical school graduates to receive accredited training in general psychiatry. Our four-year program (View Four Year Rotation Diagram) participates in the National Residency Match Program (NRMP) and regularly fills all available positions. Licensed physicians who have completed an approved PGY-1 (previously called internship) may apply for a limited number of three-year positions (View Three Year Rotation Diagram) outside the Match. Currently we anticipate accepting twelve residents for the coming academic year.

While much of our training experience takes place at UNC Hospitals in Chapel Hill, the facilities of Dorothea Dix State Hospital in Raleigh, North Carolina are fully integrated into the program, as are a number of community psychiatry sites throughout the state. Our goal is to provide a clinical training experience that effectively integrates the biological, psychological, and social aspects of psychiatric theory and practice, while also developing a comprehensive knowledge base of psychodynamic principles with considerable emphasis on psychoanalytic theory. We are committed to ensuring that each trainee is firmly grounded in the current concepts and practice of psychopharmacology, neurobiology, electroconvulsive therapy, group therapy, family therapy, crisis and emergency psychiatry, consult liaison psychiatry, behavioral/cognitive approaches, community and social psychiatry, forensic psychiatry, and in understanding the scientific and research methods which underpin our specialty. We expect our graduates to be competent physicians appropriately grounded in medicine, neurology, and neuropsychiatry, as well as in general psychiatry.

Beyond our General Psychiatry residency program, we offer a Child and Adolescent Psychiatry Residency Training Program, which typically begins in the PGY-4. We also offer a Forensic Psychiatry Residency Training Program and a NIMH Research Psychiatry Fellowship. Eligibility for these residencies/fellowships require completion of a general psychiatric residency.  Psychoanalytic training is also available through the UNC/Duke Psychoanalytic Training Program. This training may be initiated during the PGY-4.

The first year of General Psychiatry residency includes a four-block* rotation on Medicine, seven blocks of Adult Inpatient Psychiatry, one block of Child Inpatient Psychiatry, and one block of Inpatient Neurology.

» Medicine Rotation

Residents are assigned to Dorothea Dix State Hospital for two blocks of the PGY-1 Medicine rotation. This assignment is a particular asset to the program in that it provides residents with the opportunity to acquire broad-based general medical training experience in the context of caring for medically ill psychiatric patients. We feel the continuity of medical care provided to patients in this program, combined with the excellence of clinical supervision, is an extraordinary resource for resident education. The integration of the basic principles of internal medicine in a psychiatric population provides an exceptionally fertile opportunity for learning primary care medicine in a context particularly pertinent to the future careers of practicing psychiatrists.

Two blocks of the PGY-1 Medicine rotation are spent on the UNC Family Practice Inpatient service. The premise of this service is that hospital care is an essential part of the primary care of a population. Patients are admitted from a wide variety of family practitioners and general internists in the community. The UNC Department of Family Medicine has a national reputation for emphasis on critical appraisal of the literature and attention to the effectiveness of care. Care and teaching are evidence-based.

» Inpatient Psychiatry

Psychiatric training in the first year of residency includes a four-block rotation on the UNC Hospitals Inpatient Service. Residents rotate on the Acute Inpatient Crisis Stabilization service and the Acute Psychotic Disorders Inpatient service for a total of three blocks. Daily rounding and close supervision with teaching attendings is provided in both settings.

The PGY-1 experience now includes a one-block assignment on the Inpatient Child Psychiatry service. During this rotation, residents round daily with a Child psychiatrist who provides clinical supervision. All Adult and Child Inpatient services at UNC are interdisciplinary team-based.

» Dorothea Dix Hospital

At Dorothea Dix Hospital, the Inpatient assignment includes four blocks on the Acute Adult Admissions service. Here, the rich variety of the patient population is combined with strong faculty supervision. The resident heads up an interdisciplinary team of mental health professionals whose combined efforts serve the challenging clinical needs of the assigned patients. Attending psychiatrists provide daily supervision.  Both the Dix and UNC services include regular third-year medical student clinical assignments and medical student teaching serves as a catalyst in the education of both residents and students.

» UNC Neurology
An outstanding feature of the PGY-1 is a Clinical Neurology rotation that includes a one-block assignment on the Inpatient Neurology teaching service at UNC Hospitals. The second Neurology rotation of two block duration occurs during the third-year and includes assignments to Neurology Clinics, where residents can expect to encounter neurobehavioral clinical presentations (e.g. seizure, sleep disorder, and pain). We believe the basic Neurology Inpatient experience in the first year, followed by a refinement and integration of skills in Neurology and Neuropsychiatry rotations during the third year, will better prepare residents for the rapidly evolving field of Clinical Neuropsychiatry.

One hallmark of this residency program is our focus on ambulatory Psychiatry and our expectation that the resident will master psychotherapeutic skills. To assure this goal, residents spend their second year full-time in our ambulatory Psychiatry program, primarily in the UNC Hospitals Psychiatric Outpatient Clinic, with additional rotations to the Child Psychiatry Clinic and a community mental health center. During this year, residents participate in the evaluation of a large variety of adult and child outpatients, with training in Emergency Psychiatry, crisis intervention, Psychopharmacology, and a broad range of psychotherapies. A special emphasis is placed on residents being able to master skills in the provision of long-term psychoanalytic insight-oriented Psychotherapy involving three to four carefully chosen patients. Residents are assigned a minimum of two long-term psychotherapy supervisors, who each provide one hour of supervision per week. These supervisors are drawn from both full-time and community-based clinical faculty, many of whom are trained psychoanalysts. The on site presence of the jointly sponsored UNC/Duke Psychoanalytic Training Program provides both didactic and supervisory input to the residency experience.

Continuity of treatment experience is essential to truly mastering the subtlety of psychiatric practice. Therefore, we believe it important for residents to follow patients over time. Consequently, the third and fourth year have minimum ten-hour per week longitudinal tracts in the Outpatient Clinic dedicated to the ongoing care of ambulatory patients. In this context, the resident has continuity in long-term Psychotherapy training, as well as long-term clinical care and management of a broad spectrum of psychiatric patients. It should be noted that in the event a patient under the care of a third or fourth year resident requires hospitalization, the resident maintains some continuity of care for the patient on the Inpatient Service and receives the patient back into outpatient care upon discharge. We believe this is optimal for patient care as well as educational experience.

The third year of residency is composed of rotations, each of which is considered to be a three-quarter time assignment (allowing ongoing outpatient time of ten hours per week). The Consultation Liaison teaching service, a four-block rotation, is an academically charged service, which offers one-on-one bedside teaching by attendings who evaluate all patients with the residents. In addition, for the duration of the rotation, each resident is assigned to an interdisciplinary medical specialty program for a liaison experience that is supervised regularly by a faculty psychiatrist also involved with that program.

The two-block Neurology experience is described above (First Year).

The final year of residency (PGY-4) includes a ten-hour commitment to ongoing outpatient work, which includes psychotherapy cases, as well as continuity of care for other patients. Additional hours each week are dedicated to the Crisis Service (follow-up of patients from our Walk-In Clinic and bridging appointments for recently discharged patients) and Substance Abuse (outpatient management of substance abuse patients). One day per week is dedicated to an advanced community psychiatry assignment, which allows the resident to select from a wide variety of elective choices that are available through an array of modern mental health facilities under the umbrella of the North Carolina Area Health Education Center (AHEC) program. This assignment may include clinical work with special populations (substance abuse, adolescents, criminal justice, rural services, mobile crisis approaches, etc.) or it may focus on administrative issues within the community or on research interests.

The remainder of the fourth-year is elective, with numerous opportunities available to the resident. Possible electives include chief residency and senior administrative opportunities, forensic psychiatry, substance abuse, consult liaison, community and public sector psychiatry, additional psychotherapeutic training, neuropsychiatry, geriatric and child and adolescent psychiatry, to name a few opportunities. Participation in a wide range of clinical and basic science research is also available. Residents design their electives in collaboration with faculty advisors.

The call structure is supervised in all settings by senior faculty who are available to the resident and who actively participate with the resident in clinical decision making. There is currently no third- or fourth-year overnight call beyond emergency backup situations. There is, however, a possibility of some limited third-year call in the future. PGY-3, 4, 5, as well as Child and Adolescent Psychiatry residents will assist on weekend Inpatient Rounds, approximately q9 to q10 weekends. PGY-2, PGY-3, and PGY-4 residents cover, one day at a time, our Walk-In Clinic from 8:30am – 4:30pm. It should be noted that we consider call to be a significant learning experience and treat it as such by providing active faculty back up and supervision in helping residents learn to manage challenging crisis situations.

» First-Year Night Call
Night call averages currently as follows: Dorothea Dix Medicine Service every fourth night (q4); Dorothea Dix Inpatient Psychiatry Service every fourth night (q4); UNC Inpatient Psychiatry Service every fourth night (q4); and UNC Inpatient Neurology Service every fourth night (q4). First-year Psychiatry residents at UNC will have short call on Sundays through Thursdays and long call on Fridays and Saturdays.

» Second-Year Night Call
Call rotates among the second-year residents as a group and occurs approximately twice a month. In addition, there will be 3-4 weeks, one week at a time, of night float.

Residents are required to attend formal teaching seminars that are an active and integral part of each year of residency. The curriculum is designed for continuity year to year with an effort to integrate basic concepts of biological, psychodynamic, and behavioral principles. In addition, residents are exposed to group and family systems theory, as well as to the various treatment approaches and strategies targeting specific psychiatric syndromes and populations. Principles of community and social psychiatry, forensic psychiatry, cross cultural issues, minority issues, ethics, history of psychiatry, women's issues, and basic principles of office practice management, as well as consideration of career options in the academic and public sectors, are all considered. The changing health care systems, managed care influences, and the impact of changing financial systems are also considered as they impact psychiatry and the practicing psychiatrist.

In addition to being students, we also expect our residents to be teachers. During the first three years of training, the resident is in regular contact with third-year medical students and is expected to assume considerable responsibility for their clinical training. In the fourth year, senior and chief residents are given the opportunity to participate in didactic offerings to medical students.

A formal, organized resident group, called the Residents' Forum, with leaders and regular, departmentally-sanctioned meetings, serves a political, as well as a social, function for the residents. Residents at each level have substantial input into the management of their residency program. Elected representatives from each postgraduate year serve on the Residency Education Committee, the primary governing body for the residency. Faculty, in collaboration with elected resident representatives, help review, organize, and plan the program and curriculum for each resident class.

» Residency Request

» Letter from Director

» Letter from Training Administrator

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