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Didactic Thematic Structures and Values of the Program

The bio-psycho-social-cultural model of mental illness provides the framework for the entire educational experience. The principles and application of evidence-based medicine are incorporated throughout the didactic and rotation based seminars.

Psychotherapy, psychopharmacology, neurobiology/ neuropsychiatry, and Evidence Based Medicine and Critical Thinking are major themes throughout the four years of didactics and clinical rotations. All seminars are intended to supplement the clinical training with theory and the research findings to support the best clinical outcomes possible.

Summer Didactics

A summer seminar, "Cross Cultural Issues in Psychiatry" is jointly taught by residents and faculty. The seminar is required of PGY-2 residents and Psychology Interns. In this 8 week didactic/experiential seminar, trainees explore the impact of culture, class, sexual orientation, ethnicity and race on psychiatric disorders and their treatment. The seminar brings together a multidisciplinary group of diverse trainees for mutual learning and focuses on the specific issues reflected in the multicultural populations of Cambridge Health Alliance.

Each training year also has a "Summer Session" didactic series that introduces each of the Fall seminars. Also, the summer session provides additional topics that meet the training psychiatrist’s developmental needs:

Post-Graduate Year 1

Introduction to Emergency Psychiatry: Lior Givon, MD
Intro to Psychopharmacology: Matthew Ruble, MD
Intro to Addiction Psychiatry: Jan Kauffman, MPH
Preparing for clinical interviewing and CSV exams: Matt Ruble, MD
Professional Identity Development: Transitioning from Physician to Physician/Psychiatrist: Marshall Forstein, MD
Preparation Seminar for the PGY-2 year (spring PGY-1 year): Chief Residents
Residency nuts and bolts: Robert Tetirick, MA, Training Coordinator

Post-Graduate Year 2

Neuropsychiatry: TBA , MD
Rehabilitation Psychiatry: Miriam Tepper, MD,/ Raymond Flannery, Ph.D.
Multicultural Competency Seminar: Treneice Harris-Lewis, Ph.D.
Academic Writing: Malkah Notman, MD
DSM V: Jay Burke, MD, MPH
Dynamic Formulation: Marshall Forstein, MD
Great Papers: All faculty and residents – PGY2-4

Post-Graduate Year 3

Outpatient Orientation: Various Staff and Chief Residents
Geriatric psychiatry: Stephen Pinals, MD and Matthew Ehrlich, MD
DBT: Amy Sobieszczyk, LICSW
Resident as Teacher: Matthew Ruble, MD
Psychopharmacology: Jessica Goren, PharmD and Matt Ruble, MD
CBT: Wayne Brunell, MD

Post-Graduate Year 4

Master Clinician Series: Various faculty
Resident as Teacher: Matt Ruble, MD
Supervision Seminar: Marshall Forstein, MD
Chief and Supervising PGY2-3 On Call responsibilities
Ethics: J. Wesley Boyd, MD/ Bennett Simon, MD
Motivational Interviewing: Zev Schuman, MD

Fall and Spring Seminars

Post-Graduate Year 2

In the Post-Graduate Year 2, the Psychopathology, Diagnostic Formulation, and psychopharmacology seminar begins with descriptive modules based on DSM diagnostic categories. This two hour seminar integrates the pharmacologic and psychotherapeutic treatment into the discussions of psychopathology.. Lectures include an overview of epidemiology, diagnostic criteria, and hypotheses regarding etiology, course/prognosis, and treatment. This descriptive material is interspersed with lectures on various biological and psychological concepts regarding mental disorders, with an emphasis on the role of culture, class and social structures on formulation. Residents prepare and present to their peers and get feedback about their academic work as well as their teaching style and preparation.

A comprehensive seminar on rehabilitation issues for people with chronic and persistent mental illness introduces the residents to the possibilities of enhancing strengths and resiliency to improve the lives of patients.

The dynamic formulation seminar is an introduction to the concepts of formulation as a foundation of assessment and treatment. Formulation is learned through the presentation of model paradigms and case material is used to learn how to apply these models. This seminar is preparation for the year long seminar in dynamic psychotherapy.

The writing seminar is a brief introduction to writing about patients from the clinician’s countertransference. Residents use an ongoing case or new evaluation to describe the emotional responses they have to a patient.

Post-Graduate Year 2 Curriculum/Seminar Faculty

Introduction to Psychotherapy: Cathy Schen, MD
Psychodynamic Formulation: Marshall Forstein, MD
Integrated Psychopathology, Diagnostic Formulation, and Psychopharmacology. Matthew Ehrlich, MD, and Matthew Ruble, MD
Consultation-Liaison Seminar: Robert Joseph, MD
Emergency Psychiatry: Lior Givon, MD
Group Therapy Module: Steven Cadwell, Ph.D.
Rehabilitation Psychiatry: Miriam Tepper, MD
Journal Club: Lior Givon, MD; Ed Trejo, MD and PGY-4 Chief Residents.
Annual Observed Clinical Exams and ABPN Certification Exams: The Faculty
T-Group: Training group. Facilitated by Laurie Raymond, MD

Post-Graduate Year 3

In the Post-Graduate Year 3, residents are introduced to the paradigms that we have used in psychiatry to understand human development and function. The Normal and Abnormal Child and Adolescent Development seminar will provide a basic foundation for understanding the roots of childhood, adolescent, and adult behavior and psychopathology. The course is directed by a child psychiatrist who invites experts in the field of separation attachment, moral development, adolescent sexuality, childhood psychopathology and other critical issues in child development to enhance the seminar and showcase leaders in the field.

Other seminars deepen the experience of psychotherapy, and broaden the basic science knowledge in neurobiology and biological therapies.

PGY3 Curriculum/Seminar Faculty

Human Development & Developmental Psychopathology: Nancy Rappaport, MD

Psychotherapy Seminar:
- CBT: Wayne Brunell, MD
- Dynamic Therapy: Alan Siegel, Ed.D.
- Supportive psychotherapy: Marshall Forstein, MD

Biological Therapies and Neuroscience: Lior Givon, MD
Evidence Based Medicine/Research Literacy: Steve Leff, PhD; Lior Givon, MD
Psychopharmacology: Clinical cases and Advanced topics: Nassir Ghaemi, MD, MPH; Ed Trejo, MD
Brain and Behavior; Lior Givon, MD
Advanced Neurology Seminar, Bruce Price, MD et. al
Journal Club: Hsiang Hunag, MD / Lior Givon, MD
Forensics: Daniel Reilly, MD
Geriatrics: Steve Pinals, MD
History of Psychiatry: Marla Eby, PhD
Psychology and Neuropsychological Testing: Marla Eby, PhD
Sexuality and Psychiatry: Marshall Forstein, MD and Malkah Notman, MD
Spirituality and Psychotherapy: John Chirban, PhD
Annual Observed Clinical Exams and ABPN Certification ExamsMatthew Ruble, MD and the core faculty

Post-Graduate Year 4

In the Post-Graduate Year 4, seminars continue to enhance knowledge and practice in the areas of psychotherapy, psychopharmacology and neuropsychiatry. Residents may choose to pursue and deepen their knowledge in a specific area by enrolling in specialized seminars. A large number of elective seminars are open to trainees and staff at Cambridge Health Alliance. Residents may choose to acquire expertise in a specific area by becoming advanced trainees in specialized programs within our system, which offer didactics, supervision, and clinical experience. Examples of such programs are the Victims of Violence Program in which many kinds of trauma are treated and researched; the Program for Psychotherapy, in which residents treat patients with intensive psychodynamic psychotherapy.

The focus of the fourth year is integration of the biological, psychological and social aspects of mental illness into a comprehensive view of a person within the context of his/her biology/family and community.

Curriculum/Seminar Faculty

Theory and Practice of psychotherapy: Jack Beinashowitz, PhD
Psychotherapy Cases: Alfred Margulies, MD
Supervision Seminar: Marshall Forstein, MD
Neurobiology and Neuropsychiatry: Lior Givon, MD
Advanced Biologic Therapies and Neuroscience: Bruce Price, MD; Nassir Ghaemi, MD, MPH
Neurology Review: TBA , MD
Transition to Practice: Donna Moores, MD
CBT Seminar and Supervision: Robert Goisman, MD
Advanced Couples and Family Therapy Seminar and Supervision: Jill Harkaway, Ed.D.
Ethics in Psychiatry: J. Wesley Boyd, MD, PhD/ Bennett Simon, MD
Psychiatry and Neurology Boards Review: Rheinila Fernandes, MD
Annual Observed Clinical Exams and ABPN Certification Exams: Dan Reilly, MD Matthew Ruble, MD and Core Faculty
Advanced Supervision in Trauma: Judy Herman, MD
Advanced Supervision in Psychodynamics: Al Margulies, MD
Scholarly Projects: Steve Leff, Ph.D.

Biological Therapies and Neuroscience

This four-year sequence is designed to establish a solid base of knowledge in the areas of biologic therapy and neuroscience. In the PGY1, interns learn about the principles of psychopharmacology. In the PGY2 seminar, instruction is organized around the major classes of psychotropic medications. Other topics include drug interactions, toxicities, ECT, the use of medication in special patient populations, and psychodynamic issues in the practice of psychopharmacology.

The PGY3 seminar focuses on medication management in the outpatient population. The major classes of medications are discussed with an emphasis on the literature supporting their use. The mechanism of action of these drugs is reviewed and the neurobiology of major psychiatric disorders presented. In an ongoing Journal Club, residents read relevant articles and learn to critically assess their value.

The PGY4 seminar features invited speakers who are recognized experts in particular areas of biological psychiatry, psychopharmacology, and behavioral neurology.

The neurobiology and neuropsychiatry seminars provide a basic anatomical and neurobiological framework on which to place the clinical neuropsychiatric syndromes encountered by the residents in patients with complex medical and psychiatric disorders. Opportunities exist for residents with particular interests in neuropsychiatric disorders like Parkinson's Disease, Huntington's Chorea, and HIV dementia to obtain clinical experience in these areas.

Psychotherapy Seminar

Psychotherapy is taught over the course of three years as a series of seminars that focus on clinical work at each stage of training. In the PGY2, when residents are primarily on inpatient units in an acute care setting, the focus of the seminar is on crisis management, alliance formation, and underlying dynamic processes in the patient-therapist relationship. In the first month of the seminar, the discussion centers on meeting and beginning therapy with outpatients. Subsequently, residents are asked to present transcribed material from inpatient cases or from their outpatient psychotherapy sessions. Adjunctive readings are assigned. The case-based format encourages residents to learn experientially about basic concepts of psychotherapy, such as transference, countertransference, resistance, and interpretation.

The PGY3 psychotherapy seminar introduces residents to a variety of therapeutic modalities while they are working on multidisciplinary outpatient treatment teams. Residents learn about cognitive behavioral therapy, supportive, and short-term therapy. They continue to deepen their understanding of dynamic psychotherapy with guided reading and case-based discussions. The two PGY4 psychotherapy seminars are advanced courses that introduce multiple theoretical perspectives and techniques. An integrative approach is emphasized in topics such as process and outcome research, models of brain/mind, and the interaction between psychopharmacology and psychodynamics. Case-based discussions with senior staff help the Residents gain insight into their own therapeutic style.

Over the span of three years, the resident emerges with a solid foundation in psychotherapy practice and theory as preparation for the further study of psychotherapy or for a career as a general psychiatrist.

Evidence Based Medicine/Research Seminar

Evidence based medicine, journal club and research seminars are threaded throughout each of the 4 years of training. During the PGY1 year, residents learn research skill building and practice the use of library resources, which include not only the Cambridge Health Alliance library but direct access to the Harvard Medical School Countway Library and Electronic Journal system. In the second year, residents work through individually the basics of Evidence-Based psychiatry, identifying areas for further study through the critical reading of published research articles in the Journal Club. Residents are encouraged to find mentors in the areas of interest to begin thinking about the scholarly project that is required by the end of the program.

In the PGY3 year, residents will learn about research design and review important methodological and statistical concepts. Each resident will pursue a clinical question and create a research protocol. In the research seminar, residents are also encouraged to develop and present on topics of their own choice. Residents will determine how to conduct the research and what its impact might be, and in the PGY4 year a subset of residents will elect to implement their research protocols. While not all residents will choose to pursue clinical research in the fourth year, or afterwards, every resident will develop the skills required to be critical evaluators of research in order to bring the highest quality of care to their patients, and to develop the skills necessary for lifelong learning.

As part of the PGY-4 experience, residents are required to engage in a Scholarly Project. Projects have included: Review articles, pilot research studies, case reports, development of teaching materials and curriculum, presentations at national meetings, a literature review, participation in an ongoing research project, a teaching experience with written assessment and critique, amongst many others.

Group Therapy Module/Training Group

At the beginning of the PGY2, Residents are introduced to concepts of group therapy in a didactic module that precedes the beginning of their own group experience. PGY2 Residents are required to participate in a weekly training group led by an experienced group therapist. This module and personal exposure to group dynamics prepares them to lead psychotherapy groups for patients. At the end of the PGY-2 year, the residents make a group decision about whether to continue their training group for the PGY-3 year.

Special Seminars

During the summer residents in all years attend a session called Great Papers in which selected faculty present a discussion of an article in the literature that has a profound meaning for the field of psychiatry. A resident provides a synopsis of the paper and the faculty member is the discussant. Each year the papers change to provide exposure to either historical or current papers in the literature.

A series of shorter seminars that compliment specific clinical rotations or stages of training are offered throughout the residency. These seminars include cross-cultural psychiatry, ethical principles in the practice of psychiatry, sexuality and psychiatry, and psychosocial rehabilitation. Residents also learn about the history of psychiatry and have an opportunity to think about the role of spirituality in the treatment of patients with psychiatric disorders. Throughout the four years of the program a considerable emphasis is given to learning how to interview patients from various points of views and schools of thought. An ongoing discussion throughout the academic year starts with a Summer Grand Rounds Series on Gender and Sexuality that is open to all trainees and faculty.