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Adult Psychiatry Residency

An exceptional training experience at a Harvard Teaching Hospital

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The CHA Adult Psychiatry Training Program aims to prepare residents for careers as clinicians, educators, and leaders by fostering a collaborative learning environment that emphasizes critical thinking, scholarship, leadership, social justice, humanistic care and a biopsychosociocultural approach to patient care, in the context of population health.

Program Philosophy and Educational Approach

Our program provides a broad-based experience that prepares residents for their chosen careers. Didactic and clinical responsibilities are designed to foster the development of ethical, independent, and responsible psychiatrists who will make significant contributions to the mental and global health of adults and their families. We provide a flexible environment that trains residents to excel professionally in psychotherapy, psychopharmacology, administration, academic education, and/or clinical investigation. Graduates are competent in the diagnosis and treatment of the full range of mental disorders. The overall philosophy of the department is pluralistic: assessing each individual, couple, or family thoroughly and applying the most evidence-based, humanistic approaches to any clinical situation.

At Cambridge Health Alliance, we emphasize a bio-psycho-social-cultural approach to the understanding of mental illness. We value psychotherapy and we have a deep and enduring commitment to teaching psychodynamic formulation and dynamic psychotherapy. Residents Image of Lior Glyon, MD and Todd Griswold, MDlearn about psychodynamic principles through didactics and close supervision throughout the residency. Faculty Lior Givon, MD winner of Al Margulies Teaching Award, with Todd Griswold, MD Director of Medical Student Education CHA.Our curriculum also includes training in the use of major psychotherapies including cognitive-behavioral, dialectical behavioral, time-limited as well as long -term dynamic and supportive therapies, group therapy, and family systems therapy. The curriculum also has a strong biological psychiatry component that includes neuroscience, neuropsychiatry, and the principles and practice of psychopharmacology. Psychopharmacology is taught throughout the four-year residency, as well as in each clinical rotation where population specific and illness specific nuances of psychopharmacologic treatment are studied. Training includes integrating psychopharmacology into psychotherapeutic treatment as well as managing the psychopharmacologic treatment of patients seen by other non-medical therapists.

The overall goals of the training program are to prepare psychiatrists who are skilled clinicians, critical appraisers of the science behind the practice of psychiatry and medicine, and lifelong learners in order to keep up with extraordinary ongoing developments in psychiatric research and clinical practice. Lifelong learning skills are developed in a context of scientific knowledge and clinical application. Over the four years of didactics and clinical rotations, increasing emphasis is placed on the process of learning by case based seminars and cooperative learning experiences. Residents consolidate their learning through having to teach medical students and in presenting to each other and to the department of psychiatry in various formats.

During the Residency we stress a developmental point of view through didactics on human development and clinical work with children. Our goal is to enhance the understanding of adults and to provide basic skills in child psychiatry. Training is conducted with assistance from expert and senior faculty of the Department's Child and Adolescent division.

Clinical and didactic education occurs in multidisciplinary settings in which there are training programs for a full range of mental health professionals. Inter-disciplinary conferences have been developed for trainees in psychiatry, psychology, social work, and psychiatric nursing.

The Patient Population
A particular strength of our program is the diverse patient population, which includes people with a broad spectrum of mental health problems and an impressive array of ages, cultures, and socioeconomic backgrounds. Of equal importance, training in our program is integrated within a comprehensive community mental health delivery system. Residents can choose to focus part of their outpatient training in one of the linguistic minority clinics (Latino, Portuguese, Haitian Creole, and several Southeast Asian languages).

Service and training occur in a variety of settings: inpatient, outpatient, partial hospital, emergency service and outreach, home visits, and in primary care/ behavioral health collaborative care outpatient clinics. Other clinics within Cambridge Health Alliance include: Health Care for the Homeless, the Women’s Health Center, The Zinberg HIV Clinic and the Asylum Clinic. Residents can elect clinical rotations at other health care centers as well. A newly reorganized Gender and Sexuality Consultation Service offers provider to provider consultations as well as evaluation for patients throughout the life cycle with concerns about gender identity and/or sexual orientation.

This comprehensive four year training program has 32 residents. The training program is one of the four Harvard Medical School Adult Psychiatric Residencies, and the department serves as a popular training site for Harvard Medical students. Medical student teaching is an active part of the psychiatric residency program. Specialized chief residency positions provide opportunities for residents interested in pursuing clinical, academic, and research interests. An intensive two-year psychotherapy fellowship provides an opportunity for advanced work in long-term psychodynamic therapy.

The Department also sponsors a two-year Child & Adolescent Psychiatry Fellowship, to which some Residents choose to apply after their PGY3 or PGY4 in our Adult Psychiatry program. Our Adult and Child Training Programs are certified and in good standing with the Residency Review Committee in Psychiatry of the Accreditation Council for Graduate Medical Education (ACGME). The Department also sponsors ACGME accredited fellowships in Geriatric Psychiatry and Psychosomatic Medicine.

Pioneering innovations in health care delivery / transitioning to ACO model
As outlined in the Medicaid Waiver granted to Massachusetts, "Cambridge Health Alliance (CHA) is the only public acute hospital system in the Commonwealth. CHA was founded to fulfill a public mission: the provision of high-quality medical and mental health services to the most vulnerable, underserved populations."

CHA is evolving from a traditional fee-for-service system to an Accountable Care Organization (ACO) with the emphasis on primary and mental health care. The Massachusetts Universal Health Care system has served as the model for the National Health Care Reform passed under the Obama administration, and the Commonwealth of Massachusetts has positioned Cambridge Health Alliance to pilot the development of the Accountable Care Organizational structures to provide universal, cost effective and comprehensive primary and mental health care.

We see this evolution as an exciting opportunity to train residents and other health professionals in the integration of primary care and mental health to prepare the providers for the future in the model of a comprehensive medical home as outlined in the Institute of Medicine's recent report.

CHA has been engaging in Integrated, Collaborative Care for over 20 years in our primary care centers. We have a growing program in training providers for the future of integrated care, and a project involving telemedicine to provide psychiatric consultation to primary care providers throughout Cambridge Health Alliance.

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