PGY1
PGY1s focus on the fundamentals of psychiatry, including interviewing skills and diagnosing patients within the framework of the DSM-5. They also practice biopsychosocial formulation and case presentation. They are expected to read independently about the evidence-based management of their patients’ pathology and propose appropriate psychopharmacologic management. Call is limited to on-service rotations, with interns taking 1-2 shifts/week (M-F) coveraging admissions to HMHI and IPU from 5-8PM, capped at 3 admissions total.
On-Service Rotations
PGY1s rotate between our program’s home base, the Huntsman Mental Health Institute (HMHI), the inpatient medical-psychiatry (IMP) service at the University of Utah Medical Center (UUMC), and the inpatient psychiatry unit (IPU) the George E. Wahlen VA Medical Center (VAMC). A typical schedule includes two or more months at HMHI on general adult inpatient psychiatry, one month of specialized inpatient addiction training, one month on IMP, and one month at the IPU. PGY1s also complete several weeks of day float where they oversee admissions to adult inpatient psychiatry at HMHI. Day float residents assess patients for medical and psychiatric appropriateness for admission and triage patients who need urgent evaluation.
Off-Service Rotations
PGY1s complete a total of six months in off-service rotations, where they perform the same duties as categorical medicine and neurology interns. Off-service rotations are done in three month blocks which alternate with three month blocks of psychiatry training. Core rotations are based at UUMC and the VAMC. Residents may also rotate at Intermountain Primary Children’s Hospital for experience with child neurology or pediatrics. All rotations are inpatient with the exception of a one month elective in either UUMC Emergency Medicine or VAMC Outpatient Internal Medicine.
PGY2
PGY2 residents complete a diverse array of psychiatric rotations, including: consult-liaison psychiatry (University Hospital, VAMC; see description below), crisis management (UUMC ED), geriatric psychiatry (VA clinics), child psychiatry (HMHI), and night float (see description below). PGY2s also continue to rotate on the general adult inpatient psychiatry units at HMHI.
PGY2s have more flexibility to travel for electives or develop their own educational experiences. Elective options include: inpatient psychiatry at the Utah State Hospital forensics unit, inpatient units at community hospitals outside of the Salt Lake Valley through our rural outreach program (RETURN), and many more.
PGY2s further incorporate psychotherapeutic concepts from the didactic curriculum into their interviews. They continue to refine skills and develop autonomy in medical decision-making and leading an interdisciplinary team. They also begin seeing their first psychotherapy patient.
Night Float
Night float residents provide overnight cross coverage for patients admitted to HMHI. All residents rotate for several weeks in PGY2 on night float, developing increased expertise in medical screening and triage, and respond to issues that arise with admitted patients. Residents commonly report that night float is a challenging and rewarding experience where they are able to exercise clinical judgment with increased autonomy.
UUMC Consult-Liaison Psychiatry
PGY2s complete one month on the consult-liaison (CL) service at UUMC. Here, residents are exposed to diverse manifestations of psychiatric illness in medical and surgical patients. They evaluate whether behavioral presentations have non-psychiatric etiologies. They gain insight into the psychological impact of medical illness on patients and into the barriers psychiatric illness can present to accessing and accepting medical care. Residents practice determining which pharmacologic and therapeutic interventions are appropriate for a given medically-ill patient, as well as triaging consults and leading an interdisciplinary team with other learners. There is a second month of CL that takes place at the VAMC.
PGY3
Residents begin their outpatient rotations in PGY3. PGY3s spent this year continuing to develop pharmacologic expertise and clinical judgment in the setting of increased autonomy and lower acuity patients. Call is limited to several weeks of supervision of junior residents from home. For further discussion of PGY3 elective rotations: see below (‘PGY3-4 Electives’).
Resident Continuity Clinic
PGY3 residents have one full day of (RCC) per week. This continues with a half day as a PGY4, giving the potential to follow patients through those 2 years. RCC clinics sites include the HMHI Downtown Clinic, the HMHI Park City Behavioral Health Clinic, and the VAMC. PGY4 residents may also choose to commit more time to RCC, including the option to rotate as a junior attending.
Mental Health Integration (MHI)
PGY3 residents spend one half day per week for the year in a primary care clinic serving as a consultant role in MHI format.
PGY4
PGY4 residents have an even greater degree of freedom to pursue their own interests and prepare to take the next step in their professional development. There is no call in PGY4. For further discussion of PGY4 elective rotations: see below (‘PGY3-4 Electives’).
Collaborative Care Model (CoCM)
PGY4 residents spend one half day per week for 6 months providing medication recommendations as a consultant in a CoCM format.
PGY3-4 Electives
Once residents have completed their ACGME requirements, the remaining clinic days can be spent at a wide variety of elective sites. A sampling of sites are listed below, though subject to change. There are also a number of well-supervised psychotherapy electives for residents who want therapy experience beyond the patients they will carry in RCC. Residents may also choose to return to inpatient or consult sites as junior attendings.
Child and Adolescent Psychiatry
- Child and adolescent elective opportunities span the continuum of care, from outpatient specialty clinics to day treatment programs to inpatient units. Resident roles can include diagnostic evaluation, medication management, individual or group therapy including settings where residents can co-lead DBT groups.
- Residents can also work with the Primary Children’s Hospital Consult-Liaison Psychiatry service or with the Neurobehavioral Consults service, which advises on management of particularly challenging cases involving children and adults on the autism spectrum.
- Additionally, the University of Utah has a Child and Adolescent Psychiatry Fellowship, which gives residents the option to fast track into fellowship training as a PGY4.
Psychosomatic Medicine and Integrative Care
- University of Utah Health is a large system with numerous subspecialty clinics. Integrative care is an area where residents are particularly encouraged to seek electives in an area of interest. Residents participate in a broad range of clinics, including: sleep medicine, movement disorders, neuropsychiatry, neuroradiology, HIV, eating disorders, palliative care, geriatric psychiatry, and psycho-oncology clinics. Interdisciplinary clinics through the VAMC include internal medicine and geriatrics.
- Residents can additionally choose to spend one day per week with a preferred inpatient psychosomatic site, such as the inpatient consult-liaison services at UUMC, VAMC, or Intermountain Medical Center
HMHI Neurobehavioral HOME
- Residents frequently rotate at this groundbreaking comprehensive care center which provides for individuals of any age with developmental disorders. In HMHI HOME clinics, resident psychiatrists have the opportunity to work with in-house primary care doctors, nutritionists, behaviorists, case managers, and more.
Treatment-Resistant Mood Disorders
- While all residents learn to appropriately diagnose and manage complex psychiatric pathology, some choose to specifically focus their learning on interventions for treatment resistant cases. Residents can participate in the ECT services at HMHI, UUMC, or VAMC.
- The HMHI Treatment-Resistant Mood Disorders clinic also provides residents with experience utilizing ketamine infusions and TMS treatment. Other electives offering more in-depth exposure to populations with serious and persistent mental illness (SPMI) include the VAMC clozapine clinic and several community health rotations.
Forensic Psychiatry
- Residents have several options to fulfill their forensic psychiatry requirement. Many rotate in the Salt Lake County Mental Health Court, where they serve as designated examiners for civil commitment hearings. Others rotate on the forensic inpatient unit of the Utah or Idaho State Hospital. Still others have developed individual electives working with their populations of interest. Residents have recently worked with the Utah State Department of Corrections as well as in private practice civil and criminal forensics.
- The University of Utah is establishing a Forensic Psychiatry fellowship with an anticipated start date of its inaugural class in July 2025.
Neuropsychiatry
- Neuropsychiatry electives include interdisciplinary outpatient rotations in movement disorders, neurocognitive disorders, neuropsychiatry, and neuroradiology. Residents can also be involved in ECT, Transcranial Magnetic Stimulation (TMS), and ketamine infusions via the Treatment-Resistant Mood Disorders Clinic.
Junior Attending Rotations
- PGY4s have the option to rotate on our inpatient psychiatry units (HMHI, IPU, IMP) with increased autonomy and responsibility. These rotations are scheduled for one month blocks. Residents work on inpatient units in the mornings and attend outpatient clinics in the afternoons.