General Psychiatry Electives at NSLIJHS
Adult Psychiatric Day Program
This elective allows a student to become acquainted with the structure and function of a day treatment program and with the clinical management issues involved for patients in treatment with this modality.
Day treatment is a unique and emerging field in psychiatry. The Zucker Hillside Hospital provides multiple, specifically targeted day programs for patients who are well enough not to require 24-hour hospitalization but who would benefit from more treatment contact than can be provided in a clinic setting. Facilities, both on-campus and in the community, provide Partial Hospitalization, Continuing Treatment, Intensive Psychiatric Rehabilitation and Day Treatment Programs. In these settings intensive interventions may be undertaken with close monitoring of the patient's condition and adjustment of treatment in a more realistic time frame in terms of what we currently know about the course of psychiatric disorders and the recovery process. Moreover, treatment in these settings is measured against "real life". Patients spend evenings and weekends at home, have an opportunity for leisure and social activities and can plan for vocational preparation and rehabilitation within the context of the program. Patients are assigned to these programs on the basis of their clinical needs and can move back and forth appropriately among them as their treatment progresses.
A student participating in this elective has the opportunity to become familiar with the various components of day treatment and develop an expertise in modalities which are likely to become increasingly important and more highly utilized in psychiatry.
The Evaluation Center functions as a combination psychiatric crisis intervention and brief psychotherapy service as well as the place where all new admissions to The Zucker Hillside Hospital In-patient Service have their initial work-up. As a psychiatric crisis service, the Evaluation Center provides professional consultation to the LIJ Emergency Room during the day. The Center also evaluates patients who come in without an appointment.
Approaches to care may include appointments/referrals to private clinicians, clinics, day programs or psychiatric hospitalization. The Evaluation Center also offers brief psychotherapy to patients who could benefit from this approach. This brief therapy is flexibly defined and may call for such activities as clarifying aspects of the patient's life which are producing distress, environmental manipulation (e.g., patient may need referral to social service agencies), family interviews, medication and support. An ambivalent patient may be seen briefly with the hope that he/she can be motivated to accept further needed treatment.
During the rotation in the Hillside Evaluation Center, the student has the opportunity to experience first-hand the assessment of patients in crisis and receive direct supervision by the attending psychiatrist. After successfully completing a rotation in the Evaluation Center, the student will have been trained in the rapid assessment of psychiatric emergency situations.
Depending on the student's interest, there may be time to participate in the intake and treatment of patients in the Ambulatory Care Center.
With the ever increasing recognition of the interface that can occur between medical and psychiatric illnesses, our Department offers a month-long elective based in the Medical Clinic at The Zucker Hillside Hospital. The student participates in the following activities:
• Primary medical care of both hospitalized and ambulatory patients with psychiatric disorders
• Medical consultation directed at the interface of Medicine and Psychiatry (e.g., medical causes of behavioral disorders)
• Clinical conferences involving Psychiatry, Neurology and Medicine
During this elective, the student is taught how to differentiate between psychiatric and medical conditions, proper diagnostic evaluation procedures and how to recognize drug interactions between psychotropic medications and drugs used to treat medical conditions. The student also gains expertise in the medical effects and side effects of specific psychotropics and other therapies (e.g., ECT), medical contraindications to their use and appropriate ways in which to follow psychotropic use in medically complicated patients.
Child and Adolescent Psychiatry
The Division of Child and Adolescent Psychiatry offers electives for medical students in in-patient, out-patient, consultation-liaison and research settings. Interested students join the Division staff in the evaluation and treatment of mentally ill children and adolescents. Special opportunities for learning through the use of one-way mirror psychotherapy and assessment clinics are available.
Students may also participate in a clinical research project within the Division. Each student is assigned to an attending physician who serves as a mentor and advocate during the course of the rotation. Every attempt is made to tailor the elective to the particular needs of the individual.
The broad-based goal of this program is in-depth exposure to the rapidly developing field of Geriatric Psychiatry. Medical students participate in a wide range of clinical activities at diverse sites, including a 20-bed geriatric psychiatry in-patient unit, a comprehensive geropsychiatry out-patient clinic, a geriatric psychiatric day hospital, community-based and home care programs and a long-term care facility. They have exposure to ongoing research initiatives in late-life depression and dementia, tardive dyskinesia, brain imaging and psychiatric health care delivery in nursing homes. Students participate in structured educational activities that include clinical case conferences, family conferences, geropsychiatry journal club and didactic curriculum.
The medical student rotates on one of the in-patient service units and has primary responsibility for the care of assigned cases. This includes the history and physical, psychiatric examinations, laboratory evaluations, diagnostic assessment, biopsychosocial formulations, and treatment plans for newly admitted patients. The student receives individual supervision from an attending physician and works alongside PGY-I or PGY-II residents. Part of the experience involves participation in didactic seminars, educational conferences in psychopharmacology and movement disorders, as well as clinical cases involving Neurology, Medicine and Psychiatry. Depending on the student's interest, this rotation can include time spent in the Hillside
The Zucker Hillside Hospital is a Clinical Research Center sponsored by the National Institute of Mental Health. Current research activities include more than 50 on-going clinical studies within the Department of Psychiatry, in collaboration with other departments in the Medical Center and with the active involvement of the Department's two basic Neuroscience Laboratories. Clinical research studies focus on specific diagnostic categories including schizophrenia, tardive dyskinesia, affective disorders, anxiety disorders, dementia and childhood disorders (e.g., hyperkinetic impulse disorders, learning disabilities and affective disorders). Types of studies range from long-term naturalistic outcome designs to control acute and maintenance pharmacologic treatment trials as well as intensive cross-sectional biologic assessment protocols. A wide-ranging project in psychobiology focuses on longitudinal studies of first episode, recent onset schizophrenia. A Geropsychiatry group focuses on characterization and treatment of severe behavioral disturbances and depression in the elderly.
Specialized assessment methods used by the Department include clinical neurochemistry, neuroendocrinology, neuropsychology, psychophysiology and brain imaging using magnetic resonance imaging, computed tomography, single photon emission tomography and positron emission tomography. The Electroencephalography Laboratory has evoked potential and an all-night polysomnography capability. The Psychobiology Laboratory has staff and facilities to conduct pharmacologic probe tests and collection of biologic fluids including: CSF, blood and urine. A state-of-the-art video facility allows for on-site and remote recording of biologic assessment procedures, clinical interviewing and staff training.
Students participate in weekly meetings, receive individual supervision from a senior attending and, if desired, get assistance in writing a paper. This is a unique opportunity to learn what clinical psychiatric research is like from the view of an insider.
Consultation-Liaison Psychiatry is a unique discipline within the field of psychiatry which combines knowledge of medical illnesses, psychotherapy and psychopharmacology with an ability to forge liaisons within the medical community. This field is perfect for the psychiatrist who has an interest in psychotherapy, psychopharmacology and also enjoys working within a general hospital setting.
The elective in Consultation-Liaison (CL) Psychiatry exposes students to the daily work of the CL psychiatrist. Clinical experience is gained by seeing patients with fellows and residents and by participating in the teaching rounds led by one of the psychiatric attendings. As the students gain skills and confidence, they work up consults on their own and present the patients on rounds. In addition to the clinical work, the students attend classes given by attendings and fellows, which focus on various aspects of CL work, e.g.: "Psychiatric Aspects of Obstetrics", "Psychiatric Complications of Medical Drugs" and "Delirium". One of the highlights is the clinical case conference during which a current case is presented (either by an attending, a fellow, a resident or a medical student), in which the patient is interviewed and the case is discussed. For the medical students this is a special opportunity to get to know how psychiatrists with different interests and backgrounds formulate opinions and treatment plans. Students are encouraged to discuss their own thoughts about cases.
In summary, the goal of this elective is to acquaint the medical students with the field of CL psychiatry and help them to become comfortable with the role of the psychiatrist within the general hospital.
Substance Abuse/Community Psychiatry
This elective exposes students to comprehensive substance abuse treatment and to patients in varying degrees of recovery from this type of psychiatric illness. Students may choose to join clinical teams from a variety of community-based and hospital based programs. With nine separate sites to select from and the opportunity to work at different sites simultaneously, a meaningful experience can be fashioned to suit almost any interest and educational need. Electives may be of variable length depending on a student's interest.
Students may elect to work with patients of different ages, ranging from adolescents to elderly adults. There is also the opportunity to gain experience with different treatment modalities such as methadone maintenance, medically monitored detoxification and group psychotherapy. Those students with research interests are welcome to participate in ongoing protocols. In all electives the student is given on-site supervision.
Students will become acquainted with the principles of dynamically oriented psychotherapy and other psychotherapeutic modalities. Intake evaluations, biopsychosocial formulations and implementation of initial treatment plans will provide the core of the clinical experience. On-going intensive individual supervision and preceptorships comprise the supervisory component of the rotation. Didactics will include reading tutorials with individual mentors, as well as participation in psychotherapy classes and case conferences.
Neurology at The Zucker Hillside Hospital
Students participating in this elective have the opportunity to work with the Hillside neurologist evaluating psychiatric patients on the in-patient services and in the out-patient clinics who have comorbid neurologic presentations. This enables students to experience the interactions and interfaces between psychiatric and neurologic disorders.
In recognition of the fact that students may wish to pursue more than one specific area of interest, we offer an elective that may be tailored to the individual interests and needs of the student. A variety of combinations are possible, integrating material from the menu of different electives that are offered at The Zucker Hillside Hospital (Adult Psychiatry Day Program, Evaluation Center, Medical Clinic, Geropsychiatry, Child and Adolescent Psychiatry, In-patient Psychiatry, Research Psychiatry, Consultation-Liaison Psychiatry, Substance Abuse/Community Psychiatry, Behavioral Neurology and Psychotherapeutic Modalities). For example, a student may choose to have a core experience in Adult In-patient Psychiatry that is also supplemented by the Evaluation Center or the Medical Clinic. Perhaps half-time Day Hospital Programs and half-time Medical Clinic would be another student's choice. Each student works with the Director of Medical Student Education to develop a unique elective experience.
Laura A. Herman, MD
Associate Director, Residency Training and Director, Medical Student Education
Department of Psychiatry
The Zucker-Hillside Hospital
75-59 263rd Street
Glen Oaks, NY 11004
Phone: (718) 470-8384