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The Residency Program

The Residency Program

Context for Training
You are entering psychiatry at an incredibly exciting time. Healthcare reform will emphasize the unmet needs of those suffering from psychiatric and addictive disorders, not only because they are among the most common and disabling illnesses, but because inadequate recognition of emotional and behavioral issues in general medical care is a major contributor to higher risk, excess cost and poor outcomes.

We have the unique advantage of a large and highly specialized range of psychiatric services (Zucker Hillside Hospital) embedded within one of the country’s largest and most visionary health systems (North Shore-LIJ Health System) and one of the country’s newest and most innovative medical schools (Hofstra North Shore-LIJ School of Medicine). A brief description of each follows.

Zucker Hillside Hospital
As the psychiatric division of the Long Island Jewish Medical Center, The Zucker Hillside Hospital (ZHH) is known for its pioneering work in the diagnosis, treatment, and research of mental illness.  It was the #16 ranked hospital in the country for psychiatric care by U.S. News in 2013.  Located on the border of New York City’s Borough of Queens and suburban Nassau County, the hospital serves a remarkably diverse patient population.

The ZHH offers the full continuum of behavioral health services – an integrated setting that is ideal to learn clinical psychiatry. The ZHH has 228 inpatient beds, including an Early Phase Illness unit, a Women’s unit, an Affective Disorders unit, an Adolescent unit, Geriatric units, and general adult units.  Our new Behavioral Health Pavilion houses 6 of our inpatient units, a new ECT Suite, a state-of-the-art Conference Center, and spaces for gatherings among patients, families and clinical teams.  This modern, patient-centered facility is surrounded by a tranquil and sprawling environment that preserves the unique history of the ZHH campus. Acute care services in the department include a fully staffed psychiatric emergency room within the emergency department of Long Island Jewish Hospital that utilizes telepsychiatry to serve outlying hospitals with no overnight psychiatry coverage. 

ZHH also offers a wide variety of ambulatory services including a large adult general clinic, a Bipolar Disorder Diagnostic Center, an Obsessive Compulsive Disorder Diagnostic Center, a College Program, a Clozapine Clinic, ECT Inpatient and Outpatient Treatment Programs, Partial and Day Hospital Programs, a Child and Adolescent Outpatient Program, a Perinatal Psychiatry Program, substance abuse treatment, and the Recognition and Prevention Program.

North Shore-LIJ Health System
The Zucker Hillside Hospital is a psychiatry specialty hospital embedded within the Long Island Jewish Medical Center and a hospital of the North Shore-LIJ Health System, the largest healthcare system in New York State.  It includes 16 hospitals, 3 skilled nursing facliteis, and nearly 400 ambulatory practices. The North Shore-LIJ Health System is visionary in developing new care delivery models in efforts to enhance the health of its patients. It is home to the largest ‘corporate university’ in the healthcare industry – the Center for Learning and Innovation – and it has created the nation’s largest patient simulation center – the Patient Safety Institute. It continues to be recognized as a national leader in quality improvement. And the Feinstein Institute for Medical Research ranks among the nation’s top 5 percent of all institutions that receive funding from the National Institutes of Health.

Hofstra North Shore-LIJ School of Medicine
The Hofstra North Shore-LIJ School of Medicine is a unique partnership between two outstanding Long Island institutions.  Hofstra University, with its distinguished schools of law, business, liberal arts and sciences, communication, education, and human and health services, contributes its accomplished faculty and existing admissions and student services infrastructure, as well as a beautiful campus.  North Shore-LIJ Health System, as one of the largest integrated health systems in the nation, provides a first class group of hospitals, health care facilities and research institutions, and some of the nation’s most respected physicians and researchers.

The first allopathic medical school in Nassau County and the first new medical school in the New York metropolitan area in more than 35 years, the School of Medicine welcomed their first class in 2011 with the goal of accomplishing the following visionary objectives:

  • To be a premier "Millennial Medical School"
  • To be a major contributor to the redefining of medical education
  • To have positively changed the University, North Shore-LIJ Health and the community
  • To have improved the health of the region

Putting it all together
This array of clinical services and systems gives us an opportunity to work with a unique mix of local communities, families and consumers, high schools and colleges, local, state and federal agencies- all on a very broad scale and serving one of the most diverse populations in the world. Our medical school, though only a few years old, has already established a national reputation for its excellent and innovative approaches to teaching the next generation of physicians.  You will have the opportunity to teach and supervise medical students and develop as an educator. And we will prepare you for the future changes in healthcare as you train in a health system that is leading the way in making care more integrated, accessible, and effective.
 

 OVERVIEW OF FOUR YEAR PROGRAM 

“As a former Zucker Hillside Hospital resident, chief resident and unit chief of a residency training unit, I have a very personal dedication to the education of the residents. A wonderful residency experience in a nurturing academic setting led me to stay here to practice psychiatry and train residents. By having a position in the residency program leadership at the Zucker Hillside Hospital, I am very lucky to have the unique opportunity to be involved with what has been most formative for me professionally. I am dedicated to developing outstanding experiences for current and future residents that are as rich as my education here has been.”

- Andrea Klufas, Former Chief Resident, Associate Director, Residency Training 

The training program is structured to help you become an outstanding, well-rounded clinician and a leader in your chosen area of interest – whether that is research, clinical care, education, and/or health systems leadership. The program exposes you to the full breadth of psychiatric knowledge and practice – with a strong grounding in medicine and the spectrum of inpatient, child and adolescent, addiction, consult-liason, geriatric, and ambulatory psychiatry. You will learn how to integrate neuroscience, evidence-based medicine and measurement-based care with pharmacotherapy and psychotherapy. You will develop skills in state-of-the-art, disease-specific clinical care through our specialty clinics and units. And you will have opportunities to supervise medical students and, as you progress, to lead clinical teams and contribute to quality improvement initiatives.

Importantly, your training here will prepare you for the significant changes in the broader healthcare delivery system. As part of an outstanding, integrated regional health system, you will participate in the ‘leading edge’ of care delivery innovation, including the integration of behavioral health into primary care, general medicine and all medical specialties, healthcare financing and policy, patient safety and quality improvement, patient centered outcomes, early detection and intervention, the use of new technology (e.g., telepsychiatry), patient and physician incentives and all of the other facets of the healthcare enterprise in which you and all other physicians of the future will be participating directly or indirectly. And a  series of electives are available or can be individually created that will help you develop and sharpen expertise and leadership in any topic or subspeciality that inspires passion and possible career ambition. 

As you learn about our program, we hope you will be as excited as we are about the tremendous opportunities here at North Shore-LIJ/Zucker Hillside Hospital.  Our strong academic tradition, continuum of behavioral health programming in modern facilities, commitment to engage health care reform, robust research programs, and friendly and nurturing environment collectively offer a wonderful beginning to your professional life as a psychiatrist who will make a difference.

R1 Adult Inpatient Psychiatry

12 weeks

Structured
Clinical Learning 

4 weeks

Consult Liason Psychiatry 

4 weeks

Admitting Service

4 weeks

Internal Medicine/Pediatrics

16 weeks

Neurology

8 weeks
Vacation

4 weeks
R2 Consult Liaison Psychiatry

12 weeks
Geriatric Inpatient Psychiatry

4 weeks

Emergency Psychiatry

8 weeks
Specialty Inpatient  Psychiatry

6 weeks

Adolescent
Psychiatry

4 weeks

Adult Inpatient Psychiatry

14 weeks
Night Float

4 weeks
R3 Outpatient Psychiatry
Including Adult, Child, Geriatrics, Community and Addiction Treatment

12 months 

R4 Adult Outpatient Psychiatry 60% of the week
Elective 40% of the week

12 months 

The order of rotation in each year will vary.
Vacation during R-1 — two vacations, each two weeks.
Vacation during R-2, R-3, R-4 — four weeks each year — individually scheduled.


FIRST POST-GRADUATE YEAR (R-1)

Overview
The R-1 year is divided into 13 four-week periods. All residents spend three periods in Adult Inpatient Psychiatry at The Zucker Hillside Hospital, one period in the Admitting Service, one period in Consultation-Liaison Psychiatry, four periods of Medicine/Pediatrics, and two periods of Neurology.  There are 4 weeks of vacation time, and 4 weeks of Structured Clinical Learning.

Inpatient Psychiatry
All residents spend three periods working on the Inpatient Psychiatric Services at The Zucker Hillside Hospital and The North Shore University Hospital.  Residents learn the basic skills of clinical diagnosis including interviewing, mental status examination, physical and neurologic examination, history writing and the formulation of a differential diagnosis and treatment plan.  In addition, residents begin their education in the short-term inpatient treatment of patients with acute psychiatric illness who are presenting either for the first time or as an acute exacerbation of chronic illness.  Techniques of psychopharmacological therapy, milieu therapy and individual and family psychotherapy are stressed.  Residents also treat inpatients who are participating in research studies, enabling residents to familiarize themselves with research methodology and protocols.  Part of the inpatient curriculum includes didactics in psychotherapeutic techniques, such as supportive psychotherapy and motivational interviewing, which will be most helpful for this patient population.  Residents also continue their SCID training, and become versed in measurement based psychiatry and the use of rating scales in clinical care.  While working in Psychiatry, residents have several supervisors including on-unit supervisors, off-unit supervisors and preceptors.

The admitting service is responsible for the evaluation and assessment of all direct admissions to the Zucker Hillside Hospital.  Residents will have ample opportunity to practice the initial evaluation of patients, including psychiatric interviewing, medical evaluation, and initial treatment planning.

C-L
All residents spend one period working in Consultation-Liaison Psychiatry at North Shore University Hospital, where residents perform consultations on patients in the emergency department and medical inpatients with psychiatric issues.  In addition, weekly classes, case conferences and individual supervision are provided.

Medicine/Pediatrics
Residents choosing to complete their Medicine/Pediatrics requirement in the Department of Medicine spend three periods in general adult inpatient medicine at either Long Island Jewish Medical Center or North Shore University Hospital and one period in the Medical Services Department of The Zucker Hillside Hospital.  This service coordinates the medical treatment of the 225 psychiatric inpatients as well as the medical treatment of a small percentage of patients in Hillside’s psychiatric outpatient programs.  Residents with an interest in Child Psychiatry may substitute Pediatrics for up to 2 periods of their Medicine rotation. These residents will be assigned to the Steven and Alexandra Cohen Children's Medical Center of New York for these rotations.

Neurology
Two periods of the R-1 year are in the Department of Neurology.  One period is spent on the Neurology inpatient service at either Long Island Jewish Medical Center or North Shore University Hospital.  Residents are the primary caregivers for the patients on this service.  The second period in Neurology is located predominantly at The Zucker Hillside Hospital.  Here, residents work with an attending neurologist taking histories and performing examinations on the psychiatric patients who also have neurologic components to their illness.  Along with the attending neurologist, the resident follows the treatment of these patients throughout their hospital course.  In addition, residents spend approximately 25 percent of their work week in outpatient Neurology clinics at the Long Island Jewish Division.  These clinics treat patients who are primarily referred with movement disorders, neuropathic pain, or epilepsy.

Call
R-1 call periods are limited to weekday evenings and weekend days and nights.  R-1 residents cover the Zucker Hillside Hospital as well as the North Shore University Hospital Psychiatric Service.  R-1 resident is always supervised by senior residents or attendings while on call. There is no night float in the R-1 year.

Didactics: Intensive Training in Structured Diagnosis and Measurement-Based Care
The four year didactic curriculum builds on itself each year.  The first year covers foundations of psychiatry in terms of phenomenology, diagnosis, interviewing, assessment and somatic and psychotherapeutic treatments.

In tern didactics are is organized into 2 two-week blocks which book end the majority of the psychiatry experiences in the R-1 year.  During the first block, residents are taught basics of psychiatry, including interviewing, diagnosis, and treatment planning. We provide intensive training in the use of the Structured Clinical Interview for DSM-IV (SCID) – a unique aspect of our program that will provide you with lifelong skill at the diagnostic interview – such a critical part of modern psychiatry.  These topics are put into practice during the clinical work in the intervening months.  During the second block, these topics are reinforced, and explored in further detail.
 

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SECOND POST-GRADUATE YEAR (R-2)

   

“I chose Hillside because I really liked the people I met here from the residents to the staff. I felt comfortable and knew that I would graduate with a superior education and wide range of experience.”

- Jessica Richter, Former Resident ’10

Overall
The goal of the R-2 year is to continue to advance the resident's knowledge and skills of clinical diagnosis and treatment of acutely ill adult psychiatric patients.  In addition, the R-2 year focuses on the treatment of the acutely ill child, adolescent, and geriatric patients. Rotations include: 14 weeks on General Adult Psychiatry Inpatient Units, 6 weeks on Specialty Inpatient Units, 4 weeks on Geriatric Psychiatry Inpatient Units, 4 weeks on the Adolescent Psychiatry Inpatient Unit, twelve weeks on Consultation-Liaison Services, and 8 weeks total in Adult and Child Emergency Psychiatry.  Residents also have a four week night float.  Four weeks vacation time is spread throughout the year at times chosen by the residents.

C/L
R-2 residents spend 12 weeks working as part of a Consultation-Liaison Service at both Long Island Jewish and North Shore University Hospitals.  As a member of this service, residents perform consultations on medical inpatients with psychiatric issues and attend daily teaching rounds.  In addition, weekly classes, case conferences and individual supervision are provided.

Inpatient Psychiatry
Twelve weeks are spent working on adult general inpatient services organized for residency training.  While working on these units, residents continue to have on-unit and off-unit supervision and a weekly case conference.  Besides working with individual patients, residents treat the families of several of their inpatients and participate in on-going group therapy.

Eight weeks are spent in Specialty Inpatient Selectives, where residents have a choice of working on specialty units, including a women’s unit, a MICA unit, or the inpatient unit at North Shore University Hospital.

Four weeks of the R-2 year consist of a rotation on the Geriatric Psychiatry Inpatient Units.  Supervision is provided by a team of geropsychiatrists as well as specialists in Internal Medicine and Neurology

A four-week rotation is spent on the Adolescent Inpatient Psychiatry Unit at The Zucker Hillside Hospital.  There are approximately 180 admissions per year to the Adolescent Pavilion.  This co-ed inpatient unit has a population characterized by heterogeneity of age, race and diagnosis.  The residents are in charge of psychiatric and medical assessment and the individual and family treatment for the patients assigned to them.  They also participate in five community meetings held each week.

Emergency Psychiatry
There are a total of 8 weeks of psychiatric emergency room rotations in the R-2 year, covering both the adult ED and the child ED.  Staffing during these rotations include psychiatrists, psychologists, social workers and nurses, and is organized to provide both excellent clinical service and well-supervised education and training for students and house staff.  Residents evaluate several patients per shift and are able to see the patient and their families for initial triage, and continue working with the patients until a final disposition is reached.  Residents are supervised by attending psychiatrists on every patient evaluated in the Psychiatric Emergency Rooms. Residents also gain experience in using telepsychiatry to provide consultations to emergency departments that do not have a psychiatrist.

ECT
For four weeks of the year (during the Adult Inpatient rotation) each resident becomes an active participant in the Electroconvulsive Therapy (ECT) treatment program.  This includes performing ECT three mornings per week under the supervision of an attending psychiatrist.

Forensics
During the R-2 year residents learn many aspects of Forensic Psychiatry as they evaluate patients and accompany their supervisors who testify about these patients in court.  All residents also visit Rikers Island, New York City’s main jail complex, where they learn about psychiatric care in the incarcerated population.

Resident as Scholar: Introduction to Research Methods
The R-2 residents participate in a Research Mentorship in which groups of 4-5 residents are each paired with a psychiatrist or psychologist from the Department of Research to develop a research proposal.  Residents start with a clinical question, develop a research proposal to answer the question, perform all the necessary background research to develop a potential study, and then present their proposal to the research staff at the end of the year.  The goal of the Research Mentorship is for residents to understand Research Methodology, with a focus on the process of developing a research project from a clinical question.

Resident as Educator
Medical students are assigned to R-2 residents for supervision on inpatient rotations.  Courses in the R-2 year are generally scheduled two days a week and residents from all rotations join in these courses.  A special feature of the R-2 year is the "Experiential Group" during which residents learn about group process as they share their training experiences.

Call
Night and weekend on-call during the R-2 year is covered partially by the night float resident and partially by the other 16 residents.  There are approximately three calls per month.  R-2 residents cover the Zucker Hillside Hospital as well as the emergency room at Long Island Jewish Medical Center.

Didactics
The second year didactics builds on the first year with deeper coverage of somatic understanding of illness and treatment, especially in the Psychobiology and Neuroscience Course.  The Psychotherapies course offers a broad education on psychotherapy.  Subspecialty areas of child and adolescent psychiatry, consultation liaison psychiatry, forensic psychiatry, geriatric psychiatry, addiction psychiatry as well as ethics are also covered in the R-2 didactic curriculum.  

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THIRD POST-GRADUATE YEAR (R-3)

   “The patients are your own, you make your own schedule and have your own office. What's not to like?”

-Mordechai Gampel, Former Resident ’10
 

Overall
The goal of the R-3 year is to have residents learn the evaluation and outpatient treatment of adults, adolescents and children.  Residents gain experience working with patients who can benefit from a single course of treatment as well as patients with chronic illness who require long-term maintenance therapy. 

Longitudinal Training in Adult Outpatient Psychiatry
During the third year, residents begin a two year longitudinal training in outpatient psychiatry. This allows residents to develop a panel of patients who they can follow over a substantial period of time and witness response to treatment as well as the course of illness. Patients are carefully selected from the various specialty outpatient clinics and tracks within the Ambulatory Care Center so that residents treat patients covering the full spectrum of psychiatric disorders.  During this time, residents conduct intake evaluations, treat patients in comprehensive general psychiatric care, provide pharmacotherapy, and conduct exploratory, insight-oriented psychotherapy and cognitive behavioral therapy.  During this assignment, residents have supervisors for psychotherapy, intakes, psychopharmacology/comprehensive general psychiatric care and for cognitive behavioral therapy.  Residents have extensive time set aside for supervision in each of these. Direct and indirect supervision are provided, allowing for residents to be well supervised and develop independent decision-making skills concurrently.  The clinic has an enormous variety of patients in terms of socioeconomic, cultural and diagnostic diversity.  As a result, the clinic experience exposes residents to caring for patients with a multitude of presentations and builds a foundation for residents to be highly prepared for independent practice. 


Child and Adolescent
For six months of the year, residents spend a portion of their time in the Ambulatory Service of the Division of Child and Adolescent Psychiatry.  The goal of the training in this rotation is to teach the resident diagnosis and treatment of children and adolescents as well as to provide an understanding of the biological, psychological, social, economic, ethnic and family factors that significantly influence physical and psychological development in infancy, childhood and adolescence.  Residents also gain experience in the diagnosis and treatment of children with mental retardation and other developmental disabilities.  Residents are assigned to two supervisors during this experience.

Addiction Psychiatry
For six months of the year residents are also assigned to a Community Psychiatry/Outpatient Addiction Treatment rotation.  Residents see patients at our on-campus Methadone Maintenance Treatment Program and two of our local community programs.  These programs focus on the structured group treatment of chronic alcohol and other drug dependencies, and on patients whose chemical dependency is complicated by other psychiatric illnesses.

Resident as Scholar:
During the R-3 year, residents choose a preceptor to assist them in the writing of a paper during the R-3 and R-4 years.  This paper may be a review of the literature, a clinical case presentation or a research project.  By the end of the R-4 year, residents are required to submit their papers for review.  All papers are reviewed by several senior faculty members who do not know who wrote the paper.  Papers are then returned to the resident with comments that will be helpful should the resident want to publish the paper.

Resident as Educator:
R-3 residents have junior resident and medical student education responsibilities.  On-call, R-3 residents are responsible for the supervision of junior residents in the Psychiatric Emergency Department and in the Acute Care setting.  Hofstra medical students participate in outpatient treatment in conjunction with R-3 residents’ clinic time.  In addition, there is an R-3 course in comprehensive treatment of psychiatric illnesses using evidence based practice that is structured to develop residents’ research skills, presentation and self directed learning.

Call
During night and weekend call in the R-3 year residents are responsible for evaluating patients in the Emergency Room as well as emergency consultations in the general hospital.  R-3 residents are also responsible for supervising R-2 residents and medical students assigned to taking calls in the Emergency Room.  All R-3 residents share in this call and, therefore, residents are on-call approximately two weekday nights and one weekend day per month.  There is always an attending psychiatrist on the Long Island Jewish Hosptial campus 24-hours a day for supervision.

Didactics
The third and fourth year curricula delve deeper into understanding evidence based psychotherapies with an extensive curriculum in brief therapies, couples therapy, group therapy, CBT and psychodynamic psychotherapy.   In addition, there are advanced conferences in psychopharmacology and psychotherapy and a course in understanding the evidence base for comprehensive treatment in various psychiatric diagnoses.

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FOURTH POST-GRADUATE YEAR (R-4)

Overall
The entire R-4 year is divided into approximately 60 percent to continue longitudinal training in outpatient psychiatry. The remaining 40 percent is elective time to allow the resident to develop a series of experiences tailored to their interests with the goal to help the resident launch themselves as an emerging leader. 

Longitudinal Training in Adult Outpatient Psychiatry
The core includes a full year of individual psychotherapy of patients followed from the R-3 year as well as additional patients treated with couples therapy, group therapy and short-term psychotherapy.  Supervisors are assigned for each of these treatment modalities.
During this year, residents also participate in the Psychopharmacology Consultation Service.  Patients being treated in any of our Ambulatory Care Programs who present with particularly difficult diagnostic or treatment/management problems are referred to this service for an in-depth work-up including a literature review and presentation to a conference chaired by either senior faculty members or invited consultants.

Pursuing Your Passion
Forty percent of the work week is elective time chosen from either a group of planned electives or those electives developed individually by the resident.  Some of the planned electives include: multiple opportunities in Hillside's Research Department participating in on-going studies or developing new projects; an advanced program in dynamically-oriented exploratory psychotherapy; treatment of drug and/or alcohol abusing patients at the Medical Center's community-based programs; medical student teaching and program administration; adolescent psychiatry including inpatient, outpatient and day hospital; brief contact psychotherapy; community psychiatry; Hillside Day Treatment Programs; geriatric psychiatry; consultation-liaison psychiatry (clinical and research); and forensic psychiatry.

Resident as Educator
Included in the R-4 year is a specially constructed didactic and experiential program designed to develop the resident’s teaching skills.  As part of this supervised program each resident creates and teaches lectures to medical students.

Resident as Scholar
By the end of the fourth year, all residents are required to submit a scholarly paper.  Residents work with a preceptor in developing a paper topic and submit thte paper by the spring of their final year.

Call
There is no night or weekend on-call in the R-4 year, but residents may choose to join the Senior Psychiatrist-on-Call rotation for which they receive additional remuneration.

Didactics
The didactic portion of the curriculum, consisting of approximately five hours of courses per week, continues in the R-4 year. Courses include a psychotherapy continuous case conference, advanced psychopharmacology conference.



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