The Department of Psychiatry and Behavioral Sciences at Children's National Health System provides comprehensive clinical child and adolescent psychiatry training that furnishes abundant opportunities to pursue academic and administrative psychiatry, research, and service to public and/or private populations. The program provides frequent opportunities to meet with leaders in the field who are creating health policy and research that is shaping current practice. Few programs offer such scope, balance, and depth. The program offers a blend of superior faculty, diverse cultural and socioeconomic populations, a broad spectrum of clinical problems, and the opportunity to work in a superb pediatric facility and participate in a wide range of research opportunities. These clinical and academic strengths, coupled with the chance to live in one of the nation’s most attractive and exciting urban centers, make the program at Children's National Medical Center highly desirable.
Year One (usually PGY-4 or 5):
Year one provides a solid foundation of training in the basics of childhood psychopathology. Fellows rotate in three-month blocks throughout the year in a mix of inpatient, outpatient, and consultative settings. In many clinical settings fellows work in close collaboration with pre-doctoral psychology interns to provide a more in-depth opportunity to learn how to collaborate in patient care.
Adolescent Psychiatric Unit (APU)
Fellows join a multidisciplinary team of psychiatrists, psychologists, social workers, art and music therapists, education specialists, nursing staff, and child psychiatric specialists providing family-centered care on this 14 bed inpatient unit. Working under the direction of an attending psychiatrist, who also provides weekly individual supervision to the fellow, fellows have the opportunity to provide acute care to adolescents with severe psychiatric illness and gain further experience in the clinical management of bipolar disorder, schizophrenia, major depressive disorder, eating disorders, and substance use problems. They also serve as the senior trainee on the service, providing opportunities to educate general psychiatry residents, medical students, physician’s assistant students, and pediatric and neurology residents about psychiatric illness in adolescents.
Child Psychiatric Unit (CPU)
A similar multidisciplinary and teaching experience occurs on this 12 bed unit for patients up to age 13. Common clinical issues seen on the CPU include disruptive behavior problems, ADHD, behavioral issues arising in the context of autism spectrum disorders, severe anxiety and depressive disorders, and eating disorders in pre-adolescents. On this unit fellows gain more in-depth exposure to behavior management strategies and parent behavior training, and are encouraged to attend our series of Caregiver Education Classes for parents and co-lead family sessions with the unit family therapist. They also gain experience in collaborating with area child protection and foster care agencies and exposure to the special concerns that accompany children and families involved with these services.
Pediatric Consultation-Liaison Psychiatry Service (PCLS)
We offer a very strong Consultation-Liaison experience. As a major regional medical center, Children’s National serves as a primary hospital for children from the local area with acute medical issues, as well as a referral center for children from the region as well as nationally or internationally who come to Children’s National for subspecialty expertise. During the PCLS block, fellows will generally perform 1-2 new inpatient consultations a day, assessing patients presenting with a wide range of emotional, behavioral, and cognitive issues during the course of treatment for medical illness. Fellows also receive closely-supervised experience in performing emergency psychiatric assessments for children and families presenting to the ED in crisis. Communication with pediatricians and systems-based care are of particular focus during this block, and fellows also gain broader exposure to neurobiological underpinnings of psychiatric symptoms and management of illnesses at the medical/psychiatric interface, including delirium, eating disorders, and conversion and somatoform disorders. Fellows also have the opportunity to present an interesting clinical case or set of issues at departmental Grand Rounds during their PCLS rotation.
Subspecialty Outpatient Clinics
Finally, fellows also have a three month outpatient specialty clinic block which is composed of the Children’s National Freddie Mac Child and Adolescent Protection Center (CAPC), a child advocacy center evaluating and treating abused and neglected youth; the Gender Development Program, a nationally-recognized program serving gender non-conforming youth; the Feeding Disorders Program, led by Dr. Irene Chatoor, which addresses infantile anorexia and other feeding issues of infancy and early childhood; the Neurogenetics clinic, where fellows learn about genetic disorders affecting development and neurobiology; and the Craniofacial Clinic, a multidisciplinary clinic where fellows work closely with Neuropsychology, Craniofacial Surgery, ENT, and other services in a collaborative fashion to assist youth with craniofacial anomalies. Each fellow also co-leads a group with an experienced group therapist during this clinic block.
Longitudinal Outpatient Clinic
A significant advantage of the first-year fellowship program is the opportunity to follow a select group of patients on an outpatient basis. There are ample opportunities to gain experience in acute and longer-term treatment of outpatients. Outpatient activities during the first year provide both broad and in-depth experiences with the course of disorders arising in infancy, childhood, and adolescence.
Fellows have 6 to 8 hours of protected didactic time each week throughout the two-year fellowship. Didactic seminars are led by Children’s National psychiatry and psychology faculty and selected community psychiatrists, psychologists, and therapists. The first year didactic curriculum begins with a summer “crash course” series covering the basics of child and adolescent psychiatry that fellows need to know as they begin their clinical work. A core topics series in the first year covers key aspects of childhood psychopathology. Seminar series covering important aspects of psychopharmacology, child development, ethical issues, and cultural aspects of psychiatry occur in the first year, and therapy seminar series include family therapy, the use of play in psychiatric treatment and assessment, Cognitive-Behavioral Therapy, and Dialectic Behavior Therapy. Fellows also participate in a monthly joint case conference with the Adolescent medicine fellows focused on patient-physician relationship issues, a monthly journal club led by faculty from the NIMH, and the weekly departmental Grand Rounds.
Fellows are assigned two individual supervisors with whom they meet weekly throughout the academic year to discuss cases and career development. Every effort is made to match fellows with supervisors with similar interests, as well as to provide supervisors with different perspectives and approaches to patient care and career options.
Year Two (Usually PGY-5 or 6):
The second year of fellowship enhances the clinical and didactic foci of the first year by providing deeper experience in community and school consultation, forensics, infant/toddler psychiatry, and outpatient specialty clinics. At the same time, fellows continue their ongoing continuity clinic and have the opportunity to arrange elective experiences that allow them to explore interests in more depth.
Outpatient Psychiatry Department:
Fellows expand their outpatient general continuity clinic to two full days per week. Fellows perform evaluations and carry a selected cohort of patients for psychotherapy and for medication and case management, and assume primary leadership roles for a child’s care in coordination with the child’s family, therapist(s), school, and other community supports. Face-to-face faculty supervision is available for each patient encounter, as well as longitudinal supervision with the fellow’s primary supervisors.
Trainees have the opportunity to observe both typically developing children and children with psychiatric or developmental difficulties in three different school settings, including a preschool, a general education public charter school for grades Pre-K to 9, and a special education public charter school serving children with intellectual disabilities and autism spectrum disorders. During school rotations, fellows also have a community advocacy experience in which they prepare an educational session about mental health topics for teachers and/or parents.
Consistently highly regarded, the forensic psychiatry experience affords fellows the opportunity, in collaboration with staff at the Washington DC Department of Mental Health, to assess youth in the juvenile justice system. Fellows complete forensic evaluations and have the opportunity to testify in court under close supervision.
Continuing the subspecialty experiences introduced during the first year, fellows rotate through several multidisciplinary subspecialty clinic areas during year two, and have the opportunity to work with national leaders in the following areas: Sleep Disorders Clinic, directed by Dr. Judith Owens, Center for Autism Spectrum Disorders, directed by Dr. Haniya Raza, ADHD clinic, directed by Dr. Jay Salpekar, and Infant/Toddler Mental Health Clinic, directed by Dr. Irene Chatoor and facilitated by Dr. Bhavin Dave. Most of these clinics engage a multidisciplinary, multispecialty team to address complex issues, and fellows have the opportunity to learn the role of the child and adolescent psychiatrist within these teams.
Elective and Research Opportunities
Fellows have two to three half-days throughout the year to engage in elective opportunities of their choice. Fellows are provided with a menu of previous electives, but are also supported and encouraged in designing experiences that meet their educational needs. Clinical options include eating disorders, substance abuse disorders, a private psychodynamic psychotherapy clinic, or more in-depth experience in subspecialty clinic areas at Children’s National. Fellows have also participated in research projects internally and with mentors at NIMH, designed a collaborative care clinic with primary care providers and taken education elective time to create a new curriculum for rotating medical students.
Two rising 2nd year fellows are chosen by the faculty to be Chief Residents during the final year. The Chief Residents learn about administrative psychiatry through experiences managing the call schedule, designing a rotation schedule for their class, and assisting in orientation of rotating residents. They also take an active role in overseeing educational programming, and serve on the departmental fellowship training committee.
The second year didactics afford increased breadth and depth in topics related to child mental health and the practice of psychiatry. A year-long seminar in psychodynamic psychotherapy hones fellows’ dynamic listening skills and provides opportunity for case consultation. More opportunities for collaborative case-based learning occur in the Difficult Situations seminar and the Scholarly Topics seminar provides a forum for feedback and preparation for the required spring Grand Rounds presentation. Fellows also may participate in the institutional Fellows’ Core Curriculum, joining fellows from across the institution to learn about academic topics such as research fundamentals, quality improvement, and teaching skills. Second-year fellows continue their participation in the family therapy seminar and the NIMH journal club, and are invited to be an ongoing part of first-year seminars as their schedule allows. Finally, special seminars are scheduled throughout the year on selected topics such as financial management for physicians, legislative advocacy, and transition to practice issues.
Second year fellows are allowed to select their own supervisors and meet with a minimum of two supervisors per week to discuss clinical cases, research endeavors, and career planning. We are fortunate to have a group of committed and skilled voluntary faculty in various practice settings in the DC area who are willing to serve as supervisors, and second-year fellows benefit from this option to broaden perspectives they receive in supervision.