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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 (3 months). 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, 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) (3 months). Fellows are integral members of the multidisciplinary team on this 12-bed unit for patients up to age 13. Common clinical issues seen on the CPU include disruptive behavior problems, attention deficit hyperactivity disorder, 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 are encouraged to 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) (3 months). As a child psychiatry fellowship program in a freestanding pediatric hospital, we are able to offer a rich consultation-liaison experience to our fellows. 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 across the region and the world 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 Emergency Department 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 (3 months).This outpatient specialty clinic block provides foundational experiences in multiple clinics and community sites and is designed to strengthen fellows’ understanding of the complexity of child development. Highlights of the rotation include:
- School Experiences (including a preschool, a public charter elementary/middle school, public high school, special education school for children with developmental disabilities)
- Child Development Clinic and Child Neurology Clinic
- Children’s National Freddie Mac Foundation Child and Adolescent Protection Center (CAPC), a child advocacy center evaluating and treating abused and neglected youth
- Assessment Clinic, a closely supervised experience conducting comprehensive child psychiatric evaluations working 1:1 with a child psychiatry attending. The clinic is based at a primary care clinic and also provides exposure to an integrated behavioral health model.
- Opportunity to co-lead a therapy group for children
- 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.
- Didactics. Fellows have six 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. A seminar series covering important aspects of psychopharmacology, child development, ethical issues and cultural aspects of psychiatry occur in the first year. The therapy seminar series includes modules on family therapy, psychodynamic therapy, the use of play in psychiatric treatment and assessment, Cognitive Behavioral Therapy and Dialectic Behavior Therapy. Fellows also participate in a monthly journal club led by faculty from the National Institute of Mental Health (NIMH) and the weekly departmental Grand Rounds.
- Individual Supervision. 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.
View Sample Year 1 Schedule (PDF)
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 and child psychiatry subspecialties. At the same time, fellows continue their continuity clinic and have the opportunity to arrange elective experiences that allow them to explore interests in more depth.
- Children’s National Outpatient Psychiatry Clinic. 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.
- Forensic Psychiatry. Consistently highly regarded, the forensic psychiatry experience affords fellows the opportunity, in collaboration with staff at the D.C. Department of Mental Health, to learn about assessment of youth in the juvenile justice system.
- Subspecialty Clinics.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
- Center for Autism Spectrum Disorders
- Infant/Toddler Mental Health Clinic
- Gender Development Program
- Infant Feeding Disorders Program
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 additional training in eating disorders, substance use disorders, residential treatment, school-based treatment, 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, taken education elective time to create a new curriculum for rotating medical students, and worked with attorneys at the Children’s Law Center at the interface of psychiatry and the law. Interested fellows can also pursue a 2-4 week rotation at select international sites, including Japan, the United Kingdom and Chile.
- Second-Year Didactics. 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. 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 also attend the cross-cultural psychiatry course, the family therapy seminar, 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 and transition to practice issues.
- Individual Supervision. 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 volunteer faculty in various practice settings in the Washington, D.C., area who are willing to serve as supervisors. Second-year fellows benefit from this option to broaden perspectives they receive in supervision.
- Scholarly Project. All second-year fellows are engaged in a scholarly pursuit over the course of the year and present their work at Departmental Grand Rounds in the spring. Often, elective experiences provide the foundation for the scholarly project and fellows work collaboratively with faculty members and supervisors to develop the project.
- Chief Residency. Two rising second-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.
View Sample Year 2 Schedule (PDF)