Core Curriculum

The program is organized to effect an optimum balance between theory and experience in evaluating and treating children and adolescents. The clinical experience is carefully supervised and each resident has a minimum of at least three hours of weekly supervision with clinical supervisors who represent a diversity of theoretical persuasions. This eclectic orientation is also reflected in the formal seminars which reflect interests which range from neuropsychiatry to clinical psychopharmacology to psychological theories of child development and child psychoanalysis.

The entire two-year experience is coordinated in such a way as to provide the widest variety of educational experiences within a framework of longitudinal continuity. Some courses such as the psychopathology and psychodynamic literature seminars are planned as two-year experiences; several others such as the Therapeutic Intervention and Child and Adolescent Development course are completed in the first year.

In addition to formal didactic seminars, the division offers Child Psychiatry Grand Rounds, case conferences, journal clubs, board reviews and special seminars (Literature of Madness).

The Residency Education Committee (REC) meets monthly to provide regular feedback regarding the curriculum. The membership in this committee consists of selected members of the faculty and the chief resident in child and adolescent psychiatry. In addition to program development and evaluation of seminars and rotations, the committee reviews all aspects of the residency experience including case loads and on-call duties.

FIRST YEAR OF TRAINING
The first year of the program is structured around three foci:

1. A series of diagnostic seminars which provide a founding in normal development, psychopathology, and the theory of diagnosis and treatment.

2. A year-long inpatient experience with severely disturbed children at the UCSD Child and Adolescent Psychiatric Services, a twenty-eight bed inpatient service.

3. An ongoing closely supervised, diagnostic and therapeutic experience with children from birth through adolescence at the Children's Outpatient Psychiatry, the outpatient facility for Children's Hospital.

Each resident will participate on the Inpatient Unit as a team leader. The resident will be involved with diagnosis, individual and family therapy, case management and discharge planning. Individual supervision will be provided to each resident by an attending child psychiatrist working on the unit.

Each first year resident is expected to carry a minimum outpatient diagnostic/treatment caseload of six to eight each week. The supervisory experience has been organized so as to exposed each resident to approximately ten clinicians from different theoretical frameworks over the two-year span of the residency. Clinical faculty with an interest in long-term, dynamically-oriented psychotherapy will supervise the resident for a full year, ideally with a single case; while others will supervise for six month blocks, focusing on all aspects of short-term therapy, pharmacotherapy, and administration.

Therapeutic techniques for in-depth and brief diagnostic evaluations are taught. The residents evaluate children from all developmental phases-a practice which will continue throughout the two years. Each resident is asked to present fully evaluated cases at regularly scheduled diagnostic conferences and team meetings.

The didactic seminars during the first year include a therapeutic intervention seminar which deals with basic approaches to diagnosis and treatment, a course on normal development, a continuous case conference, an introduction to psychological testing and psychopharmacology with children, a psychodynamic literature seminar, a psychopathology seminar, Child Psychiatry Grand Rounds, a developmental evaluation seminar, a crash course, inpatient case conferences, journal club, and neuropsychiatry.

SECOND YEAR OF TRAINING
During the second year of training, the resident expands his or her knowledge of child psychiatry through formal seminars which continue to build upon first year courses. Each resident also has a minimum of twenty hours of outpatient clinical work. Three hours of weekly supervision remain an integral part of the clinical experience.

The clinical and theoretical basis acquired during the first year provides the tools necessary to begin to apply child psychiatric concepts to related settings such as hospitals, schools and other community agencies. Experiences in each of these areas are an integral part of the second year.

During the second year the resident continues to participate in seminars. The continuous case conference, psychopathology, psychodynamic literature seminar, and journal club are all continued from the first year. Outpatient case conferences, consultation-liaison, school consultation, pediatric neuropsychiatry, and neurology and forensic seminar are added. The Department of Psychiatry and Child Division Grand Rounds are also integral parts of the second year experience. First and second year residents are expected to present at Grand Rounds.

Outpatient clinical work and supervision extend into the second year. Long term cases are carried over from the first year and new ones are added. New year-long and six-month supervisors are assigned.

Consultation-Liaison, school consultation and forensic experience occupy central positions in the second year, significantly expanding the resident's experience with children in hospital, school and forensic settings. The resident also participates in pediatric neurology clinics at Children's Hospital and gains greater exposure to the areas of child abuse, child development, and community psychiatry.

Elective time is available during the second year to allow residents to participate in areas of special interest. Possible electives include: research, administration, medical education, anxiety disorders clinic, cognitive-behavioral therapy, cross-cultural psychiatry, group therapy, pain clinic, substance abuse, advanced forensic training, eating disorder treatment, advanced developmental evaluation of young children, advanced psychopharmacology, psychodynamic literature and psychobiology seminar.

GRAND ROUNDS AND VISITING GUEST LECTURES
Child Psychiatry Grand Rounds is a division-wide educational activity. Directed by the division chief, Grand Rounds includes clinical presentations by the residents as well as clinical and research presentations by faculty and visiting academic clinicians. Topics include ethical issues in child and adolescent psychiatry, cross-cultural psychiatry, public policy issues, as well as current topics in child psychiatry.

JOURNAL CLUBS
One of the goals of UCSD Residency in Child and Adolescent Psychiatry is to ensure that residents learn to think critically about clinical and research issues. The journal club format facilitates this process. Residents learn to read and critique current and classical medical and psychiatric literature with invited faculty.

LITERATURE OF MADNESS
One of the truly unique features of the program is the Literature of Madness Seminar. Meeting at least quarterly, this seminar covers both classical and contemporary literature, theater, and other arts as they apply to modern psychiatry. All residents, fellows and faculty are invited.

BOARDS PREPARATION
All of our residents take part in the National Child PRITE, a standardized computer self-assessment test. PG4 residents also take part in the National Psychiatry Resident-In-Training-Examinations (PRITE), which is designed to prepare residents for the written portion of the Psychiatry and Neurology Boards. Individual test scores are given to the resident and his performance is discussed with the residency training director. Residents are given preparation for the oral portion of the boards through a series of mock board examinations in each year of the program. Feedback on performance is given to the resident using the same format that is used by Board examiners.

SUPERVISION
Supervision is a crucial part of our residency training. Each resident has a minimum of three hours of assigned supervision per week. Usually this consists of one administrative supervisor and two or three clinical supervisors. Supervisory assignments are rotated at six month intervals, giving each resident exposure to as many faculty members as possible. Opportunities exist for longer term, continuous supervision upon request.

ELECTIVES
Residents have the opportunity to pursue individual areas of interest in greater depth during elective time in their second year. Possible electives include: research, administration, medical education, anxiety disorders clinic, cognitive-behavioral therapy, cross-cultural psychiatry, group therapy, pain clinic, substance abuse, advanced forensic training, eating disorder treatment, advanced developmental evaluation of young children, advanced psychopharmacology, psychodynamic literature and psychobiology seminar.

NIGHT AND WEEKEND CALL
Residents take call from home throughout their child psychiatry training. While on call, residents cover the inpatient services at CAPS and Children's Hospital, providing emergency psychiatric consultation in the emergency room of Children's Hospital as well as inpatient consultation. While on call, residents receive supervision from their faculty attending back-up.