The GW psychiatry residency is organized by its strong commitment to psychiatric humanism. Our residents learn clinical approaches that embrace the complexity of patients' lives in their family, community, and cultural contexts. They learn biological and psychosocial therapies within a broad and balanced biopsychosocial curriculum. They draw from multiple clinical perspectives and therapeutic traditions to tailor treatments that creatively address each patient's concerns. They provide both evidence-based treatments for patients’ psychiatric disorders and relief from suffering due to grief, demoralization, spiritual anguish, humiliation from stigma or social injustice, and other normal syndromes of distress. By the end of their four years of training, our residents become well-prepared for practice in the urban and international environments that characterize the Washington metropolitan area.
Psychiatrists face dual challenges during the coming decade. On one hand, neuroscientists continue to elucidate neurobiological processes that underlie each psychiatric disorder. These discoveries press psychiatrists to understand brain mechanisms of illness. On the other hand, psychiatric disorders have proven to be brain disorders that are exquisitely sensitive to the emotional and communicational environments in which patients live. The emotional stressors, shifting relationships, and cultural diversity of our patients' lives press psychiatrists to become ever more facile in using dialogue and relationships therapeutically. The GW psychiatry curriculum trains residents to meet both of these challenges capably.
Consultation-liaison psychiatry at GW joins our broad residency training in the inpatient and outpatient care of medically-ill patients with one of the nation’s oldest and most highly-regarded fellowships in psychosomatic medicine at Inova-Fairfax Hospital. The scope of consultation-liaison psychiatry training for GW is broad and unique, extending from acute medical hospitalizations to outpatient clinics and home-based care, with patients and families who bear medical illnesses over extended spans of time. Residents train rigorously in psychiatric assessment and acute treatment with hospitalized patients on medical and surgical services. However, they also learn skills for care beyond the emergency treatment and crisis management of acute hospitalizations. Residents learn skills for helping medically-ill outpatients and their families to manage the human devastation that often accompanies illness, involving uncertainty and waiting, loss of function and status, strained relationships, and caregiver burdens. They learn collaborative methods for family interventions and family-centered care that mobilize strengths and build resilience. They learn how to incorporate patients’ religious and spiritual resources in clinical treatment. Consultation-liaison psychiatry and psychosomatic medicine are taught by four full-time faculty who hold a subspecialty certification in psychosomatic medicine by the American Board of Psychiatry and Neurology.
Initial training in consultation-liaison psychiatry begins at Inova-Fairfax Hospital in the PGY-II year, when residents learn the role of psychiatric consultant on a geriatric medicine consultation team during their geriatric psychiatry rotation. Core training in hospital-based consultation-liaison psychiatry occurs on the PGY-II consultation-liaison psychiatry rotation at George Washington University Hospital. Residents conduct psychiatric consultations on medical and surgical services under the supervision of faculty attendings. Readings in the psychosomatic medicine research literature and written examinations of clinical knowledgebase provide residents with a strong foundation in the psychiatric care of medically-ill patients. Residents’ diagnostic interviews are directly observed in formal evaluations by faculty who supervise the development of interview skills.
Advanced training occurs in the PGY-III year with psychiatric consultations to outpatient medical clinics. PGY-III residents are assigned as year-long liaison psychiatrists to weekly breast cancer, young adult survivors of childhood cancers, amyotropic lateral sclerosis, stroke, and women’s reproductive psychiatry clinics, where they provide outpatient psychiatric consultations and individual or family-centered psychotherapy. A large portion of brief psychotherapy, couples therapy, and family therapy training is conducted with these medically ill patients and families. Residents with career interests in consultation-liaison psychiatry are encouraged to initiate clinical research projects that are mentored by consultation-liaison psychiatry faculty. Psychosomatic medicine fellows, psychiatry residents and faculty gather bi-monthly for an evening psychosomatic medicine interest group.
The GW Department of Psychiatry has a close affiliation with the Department of Neurology. PGY-II Psychiatry residents attend the weekly Epilepsy Conference, where patients are presented multidimensionally from neurological, neurosurgical, psychiatric, neuropsychological, and neuroradiological perspectives. Neuropsychiatry and clinical neurosciences are taught in both PGY-II and PGY-III residency seminars.
The Psychosomatic Medicine Fellowship at Inova-Fairfax Hospital/George Washington University has long stood as one of the nation’s major psychosomatic medicine psychiatry fellowships under the leadership of program director, Catherine Crone, M.D., and Inova-Fairfax psychiatry chairman, Michael Clark, M.D. Over the past three decades, the fellowship has trained more than 80 consultation-liaison psychiatrists while providing national leadership in development of psychosomatic medicine as a psychiatric subspecialty within the American Board of Medical Specialties. More than 300 research articles, clinical reports, and other scholarly works have been published by Inova-Fairfax/GW fellows during training. Drs. Wise and Crone have served on the Council of the Academy of Psychosomatic Medicine and the American Board of Psychiatry and Neurology’s Psychosomatic Medicine examination committee. Dr. Wise has served as editor-in-chief of the journal Psychosomatics and is past president for both the Academy of Psychosomatic Medicine and the American Psychosomatic Society.
The Washington metropolitan area is one of the nation's most multi-ethnic regions, with as many as 180 countries and 100 languages represented in suburban Northern Virginia and Maryland and District of Columbia public schools. Complementing its diverse patient populations, the clinical and full-time faculty of the Department of Psychiatry include more than a dozen teachers, scholars, and clinicians who are internationally recognized for their expertise in cultural psychiatry, ethnopharmacology, human rights and international relations, treatment of traumatic stress in post-conflict settings, torture-survivor rehabilitation, psychiatric evaluation of political asylum applicants, and international mental health services.
The GW Department of Psychiatry provides the psychiatric component of mental health services at Northern Virginia Family Services, whose multilingual psychosocial programs include the Program for Survivors of Torture and Severe Trauma. GW psychiatry residents study cultural psychiatry during PGY-II and PGY-III seminars, learn therapies for posttraumatic disorders, treat patients in clinics for immigrants and refugees, and conduct asylum evaluations for political refugees in the GW Human Rights Clinic. GW psychiatry residents work in a community mental health center at Gallaudet University with patients in the deaf and hard-of-hearing community.
GW psychiatry residents have unique opportunities to participate in clinical research on the role of spirituality in mental health and recovery from medical and psychiatric illnesses. GW psychiatry faculty collaborate with the George Washington University Institute for Spirituality and Health (GWISH) in educational programs that assist physicians seeking to respond to spiritual needs of patients in their provision of health care. The GW psychiatry residency was a recipient of 2002 Spirituality and Medicine Award and a 2006 Psychiatry Residency Curricular Award from the John Templeton Foundation.
Residents with specific career interests in global mental health can pursue an enriched Global Mental Health Track over their four years of residency training. Residents in the Global Mental Health Track meet quarterly with faculty in an evening Advanced Global Mental Health Seminar in which residents present research projects and other scholarship for peer review by seminar participants.
Since its inception, the GW Department of Psychiatry has been nationally recognized for its focus upon children and families. All child psychiatry faculty at the nationally renowned Children's National Health System also hold joint faculty appointments in our GW department. GW psychiatry residents have more child and adolescent training than most residents in American programs—up to four months. This child psychiatry experience occurs early in residency during the PGY-II year, presenting residents a realistic picture of career possibilities in child and adolescent psychiatry before making a decision in the PGY-III year to apply for fellowship training. From a third to a half of GW psychiatry residents go on to complete child and adolescent psychiatry fellowships.
An innovative family psychiatry curriculum in the PGY-III year teaches residents how to integrate family interventions in general psychiatric practice, how to conduct family-centered care for medically and psychiatrically ill patients, and how to aid individuals struggling to differentiate successfully within their family systems by supporting elaboration of personal self while preserving family relationships. PGY-III residents train in emotionally-focused couples therapy through seminar sessions and weekly clinical supervisions.
Our GW child and adolescent psychiatry fellowship at Children's National Health System is one of the nation’s oldest and most highly regarded child psychiatry fellowships. It provides comprehensive clinical child and adolescent psychiatry training with abundant opportunities to pursue academic and administrative psychiatry, research, and service to public and/or private populations. It provides frequent opportunities to meet with leaders in the field who are creating health policy and research that is shaping current practice. Its clinical foundation is its major teaching services—inpatient, day treatment, outpatient (including infant and toddler psychiatry), and pediatric consultation-liaison psychiatric services, each with separate units for children and adolescents. In addition, there are specific training experiences in emergency psychiatry, community psychiatry, school consultation, and forensic psychiatry. Training also occurs in subspecialty clinics for affective disorders, neurobehavioral disorders, ADHD, autism spectrum disorders, sleep disorders, Infant and Toddler Clinic, and the Feeding Team. For future academic teachers or child psychiatry researchers, a combined clinical/research track divides training time between Children's National and the National Institute for Mental Health (NIMH) over a three-year period. Clinical training in the diagnosis, treatment and clinical management of psychiatrically-ill children and adolescents is integrated with focused NIMH research training on child and adolescent psychiatric disorders.
Located a few blocks from the White House and State Department, the physical proximity of GW to the national government, public policy institutes, and headquarters of national professional and non-governmental organizations provides unique opportunities to develop a career at the interface of psychiatry and public policy. GW psychiatry residents can pursue a joint Psychiatry Residency/MPH Degree in Mental Health Policy. The GW Milken Institute School of Public Health (Milken Institute School) is the sole school of public health based in the nation's capital. Department of Psychiatry faculty collaborate with members of the nationally recognized Center for Health Policy Research in the Milken Institute School in multiple areas.
All PGY-III psychiatry residents complete a three-week intensive health policy rotation that combines morning lectures on health policy topics with afternoon field trips to Washington sites where policies are made, ranging from Capitol Hill to the Institute of Medicine. Residents with serious interests in mental health policy and advocacy can matriculate into the joint psychiatry residency/M.P.H. program. Two GW psychiatry residents in recent years have been selected by the American Psychiatric Association as a Jeanne Spurlock, M.D. Congressional Fellow on the legislative staff of a United States Congressman.
The Jerry W. Wiener, M.D. Fund in Psychiatry supports an annual lectureship in mental health advocacy and public policy, as well as attendance at national conferences for PGY-IV residents pursuing scholarly projects in mental health policy and advocacy.
Forensic psychiatry, the interface of psychiatry and the law, is a core competency training area in psychiatry residency education. A solid, balanced, interesting, and rich forensic curriculum serves residents in effectively pursuing their career paths and encourages critical evaluation of key issues in general psychiatry. The Forensic curriculum at the GW psychiatry program offers progressive exposure to forensic concepts and practices most relevant to general psychiatry residents.
Starting with the PGY-II year, residents are introduced to fundamental principles and practices of psychiatry as they apply to legal issues. The PGY-II year didactic curriculum is designed to provide a solid grounding in legal issues related to the practice of psychiatry in order to understand the origins and rationale of medico-legal requirements and guidelines. The seminar topics include introduction to the legal system as it pertains to mental health, forensic ethics, malpractice, right to treatment/right to refuse treatment, civil commitment, duty to warn/protect, competency, criminal responsibility, child custody, juvenile justice, and expert witness skills such as testimony and report writing. These didactics are delivered in an interactive format in an extensive 10-week seminar. They are taught by both medical and legal personnel, who are well-versed in confronting complex medico-legal issues, to offer valuable perspectives. By employing this interdisciplinary stance, residents benefit from learning different approaches to the same case material or different views on the same issue.
In the PGY-III and -IV years, residents with an interest in forensic psychiatry are afforded an opportunity to further pursue various forensic electives. Given the prevalence of mental illness in the incarcerated population, correctional psychiatry has become an increasingly important and valued specialty over the years. An elective is available for residents to work with faculty members on forensic cases of both civil and criminal nature. Under the tutelage of the forensic supervisor, residents learn first-hand about forensic processes, including doing a thorough document review, conducting a forensic evaluation, writing a report, communicating with the legal team, giving a deposition, and testifying in court. Residents can also work with Physicians for Human Rights, alongside an experienced supervisor, conducting pro bono political asylum evaluations and providing written affidavits/oral testimony for the court. In addition, residents can participate in court commitment hearings and mock trials with law school students, which can approximate the real life scenario of testifying in a courtroom. These are all excellent learning opportunities for residents to gain hands-on experience and receive direct supervision. Such electives and experiences help residents translate didactic knowledge into practical applications in both clinical and legal settings.
In addition to the specific electives, residents become members of the American Academy of Psychiatry and the Law and are strongly encouraged to present academic forensic projects at its annual national meeting. Residents work closely with their forensic mentors to develop and implement their academic projects, as well as to plan out their future career opportunities.
Underlying all the didactics and electives, a crucial part of forensic training involves developing the ability to review relevant material in a critical, reasoned, and informed fashion, conduct a thorough and objective evaluation, and communicate one’s opinions and recommendations in a concise, easily comprehensible manner. These skill sets are crucial in helping residents lay down a solid foundation for further training in forensic psychiatry; residents graduating from the GW psychiatry residency in the past have gone on to complete their fellowship at prestigious forensic psychiatry programs across the country. More importantly, these skill sets enable general psychiatry residents to become well-rounded clinicians with empathic sensitivity and commitment to quality patient care, who also possess well-informed legal perspectives to serve effectively as advocates, activists, and educators.
GW psychiatry residents learn how to conduct psychiatric treatment on community-based interdisciplinary teams. These include both primary care community health centers and comprehensive community mental health programs for the chronically mentally ill.
The McClendon Center is a District of Columbia Core Service Agency that serves the needs of approximately 700 adults diagnosed with serious and persistent mental illness. Its individualized, multidisciplinary programs seek rehabilitation of patients as persons, by fostering creativity, friendship, stability, independence, emotional growth, and greater participation in the community. The center provides day programming, case management, psychiatric care, and counseling at two sites. McClendon Center is the only Washington, D.C. community mental health agency with accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). PGY-III and PGY-IV residents learn community psychiatry and mental health services delivery through their work on McClendon Center interdisciplinary treatment teams.
Pathways to Housing DC is a unique community agency that specifically targets homelessness among people in the District of Columbia who are disabled by mental illnesses. Pathways for Housing has received numerous awards and commendations for the effectiveness of its innovative program, including the Gold Award from the American Psychiatric Association. Most Pathways patients have been both homeless and dually-diagnosed with mental illnesses and substance use disorders. The “housing first” Pathways model provides housing first, then supportive treatment services for mental and physical health, substance abuse, education and employment. Housing is provided in apartments throughout the community. Psychiatric care is supported by 10 ACT teams that make home visits and respond to crises. A walk-in psychiatric clinic is provided at the Q Street NE center. PGY-III and PGY-IV residents learn assertive community treatment and the “housing first” model at Pathways for Housing DC.
Merrifield and Gartlan Mental Health centers provide the core mental health services for the Fairfax County Community Services Board in Northern Virginia. PGY-IV residents acquire advanced levels of expertise as community psychiatrists through the Merrifield and Gartlan programs.
Gallaudet University Community Mental Health Center (MHC) provides student mental health services for the nation’s only university committed to education of deaf and hard of hearing students. Deaf and hard-of-hearing adults in the Washington metropolitan area make up approximately a third of Gallaudet Mental Health Center’s patients. A PGY-III resident serves as psychiatric consultant on Gallaudet MHC’s interdisciplinary treatment teams via sign interpreters.
Residents commonly choose our program for its commitment to psychotherapy training. While training in psychodynamic psychotherapy has been central to the identity of the GW residency, GW faculty have also made important contributions to teaching and research in couple and family therapy, group therapy, and brief individual psychotherapies. Outpatient psychiatry training coordinates didactic seminars, weekly supervisions, clinical case conferences, and monitored case loads representing multiple approaches to psychotherapy, including long-term psychodynamic psychotherapy, seven models of individual brief psychotherapies (cognitive-behavior, interpersonal, solution-focused, narrative, existential, motivational enhancement, somatic trauma therapies), group therapy, and couple and family therapy. Residents begin working with their first psychodynamic psychotherapy patient, and a supervisor in the middle of their PGY-II year, providing the opportunity to engage in long-term psychothearpy. Our residents become skilled clinicians who employ a breadth of approaches through which language and relationship serve as tools of healing.
In 2013, Baltimore Washington Center for Psychotherapy and Psychoanalysis formally joined the Department of Psychiatry as its Division of Psychoanalytic Studies. This educational and research partnership between the Washington Center for Psychoanalysis and the GW Department of Psychiatry provides residents with didactic teaching and psychotherapy supervision by one of the nation's major psychoanalytic faculties. Approximately a third of the membership of the Washington Psychoanalytic Institute actively teaches or supervises GW residents and medical students. Selected residents can pursue psychoanalytic training concurrently with psychiatry residency.
The Daniel S. Prager, M.D. Lectureship in Psychoanalytic Psychiatry has brought to our department such distinguished leaders in psychoanalytic thinking as Drs. Hilda Bruch, Otto Kernberg, and Glen Gabbard. PGY-IV residents who show special aptitudes for psychodynamic psychotherapy can be selected as Prager Fellows, which provides funded support for advanced studies or research in psychoanalytic psychotherapy.
Clinical training in the psychotherapies and in psychopharmacology both are grounded in neurobiological and social neuroscience perspectives in our residency curriculum. Residents learn how to integrate psychoeducation, psychosocial therapies, resilience-building interventions, and pharmacological treatments into multi-modality programs that target specific psychiatric disorders. A balanced emphasis is placed upon treatment of psychiatric disorders and interventions that can relieve suffering from such normal syndromes of distress as grief, demoralization, spiritual crises, and humiliation from stigmatization or social injustice. Emphasis is placed upon the practical use of psychotherapy skills during brief clinical encounters with medically-ill patients on the psychiatric consultation-liaison service and with pharmacologically-treated patients in community mental health centers, supporting a humanistic focus upon each patient’s well-being as a person.
Didactic seminars and clinical supervisions across each year of residency teach principles of clinical psychopharmacology and multi-modality treatment. Residents are expected to learn how to use medications not only for symptom reduction in a narrow sense, but also to open new possibilities for patients to communicate effectively, to engage more fully in personal and work relationships, and to sustain a robust sense of self.