The Child and Adolescent Psychiatry Residency of the Massachusetts General Hospital/McLean Hospital provides a two-year program of specialized training in child and adolescent psychiatry. The training program is an integral part of the General Psychiatry Residency Program at Massachusetts General Hospital (MGH) and McLean Hospital, as well as the Pediatric Residency Training Program at MGH.
Residents join staff in providing the best possible comprehensive care for children, adolescents and their families. Child and adolescent psychiatry training at MGH and McLean Hospital is based on the philosophy that no single conceptual framework is sufficient to understand human behavior. Residents are taught to approach patients and their families from a developmental perspective using five clinical orientations: psychodynamic, psychosocial, biologic, behavioral and cognitive. They are challenged to understand clinical issues in depth and to attempt formulations that integrate conceptual models.
Our program recognizes that adequate training for the current and future practice of child and adolescent psychiatry is, of necessity, demanding. Beyond attaining essential knowledge, skills and attitudes, residents need to develop a sense of professional identity that includes being a secure physician, an advocate for children, a sensitive therapist and a thoughtful participant or consultant within team structures. A primary goal of the Training Program is to produce leaders in the field of child and adolescent psychiatry.Program Design
We have designed this program to foster the development of well-rounded, competent child and adolescent psychiatrists. Above all we value a serious and passionate commitment to the highest standards of patient care. Our philosophy emphasizes the fact that first and foremost, we are clinicians, dedicated and available to the needs of our patients. Training in brief and long-term individual therapy, supportive therapy, psychodynamic psychotherapy, family therapy, crisis intervention, pharmacotherapy, combined psychotherapy and psychopharmacology, group therapy and cognitive and behavioral therapies is provided through direct clinical experience supported by supervision, theoretical and evidence-based seminars and demonstrations by the teachers and skilled clinical practitioners, consultants and administrators. We will specifically encourage pilot research protocols and other scholarly experiences. Our philosophy emphasizes the concept that research and scholarship are fundamental extensions of being a physician and child and adolescent psychiatrist.
We understand that residents will come to our program with different strengths and needs. Our objective is to ensure clinical competence in childhood and adolescent psychiatric diagnosis and treatment, while being flexible enough to support learning opportunities according to a resident’s particular interests. Ample elective time is provided to encourage exploration and acquisition of skills in specific child and adolescent psychiatry subspecialties. Residents in this program participate in a structured core clinical and educational experience, with rotations in the MGH outpatient child and adolescent psychiatry clinic, the MGH inpatient pediatric wards, the McLean Hospital inpatient, acute residential and partial hospital programs, the Boston Juvenile Court Clinic, MGH and Partners Community Health Centers and the local community public school systems. The Program is under the direction and supervision of the Training Director, Eugene V. Beresin, M.D. and the Associate Training Director, Steve Schlozman, M.D.
Each year, residents have specific “milestones” they are required to achieve as indicated below in the description of knowledge, skills and attitudes for year 1 and year 2. The measure of achievement include: competency-based assessments (see below for examples), formative and summative feedback by individual supervisors, service chiefs, seminar leaders, and the training directors. The progress of each resident is reviewed biannually with the program director. It is essential for each rotation leader to provide verbal and written feedback on progress at multiple points during every rotation; however, they are required at mid-points and at the conclusion of rotations. This feedback is sent to the program directors and reviewed in an ongoing fashion by the Executive Training Committee. We specifically consider the question of whether residents are capable of assuming greater clinical responsibility through years 1 and 2 and as each resident passes from one rotation to another. It is clear that the level of responsibility and increasingly independent practice is built in to the structure of the rotations within and between years 1 and 2.
In recent years, there have been modifications of the ACGME Common and Specific Program Requirements. These are addressed within the body of knowledge, skills and attitudes noted below. In addition, there have been a number of new regulations including duty hours, safety training, monitoring transitions and hand-offs, the specific roles and definitions of supervision (on and off site), transportation home for fatigued residents, once-weekly time off all clinical duties, and ongoing electronic medical record training.
We believe that the competency levels achieved for each residency year measured by distinct instruments and observational methods, coupled with implementation of the ACGME Common, Specific and new residency regulations, will all result in the production of highly professional, ethical, competent and independent practitioners. Should any resident fall short of the requisite goals, a graduated system of warnings, close monitoring, increased supervision, academic remediation of deficits, and if necessary, academic probation will be instituted. Any remediation process shall have a designated clinical leader, a team of faculty observers, and clear documentation of progress sent to the training directors and reviewed by the Executive Training Committee. Prior to the institution of such remediation, all deficient knowledge, skills and/or attitudes will be reviewed with the resident and documented in writing, including the necessary measures for release of remediation.
Massachusetts General Hospital and McLean Hospital are both accredited by the Joint Commission for Accreditation of Hospitals. The Training Program is approved by the Accreditation Council of Graduate Medical Education’s Residency Review Committee for two years of training.