The mission of the Duke University Hospital-Child and Adolescent Psychiatry Residency Training Program is “To train leaders in clinical and academic psychiatry with an emphasis on integrating an evidenced-based approach to care for children and adolescents.”
To provide the learning experience necessary for the development of clinical expertise in child and adolescent psychiatry there are a variety of clinical opportunities to establish a solid learning experience in the core competencies while also encouraging each child psychiatry resident to develop his or her individual career interests. Many research opportunities are also readily available during the residency.
The main education seminars occur for both years during an academic half-day of protected time. This has a cornerstone two year case-based seminar series which review the epidemiology, diagnosis, and treatment of psychiatric disorders in children and adolescents. Embedded in this time are three case- and evidence-based monthly seminars which critically appraise the approach to problems in consultation-liason, psychopharmacology (popularly known as "stump the chumps" with the "chumps" being the faculty) and complex child and adolescent psychiatric presentations (chief's rounds). Articles on the clinical questions .being discussed are circulated. Special modules on human development, forensics, pre-school, consultation, systems based practice, neurophysiology, and psychopharmacology are also provided in addition to general coverage of child and adolescent psychiatric disorders.. First year residents get two additional weekly seminar series at Central Regional Hospital. One on basic concepts of development and clinical care, and a second concerned with developing skills in the evaluation of the the psychiatric literature, with the particular aim of demystifying the complex analyses in common use (including a component entitled "Generalized linear models for dummies") and particularly their application in key therapeutic studies. Empirically supported psychosocial treatments are taught at specific clinical rotations in both years.
Clinical training sites include inpatient and outpatient child and adolescent services. The inpatient psychiatry experience occurs during the first year at Central Regional Hospital-Children and Adolescent Units. This is a newly- built state-of-the-art State hospital that serves a mixture of public and private sector patients and their families. The Children’s Services provides multidisciplinary diagnostic, educational and treatment services for children age 5 years to 12 years. Adolescent Services provides diagnostic, educational and treatment service for adolescents ages 13 years to 18 years. The resident’s average caseload is five patients. Responsibility for the resident’s cases is progressive with the expectation that residents will be able to function at the junior attending level by the end of their rotations. During the in-patient treatment experience, residents interact with and lead multidisciplinary treatment teams.
Outpatient training occurs during both years. The first year residents go to The Duke Child & Family Study Center. It includes concurrent supervision behind a one way mirror of diagnostic assessments and treatment cases along with a Cognitive Behavioral Therapy case conference seminar. Also located at this site is the Family Studies Program where the first year resident does assessment and treatment of families behind a one way mirror. The second year outpatient clinical practice occurs at Duke and an affiliated community based outpatient practice (3-C Family Services, Durham Child Development and Behavioral Health Clinic, and/or Lincoln Health Center, and/or Southern High School Wellness Clinic). These clinical sites have long term treatment experience with a caseload that encompasses a wide range of ages, diagnoses, and treatment approaches that include pharmacotherapy, cognitive behavioral child and family psychotherapy, group psychotherapy and psychodynamically oriented child psychotherapy. Additional required out-patient rotations include the Center for Child and Family Health, Center for Adolescent Substance Use Treatment-CAST /Substance Abuse, Autism Clinic and Pediatric Neurology (Epilepsy Clinic at Duke, Spasticity Clinic at Duke, and Cerebral Palsy Clinic at Duke). Elective specialty clinic rotations include Medical Genetics, Rheumatology/Pain, Pediatric Sleep Disorders, Eating Disorders, Child Abuse/Neglect Clinic, and UNC Forensics Clinic.
The second year residents also have multiple consultation experiences: Consultation-Liaison on pediatric inpatient medical/surgical units at Duke University Hospital and outpatient pediatric specialty clinics, and School Consultation.
On weekdays child and adolescent fellows provide in-home advice services for junior residents in the ED who do not yet feel confident enough in their skills to contact the on-call child attending directly. On weekends, fellows cover the pediatric consultation-liason service from home, but are expected to go into the hospital to evaluate the child directly if called. However, it is rare for such visits to occur - perhaps such an evalutation will be required two or three times per year.