Duke Psychiatry Residency Education Program
Program Mission | Program Philosophy | Evidence-Based Medicine in Psychiatry | Psychotherapy Training
The three-fold mission of the Duke University Psychiatry Residency Education Program is:
- To train balanced clinicians with strengths in both psychotherapeutic and biologic aspects of psychiatry
- To teach critical thinking skills in the practice of evidence-based mental health care and to thereby graduate physicians with life-long learning skills
- To prepare leaders in psychiatry who will serve in research, teaching, administration and clinical service
The Philosophy of Residency Education at Duke
Our program is grounded in the biopsychosocial model of mental illness. Mind and brain receive equal emphasis, and learners are encouraged to pursue the integration of diverse theoretical and scientific domains of understanding. Our large and diverse faculty represent the full range of perspectives in modern psychiatry. The methods of instruction derive from the richness of clinical material at each of our training sites. Passive experiences of lecture-format didactics are being replaced by patient-stimulated learning experiences in small group interactive discussion-seminars, independent learning and evidence-based medicine case conferences and journal clubs. In a new endeavor, we are piloting problem-based learning modules (PBL) in the PGY-1 and PGY-3 years for addiction psychiatry and forensic psychiatry. In partnership with Healthstream.com, we are also creating a web-based forum for self-paced distance learning of core content areas with built-in assessment measures.
The home of the residency program is Duke University Medical Center, one of the most sophisticated centers in the world for medical education, patient care and research. First opened in 1930, it includes Duke Hospital (North) and Duke Clinic (South) housing the Private Diagnostic Clinics, the School of Medicine, and the School of Nursing. Recently expanded into the Duke University Health System, it now includes Durham Regional Hospital and Raleigh Community Hospital, as well as a number of affiliated outpatient facilities.
Duke Hospital trains more than 1,500 persons each year in the health sciences and provides care to more than 35,000 inpatients annually. The Hospital and the other clinical sites serve the Durham community and beyond, reaching out to people from all over the world who come for advanced treatment and care.
Evidence-Based Medicine in Psychiatry
What is EBM?
Evidence-Based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
Where can I learn more about EBM?
Why the emphasis on EBM at Duke?
We can't teach you everything you'll need to know for the life of your career. Our knowledge of the mind and brain will continue to expand at a rapid rate, leaving you quickly out of date after you graduate. But we can teach you how to become an effective lifelong learner by developing the skills and habits of critical thinking, so that as a busy clinician you can devote your scarce reading time to selective, efficient, patient-driven searching, appraisal and incorporation of the best available evidence. Even where evidence is limited, our graduates will select the evidence that bears on their clinical practice and recognize the strength of that evidence.
How do residents learn EBM skills at Duke?
Interns begin with an EBM Start-Up course in July of their PGY-1 year, followed by intensive practice writing CATs or Critically Appraised Topics for presentation in our weekly Chairman's Rounds. Our chief residents receive training in how to teach EBM and meet with the presenting residents to guide him/her through the process of selecting a relevant clinical problem from their patient experience, forming a researchable question, searching the literature for the best evidence and appraising that evidence for its validity. Residents practice generating the most relevant summary statistic for the study's results and evaluating the applicability of the study to their patient. Residents receive additional practice writing CATs for other seminars and conferences throughout their training. And an EBM Review course for all residents runs year-round during our Academic Half-day.
Even more important that writing CATs, however, the residents are challenged to practice these skills on the wards and in the clinic. EBM-trained attendings and supervisors apply an evidence-based approach to resident supervision, whether the topic is a medication or a psychosocial therapy question.
Duke Psychiatry has a long tradition of strong training in psychotherapy, rooted in the work of Adolf Meyer, Fred Hine and David Werman. Our large, diverse group of supervisors represents expertise in all types of psychotherapy. Seminars, experience with a range of therapy patients and therapy supervisors provides a strong foundation of psychotherapy competency for all residents, with rich opportunities to develop proficiency in one or more specific types of psychotherapy. Personal, individual psychotherapy is strongly encouraged, though not required. Approximately 80% of residents choose to do their own personal psychotherapy and 60-80% of residents make psychotherapy part of their clinical practice after graduation.
Features of our psychotherapy training include:
- Early immersion in therapy training to begin forming an identity as a therapist, starting in the PGY-1 year with a basic skills class using standardized patients, role-playing and videotapes. Interns have the option to pick up a psychotherapy case and therapy supervisor mid-year.
- Excellent therapy cases are readily available to residents through unique access to University managed care patients and Duke students.
- Interns also have a weekly intern process group.
- Live supervision of therapy patients from behind one-way mirror starts in the PGY-2 weekly outpatient clinic and continues in PGY-3 with live supervision of couples and families 6 hours/week for all PGY-3's in the Duke Family Studies program.
- All training and supervision is provided by faculty who teach (and often research) empirically-validated psychotherapies