PGY3

PGY3 Seminars

The PGY3 year is entirely an outpatient adult and child psychiatry experience, with rotations through psychiatric outpatient clinics at Ventura County Behavioral Health and Community Memorial Healthcare. Seminars in the PGY3 year provide in-depth exposure to the elements of psychiatric practice needed to work with outpatients in various clinic settings. Residents will encounter a broad spectrum of psychiatric diagnoses and illness severity, which will be addressed both in seminars and individual case presentations. All require compulsory attendance.

Advanced Topics in Biological Psychiatry and Psychopharmacology; Seminars and Case Conferences – Joseph Vlaskovits MD, Jason Cooper MD, Robert Rubin MD, PhD

In this seminar, fundamental aspects of neurochemistry and neurophysiology are presented, including theories of neurotransmitter and brain network dysfunction in major mental illness. Fundamental aspects of pharmacological actions of major classes of psychopharmaceutical agents (antipsychotics, antidepressants, antianxiety agents, mood stabilizers, hypnotics, stimulants, and cognitive enhancers), including neurotransmitter/neuromodulator receptor agonist and antagonist effects, pharmacokinetics, and pharmacodynamics, are presented. Comparisons of therapeutic effects among drugs in each class are discussed in detail. Drug-drug interactions, both among psychopharmacologic agents and between these agents and other classes of drugs, major adverse events, and frequent side effects are also discussed in detail. The genetic underpinnings of drug metabolism and interactions and their effects on therapeutic response, discussed briefly in the PGY1 seminars, are revisited. The concept of evidence-based medicine is considered with each class of medication discussed (e.g. the strength of therapeutic effect versus placebo and comparison drugs) and the strength of drug-drug interactions as established in the medical literature. Case presentations emphasize practical application of theory in the use of all classes of psychotropic medications. 32 hours (8 sessions).

Advanced Topics in the Psychotherapies; Seminars and Case Conferences – Leslie Horton MD, PhD, Ronda Doonan PsyD, Daniel Powell MA, LMFT

Major psychological theories and therapeutic approaches, including their evidence base, are discussed, including ego psychology, separation/individuation, behavior/learning and behavioral therapies (e.g. cognitive behavioral therapy), psychodynamic psychology and psychoanalytic therapy. Residents learn to develop a psychodynamic formulation and combine psychopharmacology with psychotherapy. Therapeutic techniques to improve compliance with treatment in vulnerable patients (e.g. those with poor social support systems) are emphasized. In the context of various outpatient clinic rotations, the effects of racism, poverty, addiction, discrimination, and other social determinants of health on patients’ mental health and psychosocial growth will be addressed in therapy. Psychosocial rehabilitation and community-based programs, (e.g. those that address homelessness in Ventura County), and therapies and programs adapted for co-occurring addiction and mental illness, are important considerations. Mindfulness techniques, spirituality, and the role of the arts in mental health are integrated into the curriculum. Case presentations emphasize practical application of theory and treatment techniques. 32 hours (8 sessions).

Couples, Family, and Group Therapies – Daniel Powell MA, LMFT

Extensions of individual psychotherapies incorporate inclusion of the “significant other” in couples therapy, more family members (e.g. children, when there is a shared family issue), and inclusion of a patient in a group that offers particular leverage (e.g. support, insightful challenge), in the psychotherapeutic process. Indications for use of these modalities are discussed, and residents are offered opportunities for conducting these therapies with selected patients. 16 hours (4 sessions).

Cultural Psychiatry – Leslie Horton MD, PhD

Different cultures and communities exhibit distress and explain symptoms in different ways (idioms of distress), and residents need to be aware of relevant contextual information stemming from a patient’s culture, race, ethnicity, religion and geographical origin. Ventura County has a large agricultural presence and a significant Hispanic population. Cultural aspects of presentation of psychiatric illness, diagnosis, interactions with patients’ families, approaches to both biological and psychological treatments, and development of a long-term therapeutic clinician-patient relationship are considered for the major cultures represented in Ventura County. Residents have the opportunity to explore the uses and understanding of the term culture as it relates to health, illness and healing. 12 hours (3 sessions).
Community and Social Psychiatry – Jantje Groot MD, other faculty, and outside experts

Psychosocial rehabilitation models and community-based programs, such as the ASSIST and ACT programs addressing the epidemic of homelessness in Ventura County, and community-based treatment programs, specifically targeting co-occurring addiction and mental health issues, are important considerations in this seminar. Non-medical community treatment programs, such as Alcoholics Anonymous and analogous programs for narcotic addiction, are discussed. Field trips to meetings of these community resources are planned as scheduling permits. 12 hours (3 sessions).

Forensic Psychiatry – Joseph Vlaskovits, MD

The purpose of this seminar is to provide an overview of the development of laws governing the involuntary detention of psychiatric patients, their culpability in criminal proceedings, legal competency of patients with cognitive impairment, the status of California institutions for psychiatric patients convicted of law violations, and the interface of legal and medical authority over these patients. Residents are afforded opportunities for psychiatric evaluation of persons facing legal questions in all the aforementioned areas. 12 hours (3 sessions).

Research Methods and Issues – Robert Rubin MD, PhD

What constitutes research (i.e. the development of new knowledge), is the primary focus of this seminar. The presentation of new knowledge to others, in oral and/or written form, is emphasized as a sine qua non for research endeavors. Research is broadly defined, ranging from literature reviews to laboratory projects, and includes both human and animal studies. Elements of sound research practice (e.g. experimental methods and data analysis), are discussed in detail, as will ethics in research. Contemporary examples of research malfeasance and consequences are presented as cautionary tales. Residents’ quality improvement projects, initiated at least conceptually in PGY2, are discussed in detail, so that they can be presented in Grand Rounds during the resident’s PGY4 year. 40 hours (10 sessions).

Professional Development / Transition to Practice – All faculty

The emphasis of this residency program is on training psychiatrists to meet the needs of Ventura County mental health programs. As such, the role of the psychiatrist in these programs is considered from the standpoint of both practicing clinician and administrator/team leader. This seminar series is carried through all four postgraduate years, with greater frequency in PGY4 year. In later years, post-residency opportunities in public institutions and clinics are discussed in detail, including both clinical and administrative positions. As well, opportunities and challenges in private practice, academic and educational settings, and careers in basic and clinical research are considered. 20 hours (5 sessions).

PRITE Review Course – All faculty.
16 hours (4 sessions).