Career Development

Residents interested in addiction psychiatry can seek support in preparing for advanced training as part of the addictions fellowship, or as a general psychiatrist with special skill in dealing with addicted or dual-disordered patients.

Optional Addictions Training for All Residents

• Motivational Interviewing
• Dual Disorders Treatment
• Addiction Pharmacology/Buprenorphine Training
• Behavioral Interventions

Addiction Psychiatry Interest Track

• Work with an addictions-trained faculty advisor.
• Attend periodic meetings to acquaint you with faculty, residents, and opportunities for clinical practice or research in the department.
• Supported attendance at Washington Society of Addiction Medicine Conference, and possible support for attendance at a national meeting.

Optional Consultation-Liaison Psychiatry Training for All Residents

• Advanced electives in outpatient consultation liaison psychiatry (e.g. Fred Hutchinson Cancer Center, Maternal Infant Care Clinic, HIV/AIDS Clinic, International Clinic, Diabetes Care Clinic)
• Junior attending rotations in inpatient consultation-liaison psychiatry
• Consultation-liaison psychiatry or health services research
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Interested residents have the opportunity for early experience with children through internship rotations in pediatrics and/or pediatric neurology, and through child psychiatry rotations as early as their PGY-2 year.

Residents may enter the Child and Adolescent Psychiatry Residency in either their PGY-4 or PGY-5 year.

The UW Department of Psychiatry has one of the largest geriatrics divisions in the country.

The department has research opportunities in geriatric neuroscience, neuropsychiatry, genetics, treatment and health services.

Interested residents may independently pursue mentorship in research or participate in elective opportunities. Residents may also pursue the Geriatric Psychiatry Fellowship following residency.

The Integrated Care Pathway provides opportunities for residents to learn about the spectrum of care integrating behavioral and physical health care, provides mentorship for residents interested in integrated care, and provides support to work on a project in an integrated care setting. Specific learning opportunities include:

• Attend regular lunchtime meetings in which a faculty member leads a discussion about an aspect of integrated care, particularly in terms of career opportunities.
• For senior residents, participate in a collaborative care clinical rotation, providing caseload consultation to behavioral health care managers in primary care settings.
• Gain more in depth experience by pursuing an Area of Distinction in integrated care.

The goals of the Integrated Care Pathway are to:

Background:

Reproductive age individuals have a high prevalence of mental and behavioral disorders, including depression anxiety and substance use disorder.  Due to specific concerns around diagnosis and treatment during pregnancy and lactation, effects of reproductive hormones, and higher prevalence or differing presentation and course of conditions such as eating disorders and substance use disorders, this is a population that often benefits from specialized and customized care.  This career development pathway for interested psychiatry residents is specifically geared towards clinical, educational, and scholarly experiences in perinatal and reproductive psychiatry and/or women’s mental health.

Description:

The pathway includes clinical rotations, regular meetings, and a research or scholarly project.  It can also include teaching activities or projects.  The pathway can be completed in the third and fourth year of residency, but residents in all years are welcome to join the pathway and attend meetings.

Goals and Objectives:

The overall goal of this pathway is to develop the knowledge base, clinical skills, and scholarship of general psychiatry residents in perinatal psychiatry (assessment and treatment of psychiatric symptoms during pregnancy, postpartum, and in individuals wishing to conceive) and in women’s mental health.

After participating in this pathway, residents will be able to:

• Discuss the influence of the female reproductive cycle and reproductive hormones on psychiatric disorders.
• Demonstrate knowledge of changes in pharmacokinetics and pharmacodynamics of psychotropic medications during pregnancy and postpartum, and incorporate this knowledge into patient care.
• Describe potential effects and risks of in utero exposure to psychotropic medications on the fetus and newborn.
• Discuss the implications of maternal psychiatric disorders during pregnancy and postpartum for pregnancy and child outcomes and for bonding and attachment.
• Provide information to patients, family members, and other healthcare providers about risks of medications and about the risks of stopping or not taking psychotropic medication during pregnancy and/or lactation.
• Provide and document preconception counselling.
• Incorporate knowledge about evidence-based psychotherapies, other non-pharmacologic interventions, and complementary and alternative therapies into discussions with patients and into treatment plans for pregnant and postpartum individuals.
• Display appreciation of, knowledge about, and the ability to manage psychological responses to pregnancy and pregnancy-related complications such as infertility and perinatal loss.
• Demonstrate sound clinical reasoning and the ability to weigh risks of treatments and of perinatal mental illness, patient preferences, and alternative treatment approaches in specific clinical situations.
• Demonstrate knowledge about and the ability to manage selected conditions and issues of interest to the resident and related to women’s mental health (e.g. premenstrual symptoms, mood symptoms associated with menopause, eating disorders, substance use disorders in women, intimate partner violence).
• Critically appraise the literature and the evidence base related to psychiatric practice during pregnancy and postpartum and related to issues in women’s mental health.

Faculty:

Amritha Bhat, MD, MPH; Deborah Cowley, MD; Nadejda Bespalova, MD

Clinical rotations:

MICC: The Maternal and Infant Care Clinic provides obstetric and gynecological care for high-risk pregnancies throughout pregnancy and the postpartum period. The psychiatry resident assigned to this clinic spends half a day per week providing consultation to clinic providers, who include obstetrician-gynecologists, neonatologists, and midwives, and working very closely with the two clinic social workers. The resident provides psychiatric evaluation and treatment for individuals with a wide range of mental health issues in pregnancy and postpartum, including depression, anxiety, bipolar disorder, and psychotic disorders.

Perinatal Psychiatry Clinic: Located at the outpatient psychiatry clinic at UWMC Roosevelt (OPC), this clinic provides psychiatric consultation and ongoing care to individuals with mental health issues during pregnancy, postpartum and pre-conception.

Harborview Women’s Clinic: In this rotation, the resident spends half a day per week providing psychiatric consultation to OB-GYN providers in the Harborview Women’s Clinic. This includes a new perinatal collaborative care rotation

Trauma-Focused Women’s Mental Health: This rotation at the Seattle VA includes half a day per week in the Women’s Health Clinic, providing initial evaluation and treatment planning for women Veterans referred by their Primary Care Physicians (PCPs) and half a day per week in the PTSD Outpatient Clinic.  Typical treatment referrals in the Women’s Health Clinic include short-term care in the clinic or referral to specialty and community mental health resources.  Residents also serve as consultants to PCPs, staff, and psychologists.  Examples of topics emphasized during supervision include evaluation and management of mental health concerns with special attention to topics related to women’s health such as pregnancy planning, menstrual cycles, and menopause.  Special topics may include consultation on medications in pregnancy and lactation; consultation on disruptive patients in the women’s clinic; evaluation and initial management of eating disorders, PTSD, and other mental health disorders; and readiness for hormone therapy evaluations for transgendered individuals.

In the PTSD Outpatient Clinic, residents provide specialty mental health care within an interdisciplinary team to women Veterans with a history of trauma.  There is also the potential to provide trauma-focused therapy (i.e., Prolonged Exposure or Cognitive Processing Therapy) during the rotation with supervision provided by non-prescriber clinic staff.  Examples of topics emphasized during supervision include trauma interview/assessment, providing trauma-informed care, gender differences in PTSD, IPV typologies, female genital mutilation, pregnancy loss and abortion, post-traumatic growth, and vicarious trauma/compassion fatigue.

Pathway meetings:

Pathway meetings are every other month, usually on the first Thursday of the month at noon and include presentations by perinatal providers in the community, discussions of cases, recent literature, and ongoing projects.

Perinatal Psychiatry Research/Scholarly/Education Projects:

Residents in this pathway have the opportunity to participate in research projects, write review articles, and/or develop curricula and educational materials for trainees, other healthcare professionals, and patients.  The focus of such scholarly work may include, but is not limited to, improving access to and quality of care, collaborative care, and health care delivery.  Examples of projects include:

• Developing educational modules regarding perinatal psychiatric disorders and treatment for health care providers (primary care providers, obstetricians, midwives, pediatricians, psychiatrists and other mental health providers). Example educational material developed by Kisha Clune, MD: see page 65 wa-depression-care-guide.pdf (seattlechildrens.org)
• Developing educational materials and information sheets for patients. (Example educational material developed by Aba Nduom, MD: http://healthonline.washington.edu/document/health_online/pdf/Treating-Depression-Anxiety-During-Pregnancy.pdf)
• Teaching projects and curriculum development on reproductive psychiatry.
• Developing a list of resources for patients
• Manuscripts and presentations. Examples:
  • Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review https://www.sciencedirect.com/science/article/pii/S0163834320301638
  • Universal Screening for Postpartum Depression in the NICU: A Survey Based Study of Nurses Attitudes. Presentation at the Annual meeting of the Academy of Psychosomatic Medicine, Austin, TX. November 2016; Jessie Rice MD)
  • A systematic review of the use of prazosin in pregnancy and lactation. https://europepmc.org/article/med/33840480
  • Suicide and maternal mortality https://link.springer.com/article/10.1007/s11920-022-01334-3

Criteria for Area of Distinction:

• Completion of at least one clinical rotation listed above
• Regular attendance at pathway meetings
• Completion of a scholarly (educational or research) project