Education

Year one provides a solid foundation of training in the basics of childhood psychopathology. Fellows rotate in three-month blocks throughout the year in a mix of inpatient, outpatient and consultative settings. In many clinical settings, fellows work in close collaboration with pre-doctoral psychology interns to provide a more in-depth opportunity to learn how to collaborate in patient care.

Core Components

• Adolescent Psychiatric Unit (3 months). Fellows join a multidisciplinary team of psychiatrists, psychologists, social workers, art and music therapists, education specialists, nursing staff and child psychiatric specialists providing family-centered care on this 14-bed inpatient unit. Working under the direction of an attending psychiatrist, fellows have the opportunity to provide acute care to adolescents with severe psychiatric illness and gain further experience in the clinical management of bipolar disorder, schizophrenia, major depressive disorder, eating disorders and substance use problems. They also serve as the senior trainee on the service, providing opportunities to educate general psychiatry residents, medical students, physician’s assistant students and pediatric and neurology residents about psychiatric illness in adolescents.

• Child Psychiatric Unit (CPU) (3 months). Fellows are integral members of the multidisciplinary team on this 12-bed unit for patients up to age 13. Common clinical issues seen on the CPU include disruptive behavior problems, attention deficit hyperactivity disorder, behavioral issues arising in the context of autism spectrum disorders, severe anxiety and depressive disorders and eating disorders in pre-adolescents. On this unit, fellows gain more in-depth exposure to behavior management strategies and are encouraged to co-lead family sessions with the unit family therapist. They also gain experience in collaborating with area child protection and foster care agencies and exposure to the special concerns that accompany children and families involved with these services.

• Pediatric Consultation-Liaison Psychiatry Service (PCLS) (3 months). As a child psychiatry fellowship program in a freestanding pediatric hospital, we are able to offer a rich consultation-liaison experience to our fellows. Children’s National serves as a primary hospital for children from the local area with acute medical issues, as well as a referral center for children from across the region and the world who come to Children’s National for subspecialty expertise. During the PCLS block, fellows will generally perform 1-2 new inpatient consultations a day, assessing patients presenting with a wide range of emotional, behavioral and cognitive issues during the course of treatment for medical illness. Communication with pediatricians and systems-based care are of particular focus during this block, and fellows also gain broader exposure to the neurobiological underpinnings of psychiatric symptoms and the management of illnesses at the medical/psychiatric interface, including delirium, eating disorders and conversion and somatoform disorders. Fellows also have the opportunity to present an interesting clinical case or set of issues at departmental Grand Rounds.

• Subspecialty Outpatient Clinics (3 months).This outpatient specialty clinic block provides foundational experiences in multiple clinics and community sites and is designed to strengthen fellows’ understanding of the complexity of child development. Highlights of the rotation include:
  • Child Development Clinic
  • Specialized Child Neurology Clinics
  • Children’s National Freddie Mac Foundation Child and Adolescent Protection Center (CAPC), a child advocacy center evaluating and treating abused and neglected youth
  • Consultation Clinic, a closely supervised experience conducting comprehensive child psychiatric evaluations working 1:1 with a child psychiatry attending. Fellows see referrals from pediatricians and provide clinical recommendations. The clinic is based at the outpatient psychiatry clinic and provides exposure to an integrated behavioral health model.
  • Opportunity to co-lead a therapy group for children
  • Emergency Room, where fellows perform emergency psychiatric assessments for children and families presenting to the Emergency Department in crisis.
• Didactics. Fellows have six hours of protected didactic time each week throughout the two-year fellowship. Didactic seminars are led by Children’s National psychiatry and psychology faculty and selected community psychiatrists, psychologists and therapists. The first year didactic curriculum begins with a summer “crash course” series covering the basics of child and adolescent psychiatry that fellows need to know as they begin their clinical work. A core topic series in the first year covers key aspects of childhood psychopathology. A seminar series covering important aspects of psychopharmacology, child development, ethical issues and cultural aspects of psychiatry occur in the first year. The therapy seminar series includes modules on family therapy, psychodynamic therapy, the use of play in psychiatric treatment and assessment, Cognitive Behavioral Therapy and Dialectic Behavior Therapy. Fellows also participate in a monthly journal club led by faculty from Children's National and the weekly departmental Grand Rounds.

• Longitudinal Outpatient Clinic. A significant advantage of the first-year fellowship program is the opportunity to follow a select group of patients on an outpatient basis. There are ample opportunities to gain experience in acute and longer-term treatment of outpatients. Outpatient activities during the first year provide both broad and in-depth experiences with the course of disorders arising in infancy, childhood and adolescence.

• Individual Supervision. Fellows are assigned two individual supervisors with whom they meet weekly throughout the academic year to discuss cases and career development. Every effort is made to match fellows with supervisors with similar interests, as well as to provide supervisors with different perspectives and approaches to patient care and career options.