WVU Behavioral Medicine Chestnut Ridge Center, William R Sharpe Hospital and the Veterans Administration Hospital collectively house nine inpatient units that provide residents a broad experience with intensive patient care. A diverse population of adult, adolescent, geriatric, addiction, neuropsychiatric and forensic patients are represented. Residents work closely with a multidisciplinary team through the course of care, from admission evaluation and the development of a differential diagnosis to discharge planning. Traditional patient rounds with the faculty attending are augmented with contemporary daily treatment team meetings, group therapy, family and individual counseling. Residents interact with rehabilitation therapists in art, experiential, recreational and occupational therapies. Advanced management techniques are offered on the specialized units.
Adult at CRC / Sharpe / VA
The general adult units provide residents with ample opportunity to develop the foundation of inpatient psychiatric care. Three distinct settings allow residents to learn to manage acute psychiatric illness, intermediate stabilization and chronic long-term care. The length of stay on the units ranges from 4 days to over a month so residents may appreciate the different skills necessary to manage an array of disorders in different settings. Electroconvulsive therapy is taught during this rotation.
Geriatric at CRC
The geriatric program is a subspecialized component of the adult unit that teaches residents the nuances of caring for an older population. Patients commonly present with behavioral, cognitive, mood and anxiety disorders, but also have confounding medical illnesses that must be addressed. Easy access to neuroimaging techniques (including MRI, PET and SPECT), internal medicine consultation, and advanced neuropsychological testing supports optimal care of elderly patients.
Adolescent at CRC
The adolescent unit offers experience in the management of youthful patients that focuses on individual needs yet recognizes the importance of family and social systems integration. This six- bed specialty unit, rare in an academic center, represents one end of the full continuum of care necessary for best practices in the care of the teenage population. Residents appreciate the unique opportunity to actively participate in family sessions, parental counseling and consultation to school systems.
Forensic at Sharpe
The forensic unit houses persons alleged to have committed a crime who may be incompetent to stand trial or who may have been found legally insane. Although not involved in direct patient care, residents are provided an overview of forensic psychiatry that goes beyond common civil commitment experiences. The experience has prompted most residents to take an elective in forensic psychiatry and many have pursued a fellowship in the field.
Addiction at CRC
The comprehensive dual diagnosis and addiction inpatient unit is seamlessly integrated with partial hospitalization and outpatient programs that offer detoxification and rehabilitation services to adults with substance-related disorders. Residents work with certified addiction counselors, social workers and family counselors to incorporate therapeutic modalities that include diagnostic evaluation, individual and milieu therapy, and a 12-step orientation. The teaching faculty, renowned for their clinical work and research, supervise all aspects of this 10-bed service.
Neuropsychiatry at CRC
The intensive neuropsychiatry program affords residents the special opportunity to care for the most severely ill psychiatric patients. Residents are closely supervised on this rotation as they work with a highly skilled interdisciplinary team to manage difficult neuropsychiatric disorders such as Wernicke’s encephalopathy, AIDS-induced dementia, and complications from brain injury and stroke. Through team management, residents learn advanced diagnostic skills, individualized cognitive rehabilitation techniques, specialized pharmacologic treatment, and function-based behavior modification.
Partial Hospitalization Program
The training program offers residents experience in two partial hospitalization settings: acute and chronic. Residents treat patients who manifest a variety of serious mental illnesses in need of services that fall between outpatient and inpatient care. The partial hospital environment concentrates on improved function and a return to the community and incorporates the contributions of a multidisciplinary team. Residents observe the effect of stressors, illness and loss and learn to help patients cope with the devastating consequences psychiatric disorders.
The psychiatry department outpatient experience offers a carefully organized progression through the four years of training. A very small patient population introduces residents to outpatient care in the first year. The second year builds on this foundation through one-on-one supervision, modeling and observation. Residents continue one half day per week clinics as they add to their own patient population. The third year focuses entirely on outpatients as residents are closely supervised to learn advanced techniques in cognitive, behavioral, interpersonal, dialectical, psychodynamic, family, group, couples and other therapies. Specialized clinics (for example, Thought Disorders and Community) offer a concentration of patients for residents to work with. Residents maintain their caseload from the first two years in the Continuity Clinic and begin to appreciate the success of their management. The third year also adds child and adolescent patients and a progressive ADHD clinic. The fourth year introduces residents to the administrative and business concerns of a modern private practice outpatient model. Residents also have the opportunity to continue in long-term therapy with select patients from their third year. In summary, residents are prepared for all aspects of outpatient management that marks today’s varied practice settings, from “med checks” to dual therapy to chronic case management to individual dynamic sessions.
Consultation Liaison Service
The Consultation Liaison Service operates primarily at Ruby Memorial Hospital, the academic hospital of the School of Medicine. Several dozen departments request psychiatric input into the care of medical and surgical patients. Consultation to the emergency department provides first-hand encounters with patients in need of acute crisis intervention. Every case is supervised by full time consultation liaison faculty.
All residents rotate through an emergency psychiatry service that is supervised through the faculty call system. Residents participate in a modified “night float” arrangement that allows for coverage of patients along the entire spectrum of services within the department. The service has been developed to foster communication between care providers, to guide residents through specific “decision-points” regarding level of care needs, and to allow for experience in involuntary hospitalization hearings.
During the fourth year residents have eight months to pursue special interests in psychiatry. Each resident designs his or her own schedule with the assistance of chief residents, the faculty, and the training director. Residents are encouraged to enhance their clinical skills, investigate areas of potential interest and explore opportunities for research. Favorite electives of past residents have included: a forensic experience with exposure to testimony and attorney liaison; participation in pharmaceutical research; continuation of psychodynamic training; management of juvenile sex offenders; advanced experience with inpatient services; community and public sector psychiatry; and administrative psychiatry, among many others. The remaining four months are spent as a “wards senior” on the in-patient services; the focus of these months is teaching.