Psychiatry Residency Program Structure
The UT Southwestern Psychiatry Residency Program follows the requirements of the Accreditation Council for Graduate Medical Education and provides rotations through different centers of care:
Your first post-graduate year (PGY) is designed to establish your identity and competence as a physician and your ability to manage medical emergencies, primary care, and the fundamentals of psychiatric assessment and treatment.
- Primary Care (adult and/or child)
- General Neurology
- Inpatient Psychiatry
- Community Psychiatry at Homeless Services
- Psychiatric Emergency
- Addiction Psychiatry
Your second year is designed to consolidate your identity and competence as a psychiatrist and your ability to diagnose and manage the acute presentations of all major areas of psychopathology in an ethnically and socioeconomically diverse population of patients.
- General Inpatient Care
- Psychiatric Emergency
- Geriatric Psychiatry
- Community Psychiatry at the County Jail
- Community Psychiatry at Metrocare
- Consultation-Liaison Psychiatry
The third-year curriculum aims to deepen your understanding of diagnosis and formulation and develop your competence in the long-term management of psychiatric illness. As elective time becomes available in the PGY-3 and PGY-4 year residents can craft an individualized schedule, or apply for entry into one of our areas of concentration. All PGY-3 residents participate in a quality improvement project.
- Outpatient clinics
- Subspecialty care (Child Psychiatry and electives)
- Student Mental Health or Psychiatry Primary Care
Your final year is when you will consolidate your skills, pursue your specific interests and passions, and begin to develop specific expertise. As elective time becomes available in the PGY-3 and PGY-4 years, residents can craft an individualized schedule, or apply for entry into one of our areas of concentration. All PGY-4 residents participate in a scholarly project.
- 10 months of electives
- Consult-Liaison Psychiatry
Starting in the second post-graduate year (PGY-2) of the Psychiatry Residency Program, you will have the opportunity to start focusing your training by selecting appropriate electives and/or participating in special programs in psychoanalytic psychotherapy or primary care.
The residency didactics program reserves three didactics afternoons each academic year for special education programs that are proposed and planned by residents with faculty support.
Past topics for the special seminars have included a focus on health care systems (mental health advocacy, mental health policy, insurance system effects of the delivery of psychiatric care); issues of race, culture, and caring for historically underserved populations (LGBT mental health, social determinants of health and marginalization, African Americans and psychiatry; issues of race and culture; Latino culture and mental health; the impact of racism on Asian Americans and mental health); forensic psychiatry (discussing adverse events, mental health court testimony; a mock trial experience, firearms and suicide risk, psychiatry’s response to mass shootings); addiction psychiatry (the opiate crisis); the interaction of psychiatry and art (psychiatry and the visual arts, psychiatry and the performing arts), as well as other areas of interest to residents (religion and psychiatry, personal finance in medicine). Residents continue to plan engaging programs each year. Several special programs are described below as examples.
To explore the interface of psychiatry and the visual arts, all residents spent the afternoon at the Dallas Museum of Art for a special program in April 2016 and again in April 2019 learning about the relationship between looking for and finding meaning in modern art and clinical work. An updated program occurred in Fall 2022 titled "The Power of Observation." The afternoon began with a lecture given by Bonnie Pitman, Distinguished Scholar and Director of Art-Brain Innovations, The Center for BrainHealth, The University of Texas at Dallas, on the differences among seeing, looking, and observing and the practice of scanning, attending, connecting, and transforming in observation. Then the residents were divided into small groups and rotated through five stations among the museum’s permanent collection, each led by one of the resident members of the planning group, who had selected a specific piece that they would present and guide the groups through an experience of active learning and participation. Through selections that included portraits, landscapes, and sculptures, the resident leaders provoked new ways of seeing art and rich explorations of the connections among biography, cultural context, creativity, and mental illness.
In Spring 2022, a group of residents recruited local physician experts to provide an overview of personal finance focused on topics most relevant to physicians. Topics included an overview of financial literacy, approaches to managing student loan debt, and common investment strategies. A highlight of the session was an extended, moderate, anonymized question-and-answer session.
A special session on insurance system effects on psychiatric care was held in Winter 2021, beginning with a keynote lecture delivered by the physician chief executive officer of the local state-funded provider of outpatient psychiatric care. The lecture focused an overview of the current U.S. private insurance model and the role of publicly-funded systems in the delivery of both inpatient and outpatient psychiatric care. Residents broke into smaller groups for faculty panel discussions of the role of payer sources in care delivery and common interactions between physicians and payers. The residents remained in small groups for discussion of case scenarios focused on the role of systems in care delivery. The session ended with a pub trivia game to wrap up the information covered in the session.
In this Spring 2022 special seminar, physicians from across the health care systems (UT Southwestern and Parkland hospitals, UT Southwestern outpatient psychiatry, private practice) discussed their experiences with adverse outcomes and malpractice claims. Faculty physicians spoke movingly about their emotional responses to cases with adverse outcomes, including patient suicide. A local expert on forensic psychiatry presented a didactic lecture that defined important terms and concepts in malpractice, and the chief medical officer of Parkland hospital discussed his personal experience of managing a malpractice claim. Through these sessions, the special seminar appropriately balanced the emotional and technical aspects of adverse events.
In January 2019, residents participated in an interactive session intended to provide education and exposure to the clinical challenge of assessing firearm safety. Stimulated by resident interest and research in this topic, this session first provided education on the increased risks of suicide associated with owning firearms contrasted with data that physicians, including psychiatrists, commonly skip this important part of a safety assessment. Common barriers to firearms assessment were addressed by components of the seminar. First, a legal expert discussed liability and legal protections for physicians asking patients about firearms. Second, a campus police officer provided basic education about firearms, including a demonstration with decommissioned firearms and gun locks. Finally, residents engaged in role-play scenarios to practice a thorough firearm assessment in a clinical scenario. Post-session evaluations showed improvements in residents’ confidence in their ability to perform a firearms assessment. The residents who developed the session subsequently presented a similar event at a national meeting of psychiatric educators.
With the rest of our nation, residents within our program expressed concern and a desire for enhanced preparation for the challenges associated with the management of pain, prescribed opiates, and effective treatment for opiate use disorders. Although residents at UT Southwestern have opportunities to rotate through addiction services and clinics, including those which focus on opiate replacement therapies, this September 2018 seminar served to bring residents at every level of training together to consider the management of individual patients and health issues of the broader population from opiate use. Resident leaders presented information on the history and impact of the opiate epidemic and the basics of the current landscape of prescription and non-prescription opiates. The residents were then presented with a hospital case vignette and asked to work in small groups to explore the clinical challenges of comorbid pain and substance use disorders. The case was reviewed by an interdisciplinary panel of experts, who addressed different aspects and perspectives of the case. Residents used the knowledge gained to work in small groups to brainstorm system interventions and consider opportunities for advocacy.
A special seminar on Latino culture and mental health was presented September 2017 at the Latino Cultural Center. Presentations from residents discussed the history and nuances of Latino vs. Hispanic vs. country-specific identities, as well as culture-bound syndromes. A panel of health professionals, including Parkland’s chief medical officer, the founder and chief executive officer of Centro de Mi Salud, and a physician at Child & Family Guidance, all Spanish speakers, was tasked with sharing experience as Latino/Hispanic health professionals and treating patients of Latino/Hispanic origin. They answered questions about common pitfalls and general guidance for treating patients with Latino roots and culture. The seminar then shifted to a presentation by an artist that showcased art from Latino artists and the “New Codex Oaxaca: Immigration and Cultural Memory” project. Residents were invited to participate in creating their own art in the form of collages. Collages from those who volunteered to donate their pieces were displayed in the resident lounge.
A special seminar on religion and psychiatry was held in April 2017 to help residents learn about diverse religious beliefs and begin to understand how religious beliefs influence mental health and mental health care. Specific goals included maintaining a sensitive and accepting therapeutic position with patients of diverse spiritual and/or religious beliefs and practices, as well as gaining a general understanding of world religions. The seminar included lectures discussing the evidence-based research analyzing the impact of religion on mental health and the practical approach to assessing spiritual and religious history. A chaplain provided insight into the role of chaplains, the referral process, and the chaplain approach to patients with varying religious beliefs. A highlight was a panel of various clergy representing different religious backgrounds and providing information about the basic tenets of their religion and that religion’s conceptualization and approach to mental illness. They answered questions about their role in treatment as the patient’s clergy. The seminar ended with small groups discussing cases and reflecting on the discussion.
The LGBT mental health program, held in June 2016, educated residents on the unique mental health needs of individuals who are lesbian, gay, bisexual, and transgender. As part of the curriculum, an LGBT Mental Health 101 course was created, covering LGBT-specific terminology, history of homosexuality within the Diagnostic and Statistical Manual of Mental Disorders, and mental health disparities. Other lectures given during the seminar included psychotherapeutic considerations for LGBT individuals and the neurobiology of sexual orientation. The program also included a multidisciplinary panel discussion to explore a case of gender dysphoria, with local experts drawn from psychiatry, endocrinology, pediatrics, and the law. A particularly moving highlight was the opportunity to speak in small groups with patients who identify as transgender to discuss their experiences within the health care system.
We intend for postgraduate years 3 and 4 to be a time when each of our residents will identify particular areas of interest and passion where they will develop their expertise and leadership. Many of our residents will use this elective time to craft individualized and eclectic programs. Others will apply for entry into one of our established areas of concentration and achieve distinction:
Residents who aspire to a future as academic clinical psychiatrists may apply to the Educator concentration, where they will focus on identifying a clinical focus of expertise, developing their teaching and presenting skills, and learning how to turn clinical and teaching enthusiasms into scholarly productivity.
Residents who are interested in global and cultural psychiatry will have the opportunity to work in clinical settings both locally and abroad to gain experience working within various health systems while providing care to patients from different cultural backgrounds.
The Interventional Psychiatry concentration provides the opportunity for residents to gain advanced education, mentorship, and research in the fields of electroconvulsive therapy, transcranial magnetic stimulation, and other neuromodulation techniques. This concentration takes advantage of the robust interventional psychiatry programs that already exist at UT Southwestern. The Interventional Psychiatry concentration stands as one of the few across the country and the first in the state of Texas to offer advanced training in this evolving field.
The Mental Health, Policy, and Law concentration is designed to prepare residents to become leaders in forensic psychiatry and mental health advocacy, using their clinical expertise and policy analysis skills to advocate for policies that address challenges facing people with mental illness within the legal system. Residents will work with faculty from UT Southwestern and Meadows Mental Health Policy Institute to gain an understanding of effective advocacy work. Residents will learn how to analyze health-related public policy problems and work toward developing solutions. They also will gain valuable forensic psychiatry experiences, which will both inform their advocacy efforts and help to prepare them for a career in forensic psychiatry.
The Psychotherapy concentration provides clinical and educational experiences for residents interested in developing advanced psychotherapy skills and scholarship. This track supplements our residency’s robust core psychotherapy curriculum training. Track residents can also focus on a specialty concentration, including beginning their certifications in cognitive behavioral therapy or psychoanalytic therapy.
The Transitional Age Youth concentration allows residents an opportunity to focus their training on working with adolescents and young adults and learn about the unique developmental tasks, social considerations, and neurobiological changes that are vital to understand caring for this population.
The Women's Mental Health concentration includes rotations at Parkland Memorial Hospital, at the Dallas Veterans Affairs Medical Center, and in psychosocial research to develop expertise in psychiatric issues specific to women, with a strong emphasis on peripartum psychiatry and gender-specific, evidence-based interventions.
We have three tracks of training that allow applicants to match at the same time into both Adult Psychiatry and the special area of focus:
The Child and Adult Psychiatry Combined Track allows applicants to match at the same time into both Adult and Child/Adolescent Psychiatry.
The Research Track prepares residents for a future as a principal investigator in translational research.
The Rural and Public Mental Health Track includes special seminars at Metrocare Services Center for Education and Research and progression of public psychiatry clinical experiences that prepare the resident to become a future leader in public mental health.
What Residents Learn
The didactic curriculum reflects the Psychiatry Residency Program’s eclectic model of understanding and treating mental disorders. Learning experiences are diverse and incorporate theoretical and scientific aspects of the psychiatric knowledge base, while accomplished faculty members provide ideal opportunities for learning from experts on a wide variety of topics. These experiences and resources prepare residents to be leaders in the psychiatric field and provide the skills to deliver the best available care over the course of their careers.
The Residency Program integrates active educational formats to optimize application and synthesis of knowledge and promote long-term learning. Residents participate in small-group learning in PGY1-PGY3, led by a designated faculty member, labeled as a “tutor.” The small-group tutor curriculum is integrative and designed for the scaffolding of knowledge coordinated with clinical experiences during these 3 years. Moving into PGY4, the program provides a comprehensive board-review course in preparation for the ABPN certification exam.
In addition to the weekly, tutor-led small group sessions, residents participate in 1-2 seminars each week on various topics, many organized into longitudinal series across residency years. Core seminar series topics include the following:
- Culturally-informed care, including LGBT mental health, social determinants of health, marginalization
- Global and refugee mental health
- Mental health advocacy, stigma, and health policy
- Quality improvement, patient safety, and bad outcomes
- Skills-based sessions: interviewing skills, risk assessments, capacity assessments
- Subspecialty psychiatry: addiction, child and adolescent, consultation-liaison, forensic, geriatric, sleep
- Systems-based practice
All residents participate in our structured Journal Club curriculum, which has been peer reviewed and accepted as a model curriculum by the American Association of Directors of Psychiatric Residency Training and approved for online publication. The goals of Journal Club include improving resident knowledge of evidence-based psychiatric practice while enhancing resident skills in critical evaluation of the literature. Residents prepare for this activity with well-designed study guides that highlight important learning points related to study design and statistics and application to clinical practice.
A rich experience in psychotherapy training has always been a priority of the Residency Program. Didactic components taught by departmental faculty of the Dallas Psychoanalytic Center and an internationally recognized program in cognitive behavior therapy offer intensive and state-of-the-art training throughout the Residency Program. Topics included in the psychotherapy didactic curriculum include supportive psychotherapy, psychoanalytic and object relations theory, couples and family therapy, group therapy, cognitive-behavioral therapy, interpersonal therapy, acceptance and commitment therapy, and psychodynamic therapy. The seminar and case-conference series are supplemented by individual and group supervision.