General Psychiatry Education Program

• Residency Education
• Training Programs
• History of the Department
• Present Chairman
• Rotations
• Curriculum
• Training Sites
• Research Opportunities
• A day in the life of a Resident
• What our graduates say
• Salary
• What we are looking for
• How to apply
• Interviews
• Choosing a Residency Program
• Download an Application

Residency Education in Psychiatry  
The three-fold mission of the Duke University Psychiatry Residency Education Program is:

• to train balanced clinicians with strengths in both psychotherapeutic and biologic aspects of psychiatry

•  to teach critical thinking skills in the practice of evidence-based mental health care and to thereby graduate physicians with life-long learning skills.

•  to prepare leaders in psychiatry who will serve in research, teaching, administration and clinical service

The philosophy of residency education at Duke is grounded in the biopsychosocial model of mental illness.  Mind and brain receive equal emphasis, and learners are encouraged to pursue the integration of diverse theoretical and scientific domains of understanding.  Our large and diverse faculty represent the full range of perspectives in modern psychiatry

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Training Programs
The Duke University Department of Psychiatry offers a number of graduate medical education programs in psychiatry.  All six of the programs below are fully accredited by the Accreditation Council for Graduate Medical Education (ACGME).

• General Psychiatry   (4 years)

• Combined Internal Medicine-Psychiatry   (5 years)

• Child and Adolescent Psychiatry   (2 years)

• Geriatric Psychiatry   (1 year)

• Addictions Psychiatry   (1 year)

• Forensic Psychiatry  (1 year) 

The Department of Psychiatry jointly sponsors the following research fellowships:

• Duke-Glaxo-Wellcome Fellowship in Psychopharmacology   (2 years)

• Behavioral Medicine Research Fellowship Clinical Research

• Methodology Fellowship

• Biological Psychiatry Research Fellowship

• Postdoctoral Fellowships in Mental Health Services and Systems

• Research  (1-2 years cosponsored with Cecil G. Sheps Center for Health Services Research of the University of North Carolina at Chapel Hill)

Psychoanalytic training is offered through the joint sponsorship of the Departments of Psychiatry of the University of North Carolina at Chapel Hill and Duke University:

UNC/Duke Psychoanalytic Education Program and the Psychoanalytic Psychotherapy Study Center

In addition, there are numerous opportunities for advanced study and research within other departments in the medical center and the university during and after residency training, including, but not limited to, collaborations with:

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Historical Perspectives
The Duke University Medical Center started in 1924 with a $10 million bequest from James B. Duke to build a hospital and medical school, with two goals in mind:  to improve the quality of medical care and to create excellence in medical education.  Mr. Duke’s vision has been realized.  Duke University Medical Center is recognized worldwide as one of the nation’s leading health centers, and the Duke University School of Medicine is consistently ranked among the top five medical schools in the country on both subjective and objective measures.

Over the years, the Duke Department of Psychiatry has increased in depth and breadth of its clinical, research and educational activities.  The department first achieved national prominence in the mid-1950's under the chairmanship of Dr. Ewald Busse (1953-1974).  A past president of the American Psychiatric Association, Dr. Busse is considered by many to be the founder of geriatric psychiatry.  He is now emeritus professor of psychiatry and remains active in academic pursuits at Duke.

The next chairperson, Dr. H. Keith Brodie (1974-1982), also became president of the APA, and later, Chancellor and President of the university.  His successor, Dr. Barney Carroll (1983-1990), is a major contributor to our understanding of the neuroendocrinology of mood disorders.  Dr. Dan Blazer (1990-1992), served as interim chairperson and then Dean of Medical Education at Duke.  He is renown for his research in psychiatric epidemiology and geriatric psychiatry.  He returns to the Department of Psychiatry this year as Vice Chair for Education.

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About Our Chairman 
Collaborative, cooperative, and a genuinely nice guy, Dr. K. Ranga Rama Krishnan is hailed as “a chairman for the times.”

Not so very long ago, about 15 years or so, a psychiatry resident from John Umstead Hospital, the sprawling state mental institution in Butner, N.C., was presenting a paper at a joint house-staff seminar at Duke.  He had conducted a meta-analysis of all the studies that had ever been done on the dexamethasone suppression test, a then-new development in psychiatry.

As the young man spoke, Duke psychiatrists Dan Blazer, M.D. and Jeffrey Houpt, M.D., sitting in the audience, turned and looked across the room at each other, their eyes growing wide.  “It was obvious that he was truly talented,” recalls Blazer.  “It was one of the best presentations I have ever heard, then or since,” says Houpt, now dean of the University of North Carolina School of Medicine.

Afterwards, Houpt rushed back to his office and called the department chair, Keith Brodie, M.D. and then the department’s residency director.  “There’s a guy out at Umstead who’s smarter than any of our residents and any of our assistant professors,” Houpt told them.  “We’ve got to get him over here.”  Get him they did.

An internationally recognized researcher and clinician, Krishnan is regarded by people both within and outside the department as a near perfect choice for chairman, a true “chairman for the times.”  Intensely curious, he is known for his encyclopedic knowledge of all things medical, as well as his wide-ranging research interests.  In an era when collaborative research and multidisciplinary approaches are more important than ever, Krishnan has already compiled an impressive record of fostering partnerships across disciplinary lines.

In his short time at Duke, he has taken psychiatric research far beyond psychiatry.  He has joined with radiologists to use the latest imaging techniques to study depression and other mental illnesses.  He has worked with cardiologists to conduct ground-breaking research into the relationship between depression and heart disease.  At a time when industry-sponsored research is an increasingly important component of the academic research portfolio, Krishnan has been a prolific industry researcher, having conducted many of the leading clinical trials of new anti-depressant medications.  He has brought together investigators from numerous institutions across the United States to conduct large-scale multi-center studies.

On top of it all-----and at least partially explaining his success at fostering collaboration-----he is by all accounts a genuinely nice guy.  Conventional wisdom to the contrary, they don’t always finish last.

“He’s one of the few highly successful people you can’t find anyone to say something bad about.  You simply will not find a medical student, junior faculty member, senior faculty member, chairman, former chairman, or anyone else who will say something bad about him.  I defy you to do it,” says Murali Doraiswamy, M.D., an assistant professor of psychiatry who trained under Krishnan.

Like his research, Krishnan’s fans can be found far beyond psychiatry.  “He’s one of my heroes,” says Rob Califf, M.D., a Duke cardiologist and director of the Duke Clinical Research Institute.  “More than anybody I’ve met here at Duke, Dr. Krishnan has the ability to get things done in difficult circumstances without making anybody mad.  He’s obviously motivated for the right things.  When you’re working on something with him, he’s not pushing his personal agenda.  He’s always trying to something that will advance science and patient care.  It’s almost like he doesn’t have an ego.”

Ego.  Like it or not, it’s hardly rare in academic medicine.  It’s part of what underlies the success of American medicine in this century.  Chris O’Connor, M.D., a Duke cardiologist and a Krishnan research collaborator, says the field by its very nature attracts self-motivators who are geared toward individual success.

“You don’t go through tenure as a team, you go as an individual,” says O’Connor.  “the system rewards individual achievement and can tend to undermine collaboration.  Such things as whose name is listed as first author and whose name is on a grant become critically important in career development, and unfortunately, can get a collaboration in trouble.  But Ranga is the first to understand this and makes everyone feel like they’re part of the team and an equal partner.  People want to collaborate with him.  He just has these unique personality traits and characteristics that make him a great leader.”

“I had always been interested in psychiatry and psychology,” Krishnan says.  “It goes back to my father’s interest in philosophy.  The core issue in psychiatry and philosophy is ‘Who are we as human beings?  And where do we fit in the world?’  I had been interested in the brain in medical school, and the two came together to make me want to try to understand how the brain works, and how it links to who we are as humans, the fundamental experiential kinds of questions.  It was mostly curiosity, because of all the areas I wanted to work on, the brain is the one we know the least about.”

Krishnan completed his residency at Umstead and a fellowship in neurobiology at Duke.  He studied the neuroendocrinology of depression and other mood disorders with Barney Carroll, M.D., then the relationship between back pain and depression with Houpt.  Eventually, he got into imaging studies, and was one of the first investigators in the world to use MRI in the study of depression.  Just a few years ago, he used those same MRI techniques to become the first to identify and describe a distinct form of depression in the elderly known as vascular depression, caused by small strokes in the mood centers of the brain.  In addition to three books, he has written more than 200 journal articles and 50 book chapters on depression, dementia, Alzheimer’s disease, panic disorder, manic-depression and obsessive-compulsive disorder.

“Early on, some people worried that he wasn’t focusing, but he’s managed to do it all,” says Everett Ellinwood, M.D.  “He’s a great teacher, a remarkable researcher, and an excellent clinician.  Psychiatrists throughout the region----and even throughout the department----refer their most difficult-to-treat patients to him.

Between his innate curiosity and his unique training experience across many areas of medicine, Krishnan often sees the connections and interfaces that others might miss.  An insatiable reader, he was inspired to begin using imaging as a research tool after reading an article about rocks.

“I was reading a magazine article that described how geologists would quantify the volume of a particular mineral in a piece of rock using a method called stereology,” he says.  “I began to wonder if you could use the same technique to measure the volume of various brain structures, so I read up on stereology and came up with a plan to use it in my research and it worked.”

This particular knack that Krishnan has is called “vision,” Doraiswamy says.  “He’s got the ability to say ‘This is where the future of medicine is going’ and to help show his colleagues the way.  He’s got his finger on the pulse of every major transition in psychiatry today.  Right now, the biggest research issues are imaging, genetics, and large-scale trials, and he’s setting us up to be a leader in all three.”

(excerpted with permission from Duke Medical Perspectives, Vol. 18, No. 2)

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General Psychiatry Rotation Schedule

PGY-I
2 months	4 months	1 month	3 months	2 months
Neurology	Internal Medicine with or without Pediatrics (1 month inpatient; 3 months outpatient)	Consult/Liaison Psychiatry	Inpatient Psychiatry	Outpatient Acute Care Psychiatry
Outpatient Psychiatry Continuous Care Clinic  (½ day per week)

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Curriculum
PGY-1 Seminars

PGY-2 Seminars

PGY-3 Seminars

PGY-4 Seminars

All PGY Years

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Training Sites
A strength of Duke’s general adult psychiatry residency education program is the diversity of clinical experiences available at our training sites.  Residents obtain clinical experiences with a full range of patients of different ages, gender, socioeconomic status, religious and ethnic backgrounds in five settings that reflect various types of psychiatric practice:

• a tertiary care university hospital

• a Veterans Administration hospital

• a large state psychiatric hospital staffed by Duke faculty

• state and local community mental health centers, including rural clinics, federal and state prisons, local schools and a child guidance center

• university-affiliated outpatient primary care and mental health care clinics

Duke University Medical Center is one of the most sophisticated centers in the world for medical education, patient care and research.  First opened in 1930, it includes Duke Hospital (North) and Duke Clinic (South) housing the Private Diagnostic Clinics (PDCs), the School of Medicine, and the School of Nursing.  Recently expanded into the Duke University Health System, it now includes Durham Regional Hospital and Raleigh Community Hospital, as well as a number of affiliated outpatient facilities.

Duke Hospital trains more than 1,500 persons each year in the health sciences and provides care to more than 35,000 inpatients annually.  The Hospital and the other clinical sites serve the Durham community and beyond, reaching out to people from all over the world who come for advanced treatment and care.

Psychiatric residents rotate through the Duke Hospital inpatient psychiatric unit, the psychiatry consult/liaison service and the emergency services.  Continuous outpatient psychiatric care is provided at the Duke Psychiatric Outpatient Clinic (POPC) throughout the four years of training.  Clinical psychiatric specialty experiences are available at Duke as electives, including:

• mood disorders specialty clinic

• anxiety disorders specialty clinic

• electroconvulsive therapy service

• memory disorders clinic

• geriatric evaluation and treatment clinic

• sleep disorders lab and clinic

• behavioral medicine 

• alcohol and addictions program

The Durham Veterans Administration Medical Center, located across the street from the Duke University Medical Center, provides comprehensive medical and psychiatric care to veterans from a large geographic region, including much of North Carolina and southern Virginia.  Beginning residents rotate through the 30-bed inpatient psychiatry unit, the consultation/liaison service, and the mental health acute care (walk-in) clinic.  Advanced residents may choose the VA as the main site of their outpatient clinic in the PGY-3 year.  VA psychiatric specialty experiences are available as electives, including

• women’s behavioral health clinic

• post-traumatic stress disorder clinic

• substance abuse disorders clinic

• specialty group therapies

John Umstead Hospital, approximately 25 minutes from Duke, is our closely affiliated state psychiatric hospital staffed by many Duke faculty.  There PGY-2 residents receive firsthand experience in comprehensive public sector mental health care delivery and have the opportunity to function in an increasingly autonomous capacity.  Clinical services include an acute care unit, a long-term rehabilitation unit, a geriatric service and full mental health services for children and adolescents.  In addition to their clinical experiences, residents have the opportunity to participate in clinical research programs in schizophrenia and geriatrics.  Umstead is consistently rated by our residents as one of their favorite learning experiences.

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Research Opportunities
Research opportunities are nearly limitless at Duke.  Projects in basic and clinical research can be arranged through the Department of Psychiatry and other departments in the medical center, the university and nearby biomedical industry.  Faculty research is broad ranging, including topics off the beaten path, such as studies of complementary/alternative medicine and the effects of religion on health.

Core requirements in the general psychiatry program comprise approximately 2/3 of the PGY-3 year and ½ of the PGY-4 year, leaving substantial free time for research and scholarly endeavors.  Current residents are involved in studies of depression and congestive heart failure, transcranial magnetic stimulation in schizophrenia, primary care screening instruments for PTSD, and sensory processing in delusional disorder, for example.

A sampling of faculty with external funding for clinical trials can be found at :psychiatry.mc.duke.edu/Research.html

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A Day in the Life of an Intern
By Mehul Mankad, PGY-1
Rotating through the Acute Care Clinic at the Durham Veterans Administration Medical Center is like riding that big roller coaster in the theme park that you used to walk by as a kid----you knew that once you got up the nerve to do it, you’d remember it for the rest of your life.  Your mission in the ACC is to provide medical services to all veterans who walk through the VA doors with an acute problem (hence the name).  Sure there’s an ER to handle the truly emergent cases, but everything else, and I mean everything, come to you.

My day usually starts around 8:15 am.  The residents and interns in the Acute Care Clinic meet with the ER chief and review a topic pertinent to ambulatory care.  Today the topic is physical exam of the knee, and we all gather around a reluctant resident volunteer as our attending demonstrates McMurray’s test for meniscal tear.  Tomorrow I’ll be presenting data on usage of novel antiplatelet agents in the treatment of cardiovascular disease.  I wonder, as I peruse the journal article, whether we’ll someday recommend antiplatelet therapy for patients with late adult-onset depression, so-called “vascular depression.”  Then I think that the vascular depression research group at Duke probably has something to say about that idea.

Anyway, it’s time to get down to business.  I pick up the first chart in the stack and look at the triage nurse’s one liner:  “right ear pain.”  Into my office walks a middle-aged woman with a history of four days of pain and purulent drainage after going to the beach.  Physical exam findings confirm my diagnosis of otitis externa, and after discussing my proposed plan with the senior resident, I send the patient to the pharmacy to pick up her antibiotics.  I talk with the on-call ENT resident to arrange follow-up.  And so the days goes.  Beyond managing diabetes and hypertension, I’ve seen and done things in this outpatient clinic that have vastly increased my confidence in my abilities as a physician.

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What Our Graduates Say About Duke
“Duke has one of the few deep and diverse psychiatry departments in the country---and it just happens to be in a thoroughly livable community.”   Marvin Swartz, M.D.

“The Duke psychiatry residents are a friendly, energetic, fun-loving group in addition to being among the best and brightest in the country.”   Myra McSwain-Kamran, M.D.

“Bright people, wide-ranging interests, commitment to learning and a genuine passion for the field of psychiatry.  These are what I value most at Duke.”   Craig Donnelly, M.D.

“One of the strengths of the program is the enormous variety of clinical and research electives available for residents.”   Tedra Anderson-Brown, M.D.

“The large and diverse faculty allow residents to explore specialty areas of psychiatry according to their individual interests.”   Barbara Johnson, M.D.

“Duke is an excellent training program in an outstanding medical center.  The diversity of clinical experiences and treatment settings coupled with expert clinical and research faculty are its greatest strength.”   John Beyer, M.D.

“Duke is more than great basketball.  The administration responds to resident concerns and keep changing things for the better.”   Holly Lisanby, M.D.

“We have a premier training program in a beautiful setting with ample extracurricular activities available.  Duke really offers the best of both worlds!”   Holly Rogers, M.D.

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Salary and Benefits
See complete Housestaff information at http://www2.mc.duke.edu/gme/

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What We Look for in an Applicant
Residency training is in many ways an apprenticeship.  To earn the right to become a colleague of your “master” teachers, you must submit to hours of demanding clinical work, concentrated study, and the challenge of scientific inquiry.  Our program is intellectually, emotionally and physically rigorous.  We look for those who possess a passion for psychiatry, who can take initiative for their own learning, and pursue scholarly activities beyond the core program requirements.  We provide opportunities for mentorship by expert clinicians and researchers, towards the goal of training skilled physicians who will become leaders in research, teaching, administration and clinical service in psychiatry.

On a personal level, the capacity to be reflective about yourself and your interactions with others, openness to constructive criticism, and a willingness to tolerate anxiety as you learn to apply new therapeutic skills with patients and families are essential. 

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How to Apply
We receive well over 500 completed applications for 14 residency positions each year.  When all of an applicant’s required materials have been received, his or her file is reviewed by a member of the Residency Selection Committee, which invites approximately 100 applicants for interviews.  We begin inviting candidates for an interview as completed applications are received and reviewed.  The deadline for receipt of a completed application is December 10.

Required Application Materials:

• Completed Duke or Universal Application Form

• Personal Statement (please limit to one page)

•  Dean’s letter**

• Medical school transcript

• Three letters of recommendation (at least one from psychiatry and one from internal medicine) Curriculum vitae

• USMLE score reports

• ECFMG certificate, if applicable

          **National policy requires that the Dean’s letter be released no sooner than November 1.  Interviews may be granted before the receipt of the Dean’s letter, provided that the remainder of the application materials have been received.

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Interviews:
The Residency Selection Committee will interview applicants from November through early January.  If you have a specific area of interest in a particular clinical or research area of psychiatry or a related field, please let us know in advance and we will try to arrange an interview with the relevant faculty member.

Beginning November 2, we will interview candidates on Mondays, Tuesdays, and Thursdays, as well as on two weekend dates.  Med-psych candidates interview with the Department of Internal Medicine on Wednesdays only, so interviews with Psychiatry can be scheduled on either Tuesday or Thursday.  It is best to allow at least three weeks, if possible, to schedule interviews.  To avoid potential travel disruptions associated with Y2K phenomena, we strongly urge you to schedule your interviews with us in November and December if at all possible.

Regrettably, due to the large number of applications we receive, we are often unable to provide personal responses to those candidates who are not granted an interview.  If you have not been invited for an interview by December 15, it is safe to assume that we are unable to offer you an interview.

Following the interview process, residents will be selected through the National Residency Matching Program.  We do not accept residents “outside” the match.  We wish you the best of luck in obtaining a residency position, wherever you match.

Grace Thrall, M.D.
Director, Residency Education
Phone (919) 684-2258
thral001@mc.duke.edu

Mary Pope 
Staff Assistant

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