About the Program

WainwrightWe invite you to consider the advantages of a program that:

  • Exposes you to high-powered faculty members dedicated to your success
  • Provides a state-of-the-art clinical facility
  • Helps you appreciate how illness in any domain is influenced by biologic, physiologic, psychological, and social factors
  • Teaches you to provide comprehensive, integrated care for your patients
  • Prepares you to recognize that the traditional distinctions between medical and psychiatric illness, and traditional models of delivering care do not adequately address the needs of complicated patients

 

 

Quick Facts

Internal Medicine-Psychiatry Residency group shot

By the Numbers

  • 2 residents are accepted each year
  • 10 positions are approved for our program
  • 6 faculty members completed combined training in internal medicine and psychiatry

Benefits

Board Certification

Our five-year combined training program leads to board certification eligibility in internal medicine and psychiatry. Visit the American Board of Internal Medicine or the American Board of Psychiatry and Neurology for specifics on board certification requirements.

Frequently Asked Questions

Where is Iowa City?

Iowa City is 220 miles directly west of Chicago on Interstate 80. It's also within a 4-5 hour drive to Milwaukee, Madison, Minneapolis, Omaha, Kansas City and St. Louis. It has the cultural, educational, social and political opportunities of a bigger city with the values and ambiance of a midwestern town. Its clean, safe, nothing is farther than a 15 minute car ride, it has a great city bus system (with bike racks!), wonderful parks, sports, schools and even sailing. Those who have lived here and left, frequently return because what they were looking for was in their own back yard. 

How ethnically diverse are the patients?

Like a lot of university towns, we have a large international community. Growing cultural diversity is another reason Iowa City is an interesting place to live. Diversity is embraced and celebrated with city and university events, festivals, clubs and programs. The University works hard to recruit and retain minorities with its affirmative action policies. About 13% of Iowa Citians are non-white.

What is there to do in Iowa City when you're not working?

There are 15 different festivals and art fairs, plus concerts and race events. There are many music venues, sports events and neighborhood street fairs and garden walks. We also have a really big mall and several smaller ones, 41 parks, 9 golf courses, 6 public tennis courts, 6 public pools, some lakes and a reservoir with trails, camping & boating. There are bike trails, some famous bookstores, a ton of galleries and excellent museums. There are half a dozen or more performing arts venues including Hancher Auditorium. There's always something going on. Find more information from the Iowa City/Coralville Convention and Visitors Bureau.

What's Iowa City like for kids and families?

There's ice skating, bowling, organized sports, 50 public parks, miniature golf, a great public library, a toy library, fun centers, swimming pools and 3 beaches, 9 museums including a children's museum, dance companies and public recreation centers that feature many activities for kids and families at little or no cost. We also have 20 movie screens and 50-licensed daycare providers. The Iowa City schools are perennially ranked among the top schools in the nation. Iowa City is unique in the facilities and services available for individuals with disabilities. Many families who have a family member with a disability are reluctant to leave Iowa City because they cannot duplicate those services in another location.

Are there any job opportunities for my spouse/significant other?

Yes, in May 2012, Iowa City had an average of 3.6% unemployment, one of the lowest in the country. Fore more information, check out the University of Iowa's Dual Career Network.

What are the fellowship opportunities available?

Internal Medicine-Psychiatry graduates can and have entered into a variety of fellowship programs in either discipline. At present, the Department of Internal Medicine at the University of Iowa offers fellowship opportunities in nephrology, hematology-oncology, pulmonology-critical care, cardiology, gastroenterology, endocrinology, allergy-immunology, and sleep medicine. The Department of Psychiatry offers fellowship opportunities in geriatric psychiatry, post-traumatic stress disorder, neurobiology of schizophrenia, and neuropsychiatric research.

Is this a family friendly program?

Yes, the residency is supportive of residents in their efforts to balance work with family life. We have several physician residents with young families and understand the stresses associated with attempting to find a balance. Women residents receive up to six weeks of paid maternity leave after delivery. Men get five working days off for paternity leave. The house staff health insurance policy provides full coverage for spouses and children. There are also several childcare facilities near the hospital and one on-site.

Is there sufficient patient volume so that I can have multiple exposures to a variety of diseases?

Absolutely! University of Iowa Hospitals & Clinics is Iowa's only academic medical center, and as such, routinely receives the most difficult and complex cases from Omaha to Chicago and from Rochester to Kansas City and St. Louis.

What's the call schedule like?

Call schedules depend on a rotation's sponsor department and the seniority of the resident.

In the Department of Psychiatry, two junior residents (first and second years) and one senior (third and fourth years) resident are on call for any given shift, with the junior residents on in-house call and the senior resident on home call. Junior residents can expect four to five call shifts per month as a combination of short calls (5-hour shifts) and weekend calls (12-hour shifts). Senior residents can expect two to three home calls per month for the university.

In the Department of Internal Medicine, call is every fourth night in the Cardiovascular Intensive Care Unit and the Medical Intensive Care Unit. Thanks to night inpatient teams, senior residents (second, third, fourth, and fifth years) can expect to take call only one to two weekends per year at the University of Iowa Hospitals & Clinics and at the Veterans Affairs Medical Center while on ambulatory rotations.

Do you have a research project requirement for graduation?

While there are many opportunities for residents to get involved with research in both departments, there is no formal research requirement for graduation in either department. There is a requirement to complete a scholarly activity (which can be participation in a research project, book chapter, curriculum development, case report, teaching workshop/community education, or a independent quality improvement project). Other requirements include presenting an ACP clinical vignette, an R2 talk and a journal club.

What's Iowa got that other programs don't?

  • A collaborative environment with opportunities to work with departments across the institution
  • A highly intellectual community with premier arts events that are accessible to residents in terms of cost and location
  • An outstanding school system for children in grades K-12
  • A great training program and a high quality of life at an affordable price

Elective Opportunity

The Departments of Internal Medicine and Psychiatry offer a one-month elective in medical psychiatry to fourth year medical students at the University of Iowa or qualified visiting medical students. Students work primarily on the Internal Medicine-Psychiatry Unit. This elective is an excellent way to get hands on experience in a setting dedicated to integrating medical and psychiatric care for complex patients. It is also a great introduction to medical psychiatry in general and to the Internal Medicine-Psychiatry Residency Program at University of Hospitals & Clinics in particular.

Medical students with an interest in medical psychiatry are encouraged to complete this elective at a time that the Internal Medicine-Psychiatry Unit is being staffed by a dually trained faculty. Space is limited so students are encouraged to apply early. If you are unable to participate due to lack of space, please consider consultation-liaison psychiatry as an elective. Consultation-liaison psychiatry is focused on the psychiatric care of patients with active medical illness.

For more information about this elective rotation, please contact Vicki Kijewski, MD, director of the Medical Psychiatry Rotation and the Internal Medicine-Psychiatry Residency Program, at 319-353-8647 or vicki-kijewski@uiowa.edu.

Training at a Glance

residentsOur Internal Medicine-Psychiatry Residency Program aims to:

  • Provide comprehensive care to patients, especially those with comorbid medical and psychiatric conditions, and those who have distanced themselves from care because of their mental illnesses;
  • Educate you to teach others in clinical and other settings; and
  • Furnish a learning environment that will foster interest in, and progress towards, a research career, if that is your intent.

View a chart that breaks down the PDF iconthe five year training program.pdf.

For a more in-depth look at each year of training, explore the following:

First Year

During the first year of training, residents rotate between eight months of internal medicine and four months of psychiatry.

In internal medicine, residents spend half of their rotations on inpatient teams that service University of Iowa Hospitals & Clinics and the Veterans Affairs Medical Center. Rotations include general inpatient medicine, cardiology, hematology-oncology, and medicine-psychiatry. The other half of internal medicine rotations are spent on a variety of consultation teams like infectious disease, nephrology, pulmonology, and surgical co-management; in outpatient settings like allergy-immunology, endocrinology, cardiology, dermatology, gastroenterology, neurology, pulmonology, rheumatology, geriatrics, palliative care, and the emergency room; and on night internal medicine rotations.

In psychiatry, residents rotate through the inpatient psychiatry teams that cover the geriatric psychiatry unit, eating and mood disorders unit, and psychotic disorders unit at the University of Iowa Hospitals and Clinics. Residents also cover the general inpatient unit at the Veterans Affairs Medical Center.

In addition to these rotations, residents also maintain a panel of patients in an outpatient setting through a continuity of care clinic at University of Iowa Hospitals & Clinics or the Veterans Affairs Medical Center. Continuity of Care Clinics are scheduled every Y week (occurring for one week between four-week-long rotations). During inpatient psychiatry rotations, residents are scheduled for one half-day per week in their Continuity of Care Clinic.

At the end of the first year of training, internal medicine-psychiatry residents will have obtained a broad experience of practice in both disciplines. They will have gained exposure to diagnosis, treatment, and management of both complex medical and psychiatric illness as well as approaches to patients with presentations at the complex intersection of both practices.

Supervision is provided by faculty physicians, fellows, and senior residents.

For a more in-depth look at each year of training, explore the following:

Second Year

Second year trainingThe second year of training is divided evenly between internal medicine and psychiatry.

While on internal medicine rotations, second year residents are considered senior residents and rotate in the Medical Intensive Care Unit (MICU) and the Cardiovascular Intensive Care Unit. They also lead inpatient teams in general internal medicine, hematology-oncology, cardiology, and night internal medicine rotations.

While on psychiatry rotations, second year residents are still considered junior residents (a distinction primarily relevant to the call schedule) and rotate on the emergency psychiatry service, consultation-liaison psychiatry service, geriatric psychiatry unit, eating and mood disorders unit, and psychotic disorders unit.

As in the previous year, second year residents continue to follow a panel of patients in an outpatient setting through a continuity of care clinic at University of Iowa Hospitals & Clinics or the Veterans Affairs Medical Center. Continuity of Care Clinics are scheduled every Y week (occurring for one week between four-week-long rotations). During inpatient psychiatry rotations, residents are scheduled for one half-day per week in their continuity of care clinic.

For a more in-depth look at each year of training, explore the following:

Third Year

CrossettThe third year of training begins with a four-month block of rotations in internal medicine, after which the residents join their categorical psychiatry counterparts in the outpatient setting for next 12 months. Residents split their time in outpatient psychiatry between the Adult Psychiatry Clinic at the University of Iowa Hospitals and Clinics and the Veterans Affairs Medical Center. Residents also spend one half-day per week at the Community Mental Health Center for Mid-Eastern Iowa.

At University of Iowa Hospitals & Clinics, residents see patients with a variety of illnesses – depression, anxiety, bipolar disorder, schizophrenia, attention deficit hyperactivity disorder, personality disorders, substance use disorders, eating disorders, adjustment disorders, etc. Appointments are generally 90 minutes in length for a diagnostic evaluation, 30 minutes for follow-up medication management, and 60 minutes for post-discharge follow-up. In an appointment, residents interview the patient, staff the case in a conference room with an attending faculty physician, and return to the patient (with the faculty physician) to finalize the treatment plan. Psychotherapy patients are also scheduled during clinic months. Residents are expected to follow three patients per week for the entirety of the 12 months in the Adult Psychiatry Clinic.

At the Veterans Affairs Medical Center, residents are exposed to a wide range of diagnoses, including a large amount of post-traumatic stress disorder cases. Appointments are the same length as those at University of Iowa Hospitals and Clinics, but there is more autonomy in the decision making process. For example, residents are not required to staff each patient and staff do not see the patients unless the resident feels there is a compelling reason. Instead, residents sit down with staff between patients or at the end of the day to discuss cases and get feedback on treatment plans.

In both locations, third year residents provide on-call support, usually once every other week. At University of Iowa Hospitals & Clinics, on-call time is spent on emergent appointments and phone calls. At the Veterans Affairs Medical Center, on-call time is spent on consults and emergency room patients.

Third year residents continue to follow a panel of patients in an outpatient setting one half-day per week through a continuity of care clinic at University of Iowa Hospitals & Clinics or the Veterans Affairs Medical Center. Unlike with the Internal Medicine rotations, Psychiatry rotation are not on a X+Y system, and consequently, there is no week-long Continuity of Care Clinic.

For a more in-depth look at each year of training, explore the following:

Fourth Year

BoyumThe fourth year of training begins with the last four months of outpatient psychiatry rotations. At the conclusion of this outpatient experience, residents will generally move to a rotation in the child and adolescent psychiatry unit at University of Iowa Hospitals & Clinics, which includes time in both inpatient and outpatient. After a two-month rotation in child and adolescent psychiatry, residents return to internal medicine rotations for the remaining six months of the year.

Call obligations continue as in the third year according to the particular rotation, with two to three back-up calls per month on psychiatry and calls per individual rotation schedules on internal medicine.

By the beginning of this year, residents have completed the required number of continuity of care clinics to meet board certification requirements in internal medicine.

For a more in-depth look at each year of training, explore the following:

Fifth Year

Fifth year trainingThe fifth year of training is divided evenly between internal medicine and psychiatry, usually in 3-month blocks or 6-month blocks. This year includes time to complete any remaining rotations required for board eligibility in each specialty as well as time for self-designed electives (may include research).

Call obligations continue as in the fourth year according to the particular Internal Medicine rotation, but calls are no longer required in Psychiatry rotations. 

And, as with the fourth year, residents will continue working in their Continuity of Care Clinic.

While there is no formal "chief year" for combined residents, fifth year residents help plan and organize the program, assist in recruitment, and serve as role-models and mentors to other residents.

For a more in-depth look at each year of training, explore the following:

Internal Medicine Clinical Rotations

Allergy-Immunology

Over the course of the rotation, residents work with faculty physicians in an outpatient setting to gain experience in caring for patients with acute and chronic allergic and immunologic disorders. The rotation includes exposure to a wide spectrum of diseases, including allergic rhinitis, chronic rhinosinusitis, asthma, urticaria, angioedema, eosinophilic disorders, food allergies, and insect sting reactions, as well as a spectrum of immunodeficiency disorders. Furthermore, the resident gains experience with procedures such as allergy testing, allergy immunotherapy, and drug and food challenges.

Cardiology - Outpatient

Residents work weekdays with various assigned faculty physicians in an outpatient clinic. In the clinic, residents learn the finer points of long-term management of patients with a broad variety of cardiovascular disease. Residents may also spend time in electrophysiology clinic, gaining experience with the indications and management of implantable devices. Additionally, time is also scheduled for residents in the echocardiography lab so that residents can learn advanced interpretation of echocardiograms.

Cardiology - Inpatient

A faculty physician, a senior resident, and two junior residents diagnose and manage patients with acute cardiovascular illnesses that are not qualified for the cardiovascular intensive care unit, including acute coronary syndromes, decompensated heart failure, valvular disease, pulmonary hypertension, pericarditis, and endocarditis. The team admits patients daily, with no overnight call for team members. Overnight admissions are managed by non-teaching hospitalist teams and are not added to the teaching team census.

Cardiovascular Intensive Care Unit

A faculty physician, cardiology fellow, and four senior residents manage manage up to 16 acute cardiac patients whose conditions include cardiogenic shock, myocardial infarction, and aortic dissections. Each resident takes overnight call every fourth night.

Dermatology

Residents see patients with faculty physicians in an outpatient setting to gain experience in caring for patients with a variety of diseases that include malignant and pre-malignant skin lesions, acne, rashes, and allergic skin disorders. Residents will also encounter patients with dermatologic manifestations of systemic illness. The resident will become familiar with common procedures used in dermatology, including skin scrapings, punch and shave biopsy, and cryotherapy.

Emergency Room - University of Iowa Hospitals & Clinics

Residents spend four weeks in the emergency room at University of Iowa Hospitals & Clinics. They are supervised by faculty physicians from the Department of Emergency Medicine and participate in every aspect of emergency room medicine with the exception of Level I trauma.

Emergency Room - Veterans Affairs Medical Center

Residents work in the emergency room at the Veterans Affairs Medical Center. They are supervised faculty physicians from the Department of Internal Medicine and evaluate a variety of acute complaints that range from minor musculoskeletal injuries and chronic back pain to chest pain, sepsis, and stroke.

Endocrinology

Residents spend four weeks in endocrinology, including one week on endocrine consults and three weeks in the endocrine clinic. During this rotation, residents gain experience with diabetes management, thyroid disorders, pituitary disorders, adrenal disorders, and learn the intricacies of osteoporosis and disease of the bone. Residents may also spend time in the polycystic ovary syndrome clinic, the lipid clinic, and the renal stone clinic. Residents rotate through the diabetes education and diabetes nutrition clinics to acquire experience with the aspects of diabetes self-care that may not be sufficiently emphasized in clinic.

Gastroenterology

Based on personal interests, residents have the opportunity to tailor their outpatient gastroenterology clinic experience. Residents may work in clinics that specialize in general gastroenterology, general hepatology, transplant hepatology, hepatitis C, motility disorders, and inflammatory bowel disease. Residents also have the opportunity to rotate with the inpatient liver and gastroenterology consult teams, if desired.

Geriatrics and Palliative Care - Outpatient

Residents spend two weeks in the geriatric clinic and two weeks on the palliative care consult service during this one-month rotation.

In addition to treating common medical problems, residents in the geriatric clinic gain confidence managing a variety of challenges unique to the geriatric population, including cognitive impairment and dementia, urinary and bowel incontinence, gait, falls and balance disorders, and polypharmacy. Off-site nursing home rounds educate residents about the facilities to geriatric patients are commonly referred.

On palliative consult service, residents learn the intricacies of end-of-life care. As a member of the consult team, residents may facilitate family meetings, assist a patient and their family with clarifying goals of care, and recommend treatments that maximize patient comfort.

Hematology-Oncology

A faculty physician, senior resident, and two junior residents diagnose and manage patients with a wide range of hematologic and oncologic conditions. A clinical pharmacist supports the team in the administration of chemotherapy. The team admits patients daily, with no overnight call for team members. Overnight admissions to the team census are supported by a night float senior internal medicine resident and intern.

Infectious Diseases Consultation Service

A faculty physician, fellow, and two to three residents provide consultative services for inpatients hospital-wide on a variety of known or potential infectious illnesses including HIV management, tuberculosis, endocarditis, meningitis, wound infections, osteomyelitis, vector-borne illnesses, and fungal infections.

Internal Medicine-Psychiatry Unit

Faculty physicians, a senior resident, and two junior residents care for up to 15 patients with medical and psychiatric illness. The team admits patients daily, with no overnight call for team members. Overnight admissions to the team census are supported by a night float senior resident and junior resident.

Internal Medicine - University of Iowa Hospitals & Clinics - Inpatient

Three teaching teams (each consisting of one faculty physician, one senior resident, three junior residents, and two to three medical students) diagnose and manage adults of all ages and backgrounds with a wide range of medical illnesses. Support staff (social workers, nurses, and unit clerks) assist with discharge planning and arranging follow-up appointments. Junior residents rotate on overnight call when their respective teams are admitting patients, taking an average of four to five call nights per month.

Internal Medicine - Veterans Affairs Medical Center - Inpatient

Three teaching teams (each consisting of one faculty physician, one senior resident, and two junior residents) diagnose and manage a largely male population of veterans with conditions that span the full breadth of internal medicine. The team takes care of patients on the general inpatient unit and in the ten bed intensive care unit. Patients in the intensive inpatient unit are staffed with a pulmonary-critical care faculty and fellow during daily intensive care rounds. Each inpatient team admits daily, with a team cap of 14 and a junior resident daily cap of five. Each junior resident takes an overnight call every sixth night with a night float senior.

Medical Intensive Care Unit

A faculty physician, two pulmonary-critical care fellows, and four senior residents take care of up to 26 critically ill patients. Senior residents take overnight call every fourth night with a junior resident in the Medical Intensive Care Unit. Residents on overnight call admit patients, assist with cross-cover of patients on the intensive care unit, and participate in morning teaching rounds.

Neurology

Residents work with faculty physicians and residents from the Department of Neurology during this rotation. They spend four weeks on the inpatient consult service and four weeks in general and subspecialty neurology clinics. Outpatient case mix includes chronic migraines, neuromuscular disorders, sleep medicine, multiple sclerosis, amyotrophic lateral sclerosis, and stroke follow-up. Inpatient case mix ranges from myasthenia gravis crisis to evaluation of altered mental status and stroke. If a residents would like more exposure to stroke, they may request an additional rotation with the stroke inpatient service.

Pulmonology Consultation Service

Residents will work with one faculty physician and one pulmonology fellow to respond to consultations from both medical and surgical services on a variety pulmonary conditions. This may include hypoxemia and dyspnea of unclear etiology, pleural effusions, interstitial lung disease, severe chronic obstructive pulmonary disease and asthma, infiltrates/nodules in both immunocompetent and immunocompromised patients, lung masses/suspected malignancy, mediastinal adenopathy, and granulomatous diseases. Residents may participate in thoracentesis procedures and observe chest tube placement. Residents also have the opportunity to observe bronchoscopy procedures (including standard airway exams, bronchoalveolar lavage, biopsies under fluoroscopy and endobronchial ultrasound, and super-dimension navigational bronchoscopy).

Renal Consultation Service

A faculty physician, two nephrology fellows, and two to three residents provide consultative services for inpatients hospital-wide on a variety of acute and chronic problems, including acute kidney injury, end-stage renal disease, hemodialysis, continuous renal replacement therapy, lupus nephritis, and pulmonary-renal syndromes.

Rheumatology

Residents spend four weeks in rheumatology to gain experience in the evaluation and management of common clinical presentations including joint pain and swelling, muscle aches, musculoskeletal weakness, regional pain, and non-articular signs and symptoms of rheumatologic conditions such as Raynaud’s phenomenon and skin rash. Working closely with faculty physicians, residents diagnose and manage diseases including fibromyalgia, rheumatoid arthritis, osteoarthritis, and crystalline and infectious arthropathies, as well as systemic conditions like scleroderma, systemic lupus erythematosus, and various forms of vasculitides. Three weeks of this rotations are spent in an outpatient setting. One week of this rotation is spend on the rheumatology consult service.

Surgical Co-Management Service

Two faculty physicians and two to three residents provide internal medicine consultative services for surgical and psychiatric inpatients with acute and chronic medical problems. This rotation also includes outpatient pre-operative evaluations in a clinic setting.

Psychiatry Clinical Rotations

Child and Adolescent Psychiatry

Residents spend one month in the Child and Adolescent Psychiatry Outpatient Clinic and one month in the inpatient child and adolescent psychiatry unit during their fourth year of training. Under the supervision of board-certified child psychiatry faculty, residents perform diagnostic evaluations and provide follow-up care. Residents maintain their Internal Medicine continuity of care clinics during these rotations.

Consultation-Liaison Psychiatry

Residents rotate on the consultation-liaison psychiatry service for two months. The service provides psychiatric consultation for inpatients throughout University of Iowa Hospitals & Clinics and University of Iowa Stead Family Children's Hospital. Common clinical problems managed by this service include delirium, questions of capacity, mental health commitments, and identifying patients who would be optimally managed on an inpatient psychiatry or medicine-psychiatry unit.

James Amos, MD, UI Clinical Professor of Psychiatry, operates a blog called The Practical Psychosomaticist, which includes presentations related to consultation-liaison psychiatry. 

Neuromodulation

Residents spend a month on the neuromodulation service. At University of Iowa Hospitals & Clinics, electroconvulsive therapy, transcranial magnetic stimulation and deep brain stimulation is available to inpatients and outpatients. The resident, under faculty supervision, administers therapies and also spends time evaluating patients referred for this treatment.

IMPACT

IMPACT stands for integrated medical and psychiatric assertive community treatment. This program is an interdisciplinary service that provides intensive outpatient care for people with serious mental illness. Residents can spend a month with the IMPACT program, during which they participate in interdisciplinary rounds, attend patient activities, do home visits with staff, and may see some patients in the clinic.

Medicine-Psychiatry Inpatient Unit

Residents spend one month of their first year on the Medicine-Psychiatry Inpatient Unit, which counts as one of their psychiatry inpatient months. Patients on this service are being treated simultaneously for active psychiatric and active medical problems. The unit is usually staffed with a dual-trained internal medicine-psychiatry faculty member, but some months are staffed jointly by an internal medicine faculty physician and a psychiatry faculty physician. While on the Medicine-Psychiatry Inpatient Unit, residents take psychiatry call.

Neurology - Outpatient

Residents spend one month on a neurology outpatient rotation. Most of the rotation is spent in the Neurology Outpatient Clinic, where residents may work in the seizure disorder clinic, sleep clinic, movement disorder clinic, or other specialty clinics. Residents may also participate in some neurology consultation during this rotation. While on the neurology outpatient rotation, residents take psychiatry call.

Psychiatry - Outpatient

Residents spend 12 consecutive months in the psychiatry outpatient clinics. During this longitudinal experience, residents spend time each week in the Adult Psychiatry Outpatient Clinic at the University of Iowa Hospitals and Clinics, the Outpatient Psychiatry Clinic at the Veterans Affairs Medical Center, and six months at the Community Mental Health Center for Mid-Eastern Iowa. Residents also have a weekly psychotherapy clinic, psychotherapy supervision, and weekly didactics during this rotation. Residents engage in a quality improvement project during this rotation. Residents maintain their Internal Medicine continuity of care clinic.

Psychiatry - Inpatient

Residents do a total of seven months of inpatient psychiatry during their training. Residents rotate on all of the adult psychiatry units at University of Iowa Hospitals & Clinics and on the psychiatry unit at the Veterans Affairs Medical Center. The units at University of Iowa Hospitals & Clinics include a mood disorders unit, a psychotic disorders unit, a geriatric psychiatry unit, an eating disorders unit, and a medicine-psychiatry unit.

Psychiatry - Float

Residents in this position will assume care of all inpatients in psychiatric units for the evening and overnight hours during the week and after the inpatient team has rounded on the weekends.

Continuity of Care Clinic

Residents maintain a panel of patients in an outpatient setting through a Internal Medicine continuity of care clinic at University of Iowa Hospitals & Clinics or the Veterans Affairs Medical Center for all five years of training. Working as a team with faculty physicians, nurses, and medical assistants, residents provide comprehensive care to patients with an emphasis on chronic disease management. During inpatient psychiatry rotations, residents are scheduled for one half-day per week in their continuity of care clinic. 

During medicine rotations, the continuity clinic is built in with a 4+1 model, where you will spend an entire week dedicated to the ambulatory experience. See the Internal Medicine page about the 4+1 system for more information. 

 

 

Internal Medicine-Psychiatry Conferences

lectureAlong with numerous clinical experiences, residents in our combined training program attend an equally broad array of educational conferences. These conferences are attended based on a resident's current clinical assignment, so residents rotating in internal medicine attend internal medicine conferences and residents rotating in psychiatry attend psychiatry conferences. In addition to the categorical conferences, combined residents attend a monthly Journal Club that is specific to combined training.

Internal Medicine-Psychiatry Journal Club

Internal medicine-psychiatry residents engage in a monthly Journal Club in which they select and present an article of interest. Journal Club is coordinated by the internal medicine-psychiatry chief residents and is held during a noon conference once a month. Residents and faculty from other programs may attend as well.

In addition to the article review, Journal Club is also used as an opportunity to socialize and discuss various program topics between residents and faculty. First year residents have found it particularly helpful when transitioning into resident life as the other residents understand the excitement and learning curve. 

Didactics for All Psychiatry Residents

Psychiatry Journal Club

All combined training and categorical Psychiatry residents attend Journal Club on the first and third Wednesday of each month. One resident, with the advice of a faculty mentor presents and discusses a journal article.

Grand Rounds

  • Who: Residents and faculty
  • Attendance: Required
  • When: Tuesdays, 11 am to 12:30 pm

Description: Distinguished visitors or Departmental faculty members present interesting and challenging patients, or discuss topics of special interest. When a case is presented, the patient's history is reviewed, which is followed by an interview. Relevant literature, including the natural history and current treatment of the disorder, is presented, reviewed, and discussed.

Psychopharmacology

  • Who: Residents
  • Attendance: Required
  • When: Thursdays, noon to 1 pm

Description: Faculty members and clinical psychopharmacologists provide up-to-date information on psychotropic medications and their use. The lectures review the neurochemistry, efficacy, side effects, contraindications, drug interactions, and long term effects of drugs. Additional topics include acute and maintenance treatment of the major disorders, considerations for pediatric and geriatric populations, treatment of refractory cases, management of drug-induced illnesses and side effects, and treatment of drug overdose and withdrawal.

Comprehensive Care Rounds

  • Who: Residents
  • Attendance: Required
  • When: Thursdays, 1 to 2:30 pm (protected time)

Description: Each week a resident presents a detailed case summary to a rotating faculty member. After the presentation, the patient is interviewed by the faculty member. Following the patient interview, the faculty member leads a discussion in which each resident is asked to comment on some aspect of the case.

Resident Research Forum

  • Who: Residents
  • Attendance: Required
  • When: 3rd Fridays of the month, 12 to 1 pm

Description:  Each month, faculty present varied talks pertaining to research, including critical appraisal of articles, statistical methods, careers in research, and current ongoing research in the field of psychiatry. 

Didactics for First and Second Year Psychiatry Residents

Psychotherapy

  • Attendance: Required
  • When: Thursdays, 2:30 to 3:30 pm (protected time)

Description: The history of psychotherapy, interview methods, and types of psychotherapy are discussed by faculty members. Topics include discussions on Freud, the Neofreudians, Mahler, and Erikson in addition to introductions to motivational interviewing, group therapy, and evidence-based psychotherapies. Practical applications include the therapist-patient alliance, transference, countertransference, resistance, strategies for change, and termination. The purpose of this series is to provide junior residents with a solid basis with which to base their supervised psychotherapy experience in their third and fourth years.

General Psychiatry Lectures

  • Attendance: Required
  • When: Thursdays, 3:30 to 4:30 pm (protected time)

Description: Faculty members lecture on the psychopathology of major psychiatric disorders, including schizophrenia, mood disorders, anxiety disorders, somatoform disorders, eating disorders, and personality disorders. The series also provides an introduction to the mental status examination, psychiatric emergencies, psychological testing, commitment procedures, and utilization review.

Didactics for Third and Fourth Year Psychiatry Residents

Psychotherapy

  • Attendance: Required
  • When: Thursdays, 9 to 10:30 am (protected time)

Description: A seminar series presenting both the theoretical basis, as well as the practical aspects of various psychotherapy schools, including Cognitive-Behavioral Therapy, Interpersonal Therapy, Dialectical Behavior Therapy, Supportive Therapy, Marriage and Family Therapy, and Psychodynamic Therapy. Practical applications include therapies that are illness and psychosocial-situation specific. This lecture series is required for third year residents who are excused from clinic, although all residents are welcome.

General Psychiatry Lectures

  • Attendance: Required
  • When: Tuesdays, 8 to 9 am (protected time)

Description: Comprehensive didactic series covering general topics on psychiatry. This includes lectures on psychosomatics (including transplant, HIV, hepatitis C, psychiatric oncology, and psychiatric manifestations of neurologic disorders), geriatric psychiatry, theories of personality development, forensic psychiatry, eating disorders, gender differences in psychiatry, neuropsychology, substance abuse, sexual disorders, career options, and many other topics.

Other Didactics

Clinical Skills Exams

All psychiatry residents have biannual clinical skills exams with an assigned faculty member. This involves interviewing a patient unknown to the resident and then presenting the case to the faculty member, including all relevant history, discussing case formulation, differential diagnosis and treatment plans.

Psychotherapy Supervision

Third and fourth year residents are required to meet regularly with their assigned psychotherapist (one hour per week) to discuss ongoing therapy patients and their treatment. Thursday afternoons are protected time for the third year residents to care for their psychotherapy patients.

Conferences

All residents are encouraged to attend annual psychiatry conferences that take place throughout the United States. These include, but are not limited to, conferences held by the American Psychiatric Association, Iowa Psychiatric Society, Academy of Psychosomatic Medicine, American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, American Association for Geriatric Psychiatry, and American Neuropsychiatric Association and conferences sponsored by the Substance Abuse and Mental Health Services Administration.

In addition to conferences, residents are encouraged to attend psychotherapy workshops including training events sponsored by the Iowa Psychotherapy Training Institute at the University of Iowa. These events have new topics annually and include training in interpersonal psychotherapy, motivational interviewing, and acceptance and commitment therapy.

Residents are given excused educational days each year to attend educational events related to psychiatry.

Internal Medicine Conferences

Core Curriculum

Core Conference is held Monday through Friday at both University of Iowa Hospitals & Clinics and the Veterans Affairs Medical Center. Conferences are aimed at enhancing core medical knowledge, developing diagnostic reasoning, and promoting principles of life-long learning.

Case Conference

During this interactive conference, a case is presented by the chief Resident or by the admitting resident. As the case unfolds, residents comment on differential diagnoses, work-up, and management strategy. Discussions vary and may focus on initial patient evaluation, clinical reasoning skills, diagnosis or management.

Journal Club

Once a month, residents meet for a critical appraisal of one to two articles in Journal Club. Assigned residents lead the discussion with facilitation from faculty. The purpose of Journal Club is to practice careful dissection/evaluation of the current literature.

Y Block

The Y block occurs for one week in between four week rotations for each resident. During this week, small group learning sessions complement the residents’ practical experiences. Seminars are designed to enhance knowledge and skills in the principles of evidence-based medicine including literature searching, critical appraisal and evidence-based decision-making as well as in other selected core topics of primary care medicine.

Grand Rounds

This weekly traditional conference provides an opportunity for the entire department to come together for an academic discussion which may range from innovative developments to comprehensive updates on key topics in internal medicine. In addition, monthly clinical pathological conferences will address undesirable outcomes and highlight opportunities for systems based improvements. Focus will be on case management, systematic problem-solving and prevention to promote understanding and learning.

Subspecialty Conferences

Each of the subspecialty divisions have regularly scheduled conferences. Residents scheduled for subspecialty rotations attend and may even present at one of these sessions. Subspecialty conferences are open to all residents.

House Staff Meeting

Once per month the residents meet with the program directors and chief residents to receive updates on anticipated changes and give feedback and suggestions regarding the program.

Psychiatry Conferences

Didactics for All Psychiatry Residents

Grand Rounds

  • Who: Residents and faculty
  • Attendance: Required
  • When: Tuesdays, 11 am to 12:30 pm

Description: Distinguished visitors or Departmental faculty members present interesting and challenging patients, or discuss topics of special interest. When a case is presented, the patient's history is reviewed, which is followed by an interview. Relevant literature, including the natural history and current treatment of the disorder, is presented, reviewed, and discussed.

Journal Club

  • Who: Residents
  • Attendance: Required
  • When: Wednesdays, noon to 1 pm (alternating with ER Seminar)

Description: In this twice monthly seminar, a resident presents a current journal article for review and discussion. With a faculty member serving as facilitator, the methods and design of the study, as well as the results and conclusions are discussed. In addition to helping residents remain well-informed on current research topics, the seminar encourages critical thinking about current literature.

Psychopharmacology

  • Who: Residents
  • Attendance: Required
  • When: Thursdays, noon to 1 pm

Description: Faculty members and clinical psychopharmacologists provide up-to-date information on psychotropic medications and their use. The lectures review the neurochemistry, efficacy, side effects, contraindications, drug interactions, and long term effects of drugs. Additional topics include acute and maintenance treatment of the major disorders, considerations for pediatric and geriatric populations, treatment of refractory cases, management of drug-induced illnesses and side effects, and treatment of drug overdose and withdrawal.

Comprehensive Care Rounds

  • Who: Residents
  • Attendance: Required
  • When: Thursdays, 1 to 2:30 pm (protected time)

Description: Each week a resident presents a detailed case summary to a rotating faculty member. After the presentation, the patient is interviewed by the faculty member. Following the patient interview, the faculty member leads a discussion in which each resident is asked to comment on some aspect of the case.

ER Seminar

  • Who: Residents
  • Attendance: Required
  • When: Wednesdays, noon to 1 pm (alternating with Journal Club)

Description: Each month ER-psychiatry specific topics are presented by a senior resident, paired with an interesting ER psychiatry case seen by a junior resident. Topics include child assessment, disruptive behaviors in children, decision making, malingering, abuse, medical co-morbidities, and treatment of drug overdose.

Resident Research Forum

  • Who: Residents
  • Attendance: Required
  • When: 3rd Fridays of the month, 12 to 1 pm

Description:  Each month, faculty present varied talks pertaining to research, including critical appraisal of articles, statistical methods, careers in research, and current ongoing research in the field of psychiatry. 

Didactics for First and Second Year Psychiatry Residents

Psychotherapy

  • Attendance: Required
  • When: Thursdays, 2:30 to 3:30 pm (protected time)

Description: The history of psychotherapy, interview methods, and types of psychotherapy are discussed by faculty members. Topics include discussions on Freud, the Neofreudians, Mahler, and Erikson in addition to introductions to motivational interviewing, group therapy, and evidence-based psychotherapies. Practical applications include the therapist-patient alliance, transference, countertransference, resistance, strategies for change, and termination. The purpose of this series is to provide junior residents with a solid basis with which to base their supervised psychotherapy experience in their third and fourth years.

General Psychiatry Lectures

  • Attendance: Required
  • When: Thursdays, 3:30 to 4:30 pm (protected time)

Description: Faculty members lecture on the psychopathology of major psychiatric disorders, including schizophrenia, mood disorders, anxiety disorders, somatoform disorders, eating disorders, and personality disorders. The series also provides an introduction to the mental status examination, psychiatric emergencies, psychological testing, commitment procedures, and utilization review.

Didactics for Third and Fourth Year Psychiatry Residents

Psychotherapy

  • Attendance: Required
  • When: Thursdays, 9 to 10:30 am (protected time)

Description: A seminar series presenting both the theoretical basis, as well as the practical aspects of various psychotherapy schools, including Cognitive-Behavioral Therapy, Interpersonal Therapy, Dialectical Behavior Therapy, Supportive Therapy, Marriage and Family Therapy, and Psychodynamic Therapy. Practical applications include therapies that are illness and psychosocial-situation specific. This lecture series is required for third year residents who are excused from clinic, although all residents are welcome.

General Psychiatry Lectures

  • Attendance: Required
  • When: Tuesdays, 8 to 9 am (protected time)

Description: Comprehensive didactic series covering general topics on psychiatry. This includes lectures on psychosomatics (including transplant, HIV, hepatitis C, psychiatric oncology, and psychiatric manifestations of neurologic disorders), geriatric psychiatry, theories of personality development, forensic psychiatry, eating disorders, gender differences in psychiatry, neuropsychology, substance abuse, sexual disorders, career options, and many other topics.

Other Didactics

Clinical Skills Exams

All psychiatry residents have biannual clinical skills exams with an assigned faculty member. This involves interviewing a patient unknown to the resident and then presenting the case to the faculty member, including all relevant history, discussing case formulation, differential diagnosis and treatment plans.

Psychotherapy Supervision

Third and fourth year residents are required to meet regularly with their assigned psychotherapist (one hour per week) to discuss ongoing therapy patients and their treatment. Thursday afternoons are protected time for the third year residents to care for their psychotherapy patients.

Conferences

All residents are encouraged to attend annual psychiatry conferences that take place throughout the United States. These include, but are not limited to, conferences held by the American Psychiatric Association, Iowa Psychiatric Society, Academy of Psychosomatic Medicine, American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, American Association for Geriatric Psychiatry, and American Neuropsychiatric Association and conferences sponsored by the Substance Abuse and Mental Health Services Administration.

In addition to conferences, residents are encouraged to attend psychotherapy workshops including training events sponsored by the Iowa Psychotherapy Training Institute at the University of Iowa. These events have new topics annually and include training in interpersonal psychotherapy, motivational interviewing, and acceptance and commitment therapy.

Residents are given excused educational days each year to attend educational events related to psychiatry.

Veterans Affairs Medical Center

The Veterans Affairs Medical Center in Iowa City has been caring for United States veterans since 1952. Services are available to more than 184,000 veterans living in 56 counties in Eastern Iowa and Western Illinois. The system consists of a main hospital in Iowa City, seven outpatient clinics in Eastern Iowa, and three outpatient clinics in Western Illinois. Veterans Affairs Medical Center also provides care to outlying clinics via telehealth technology.

Internal Medicine-Psychiatry Unit

Pick an acute psychiatric disease. Now pick a severe medical disease. Now put them in the same patient. You may just have described a patient who is an appropriate patient for our inpatient unit, a resource for treating patients with an acute problem in both the psychiatric and medical domains. Herein lies the excitement in working in this interesting and invigorating environment. Any combination of problems can be seen and treated here. This unit serves the hospital and the community by specializing in the treatment of delirium, and substance intoxication and withdrawal syndromes, but also can manage patients/problems such as:

  • Psychiatric syndromes associated with hyponatremia
  • Schizophrenia with gastrointestinal bleeding
  • Suicide attempt victims with severe body and head injuries
  • Hyperthyroidism with bipolar disorder
  • Anorexia nervosa, with metabolic derangements, and/or congestive heart failure
  • Person with intellectual disability/agitation in patient who has swallowed a sharp object
  • Serotonin syndrome
  • Neuroleptic malignant syndrome
  • Catatonia

The Internal Medicine-Psychiatry Unit at University of Iowa Hospitals & Clinics is staffed by one to two faculty physicians (one dually-trained faculty physician or by two faculty physicians - one from internal medicine and one from psychiatry), one senior resident (internal medicine-psychiatry, internal medicine), and two junior residents (internal medicine, psychiatry, internal medicine-psychiatry, or neurology). All nurses on this unit have training in medical and psychiatric nursing, and are equipped to deal with both sets of problems.

Over the course of the residency, each trainee spends three to five months on this unit evaluating and treating patients with combined illness. Not only do they develop the skills to treat the illness in each discipline, they also develop an understanding of the complex disease relationships occurring in these patients.

Quality Improvement

Quality Improvement is a skill that we believe should be shaped during residency training, and has lifelong impact on practice development in your career. It is a requirement in both Internal Medicine and Psychiatry categorical programs that residents complete a Quality Improvement Project.

Recently, the residents were able to develop a dedicated, longitudinal Internal Medicine-Psychiatry QI project with combined trained faculty mentors, in order to enhance their integrated care training. Their work has been accepted to national conferences and is another way that we foster close relationships between the residents in our combined program.

For more information about the QI curriculum.

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