General psychiatry Neuropsychiatry at Wash.U.

Why choose WUSTL for psychiatry residency training?

Notes from an email to an applicant

Psychiatry residency training at Wash.U. has several strengths that I think are not widely appreciated.

One is clinical experience. WU is rightly known for superb research infrastructure, both human and physical. But I think the breadth and depth of the clinical exposure our residents have are second to none. When you finish, you may not feel you know everything about every kind of psychiatric illness, but you will know how to take care of any patient in the emergency department, and you’ll know where to go for more information. You will have managed the sickest of the sick, plus some better functioning people with more focused problems.

Second is that while most institutions give lip service to evidence-based medicine, WU psychiatry has used that approach for decades. It’s essentially coterminous with what Sam Guze called “the medical basis of psychiatry”. The reason this matters is that neuroscience including clinical research is moving very quickly. Any dogmatic approach to psychiatric training will be out of date a few years after you finish residency. By contrast, faculty here—the supervising clinicians as well as the primarily research faculty—sincerely buy into evidence-based psychiatry. We’re all still human, but you are more likely here to be asked, “what’s the evidence for occupational therapy for schizophrenia?” or “after somatic therapies, what’s the best proven form of treatment for schizophrenia?” than to be told that only meds help. Ditto the other way around for treating severe personality disorders. With these clinical supervisors, you’ll build a tree of knowledge that can adapt to new clinical trials results hung on its branches, rather than an inflexible pattern of patient evaluation and treatment that will break when exposed to the winds of change.

As I am board certified in BN&NP (behavioral neurology and neuropsychiatry), I’ll add a few words about neuropsychiatry here. The clinical and research opportunities are very deep. Perhaps the most famous is the dementia centers, which have produced some of the research of deepest impact, starting with the CDR rating scale and ranging to genetics and imaging. There’s a good epilepsy and sleep group. The MS group in neurology is very strong. Stroke and head injury are represented, too. And I am biased, but I think the movement disorders group is as strong here as anywhere. In my experience, the neurologists at Wash.U. have been almost uniformly thoughtful, kind and inclusive, and are enthusiastic about psychiatrists collaborating in patient care or working with them in research.

Additionally, for a medium-sized metropolis, St. Louis has excellent cultural resources, a lot of friendly communities, and a remarkably low cost of living. And the residency program is structured so you’ll have some time to enjoy all of that.

Negatives? I think it is possible to finish residency training here without becoming skilled in psychotherapy. Then again, it’s also easy to find superb supervision. There are excellent psychotherapy colleagues here, including a geriatric anxiety research program headed by our department chair and a long-time very strong behavioral medicine group. Some very skilled and collegial psychologists at the medical center specialize in clinical psychotherapy.

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