Duke Psychiatry Residency : Med/Psych FAQ's

Med/Psych FAQ's

Why choose a dual career in Med/Psych?

The medical literature has many examples of patients with psychiatric problems that impact on the diagnosis, treatment, and outcome of their medical problems. For instance, there is a growing body of evidence that symptoms of depression affect prognosis in patients with heart disease. In addition, many medical diseases have psychiatric manifestations requiring physicians to have a firm knowledge of both medicine and psychiatry to better care for the patient, as in the case of delirium and neurosarcoidosis. Finally, many patients with a major psychiatric diagnosis, like schizophrenia, bipolar disorder, or alcohol dependence, have comorbid medical problems, which are often untreated, leaving these patients at higher risk for adverse outcomes.

Med/Psych training provides optimal preparation for comprehensive and integrated care of all patients. Dual training offers special advantages for the care of psychiatric patients with medical problems as well as medically ill patients whose illnesses have psychiatric contributors. Additionally, special roles exist for Med/Psych physicians to provide for the primary care needs of underserved psychiatric patients as well as the psychiatric needs of medically ill patients who would not otherwise accept mental healthcare.

Other examples of patient populations that benefit from the care of dually trained physicians include geriatric patients, patients with chronic medical conditions such as ischemic heart disease, CHF, renal failure, stroke, HIV, functional GI disorders, chronic pain, and patients with eating disorders, substance abuse/dependence or psychosomatic illnesses.

Why choose Duke Med/Psych?

The program is well established and fully funded with strong support and respect from both the Departments of Internal Medicine and Psychiatry.
Both Departments have top residency programs and are national leaders in clinical care and research.
Research is active at Duke: There are abundant behavioral medicine research and established research collaborations between departments
The program is sizable, with enough residents for collegiality, group identity and learning
Duke has a number of dually trained faculty, including the two co-associate program directors, for expert teaching on inpatient services and clinics.
There is strong training in psychotherapy to complement biologic approaches.
Evidenced-based approach to medical decision making in both internal medicine and psychiatry is emphasized in the curriculum.
During the PGY-5 year, residents are eligible to practice internal medicine overseas for three months in countries such as Brazil, Tanzania, Thailand, China, or England through the International Health Program. The Department of Internal Medicine subsidizes travel and housing costs while abroad, and residents continue to collect pay during their time abroad.
There are opportunities to remain on faculty after graduation.
Duke has a med/psych unit that provides unique education for our residents

What can you do after graduation?

Primary care medicine with psychiatric care services
Psychiatry with primary care medical services
Consultation/liaison psychiatry (inpatient or outpatient setting)
Combined medicine/psychiatry inpatient and/or outpatient care
Specialty or "niche" care of patients with psychosomatic syndromes, such as functional GI disorders, chronic pain, pseudoseizures, and atypical chest pain
Academic or industry research on disorders at the interface of medicine and psychiatry
Treatment of patients with eating disorders, substance abuse disorders, and other patients with needs in both Medicine and Psychiatry
Medical director of a psychiatric unit, hospital or community mental health program

What have our graduates done?

Consult/Liaison Psychiatry
Infectious disease fellowship training
Religion and health fellowship training
Academic inpatient and outpatient med/psych clinical care
Academic research in behavioral medicine
General Medicine hospitalist
Robert Woods Johnson fellowship
Private practice medicine
Electroconvulsive therapy
Outpatient eating disorders program
Medical director for mental health primary care at the Durham VA

Is the Med/Psych program at Duke "malignant"?

Duke Med/Psych residents train in a rigorous internal medicine program, which is one of the best in the country. The important thing to understand is that the residents works in a friendly, supportive environment, which is anything but malignant. There are established expectations for resident performance and aptitude, as with any medicine program, but they enjoy a high level of support from senior residents and faculty who are dedicated to teaching.

Is research required?

Currently, the ABIM requires "some scholarly activity" during residency in order to be board certified in internal medicine. Residents are asked to complete a research project on the topic of their choosing by the end of five years. Though publication of results is not a stated goal, it is encouraged as a way to showcase one's efforts while adding to the literature. Research projects can be of any size or design. Residents are encouraged to keep research simple and focused in order to ensure completion. Typically, residents assist faculty members with their projects and develop a portion of the project themselves. The Departments of Internal Medicine and Psychiatry are committed to assisting residents in this process. Residents may feel dismayed at the thought of organizing a research project, but developing research interests becomes a part of residency as clinical learning evolves and unanswered questions arise.

Does Duke offer a visiting Sub-Internship or clerkship?

Yes! We have opportunities to work on the med/psych service first hand. Please click here for more information..