• The program emphasizes the importance of comprehensive pediatric residency training in the first year. Residents participate fully in the clinical rotations and teaching exercises of the pediatric house staff. Modifications of the general pediatric residency program for the Triple Board residents has been thoughtfully limited to those that are consistent with maintaining an identity and integration with the pediatric house staff.

• The pediatric training for the “Triple Board” residents includes general pediatric services (both inpatient and outpatient) and subspecialty rotations. Twenty-four months of pediatric rotation requirements are met by the end of the fifth year, with 50 % completed in internship and the remaining 50% completed in 6 month rotations during the PGY-2 and PGY-3 years. The resident spends four months on subspecialty rotations. A minimum of three months is also spent in the acute illness clinic and emergency room.

• Five months are spent in general pediatric inpatient rotations, two of which are in a supervisory role. Four months are spent in an intensive care experience, with three months of NICU and one month of PICU. One month is spent in the newborn nursery. Fifty percent of the total time in pediatrics is spent in ambulatory settings. Continuity clinic is held for one half day weekly for the entire five years.

• Residents treat patients with a wide spectrum of disease, symptom severity, and cultural background. All ages including newborn, children, and adolescents are seen. Residents have a graduated patient care responsibility throughout their experience.

Pediatrics: Integration with Child Psychiatry

• Training in child psychiatry does start in the first two years. The following efforts are made to make sure of the integrated experience across five years and to have some child psychiatry training during PGY-1 and PGY- 2 years.

• Pediatric Continuity Clinic – Triple Board residents attend this clinic one-half day per week in order to develop and maintain their clinical practice across the five years and to enhance communication and support within the residency. PGY-5 residents are available to supervise and consult with PGY-1 and PGY-2 residents.

• The continuity clinic is co-attended by a pediatrician and a faculty child psychologist or child psychiatrist. Pediatric cases with more issues of behavior difficulties and psychosocial stressors may occasionally be scheduled there.

• One month in PGY-1 will be a developmental pediatrics rotation aimed to provide an introduction to child development.

• The yearlong daily Pediatric Noon Teaching Conference includes monthly child psychiatry/developmental psychopathology topics taught by child psychiatry faculty and PGY-5 triple board residents or child psychiatry fellows.

• Triple Board residents have a child psychiatry faculty advisor / mentor for all five years.

• All Triple Board Program residents and relevant faculty attend the annual retreat to review and critique the overall Triple Board Training Program.

Adult Psychiatry

• In the second year, PGY-2, Triple Board residents transition to adult psychiatry. They rotate on the adult psychiatry inpatient units at New Orleans Adolescent Hospital and MCLNO Behavioral Health Unit for six months. While on adult psychiatry rotations, PGY-2 Triple Board residents participate in the PGY-2 general psychiatry seminars on the Intro to Psychiatry, DSM-IV, Psychopharmacology, and Medicine + Neurology for Psychiatrists.

• They also receive didactics on child and forensic psychiatry, as well as five to six hours/week of supervision, and attend weekly psychiatry grand rounds. Their experience is similar to that of the adult psychiatry residents, except that continuity and integration with pediatrics and child psychiatry are emphasized.

• The emphasis of the PGY-4 is primarily on adult psychiatry. During this year, the residents complete a two-month rotation of consult/liaison adult psychiatry, one month of geriatric psychiatry, and one month of addictions.

• The focus of this year, however, is on outpatient practice and emphasizes the development of continuity of care and consolidation of skills in patient evaluation and individual, group, marital, and family psychotherapy.

• Pediatric Continuity Clinic (one-half day per week) is continued. Additionally, supervision with a child psychiatrist for several child psychiatry cases is maintained. However, the majority of outpatient work is done in adult psychiatry.

Child Psychiatry

• The emphasis during the PGY-3 year is on development and psychopathology throughout the life cycle. There is a focus on understanding illness and adaptation in the context of the family. This early orientation in the psychiatric component of the residency to thinking in terms of psychosocial growth and developmental psychopathology facilitates consolidation of the identity as a "child and family" oriented practitioner begun during the PG-1 and PG-2 years and continues in the later years.

• The resident starts the year in Child Psychiatry at Southeast Louisiana State Hospital. During these six months, the resident rotates through the inpatient child and adolescent psychiatry unit and Challenges, a day treatment unit for children and adolescent. There is also the option of rotating on the Developmental Neuro-Psychiaty Unit.

• During the PGY-3 year, Triple Board residents attend a minimum of five hours per week of seminars in child and adolescent psychiatry, including Developmental Psychopathology, Child Development, Continuous Case Conference, Basic Skills and Techniques, Clinical Therapy Issues, and the Consult/Liaison Seminar. They have five to six hours/week of supervision for their clinical rotations and their long-term therapy cases, and attend weekly child psychiatry grand rounds.

Pediatric continuity clinic and long-term psychotherapy training with adult and child outpatients are maintained throughout the year.

• During the PGY-5 year, the emphasis is on consolidating child and adolescent psychiatry experience, while maintaining adult long-term psychotherapy and pediatric continuity clinic (one half-day) training.

• The year is focused on child and adolescent psychiatry outpatient, consultation-liaison (C/L), infant psychiatry, forensic psychiatry and community mental health clinical rotations.

• The emphasis in these assignments is on continuity of care, the development of consultation-liaison skills, the consolidation of evaluation skills, and continued experience in short- and long-term individual, group, and family psychotherapy.

• In their elective time, Triple Board residents are encouraged to develop a scholarly project that combines child psychiatry and pediatrics. Additionally, PGY-5's may serve as liaisons to pediatric units, subspecialty team, or clinics in order to further consolidate their pediatric knowledge and skills.

• PGY-5 Triple Board trainees continue to attend the child and adolescent psychiatry seminars and receive supervision for clinical assignments and long-term therapy training as previously described.

• A basic proficiency in research methods in the clinical and behavioral sciences related to psychiatry is required. They are expected to present child psychiatry grand rounds during this year and may collaborate on research projects or other scholarly endeavors.

Tulane’s Triple Board Curriculum

PGY-1 12 months of Pediatrics 1mo General Pediatric Clinic 1mo Adolescent Medicine 2mo NICU 1mo Developmental Pediatrics 1mo Newborn Nursery 2mo Acute Care Pediatrics 1mo Emergency Room 3mo Pediatric Wards	Educational Component Pediatric Noon Conference Morning Report
PGY-2 6 months of Pediatrics 1mo PICU 1mo Acute Care Pediatrics 1mo Pediatric Wards 1mo Pediatric Neurology 2mo RRC Pediatric Electives 6 months Inpatient Adult Psychiatry	Educational Component Pediatric Noon Conference Morning Report Educational Component Grand Rounds, Intro to Psych, Psychopharm, Forensic/Child, DSM-IV, Medicine & Neurology for Psychiatrists
PGY-3 6 months of Pediatrics 1 mo NICU 1 mo General Pediatric Clinic 1 mo Pediatric Wards 1 mo Pediatric Neurology 2 mo RRC Pediatric Electives 6 months Inpatient Child + Adolescent Psychiatry 3 mo Child and Adolescent inpatient 3 mo Day Treatment	Educational Component Pediatric Noon Conference Morning Report Educational Component Basic Shills and Techniques Continuous Case Conference Clinical therapy issues Development Psychopathology Grand Rounds
PGY-4 12 months Outpatient Psychiatry 2 mo Adult Consult Liaison Psychiatry 1 mo Addiction Psychiatry 8 mo Outpatient Psychiatry 1 mo Geriatric Psychiatry	Educational Component CBT, Grand Rounds, Psychotherapy Case Conference, Existential/Philosophy/Spirituality, Public Psychiatry
PGY-5 12 months Outpatient Infant, Child, & Adolescent Psychiatry – Community Psych – Consult Liaison – School Psychiatry – Forensic Psychiatry	Educational Component Consult/Liaison Rounds Continuous Case Conference Psychopathology Clinical Therapy Skills Grand Rounds