Opinions/Experience on C&A fellowship during residency??

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luckyt66

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Hello All.

Would anyone have any opinions or experience they would be able to share on the pros and cons of beginning fellowship training in C&A Psychiatry after PGY-I year of residency and finishing remaining 2 years of residency after the fellowship?

Thank you!

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Here's the pros and cons. The cons is that this is not possible. The pros is that this is not possible.
 
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Here's the pros and cons. The cons is that this is not possible. The pros is that this is not possible.
It absolutely is possible. I haven't done this and have not asked the same question of anyone who has done it but some cons that come to mind:

1) Not all programs guarantee that you will be able to finish the remaining 2 years of residency at their own program, meaning that after you finish you C&A fellowship, you'll be on your own to try to find a vacant PGY-2 spot (likely not be that hard).

2) I can't imagine that you will have learned psychiatry in any cohesive manner, or at least in the way that ACGME has designed the residency milestones. It can be argued that psychiatry isn't rocket science and you will gain the knowledge necessary to practice but that will depend on the individual candidate and their learning style/motivation/etc.
 
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Really? I didn't know that. Program directors know much more about this than I do... My program only gives us the option for PGY3s to start CAP fellowship in their PGY4 year or after residency.
 
Really? I didn't know that. Program directors know much more about this than I do... My program only gives us the option for PGY3s to start CAP fellowship in their PGY4 year or after residency.

Yes, I didn't know this was an option either. lol. That's why I was looking into the pros and cons of the situation.
 
I wouldn't do this.


Any specific reasons you are saying that? I know it's not the typical route or ideal situation, but I was looking to switch from my current program for problems with the department here- desperately. I just want to make sure there aren't any major negatives in going this route that I am not realizing at the forefront.
 
Our program often takes people after PGYII. I even knew of one person who completed a C&A fellowship without ever doing a residency. No idea how that ever happened, but it did.
 
Never heard of this being done. I think you have to be near completing general psyc residency before you may attempt board cert in general and I had to be general psyc certified before I could attempt C&A cert.
 
Once I have heard of a resident finishing PGY-II and then doing two years of fellowship to then return to do the PGY-III year. I think the fellowship needed to fill a complement. Really not a good idea in my opinion, and yes, I don't think you can sit for child boards until after you have adult boards.
 
Hello All.

Would anyone have any opinions or experience they would be able to share on the pros and cons of beginning fellowship training in C&A Psychiatry after PGY-I year of residency and finishing remaining 2 years of residency after the fellowship?

Thank you!

One of the new incoming child fellows next year in my program will do this. I wouldn't. And yes, you cannot sit for adult boards until you complete 3 full adult years, and you can use one of the child years to finish 4 post-graduate years. So this ends up delaying both adult and child psych boards.
 
Any specific reasons you are saying that? I know it's not the typical route or ideal situation, but I was looking to switch from my current program for problems with the department here- desperately. I just want to make sure there aren't any major negatives in going this route that I am not realizing at the forefront.

Delayed boards, disjointed peer camaraderie, no adult outpatient experience to draw from, etc.
 
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I'm not child trained, but my understanding of most fellowships is that they assume a certain level of competence. Jumping straight to child fellowship after intern year, I think they would have to dumb it down quite a bit. Most fellowships are going to assume you are a mostly-competent adult psychiatrist going into the program, and should give you more responsibility and autonomy accordingly.

I also imagine it would be boring going back to a lower-responsibility, lower-autonomy position after finishing as a "fellow."
 
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My medical school has an integrated child psych fellowship that lets 5 year combined candidates do 2 years of child psych after PGY-2. The resident/fellows who have done it said they liked being able to work with the younger population earlier, and it breaks up the monotony of otherwise having to see adults for 3 years in a row.
 
Even combined programs don't put you in child after the PGY-I year. I get the appeal of a combined program, but the flip side is that you commit to 5 years right at the beginning of training and a lot of people change their minds about child. As I enter into a fourth decade of treating adults, "breaking up the monotony" by the end of PGY-II vs. the end of the PGY-III year seems like a fairly light difference in the totality of a career. Then again, years seem a lot shorter than they used to and a PGY-II year is about the longest year in any resident's life. I do think the delay in commitment is something to think about.
 
One of the new incoming child fellows next year in my program will do this. I wouldn't. And yes, you cannot sit for adult boards until you complete 3 full adult years, and you can use one of the child years to finish 4 post-graduate years. So this ends up delaying both adult and child psych boards.

Thanks. That's a good point and something I wouldn't have thought at the outset.


I understand that there are negatives to taking this route, but I am just having a lot of issues with my current program (department politics)- and this is the reason I was contemplating this route. Essentially, my decision is to choose between the lesser of two evils. If someone would like more details or think they would be able to provide additional insight, please PM.

Thanks
 
Regardless of the inherent problems with doing a fellowship ahead of a full residency, you have to see if its the right choice for YOU. Based on your other thread, it sounds like you are having major problems with your current program and the alternative may even lead to your termination from your program. In that case, barring any other opportunities for residency transfer, going elsewhere for fellowship is a good idea.

I will add that C&A is not the only field where this has been done. Other fellowships in other specialties can also be completed ahead of the residency, though perhaps mostly research based. For example, I know someone who did a neuroophthalmology (sp?) fellowship prior to doing a neurology residency. If anything, psych is one field where (unfortunately) I have seen PGY2s and PGY3s with less knowledge and capability than a PGY1. So the disjointedness may not be such a big deal.

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You will need 12 months of continuous outpatient experience in the same program. If you burn bridges with your first program by going to a second, make sure the adult training director of the second is willing to complete your requirements. This will not be up to the child training director.
 
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This is a stupid idea. C/a fellowship requires and assumes a good foundation on and solid competence in general psychiatry - especially in the advanced training in therapy. It's greatly important to have experience and knowledge in adult psychopathology, because many child cases are really about the parents and how their issues affect the family and child.

Going into the fellowship without any of this is a disservice to your patients, and any program that allows it insults their own profession and specialty by their ignorance of its complexity.


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This is a stupid idea. C/a fellowship requires and assumes a good foundation on and solid competence in general psychiatry - especially in the advanced training in therapy. It's greatly important to have experience and knowledge in adult psychopathology, because many child cases are really about the parents and how their issues affect the family and child.

Going into the fellowship without any of this is a disservice to your patients, and any program that allows it insults their own profession and specialty by their ignorance of its complexity.

I would think the PD of the child fellowship would have to have a very different setup for such a "fellow" than the traditional track. Certainly if they just plugged them in normally it would be a disaster as supervision levels are intentionally lower in fellowships than residency.
 
The ones who came after pgy-2 were clueless, I can't imagine pgy-1.


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This is a stupid idea. C/a fellowship requires and assumes a good foundation on and solid competence in general psychiatry - especially in the advanced training in therapy. It's greatly important to have experience and knowledge in adult psychopathology, because many child cases are really about the parents and how their issues affect the family and child.

Going into the fellowship without any of this is a disservice to your patients, and any program that allows it insults their own profession and specialty by their ignorance of its complexity.


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See thats what scares me. I'm 50/50 whether to go to child or not, but want to have a SOLID foundation of adult down before making a transition. I was contemplating not applying and seeing how much I like child in 3rd year. Are there a lot of open positions open at the end of the app cycle? say if I decide to apply like middle of 3rd year?

Thanks
 
See thats what scares me. I'm 50/50 whether to go to child or not, but want to have a SOLID foundation of adult down before making a transition. I was contemplating not applying and seeing how much I like child in 3rd year. Are there a lot of open positions open at the end of the app cycle? say if I decide to apply like middle of 3rd year?

Thanks
If you decide by early/mid autumn, you'll still have a good shot. And by spring there will likely still be open child positions at many good programs as well.
 
See thats what scares me. I'm 50/50 whether to go to child or not, but want to have a SOLID foundation of adult down before making a transition. I was contemplating not applying and seeing how much I like child in 3rd year. Are there a lot of open positions open at the end of the app cycle? say if I decide to apply like middle of 3rd year?

Thanks

I'm not sure, I didn't do a civilian program. I think it's wise to wait until your child rotation to get a better sense of whether you'd like it or not. Many first year child fellows made the mistake of not doing so, and ended up absolutely hating it and being miserable. Child fellowship is probably the most demanding fellowship in psych and felt more like PGY2 again. Many who hated it dropped out of the fellowship, and a few simply decided to be miserable and angry for two years.

In many ways, CAPS is much more frustrating than general psych. You had to experience it before you can decide if you'd really like it.
 
I find child psych hits almost no one neutrally. Residents seem to love or hate it with very little in between. Personally, I would rather put sharp pins in my eyes than do child psych, but thank goodness for those that like it.
 
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Personally I was miserable and angry during the last year of my general residency, not because of psychiatry but because of the way the program was structured, department politics, general lack of funding..Will see how things are in a few months after fellowship starts ;)
 
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