Mission

We train military psychiatrists to provide outstanding psychiatric treatment along with psychiatrically informed guidance to military leadership, anytime, anywhere. Our graduates will be the versatile future leaders of Navy and Civilian Psychiatry who will be ready to take on the challenges of a rapidly changing military and medical system.

Vision

Our graduates will be ready to care for warfighters and their beneficiaries throughout the globe, from field hospitals and ships to stateside hospitals. They will be outstanding, well-rounded clinicians and leaders, ready to reshape military psychiatry to meet the needs of an increasingly dynamic environment.

Aims

Our program will strive to create a robust clinical learning environment to help our trainees reach their fullest potential.

• We will value compassion, for our patients, for our colleagues, and ourselves.
• We will work to recognize the disparities in our medical and military systems and become increasingly aware of the impact of conscious and unconscious biases have on our behavior and our system.
• We will endeavor to be exemplary professionals, worthy of societies trust in our skills, knowledge, and a commitment to embodying the highest standards. We will develop and hone the skills to remain lifelong learners, who continue to independently expand our personal knowledge.

The faculty will enable trainees to accomplish their professional goals and become outstanding military officers and psychiatrists. Our only measure of success is our trainees’ development as physicians and leaders.

Didactics

PGY-1 Didactics

Held weekly on Tuesdays, ~2 hours. Focus is on broad introduction to psychiatry, journal club, and introduction to military psychiatry.

PGY-2 Didactics

Held weekly on Wednesday, ~3 hours. Focus is on basic psychopathology, psychopharmacology, interview skills, motivational interviewing.

PGY-3 Didactics

Held weekly on Wednesday, ~5 hours. Focus is on advanced psychopharmacology, multiple psychotherapy modalities, child/adolescent psychiatry.

PGY-4 Didactics

Held variably throughout the year. Focus is on military psychiatry, systems-based practice, healthcare economics. 

Educational Activities and Conferences

Residents are excused from clinical duties to attend conferences, psychotherapy trainings, and didactics.

Weekly Grand Rounds

The Directorate of Mental Health hosts a weekly grand rounds series on Thursdays at 12:30 p.m. (Pacific) featuring a variety of speakers from across the country. When speakers are delivering talks remotely, it is held on Microsoft Teams, though some talks are given in person.

Training Directors Rounds

Held on Thursday mornings from 7:30 to 8 a.m. TDR is a case conference series for trainees from our directorate’s training programs (psychiatry, psychology, social work) to present a challenging case for discussion amongst our faculty and trainees.

Critical Appraisal of the Literature

A monthly conference held in place of TDR, our CAOL conference teaches core concepts of how to review medical literature. Each month a different paper is reviewed, to expound on a specific statistical concept to improve our ability to review scientific findings.

Literature Tuesdays

Tuesday mornings following our inpatient turnover (typically around 7:30 a.m.) our inpatient attendings and residents meet to host a case conference focused on psychopharmacology. The trainees rotating on our inpatient unit take turns selecting and presenting a paper.

Dr. Jonathan Meyer’s Invitational

Dr. Meyer is a nationally regarded expert in psychopharmacology who provides consultation to the California State Hospital System and is a leading lecturer at the Neuroscience Education Institute. On Mondays he holds a 30-minute psychopharmacology discussion with UCSD and NMCSD Residents/Faculty.

Resident Journal Club

Held weekly on Tuesdays virtually to facilitate residency-wide participation. Led by the Chief Residents to foster a culture of intellectual inquiry and life-long learning.

Resident/Faculty Research Working Group

Led by our Academic Chief Resident, a monthly meeting to facilitate research mentorship, collaboration, and improve scholarly work in the residency.

R Group

A monthly meeting with the Residents and Education team (Chair, Program Director, Associate Program Directors, Chief Residents) to discuss residency priorities and address resident concerns.

Monthly Class Meetings with Program Director

Monthly meetings scheduled during breaks in the didactics schedule for the program director to engage in collaborative discussions with residents for program improvement.

Training Group (T Group)

A weekly trainee process group led by a faculty member not involved in resident assessment.

Psychotherapy Training

Military Psychiatry requires a high level of psychotherapy competency. Our program has a robust psychotherapy training curriculum to ensure residents are competent in several modalities of psychotherapy by graduation. Residents are encouraged to engage in additional work in psychotherapy with additional supervision available in our department.

Psychodynamic Training

One hour of psychoanalytic supervision weekly throughout the 3rd year along with a 30-week curriculum in intermediate and advanced psychodynamic psychotherapy.

Cognitive Processing Therapy

Residents attend at 2-day course in CPT, training them to engage in a gold-standard evidence-based treatment for PTSD, followed by a monthly supervision during their third year.

Cognitive Behavioral Therapy

12- week course in the PGY3 year followed by monthly supervision during the third year.

PGY-1 Rotations

There are 13 28-day blocks that make up the PGY-1 academic year. 

PGY1 Vacation Time

• PGY-1 residents are allowed three weeks of vacation.
• Up to seven days of vacation may be taken on any rotation. 

PGY-2 Rotations

PGY2s - PGY4s have clinical rotation assignments lasting one calendar month (12 rotations per year)

PGY-2 Vacation Time

• PGY-2 residents are allowed four weeks of vacation.
• Up to seven days of vacation may be taken on any rotation except Night Float.

PGY-3 Rotations

Notes: During the Community Psychiatry rotation (six months), the residents spend one day per week at University of California San Diego (UCSD) or the Veterans Administration Medical Center (VAMC). During the Child and Adolescent Psychiatry rotation (six months), the residents spend one and a half days per week in outpatient Child Psychiatry.

All residents spend one day per week on our Adult Outpatient Rotation for 12 months. All Residents spend six months rotating for one day per week on CAP. The remaining experiences differ based on resident interest and availability. Potential rotations include:

• Psychiatric Transition Program: The DOD’s only First Episode Psychosis program providing intensive multidisciplinary coordinated specialty care to patients serving in the Navy or Marine Corps experiencing serious, persistent mental illness.
• Naval Special Warfare: Providing psychiatric care to the Navy SEALs and support personnel stationed in San Diego
• UCSD Owen Clinic: HIV Clinic
• VAMC Psychosis Program
• VAMC Mood Disorder Program
• Family Health Centers of San Diego: Refugee Health

PGY-3 Vacation Times

• PGY-3 residents are allowed 4 weeks of vacation. 
• Up to seven days of vacation may be taken on any rotation.

PGY-4 Rotations

Notes:  Sub-A is an Inpatient Psychiatry Sub Attending Rotation. Consult is the Consult Liaison Psychiatry Sub Attending rotation. PGY4 residents maintain an outpatient clinic ½ to 1 day each week throughout the year.  Possible electives include: Child and Adolescent Psych, Addictions Psych, Geriatric Psych, Forensics Psych, Electroconvulsive Therapy, Palliative Care, Eating Disorders, Residential PTSD, Correctional Psychiatry, Eating Disorders, Sports Psychiatry and Research.  Residents are encouraged to identify other experiences in our geographic area that are of interest to further expand the available electives.

PGY-4 Vacation Times

• PGY-4 residents are allowed 4 weeks of vacation. 
• Up to 7 days of vacation may be taken on any rotation.

Possible electives include:

• Addictions Psychiatry
• Child and Adolescent Psychiatry
• Correctional Psychiatry
• Eating Disorders
• Electroconvulsive Therapy
• Forensic Psychiatry
• Geriatric Psychiatry
• Group Psychotherapy
• Multiple Operational Electives (Surface Forces, Naval Special Warfare, Submarines, Marine Corps)
• Palliative Care
• Residential PTSD
• Sports Psychiatry
• Transcranial Magnetic Stimulation
• Transplant Psychiatry

Residents are encouraged to identify other experiences in our geographic area that are of interest to further expand the available electives.

PGY1

Interns do not take psychiatry call when assigned to the Internal Medicine wards, Emergency Medicine service, or the Psychiatry Emergency Service. They take psychiatry call on Saturdays and Sundays from 8 a.m. - 10 p.m. throughout the year when assigned to psychiatry, Neurology, Family, Adolescent, and Addiction. With a complement of eight interns, each intern takes approximately fifteen call shifts per calendar year (~13 hours per call shift).

PGY2

Second year residents are assigned to night float six to seven weeks per year. Night Float covers the emergency and inpatient psychiatry services from 10 p.m. through morning turnover (typically departing the hospital at 8 a.m.). Night Float covers the hospital each evening with the exception of Fridays (when this is covered by a third-year resident). Second year residents share call responsibilities for weekends and holidays, taking approximately 15 call shifts per calendar year (~13 hours per call shift).

PGY3

Third year residents are assigned to cover swing shifts Monday through Thursday, taking over the Emergency and Inpatient service at 4 p.m., and running a team of interns until they turn over to the night float (around 10 p.m.). When assigned to swing, residents are not scheduled to see clinic patients. Divided evenly amongst eight residents, they take 6-7 weeks of swing call per year. Third-year residents also cover the hospital on Friday afternoons until morning turnover on Saturday. This 16-hour shift is the longest call shift on our calendar Third year residents also share the back-up call responsibilities. This is activated in the case that a resident on call is sick or too fatigued to safely care for patients.

PGY4

Fourth year residents are not required to take call but can choose to be available to join Special Psychiatric Rapid Intervention Team (SPRINT) missions.

Our graduates must attain or exceed not only the core ACGME graduation requirements but must also be capable of serving as a Navy Psychiatrist in unique settings across the globe. Our program has dedicated rotations, formal didactics, and mentorship experiences to ensure our graduates leave NMCSD ready to meet the mission requirements wherever they serve.

Our program strives to take full advantage of our geographic proximity to the major Fleet and USMC concentration areas in the vicinity of our hospital. All our MTF rotations provide ample experience communicating with commands, understanding their missions and cultural competencies, and communicating with them about how their service member’s psychiatric illness may or may not interact with their specific mission.

In the first year of residency, we teach an 8-session course on the fundamentals of operational psychiatry, including the basics of the military’s organization, history of military psychiatry, and a discussion of embedded mental health roles in the Navy and USMC.

In the second year, residents are paired with an operational mentor, a psychiatrist who recently graduated from the NMCSD program who is serving in an operational or remote overseas billet. They are asked to meet with the PGY2 approximately monthly (or more) to discuss how they have applied lessons from their residency training to succeed.

In the third year, a portion of our residents can work for one day per week with Naval Special Warfare, where they receive referrals from embedded psychologists and social workers treating the Navy SEALS and support personnel in the area. They learn about the unique culture of this community, and about the fundamentals of providing psychiatric care to this group.

In the fourth year, our residents are encouraged to engage in operational electives with the Surface, Submarine, NSW or USMC embedded mental health clinicians. We also have a curriculum in operational psychiatry, a seminar class that aims to prepare residents for their specific first duty station. Thought the rest of the year we have formal classes on writing awards, reading orders, and a final career development board to prepare residents to have the best possible chances of promoting.

• All of our residents are required to maintain Basic Life Support qualification throughout training.
• PGY-1 residents who receive orders to overseas or operational assignments are required to attend the Combat Casualty Care Course (C4) in San Antonio, Texas or attend a Tactical Combat Casualty Care course (TCCC) and Advanced Trauma Life Support (ATLS) at NMCSD prior to departing for their new assignment. This requirement is waived for prior USUHS medical students who completed the Bushmaster training. 
• Senior residents will attend the Tactical Combat Casualty Care course prior graduation.
• All Psychiatry residents must receive training to participate in Special Psychiatric Rapid Intervention Teams (SPRINT).

We offer a simulation in "Breaking Bad News" in partnership with our simulation center. Trained actors are hired to portray patients or family members in challenging scenarios, and trainees are taught about the fundamentals of delivering bad news to patients, and then observed and provided feedback with these simulated patients.

We have implemented a 12-session leadership course in the second year of training. This was developed by the Walter Reed Internal Medicine Program and modified to incorporate Navy and Psychiatry specific topics. Two of our PGY4 residents are selected to be Chiefs, and the remaining senior residents gain experience in a leadership role on our inpatient and emergency services.

Our residents are required to participate in a range of scholarly/academic activities throughout their time in training. In the first year, every trainee is required to create a written presentation for our And Now This series, which entails preforming a literature review under the guidance of our academic chief resident about an interesting case and summarizing what they learned to the faculty and residents. Most of our residents go on to convert these presentations into posters or articles for publication, and this initiative has led to a rapid 200% increase in the output of published scholarly work.

Residents are not required to pursue further academic scholarship, though the program aims to have ample support and mentorship for those that are interested in taking their ideas further. We have a monthly research meeting led by our Academic Chief resident and one of our Associate Program Directors. We discuss ongoing opportunities to join research projects in our program and connect faculty and residents who can help each other take projects to conclusion.

Our command has been extraordinarily supportive of funding travel to present research. In the past two years, every resident who has had a poster or a panel presentation accepted to a national meeting (such as the American Psychiatric Association) has been funded to present their work.

Our directorate and department have been very receptive to listening to resident input about processes that can be improved and implementing solutions to these challenges. Recent examples include the development of our Naval Special Warfare rotation, the elimination of 24-hour call, the creation of manuals and handouts for our services, and on and on. Residents are required to participate in Root Cause Analyses, and in their senior year, participate in at least one departmental clinical quality review.

Our program’s rotations, didactics, supervision, and mentorship experiences ensure our graduates are prepared to practice psychiatry in the military and in civilian settings. To ensure we are meeting the individual needs of each of our trainees, and helping them to maximize their potential, professional development is a primary focus of the twice-yearly meetings each resident has with the program director. During these sessions, we ensure residents have mentors to help them meet their specific goals, and we discuss training opportunities in the Navy, Navy Medicine, USU, or beyond that will help them become the psychiatrist they aim to be.

• Family Health Centers of San Diego: Refugee Mental Health
• Rady’s Children’s Hospital: Child and Adolescent Inpatient, Emergency, Consult-Liaison, Eating Disorders, rotations.
• San Diego Veterans Administration Medical Center: Inpatient, Addiction, Psychosis Program, Mood Disorders Program
• University of California, San Diego: Geriatric Psychiatry, Inpatient, Consult-Liaison, HIV Clinic, and numerous elective experiences

Please visit our Medical Student Rotation informational page to see a listing of available medical student rotations offered at NMCSD.

We welcome interview requests from medical students, residents, general medical officers (flight/dive/FMF/Surface), or current staff physicians in any specialty (in the case they wish to seek approval to obtain a second residency training). We also welcome applicants from any uniformed service. Prospective applicants are encouraged to reach out early in the interview season to schedule an interview.  We can accommodate requests for in-person interviews or auditory/virtual interviews. Our interview format is the same whether done in person or virtually with all applicants interviewing with our Program Director, one Associate Program Director, and a Chief Resident.

To request an interview with the Psychiatry Residency Program, please email the program at: dha.san-diego.San-Diego-NMC.list.nmcsd-psych@health.mil and include your most recent CV and a personal statement describing your interest in this medical field.  

Program graduates are eligible to take the written board examination offered by the American Board of Psychiatry and Neurology (ABPN). This exam is offered annually in September; graduates are board eligible immediately upon graduation and are encouraged to take the examination the September following their graduation date.  Additional information can be found on the ABPN website at: American Board of Psychiatry and Neurology - ABPN

Our program includes a specific class titled “Residents as Educators,” where residents receive formal instruction on bedside and formal teaching methods. All our acute services include USU and at times HPSP medical students, and residents are expected mentor and train these students. In the PGY4 year, the senior residents provide the majority of instruction in introduction to psychiatry to our first-year residents.

Our residents have ample additional training opportunities for our enlisted personnel, nurses, psychologists and social workers.

Our training program has faculty with subspecialty training in:

• Addiction
• Child/Adolescent
• Consult-Liaison
• Geriatric
• Integrative Medicine
• Neuromodulatory
• Neuropsychiatry
• Pain Management

Our program has both formal/required mentorship opportunities to ensure each resident is connected to senior residents and faculty to help them achieve their goals, but we also foster a culture of open communication and connection between residents and faculty to provide flexible mentorship and coaching to help ensure residents are maximizing their potential. A formal mentorship program would not be sufficient to ensure every resident meets their own unique goals in psychiatry training. Residents will likely need a variety of diverse mentors throughout the stages of their training to help them meet their military, academic, and clinical goals.

Our mentorship program is multifaceted. Upon selection to our program, each incoming trainee is assigned a senior resident to serve as their sponsor/mentor; helping them to arrive safely at the command, answering questions about where to live, how to check in, how to prepare for their orientation and first rotations. They are also connected to their mentorship family: the residency has eight faculty members who are partnered with a resident from each year group. This mentorship family is encouraged to meet periodically to discuss how people are doing and provide ongoing guidance and support. We have found that faculty aren’t always able to help answer questions about the early stages of residency, and that mentorship from senior residents is most helpful.

During the second year of residency, we also partner each resident with an operational mentor. This is a recent graduate from the program who is currently serving in an embedded or overseas billet. Their role is to connect with their trainee, providing support and guidance to help connect the trainees’ current experiences to their utility in their first duty station.

Establishing a culture where residents and staff have a healthy relationship with their work is crucial to our program. We will foster this by creating opportunities for residents and faculty to connect with one another, discuss their challenges without stigma or fear of reprisal, and work together to maintain a sense of meaning and connectedness to work. We have pathways in place to address our specialties specific occupational hazards, providing education and support if our patients end their lives, and we have protected time for residents to engage in a supportive group led by a faculty member not otherwise engaged in the program (T Group). Psychiatry residency is emotionally and physically taxing; our program endeavors to help residents maintain a sense of meaning and connection through this challenge.